I find it amazing that so many people accept the anti-psychiatry views of a medical journalist about medication and schizophrenia. I'm referring to Robert Whitaker whose book, The Anatomy of an Epidemic, is considered the bible for so many when much of his science and knowledge of the history of mental illness treatment is wrong.
Dr. E. Fuller Torrey, a psychiatrist and director of the Stanley Medical Research Institute that funds and conducts research into schizophrenia, recently reviewed Whitaker's conclusions and described them as "The Anatomy of a Non-Epidemic: How Robert Whitaker Got It Wrong."
Whitaker's main conclusion is that antipsychotic medications are bad. He argues that the outcomes for schizophrenia recovery rates have worsened with the introduction of medication. To demonstrate this, he cites a World Health Organization study. The problem is that the definition used for schizophrenia has tightened. Previously, acute psychotic episodes were included with schizophrenia but that is not schizophrenia. It is not unusual for someone to have an acute episode and then to never have another one. Today, schizophrenia-like symptoms have to exist for at least six months for someone to be diagnosed as schizophrenic.
If the acute non-schizophrenic episodes are called schizophrenia, then outcomes will be better. If the diagnosis of schizophrenia is limited to only those with true schizophrenia, the outcomes will be worse. And that is what has happened. Whitaker is comparing apples to oranges.
He also states that the outcomes are better in developing countries compared to developed countries. But, the two studies he cites were highly criticized when they were first published as they did not include only true schizophrenia for the developing countries as in the example above. More recent studies suggest that mortality was worse amongst the sickest patients in the developing countries. They died off, so the outcomes looked better.
China, a developing country, just announced that they are planning to establish a treatment network for serious mental illness to cover 95 per cent of the country by 2015. The news report states "the country has 16 million people suffering from schizophrenia and other severe mental diseases, and services and treatments for them are inadequate." If Whitaker is correct, they should already be doing well.
And, in India, over 60 per cent of people suffering from mental illness do not seek help and the entire family of the mentally ill suffer because of the prejudices against them.
Colonial times could be equated to a developing world and this is a description of treatment:
"By the 18th century, the religious fervour in Europe and colonial North America had given way somewhat to the rational humanitarian thought attributed to the Age of Enlightenment. The mentally ill were no longer persecuted as witches yet their situation was little improved. Although more asylums were beginning to spring up even in the American colonies, most of the inflicted were cared for by family, left to wander on their own or confined to gaols and poorhouses where the living conditions were wretched. Even those confined to asylums were kept shackled in chains or other mechanical restraint. The treatment of mental illness, which varied from asylum to asylum, consisted of duckings, beatings, chairs which twirled until the patient lost consciousness, bleedings, leechings and the administrations of purgatives and emetics."
The situation in Africa and Asia was no different. And, because of our policies of deinstitutionalization, we have gone back to those days. On any given day in the United States, Canada and many other industrialized nations, there are tens of thousands or more people with untreated schizophrenia living in shelters, parks, under bridges, in jail and on the streets. They are without medication and are sick and delusional. There are even thousands living in the tunnels under New York City and Grand Central Station.
Whitaker also claims that antipsychotic medication causes brain damage and is responsible for many of the symptoms attributed to schizophrenia. He cites the Vermont Outcomes Study which followed 168 patients for 20 years. Many in that study were able to go off medications but the average age of the patients in that study was 61. It is a well known fact, says Torrey, that as people with schizophrenia age, the need for medication declines. Another feature of the study was that the clinician personally followed up with his patients for years. The lesson, Torrey says, is that continuity of care and of a caregiver, is necessary for positive outcomes. Patients did well because they were older and they received continual care from one provider.
A recent review of the medical literature on the question of medications causing changes in brain structure stated:
"The findings that antipsychotic drugs produce structural brain changes should not be a surprise. Schizophrenia and bipolar disorder are known to produce structural brain changes as part of the disease process, so it is reasonable to expect drugs that are effective in treating these diseases to do likewise. Some opponents of the use of antipsychotic medication misunderstand such research, arguing that brain changes prove that antipsychotic drugs are dangerous and should not be used. On the contrary, this research is very important and may eventually lead to better and more effective medications."
Whitaker goes so far as to hypothesize (p. 214) that antipsychotic medication might even cause cancer. But, a recent study suggests that an antipsychotic appears to have an unusual property -- it can neutralize some cancer stem cells that allow tumours to come back after treatment. Further, it is known that people with schizophrenia have a reduced incidence of cancer despite a cancer-inducing lifestyle like increased percentages who smoke. So much for Whitaker's belief!
Another study that Whitaker cites was done by a Finnish psychoanalyst and began in 1969. The analyst used a combination of psychoanalysis and group family therapy. Whitaker claims that schizophrenia has now disappeared from this northern region of Finland. But, as Torrey points out, there are almost no publications describing the results of this study and it has never been replicated. Replicating studies is a foundation of scientific research.
A very recent study done by the prestigious medical journal, The Lancet, just concluded that after 50 years of antipsychotic medication use, the benefit of these drugs has been proven.
And, all of us with a relative with schizophrenia can attest to this fact. We have all seen the transformation when the right medication at the right dose is prescribed. It is a miracle and a vast improvement on the treatments used from the Stone Age and on!
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Unlike the commenter, however, I was not impressed.
Although it's tricky to decipher his exact point, Whitaker seems to reject the idea that people in the midst of psychotic experiences often lack insight into their disease.. Whitaker writes:
"The medications are known to be helpful, but—or so the argument goes—people with “severe mental illness” lack insight into their disease and this is why they reject the medication."
It's hard to believe that Mr. Whitaker has been around many (any?) people in the midst of the florid delusions of psychosis, if he thinks people are always rationally aware of what is occurring and so should never be treated involuntarily. He also seems to be unaware of the vast research literature documenting this phenomenon; interested readers just have to visit good scholar and search for: "lack of insight" psychosis
The topic of "lack of insight" has enormous impact on mental health policy. I haven't seen Robert Whitaker's critique of the growing body of research literature demonstrating that people who have been helped, involuntarily, through Assertive Outreach Treatment laws, report in a wide variety of follow-up studies that they have reduced rates of victimization, rehospitalization, homelessness, and interaction with the criminal justice system.
see: http://www.treatmentadvocacycenter.org/resources/assisted-outpatient-treatment/about-aot/471
This journalist displays no awareness of the true history of diagnoses and treatments of schizophrenia, yet his views are used by many people to bolster their own misperceptions regarding diagnosis and treatment of serious brain diseases.
We need critical awareness to become immune to incorrect suppositions, like this.
Schizophrenia recovery rates have worsened because drug therapy has replaced the support system that was previously in place instead of adding to it. Many identified as schizophrenic avoid the medications due to unacceptable side effects. Again, without funding, effective support is not available to address their issues.
Then there is the yardstick used to determine "recovery". If a patient on meds stops hearing voices is he recovered? If he becomes compliant with authority is he recovered? If he becomes functional in that he can care for himself is he recovered? To me, yes! However the current recovery benchmark leans heavily towards productivity. They are not recovered unless they can return to work. Which leads us to the social resistance to employing a recovered schizophrenic that, without well funded support, makes it likely they will eventually join/rejoin those under the bridge. And the beat goes on...
Anatomy of an Epidemic is worth reading -- chock full of citations. The full book, in context, is highly convincing and very difficult to dispute (as Torrey's failed attempt shows -- hard to do it without dishonesty). Meanwhile Torrey still thinks that schizophrenia is spread by an airborne cat virus?
Which source appears more credible to you??
It describes the scientific and historical underpinnings of past and present epidemics of the spread of diseases from animals to people. If you read this book you will understand that a "cat virus" causing disease is not the wild and crazy idea you seem to think it is.
I propose Marvin Ross look at Whitaker's rebuttal to Fuller here.
http://www.madinamerica.com/2012/05/e-fuller-torreys-review-of-anatomy-of-an-epidemic-what-does-it-reveal-about-the-rationale-for-forced-treatment/
Where all his assertions in this writer up are addressed and successfully defended.
I have worked in the mental health field for over 23 years, worked with many with schizophrenia in our communities and can tell you without a doubt that these people are over medicated, wrongly medicated and suffer terrible side effects from them. The best approach is a bio-psycho social one.
You write: "Today, schizophrenia-like symptoms have to exist for at least six months for someone to be diagnosed as schizophrenic."
If that is indeed the case, how do you explain the phenomenal rise in the number of people taking antipsychotic medications that were approved only for schizophrenia and bi-polar disorder? Far too often is the case that people are being given these medications after a SINGLE psychotic episode, and there are many documented cases presented in Whitaker's book (and elsewhere!) that attest to this fact.
If, as you claim, that there is this six month rule before declaring somebody schizophrenic, then how do you explain the radical rise of people on SSI/SSDI since the introduction of atypicals? In 1987, 1 in 184 Americans were hospitalized or on SSI/SSDI due to mental illness. In 2007 that number became 1 in 76. Why the sharp increase? Is schizophrenia contagious?
There are thousands of pages of leaked documents that reveal how big pharma attempted to re-educate psychiatrists to identify mental illness from factors such as "poor sleep" and "messy clothes". (See the Zyprexa Papers, for example.)
Atypicals have unquestionably helped some with acute cases of schizophrenia and bi-polar disorder, but the fact that they have become blockbuster drugs is a clear indicator that they are being abused, and given to people (namely children and the elderly) who have no business taking them.
http://www.cause-of-death-unknown.com/
Whitaker's whole notion that there's been an epidemic of severe mental illness (which he attributes to the use of anti-psychotic medication) is highly flawed. As Fuller Torrey points out in his detailed critique (hyplerlinked in the article above), Whitaker bases this assumption on the rise in the number of people getting disability payments for psychiatric problems. This dramatic rise can easily be understood by two factors: as hospitals have closed psychiatric beds, this population has begun receiving disability payments. Also, as Torrey mentions, "The other reason for the dramatic increase in SSI and SSDI disability numbers is that SSI and SSDI have become alternatives to welfare for poor and unemployed individuals who have any kind of psychiatric problem."
Big Pharma promotes the use of medications that people don't need. Whitaker's book helps make people aware of this and other aspects of the destructive practices of the pharmaceutical industry. However, we need to acknowledge, as is discussed in the Lancet article Marvin Ross cites, that the benefit of anti-psychotic medications for most people with psychotic disorders is firmly established.
Risperdal reproached.
The saga of the so called *atypical antipsychotics* is one of incredible profit.Eli Lilly made $65 BILLION on Zyprexa.Described as *the most successful drug in the history of neuroscience* the drugs at $12 pill are used by states to medicate deinstitutionalized mental patients to keep them out of the $500-$1,200 day hospitals.
There is a whole underclass block of our society,including children in foster care that are the market for these drugs,but have little voice of protest if harmed by them.I am an exception,I got diabetes from Zyprexa as an off-label treatment for PTSD and I am not a mentally challenged victim so I post.
--Daniel Haszard FMI http://www.zyprexa-victims.com
The side effects of Zyprexa can include death. Over 3,000 died, as of statistics from 2008. Seroquel is killing soldiers with PTSD (sudden cardiac arrest). The atypicals are approved for manic depression, when everyone who knows anything is aware that the drug that helps with this condition is lithium (yes, cheap and generic).
Then there are all the children being given these drugs for bogus reasons – many children in foster care, or with the fake diagnosis of “pediatric bipolar”, and etc.,etc.Serious risk of them becoming life-long diabetic.
Pick up any magazine (especially women’s magazines) and there are ads for “if your antidepressant isn't working, just add Abilify”. No mention of why a person would continue to take a non-working anti-depressant, let alone add one of the atypicals, a drug class that should really never have been.
Psychiatric meds have great benefits, but just as important are lifestyle and community aspects of recovery, those have been completely neglected, considering the way, in the US and Canada, that we've ignored or criminalized people with mental illness, who would have been hidden away in asylums or hospitals, which is just as bad. Medication is vital for almost everyone with mental illness, and newer drugs have fewer side effects, but they can still be problematic.
But you are right about everything else and I am sorry for the crap you've had to deal with.