STEVE COE: Thanks so much for being here tonight to share your new book with Community Access. Tell me about Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, and how the concept of medications as magic bullets started.
ROBERT WHITAKER: This book is really relevant to the history of psychiatry, actually. The magic bullet idea all started when penicillin reached its fruition. The notion was that you could have a drug that would kill the invading bacteria without harming the host tissue, and then therefore it would be a cure. And in fact, that's what we got in World War II with penicillin, and it was like, wow, medicine has made this astonishing leap forward. We also, by the way, got the polio vaccine in the early 1950s. So that started this whole sense that we could get magic bullets for all sorts of disorders.
And then Thorazine came along in 1955, invented originally for use in surgery as basically an anesthetic, and then introduced into psychiatry. As I understand this, psychiatry sort of wanted its own magic bullet—to all of a sudden believe in the powers of science. And the only problem here was, that you can start to delude yourself about the nature of a medication if you start putting everything into a magic bullet category, and that's clearly what happened with the first generation drugs.
STEVE COE: You talk about psychiatry as sort of an evolution from a mysterious art from Freud's days to then becoming a legitimate medical phenomenon, because all of a sudden they had medicine.
ROBERT WHITAKER: Yes, you know psychiatry had always been on sort of the outskirts of mainstream medicine, because it had its roots in asylum medicine. And then all of a sudden we got these magic bullets, and American medicine got used to saying you go to a doctor for a pill. And so, psychiatry, like everybody else, wanted to see their medications through that type of prism. The problem here was that psychiatry has a much more difficult sort of thing to be studying. It's the human being. It's mental disorders. In infection medicines, we see the bacteria, and so we have this target to cure. The problem in psychiatry is that the sort of biological underpinnings of mental illness remain a mystery.
STEVE COE: So, if you ask 99 percent of doctors, they'll say the drugs are correcting a chemical imbalance in the brain, but the studies you share in this book reveal a different story?
ROBERT WHITAKER: Yes, I think this is the biggest, fundamental problem. I think good medicine arises out of sort of a good, clear understanding about if there is a pathology and what the drugs do. The chemical imbalance story really arose as a hypothesis to help researchers come to understand what the drugs do. Let's say they block dopamines.
So if the hypothesis was, "Maybe people with schizophrenia have too much dopamine." It was still just a hypothesis. I really think the big element of the tragedy was if they didn't find that people with schizophrenia had overactive dopamine systems, then they still wanted this magic bullet sort of image of their drugs. They wanted an antibiotic image of their drugs, and they actually started fooling themselves.
It's as you say, go ask the average psychiatrist, and he'll say "Well, our drugs are fixing a chemical imbalance in the brain." But I think where psychiatry can go a little bit off the rails, is when they do the research, do people with mental disorders have some sort of characteristic mental chemical imbalance, and they have found no. And then that gets them to conceive of drugs in a wrong way. They think of them as fixing something, when in fact they're not. And this has the potential to lead to a sort of misuse of the medication.
STEVE COE: So why is the dichotomy there? If the medications are dangerous and harmful on one hand, how can they be helpful on the other?
ROBERT WHITAKER: I think one thing that's pretty clear is that there's a wide variety of reactions to psychiatric medications. In the overall outcomes, let's say that there definitely are some people who stabilize well on them, and we're absolutely certain of that. But the truth of the matter is, if you follow the long—term outcomes with this paradigm of care, you actually do see increased chronicity. You see increased physical problems.
And that's consistent with the idea of a drug that, in fact, is sort of interrupting a normal process and not correcting it. So I would say outcomes in the aggregate are actually reflective of the problem over the longer term that the drugs aren't normalizers, but in fact they are abnormalizers. And we're seeing this, I think, with the physical problems you see in a lot of people on medications, the early death problem. All those things are consistent with medications that have this sort of abnormalizing function.
STEVE COE: So most drugs are tested—and the pharmaceutical companies pay for the testing and evaluation of the drugs—with the standard routine of a six—week trial with a placebo control group, yes?
ROBERT WHITAKER: Right.
STEVE COE: And most of those studies show that the drugs have some benefit?
ROBERT WHITAKER: Exactly.
STEVE COE: So what's going on?
ROBERT WHITAKER: This is really a great question. So the way that we assess the merits of a medication in the United States is using the antibiotic model. Antibiotics knock out bacterial infections in six weeks, and they show that that means it's effective as a treatment against the disease. Now, psychiatric medications, as you say, are effective more than placebo generally over six weeks. In other words, they knock down that symptom better than placebo. You know, why that is, I'm not exactly sure. But whatever's being done—I mean, some of these drugs—let's say for example they really do prevent you from becoming so anxious. They actually sort of—they do dim your sort of emotional response to the world. Well, you can see if someone's in a quite distressed state, well that might be good for a short period of time. So that makes perfect sense.
That's why they meet our societal standard of efficacy and our FDA standard, because that's how we measure drugs. But one of the most telling moments in this book is related to when they were just starting at the very beginning of this. The NIMH had a meeting to determine how to assess the merits of these drugs. And a guy stood up and said to the effect of, "You know, with psychiatric care, you really need to have two— and five—year follow—up, because something that works in the short-term may be quite different over the long—term." And the long term really gets much harder to see for various reasons. And one of the things I'm trying to do in this book is to focus this back on the long term.
STEVE COE: So where are the long-term studies? How come we're not doing those? Or are they being done and we're just not paying attention to them?
ROBERT WHITAKER: The data comes from a variety of different sources. There are some randomized studies that might last a year. There are observational studies, and there are also epidemiological studies that ask what was the course before the meds, and now what's the course today. You have to look at all of this different information. So for example, the NIMH did a long-term follow-up study of schizophrenia patients. It goes back to the 1980s, and was done by Martin Harrow at the University of Illinois. And what did he find? He actually found a really problematic thing, in a certain sense. He found that for those off medication, the recovery rate long term at 15 years was 40 percent. The recovery rate for those on medication, unfortunately, was only 5 percent. Did you read about that study?
STEVE COE: No, I didn't see that.
ROBERT WHITAKER: Did you see it in any newspaper?
STEVE COE: No, I don't think so.
ROBERT WHITAKER: Any magazine?
STEVE COE: No.
ROBERT WHITAKER: The studies are being done, but what you'll find, and what I report on in this book is that, unfortunately, the long-term studies time and time again are telling us we have problems, and they get buried. They get hidden. Because if they really are revealed in a pronounced way, then there can be a threat to this sort of model of care which produces so much profit. And that's actually one of my complaints in this book, is that if we knew this information, and if it was freely discussed, we might alter our paradigm of care. We might use the medications in a different, sort of more selective, cautious way. But we need to know this.
STEVE COE: But then, do you run the risk in this book of people accusing you as being some kind of a conspiracy theorist?
ROBERT WHITAKER: I do, but remember that I started out on this intellectual journey as a complete, you know, I've been a journalist for a number of years, and I was a believer in the common wisdom. If you went back ten years ago, I was writing a series for the Globe about how awful it was to ever withdraw medications from schizophrenic patients. This book does leave me personally, and anybody who follows the book, sort of convinced that this evidence trail leads to an awkward place. You see the world, through the evidence, in a way that is out of sync with how everybody else does. It's not a pleasant place to be. In fact, one of the people I asked to blurb the book, David Healy, the famous psychiatrist from the U.K., said: "Either Bob Whitaker's mad, or we're all mad. The odd thing is the evidence seems to be on his side."
And what I'm doing in this book is looking at the research done by the NIMH, the research done by the World Health Organization. And, all I'm doing here is saying, look at what your studies show over time. I'm not doing the research. I'm really only the guy holding up the documents and asking what story do they tell over time. And actually, they tell this chronicity story time and time again. And I'm quite convinced they do tell that.