Doc Reviews Mad In America: Bad Science, Bad Medicine, and the Enduring
Mistrea
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Will Hall
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Sep 20, 2006 13:04 PDT
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-------- Original Message --------
Subject: PPEN # 3: Mad In America: Bad Science, Bad Medicine, and the
Enduring Mistreatment of the Mentally Ill
Date: Tue, 19 Sep 2006 20:03:25 -0500
From: Gary Kohls <gko-@cpinternet.com>
To: Gary Kohls <gko-@cpinternet.com>
Preventive Psychiatry E-Newsletter # 3
Robert Whitaker's Mad In America: Bad Science, Bad Medicine, And The
Enduring Mistreatment Of The Mentally Ill
Book Review by Nathaniel S. Lehrman, M.D.
former Clinical Director, Kingsboro Psychiatric Center, Brooklyn NY
Drug company scams are finally becoming increasingly visible. And a new
book shows how much they harm the most seriously mentally ill.
The front page of the May 17, 2002. Wall Street Journal compared the use
of a generic drug selling for less than $50 a dose with that of another
new, highly-promoted product costing $7,000, and concluded that it is
the drug manufacturers' financial clout, rather than a drug's
effectiveness, which influences doctors' prescribing choices. The
Washington Post reported on May 28 that "the American Psychiatric
Association/ GlaxoSmithKline Convention" was one member's
characterization of its just-ended annual meeting. "Each of the 19,000
attendees was given a gray bag with the insignia of the meeting and the
orange logo of GlaxoSmithKline PLC, the maker of the antidepresant
Paxil" - which has just been banned for children in Great Britain.
Pharmaceutical companies paid the APA about $50,000 for each of several
dozen symposia at the 2002 meeting, so they could "control which
scientists and papers were presented and help shape the presentations."
Convention revenues, primarily from drug companies, "represent about 22
percent of all Association funding.
Psychiatry has been my specialty since 1947. The fundamentally flawed
basis of drug company influences within it have now been exposed by
Robert Whitaker's masterful Mad in America: Bad Science, Bad Medicine,
and the Enduring Mistreatment of the Mentally Ill.
Neuroleptic drugs are the basis of this multi-billion dollar enterprise.
Do they help schizophrenic patients - as has been claimed since their
introduction in the 1950's - or harm them? Whitaker answers this key
question by proving that the drugs are harmful, and that psychiatry,
paid off by the drug companies, refuses to face its consequently
worsening treatment results.
The first half of the book catalogs the often-shameful history of
psychiatric treatment: surgical removal of organs, multiple dental
extractions, insulin-induced comas, and the widely-acclaimed,
Nobel-prize-winning lobotomy - the ice-pick operation. He maintains that
psychiatrists' search for physiological causes of mental illness
underlies both these various horrors and what he sees as their
continuation - the neuroleptic drugs originally called "chemical
lobotomies."
The book's second half, which has evoked intense psychiatric fury,
examines the drugs and their effects: how their original acceptance, as
aids to psychotherapy by helping patients talk more easily, resulted
from skillful but dubious drug company public relations ploys; how
their gradual subsequent authentication as the heart of treatment,
rather than as ancillaries, transformed psychiatry into an increasingly
mechanical, de-humanized profession which treats patients more and more
according to "diagnostic label" - prescribing drugs supposedly specific
for the numbered "disorder" in the American Psychiatric Association's
Diagnostic and Statistical Manual (DSM); how the organization and
provision of patient care have been eclipsed by drug and brain research
as the path to psychiatric success and power; how the drugs themselves
harm patients' brains; and how, despite media hoopla about brave new
substances, today's treatment results are far worse than in times past.
The centrality of drugs in treatment has led to the almost complete
disappearance of individualized care by psychiatrists - psychotherapy or
counseling. Whatever close personal relationships still exist in
treatment situations - formerly (and still properly) seen as the essence
of good psychiatric care - are now supplied by lower-paid, non-medical
professionals: psychologists, social workers and nurses.
Wagging the dog of psychiatric treatment by the tail of drug research
has been another result of today's psychopharmaceutical primacy. The
chairs of medical school psychiatry departments, who shape psychiatric
training, are selected increasingly for their fund-finding abilities -
drug company grants are plentiful - rather than for knowing how to
provide and organize effective care. Medical schools' bottom lines have
thus superseded the needs of the patients they train doctors to treat;
one result has been the virtual disappearance of
psychotherapy/counseling training from psychiatric residency program.
Whitaker points out how the psychiatric literature itself shows that the
drugs "do not fix any known brain abnormality nor do they put brain
chemistry back into balance. What they do is alter brain functions in a
manner that diminishes certain characteristic symptoms." They blunt and
distort patients' emotionality, thus reducing both their explosiveness
and their ability to think. The drugs also cause severe brain changes
"associated both with tardive dyskinesia and an increased biological
vulnerabilty to psychosis.
The best way to evaluate any treatment is to examine its effect on
patients. Patients and non-patient research subjects (some of them
physicians) describe the same horrendous subjective effects from
neuroleptics. One woman told a 1975 United States Senate hearing that
they led her "to the most fatalistic and despairing moments I've had on
this planet. The only way I can describe the despair is that my
consciousness was being beaten back."
The long-term effects of neuroleptics on patients had already been
recognized by the mid-1980's. "A fairly clear profile of the long-term
course of 'medicated schizophrenia' had emerged in the medical
literature," Whitaker writes. "The drugs made people chronically ill,
more prone to violence and criminal behavior, and more socially
withdrawn. Permanent brain damage and early death were two other
consequences of neuroleptic use."
Other data also demonstrate neuroleptics' harm. A 1994 Harvard study
showed that treatment results in schizophrenia had worsened over the
previous twenty years, during which time the treatment focus had shifted
almost entirely to drugs. Treatment results in Third World countries,
which use neuroleptics much less than we, are far better than ours. Of
the 2,941 schizophrenic patients admitted in 1943 - before the drug era
- to all of New York State's mental hospitals, 44% had been discharged
five years later without ever being readmitted. But in 2002, 15.000
(!) former mental patients, almost all on medication, were the subject
of a New York Times series about the horrendous adult homes into which
they had been sent, and often kept prisoner after discharge from hospital.
Whitaker's startling book has evoked strong reactions. Loren R. Mosher,
M.D., former chief of the Center for Studies of Schizophrenia at the
National Institute of Mental Health, called it "investigative journalism
at its scholarly, perceptive, and explanatory best; an insightful,
courageous expose of how madness went from 'out of mind, out of sight'
to a source of massive corporate profits." Marcia Angell, M.D., former
editor-in-chief of the New England Journal of Medicine (who left that
position after a dispute over the handling of possible conflicts of
interest among Journal reviewers) lauded it as "fascinating and
provocative." Many lay publications praised it.
But three psychiatrists who reviewed the book all attacked it - by
impugning Whitaker personally rather than by refuting any of his
important points. One called the book "propaganda masquerading as
fact." In Medscape, Larry S. Goldman, M.D. of Chicago, author of an
"educational drug-interaction CD program," called it an example of "when
good journalists go bad," and suggested that the book "looks as if it
were commissioned by Scientologists." E. Fuller Torrey, M.D., one of
psychiatric drugging's strongest supporters, wrote that although
Whitaker has heretofore been "known as a serious medical writer for the
Boston Globe, Mad in America rarely ascends to the level of that
newspaper; rather, it mostly descends to the level of the tabloid Globe,
available at supermarket check-out counters."
The heart of Whitaker's book is the drug companies' unholy influence on
all of psychiatry. It is ironic that while Dr. Goldman acknowledges the
importance of Whitaker's demonstration of "the unhealthy symbiosis
between the U.S. pharmaceutical industry and much of the psychiatric
research community" (but he says Whitaker's "overheated style"
undermines his book's effectiveness), Dr. Torrey belittles any alleged
"excess influence and profits of the pharmaceutical industry," and calls
it "unfortunate that Whitaker did not turn his attention to [this] real
problem in American psychiatry," the brain damage he insists causes
mental illness.
Psychiatry is a mess, primarily because the drug-pushers have taken it
over, and succeeded in suppressing, diverting or diluting long-needed
criticism. The title of a 2001 book by Harvard professor J. Allan
Hobson, M.D. - Out Of Its Mind: Psychiatry In Crisis - accurately
describes the specialty's current state. Ann Braden Johnson's elegant
1990 book, Out of Bedlam, which exquisitely delineated the utter
incompetence of public psychiatry, was dismissed by the media by being
reviewed together with an inferior book published at the same time.
Prof. Elliot S. Valenstein's scientifically precise 1998 book, Blaming
the Brain - The Truth about Drugs and Mental Health, also got the cold
shoulder. The major media have similarly marginalized the major
contributions of Peter Breggin, M.D. over the years. That's why the
importance of Whitaker's immense contribution deserves shouting from the
housetops.
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