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Book Review: Anatomy of an Epidemic, Magic Bullets, Psychiatric Drugs and the Astonishing rise of Mental Illness in America

Mental Health Neuroscience

My career, as a mental health nurse, began in 1975. Initially I worked on what was called a locked ward as a nursing assistant with some of the most disturbed, floridly psychotic people you could imagine. Most had been incarcerated in the Victorian institution for many years, their symptoms and behaviours excluding them from any kind of open ward or community rehabilitation programme. Almost everyone had a diagnosis of some kind of schizophrenia (back then there were loads) and/or manic depression and we were told by senior nurses and consultant psychiatrists that the illnesses had caused chemical imbalances in their brains and their only hope, for any kind of remittance, would be to find the right combination of medications. I’ve always been a pain in the arse because, if I’m going to get involved with something, I’ve got this insatiable curiosity that manifests in lots of rather difficult questions.
I, fairly constantly, asked, “what are these chemical imbalances?” “Where do they come from and why.” The answers I got never seemed to adequately describe what I was seeing with my eyes. I was told it was to do with dopamine and that schizophrenia was caused by an excess of dopamine in the brain. It could be seen on EEGs, which they seemed to do back then with gay abandon, consultant psychiatrists spending hours pawing over this series of squiggly lines, pointing at “abnormalities” as some kind of definitive proof of the presence of the pathology of schizophrenia and/or manic depression. But the evidence wasn’t stacking up, surely if it was some kind of chemical imbalance we would or should be seeing some kind of improvements as doses were increased or more drugs were thrown in the mix? All I was seeing was people getting progressively worse psychologically and deteriorating physically. Then when all else failed it was electro-convulsive therapy and, if that didn’t work, pre-frontal leucotomy.
I started nurse training in 1975, training that stayed in line with brain chemical imbalance theories and a whole stack of text books describing the hopelessness of psychoses. Fortunately, around this time, I was able to find some of the answers that I was looking for. I devoured Laing and Szasz, finding they made much more sense of my experience than any of the other text books I was being almost force fed. Unfortunately this newly acquired knowledge began to get me into trouble. I started to question some of the diagnoses that consultant psychiatrists were making, “how dare this young student nurse question my authority,” was one particular note made to my supervisor from a consultant psychiatrist. I was only 22 at the time, lacking in confidence and getting a bit chaotic with substances in my home life. I thought my best course of action would be to shut up, learn and try to hold off on the questions until maybe I had the knowledge and experience to back them up.
Following qualification I seemed to spend most of my time advocating for patients and trying to negotiate packages of care that didn’t depend exclusively on medicating. As a community psychiatric nurse, looking after around 80 very damaged people in a very deprived area of Salford, I tried to ensure the people in my care were on the smallest amount of medication possible. Often this involved actually keeping them away from psychiatrists and helping them to ride a crisis without increasing medications. I began to find that the people I was working with were needing less hospitalizations and were remaining in much better all-round health than the people my colleagues were working with. I didn’t really think about this at the time, putting it down to me rebelling, as is usual for me, against a system.
When I read this book, it all began to make sense. Back then we had been right in the middle of the “magic bullet” era of psychiatry when the belief was that every symptom and every condition had a biological cause and could be, if not cured, managed with psychopharmacology. Psychoses by controlling dopamine release, depression by increasing serotonin uptake and anxiety by tweaking about with the way that gaba works. Everybody including professors in psychiatry bought this hook line and sinker. Pharmaceutical companies were bringing out ever more specific drugs and we were reassured that this new generation was much safer, worked much more effectively and had a robust evidence base that it definitively improved lives. We all read the impressive clinical trials, attended the conferences were the experts reassured us. Little did we know that almost everything had been grossly exaggerated, bad results had been covered up and statistics manipulated. God knows how much money has been made, basically under false pretences and just how many people’s lives have been ruined? Whittaker exposes it all, although much of his data is admittedly from America and psychiatry is quite different over there, much of what he is saying has happened and is still happening over here.
Whittaker throws out some real challenges, his research very clearly demonstrates that, although most psychotropics work in the short term, long term the positive outcome prognosis is dire. The longer anyone stays on antipsychotics, mood stabilisers, anti-depressants and/or anxiolytics, the less chance they have of being able to work or be a productive member of society. Long term psychotropics actually make people more prone to relapse of the original condition than less. As the brain adapts to the presence of the drug/s it either sheds receptors or thickens them, often leading to permanent brain damage. As we, in the mental healthcare fields, move towards using things like employment as outcome markers and there is more and more coercive influences, we are going to find ourselves in somewhat of an impasse. Many of the people who have been in drug treatment for many years have also been on psychotropics for many years. Whittaker very clearly demonstrates that most long term psychotropic treatments cause cognitive impairment, probably increase the chances of relapse and will be almost impossible to come off. Doesn’t sound like good employment prospects does it?
This is a fantastic book, it really questions the keep taking the medication to stay well message, that we’ve all been sold. It’s looking like quite the reverse is true, so what are we going to do about it? For me it makes things like open dialogue all the more important.

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