Analysis of Bipolar Disorder in Anatomy of an Epidemic

Robert Whitakers book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America argues that mental illness has been exacerbated by pharmacological treatments. He does so by dividing his book into five sections to thoroughly make his points. The five sections of the book are; the epidemic, the science of psychiatric drugs, outcomes, explication of a delusion, and solutions. Whitakers book begins by describing what the epidemic is and how it has unfolded in our society. He begins by describing how the epidemic is diminishing the lives of millions of Americans, including children. Over the past five years this modern plague has disabled 850 adults and 250 children every day. In 2007 alone Americans spent twenty-five billion on antidepressants and antipsychotics.

The beginning of this epidemic could be traced back to the introduction of Thorazine, before the discovery of Thorazine psychiatry lacked treatments that could help prevent patients from becoming chronically ill. It was after the discovery of Thorazine that the pharmaceutical industry began developing more and more forms of medication that could help the mentally ill live better lives. Before the discovery of Thorazine there was three methods that were being implemented to help those, who were mentally ill. These methods were therapies that acted directly on the brain and popular media portrayed these methods as “miracle” cures. The first type of these therapies was insulin coma therapy which worked by injecting a high dose of insulin into patients that led to hypoglycemic comas and brought back to life with a glucose injection.

They believed that by doing so the short circuits of the brain vanished and the normal circuits were restored. The second type of therapy was convulsion therapy which worked with either electroshock or a poison named Metrazol used to induce seizures in patients. It was believed that once the patient awoke from their seizures they would be free from psychotic thoughts. The third type of therapy was frontal lobotomies which worked by surgically destroying the frontal lobes and producing an instant cure. These three forms of therapy were being implemented in the very few mental health institutes that were available. The public and government believed that these methods were helping those who were mentally ill but they soon discovered that this was not the case. Shortly after congress passed the National Mental Health Act in 1946 that allowed the government to sponsor research of the prevention, diagnosis, and treatment of mental health disorders.

Whitaker goes on to describe how what was supposed to be a step-forward for mental health turned out to be only truly beneficial to the pharmaceutical industry who began developing new drugs that were supposed to help the mentally ill left and right. What was most disturbing about this was that even when the selling of drugs to the United States changed in 1938 with the passage of the Food and Drug Administration all the law required drug firms to prove was that the products were safe to use but not that they were helpful. Some may think that this is not that big of a deal because either way you are being given a medication that is safe but it’s important to note that all drugs can affect your health even if they are safe. Furthermore, psychiatric drugs can cause individuals with minor problems to have severe and chronic problems that can lead to mental health disorders when being taken for a long time. This is why it is mind boggling that the FDA was not requiring drug firms to provide significant evidence that their new drugs were helpful and not just safe especially when taking them long-term. In fact, Whitaker provides some cases in which it is shown that taking anti-psychotics over a long period of time proved to lead to worse results than with patients who have did not take anti-psychotics over a long period of time. There are three disorders that caught my attention the most.

They are schizophrenia, depression, and overall treating children for mental health disorders. To start off Whitaker mentions that prior to the discovery and arrival of Thorazine between 1946 to 1950 newly diagnosed schizophrenia patients who were hospitalized were part of a studies to determine the “natural outcome” of schizophrenia. They all found that most patients who were diagnosed with schizophrenia were released on average 5-6 years after their initial hospitalization and were able to return to their communities and successfully live in them. The majority of patients who were admitted into hospitals during this time period were admitted after their first episode and those patients were often released after the first 12 months. The arrival of the neuroleptic Thorazine did not improve discharge rates in the 1950s for either patients who had been newly diagnosed nor patients who had been already hospitalized with chronic forms of schizophrenia. The discharge of chronic schizophrenia patients from state hospitals, beginning of deinstitutionalization, began in 1965 with the enhancement of Medicare and Medicaid. Patients with chronic schizophrenia were admitted into nursing homes. this is when the census in state mental hospitals began to drop, after the introduction of Thorazine which was societally believed to be the medication that emptied the asylums.

What wad interesting was the fact that patients who were not medicated at all throughout their time at the hospital or the patients who were put on a placebo and not given any form of medication to help reduce their schizophrenic symptoms had an overall less chance of relapse than those patients who were given any form of medication. Furthermore, patients not given any form of medication were the patients more likely to be able to reintegrate themselves into society and live relativity normal lives. If this is the case, then why do we as a society believe that the first step to treatment of schizophrenia is medication? This is what Whitaker is trying to decipher for us, the fact that as a society we are quick to administer medications to help the patients deal with their symptoms but fail to provide them with other forms of treatment that can help them cope with their disorder. Of course, there are some individuals who have schizophrenia on a severe level who benefit from taking medication throughout their lifetime and Whitaker does not dispute this but rather is trying to make the point that we, as a society, need to do a better job at evaluating the severity of an individual’s schizophrenia to determine if they truly need to be put on medication or if they could be put given a different from of treatment. Additionally, Whitaker describes how the outcomes for bipolar disorder have also worsened in the pharmacotherapy era.

This is not surprising because scientific literature has revealed that long-term outcomes are not good for medicated schizophrenics, anxiety, and depression. In 1955, bipolar had a disability rate of one in every 13,000 people while today, according to the NIMH, bipolar is a disorder that affects one in every forty adults in the United States. Whitaker makes it a priority to point out that yes, the prevalence rates could be higher because of the expanded diagnostic boundaries it is important to take a look at how the psychotropic drugs helped fuel the bipolar boom. To support his claim, he explains how in studies of first-episode bipolar patients it was found that at least one-third of the patients had used marijuana or some other type of mind altering drug before they experienced their first manic/ psychotic episode. There were various studies that found that the use of stimulants, cocaine, marijuana, and hallucinogens were common culprits in the first experience of mood instability that led to the patient’s diagnosis of bipolar disorder. It was these legal and illegal drugs that were paving the way for bipolar illness but they did not act alone. Whitaker goes on to detail how patients who are diagnosed with unipolar depression and are treated with antidepressants are more at risk relapsing frequently, naturally reduce their ability to return to work, and even eventually turning their unipolar illness into bipolar illness.

Once again proving that psychiatric medication was worsening the course of treatment in mental illnesses. The worst part of this all is that this epidemic is now also starting to affect children. Prescribing psychiatric drugs to children and adolescents is a recent phenomenon that has begun which makes it that more important to take a look at. Whitaker believes that we have to ask ourselves if we want to set our kids up to a life-long dependency on these drugs and if doing so is producing more harm than good for our youth. The first identifiable disease that psychiatry discovered was ADHD and then determined that major depression and bipolar illness regularly affects children and adolescents. Before children who are now diagnosed with ADHD were seen as the bullies and goofballs in elementary school but now these are the children that are often diagnosed with having ADHD. The idea that stimulants may be beneficial to children with ADHD began in 1937 when Charles Bradley gave a newly synthesized amphetamine, Benzedrine, to hyperactive children complaining of headaches. the drug did not help the headaches but it did subdue the children enough to allow them to concentrate on their schoolwork. This finding by Bradley was nearly forgotten until Ciba-Geigy brought Ritalin to market as a treatment for narcolepsy.

At first psychiatrist did not see the need to prescribe children Ritalin because of the psychoactive drugs risks. Unfortunately, psychiatry’s use of Ritalin began to increase in the 1970s and by the end of that decade about 150,000 children were taking Ritalin on a daily basis. The real problem is that there are long-term studies that show medicated youth have not shown that they are doing better than children with ADHD who are unmedicated. If fact a long-term study that was conducted by the NIMH found that by the third year there was a significant marker for deterioration and no benefits. Furthermore, it was found that children who are treated with stimulants are exposed to long-term risk of developing bipolar illness (20%). Despite these findings that are shocking, we as a society are still quick to ask for a psychiatrist to write a prescription to give to children without trying other forms of treatment first which is part of the problem. All in all, Whitaker does point out that it is important to note that the reason why we see more diagnosis being made could be due to the heightened awareness about mental health disorders and the less stigmatization that surrounds them.

However, we should also ask ourselves why is there a rise in diagnosis but not a growth in better long-term outcomes especially with the development of all of these new drugs that are being discovered by the pharmaceutical industry. Whitaker does note that not all psychiatric medications are bed, in fact some medications are good for long-term outcomes of those individuals with severe forms of mental illness, and are helpful on a short-term basis for most patients. Nevertheless, outcomes for affective disorders have worsened and there is ample evidence that support the fact that patients with schizophrenia, depression, bipolar illness, and children with ADHD can fare well over the long term with no use of antipsychotic drugs. Meaning that as a society we should start to think twice before automatically turning to the help of drugs to solve mental health issues because although they are helpful for the short-term they have yet proven to be helpful in the long-term. As Whitaker pointed out it should also be easier to treat these disorders properly and with much higher rates of positive long-term outcomes because of the rapid growth of the pharmaceutical industry and until this is the case we should keep questioning the use of these psychiatric drugs especially the ones we give to children.

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