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    Leeches and Psychotropic Drugs Part 4

    Psychotropic Drugs Reviews
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    This is the fourth part of my blog on Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Riase of Mental Illness in America.

    The previous blog explored the accidental nature of the discoveries of these so-called magic bullets, and this blog will examine how the tail of those discoveries came to wag the dog of scientific theory.

    Whitaker notes how psychiatry was viewed very differently from other branches of medicine. Traditionally, the patient would lie on a couch as the psychiatrist led them back through the labyrinthine convolutions of their childhood or provided interpretations for their dreams. This was a far cry from the medical practitioner who diagnosed specific illnesses and prescribed scientifically formulated medicines to correct the condition. With the discovery of “magic bullet” antibiotics, the prestige of doctors rose considerably, and psychiatrists were eager to see their practice achieve the same degree of validation and popularity. If only there was some way to frame these accidentally-discovered drugs as disease-fighting agents!  
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    All they needed was a good theory, and that’s what they got: The Theory of the Chemically Unbalanced Brain.  Some mental illness is caused by brains that have too much of something, and other mental illness is caused by brains that have too little of something. Psychotropic drugs work by inhibiting the uptake or production of the thing of which there is too much … or else the drugs provide the thing of which there is too little.

    A beautiful theory, easily understood by patients.

    The hunt for chemical imbalances in the brain was as unsuccessful as the US hunt for weapons of mass destruction in Iraq. Equally unfortunately, the failure of the hunt for these imbalances was as irrelevant to public policy as was the failure to locate the weapons of mass destruction. When the public is clamoring for action, and when there is a theory so perfectly tailored to justify said action… well, researchers can either get on the bandwagon or risk the stigma and obscurity reserved for party-poopers and whistleblowers.

    The twin pillars of the Chemically Imbalance Theory were 1) the low serotonin hypothesis of depression and 2) the high-dopamine hypothesis of schizophrenia. By the late 1980’s, research had shown both theories to be wanting. Whitaker cites hundreds of studies, and my blog in no way does justice to the thoroughness of his research into the testing done on these drugs. As a former founder of a publishing company that reported on clinical testing of new drugs, the author brings a level of professional expertise to his knowledge of the field and analysis of findings.

    So… the researchers did not find the  Chemically Imbalanced Brain that would be healed by the administration of drugs that had been originally developed for other purposes.  But, in studying the psychiatric patients taking these drugs, they did discover something else. In the words of Whitaker:

    "Prior to treatment, patients diagnosed with schizophrenia, depression, and other psychiatric disorders do not suffer from any known 'chemical imbalance.' However, once a person is put on psychiatric medication, which, in one manner or another, throws a wrench into the usual mechanics of a neuronal pathway, his or her brain begins to function… abnormally.”

    The chemical imbalance was turning up after administration of the drugs, and often it appeared to be permanent. Which raises the question: After fifty years of prescribing these drugs, what exactly have been the outcomes? 

    Click here to go back to Part 1
    Click here to go to Part 5

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    Leeches and Psychotropic Drugs Part Three

    Psychotropic Drugs Reviews
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    I’m blogging my response to Robert Whitaker’s book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Rise of Mental Illness in America. In Part One, I explored the historical disconnect between popular support for a medical treatment and the fact that this treatment may be ineffective or even dangerous, with no supporting research. Part Two reviewed the statistics for the epidemic.

    Today’s subjet is “magic bullets.”  Medicine does have some. Antibiotics and insulin are examples. Researchers identified a medical condition, like bacterial infection or insulin deficiency, and then they developed a medicine that would fix it… Antibiotics to kill the bacteria, and insulin to provide insulin.
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    The “magic bullets” of psychiatric drugs evolved from a very different process. It might be more apt to label them “stray bullets.” For example, Thorzine, the drug that, in the author’s words, kicked off the whole psychopharmaceutical revolution, had its origins in a search for a drug that would be toxic to malarial microbes. That search came to a dead end, but... all was not lost, because it was discovered that one of the compounds might be useful as an antihistamine in surgery.

    Unfortunately, the blood-pressure-lowering side effect was causing patients to die, and so the application was discontinued. One doctor, however, discovered that the drug produced a “veritable medicinal lobotomy”—and a magic bullet was born. In the 1950’s, chlorpromazine (Thorzine) began to be administered to psychotic patients, and the drug that was rendering patients quiet and manageable spread like wildfire through the asylums. When a drug treatment becomes so widely prescribed, it is difficult to keep in mind that it is not treating any disease.

    Thorzine is considered a major tranquilizer. How about the minor ones? Well, they also began with a search for something else. Scientists were looking for a drug that would kill the bacteria that  penicillin couldn’t zap, and to that end, they were isolating a compound found in disinfectants. Research showed that this compound produced temporary paralysis of muscles, but, what was even more interesting, is that the mice who were being experimented on, did not seem to be upset when they found themselves on their backs and unable to move. Their heartrate remained steady. They were not stressed. And, low and behold, meprobonate found its way to the market in 1955 as “Miltown,” and the race for anti-anxiety drugs was on.   Four years later, chlordiazepoxide made it to the shelves as “Librium.”
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    How about the magic bullet for depression? Same story: stray bullets. Hydrazine was developed during World War II as a fuel substitute. After the war, the drug companies snatched up the surplus to test the toxic properties for “magic bullet” potential. Two hydrazine compounds were found effective against the tuberculosis bacillus. Good news, but something interesting was happening to the patients to whom it was administered. They were being energized—dancing on their beds, even. By 1957, in spite of alarming side effects, iproniazid was being recommended for long-term use with depressed patients.

    Meanwhile… back at the Amercian Medical Association ranch, things were changing. In the 1950’s the Food and Drug Administration took over the job of licensing and approving drugs, and most drugs became available by prescription only. The AMA was no longer the watchdog, but the exclusive purveyors, and by 1960, pharmaceutical ads in AMA publications were bringing in $10 million in annual revenue. The PR rush was on.  And as the miracle stories multiplied, the rhetoric began to shift.

    Tranquilizers became “antipsychotics,” and muscle relaxants became “mood normalizers.” The psychic energizers were “anti-depressants.” The public began to view these as antidotes to specific disorders, and scientists were under pressure to come up with a theory about broken brains to support the "magic bullets" that were achieving celebrity status. 

    Click here to go back to  Part One.
    Click here to go to Part Four.


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    Leeches and Psychotropic Drugs Part 2

    Psychotropic Drugs Reviews
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    This is the second part of a series of blogs about the book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America by Robert Whitaker.

    The book is by a man who founded a publishing company to report on the business aspects of clinical testing of new drugs… an “industry-friendly” enterprise. Baffled by studies suggesting the inefficacy of medications for patients with schizophrenia, he began an investigative journey that resulted in this book.

    “Epidemic” is  a strong word. How does Whitaker support it? 

    He starts by looking at the data for 1955, when the disabled mentally ill were primarily cared for in state and county mental hospitals. Today, these folks would typically be receiving SSI (Supplemental Security Income) or SSDI (Social Security Disability Insurance) payment, with many of them living in residential shelters or other subsidized living arrangements. 
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    In 1955, 1 out of every 468 Americans was hospitalized from mental illness. In 1987, 1 out of 184 Americans were receiving SSI or SSDI payment for disabling psychiatric conditions. The author concedes that this is an apples-to-oranges comparison, because the increase could be a result of the lowering of social taboos for seeking treatment for mental illness… but, the argument could also go the other way—that the 1987 statistics could be conservative, because they only include folks younger than 65 (older disabled patients are on Medicare and Social Security.) Okay… apples-to-oranges, because SSI and SSDI did not exist in 1955.

    So let’s look at a more meaningful comparison, apples-to-apples. Let’s compare the number of folks on SSI and SSDI in 1987 to those in 2007.  Why 1987? Because that’s the year that Prozac was approved by the FDA. Twenty years later, the rate for folks disabled by mental illness was 1 in 76 Americans. That’s more than double the rate in 1987.

    Whitaker asks us to go deeper. In 1955, comparatively few of the people disabled by mental illness were diagnosed with major depression or bipolar illness. By 2006, 46 percent of young people (18-26 years old) on psychiatric disability were diagnosed with an affective illness, and 8 percent with anxiety disorder. 

    What about children? In 1987, pre-Prozac, only 5.5 percent of disabled children were diagnosed with psychiatric conditions. Twenty years later, that figure had changed to 50 percent. Today, mental illness is the leading cause of disability in children.  And here’s an interesting statistic: Between 1996 and 2007, the number of children on SSI for other reasons (cancer, developmental disorders) declined, while the number on SSI for mental illness more than doubled.  In other words, doctors seemed to be making progress in the treatment of other conditions, but losing some serious ground in combating mental illness.

    Looking at these statistics, and especially those dating from the entry of Prozac into the marketplace, the author has the temerity to ask about the emperor’s new psychiatric clothes:

    Could the current drug-based paradigm of care be causing this epidemic? In other words, is this epidemic iatrogenic in nature? (Etymology: Greek. iatros—physician, genein—to produce.)  Is the theory of the “broken brain” actually a broken theory?  Are the two decades of psychiatric drugging analogous to the two millennia of bloodletting—a pseudo-scientific practice rooted in the vulnerabilities of human nature, not medical science?

    So here was Whitaker’s thinking: Since the general consensus is that millions of people are living better lives because of psychiatric medication, then surely the scientific literature should support this consensus with research into the biological disorders being treated and legions of studies reflecting the success of the new drugs.

    In fact, the scientific literature tells an opposite story. 

    Click here to go back to Part 1.
    Click here to read Part 3.
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    Leeches and Psychotropic Drugs Part One

    Psychotropic Drugs Reviews
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    Did you know that bloodletting was the most common medical practice from the first century AD until the nineteenth century—nearly two thousand years!—even though, in the majority of cases, the practice was harmful and even fatal to patients?

    Wow.

    Wouldn’t you think that in two millennia, people might have noticed that folks losing pints of blood got worse instead of better?

    Actually, I’m sure they did. They would definitely notice when the patient died. So why the extraordinary longevity of such an obviously pernicious therapy?

    The answer is simple: human nature. We are emotional, not rational creatures. And we are creatures of habit; our traditions die hard. And we are social animals; shunning by the herd will bring most of us back into line. 
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    Bloodletting was the accepted practice. The patient who challenged it, would be accused of malingering. The parent who refused it for their child would be perceived as negligent, or even malicious. The story is so strong, so rooted in human nature that it hijacks the  narrative: The patient who gets worse after bloodletting would have been even sicker without the procedure. The patient who eventually dies from loss of blood was going to die anyway, and the bloodletting came too late to save her.

    Who needs science when there is a story as powerful as the story of blood gone bad, blood carrying humors which must be expelled? It is a graphic and compelling story—blood being such a dramatic metaphor for life. Blood is present at the birthing, present on the battlefield, emblematic of the transition to womanhood, and also emblematic of the manhood rite of wounding. Blood ties of kinship, blood feuds to the death. Blood as giver and as taker of life.

    And then there is that human tendency to believe that it is better to do something than nothing. And bloodletting had the additional advantage of being quantifiable. Specific amounts of blood could be let at specific intervals. These could be recorded, charted, studied. There could be right ways and wrong ways for the letting-of-blood. Various techniques were developed, each with its own theory. But best of all, everyone has blood.

    And, finally, there is an exchange of some sort going on. The bloodletter is receiving payment. The bloodletter is invested in promoting the practice, and the patient and the patient’s family have a disincentive in understanding that they have been hoodwinked… or that they might be responsible for enabling the harm or death of the one they loved. And then, of course, there is the lucrative cottage industry of leech-farming/ leech-harvesting.
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    Why am I telling you this? Because it might make it easier to swallow the fact that millions of people today are receiving a medically prescribed treatment that is making the majority of them much sicker, shortening their lives, and sometimes killing them… and there is absolutely no research to support the theory upon which these treatments are based.

    In this case, the practice is only a few decades old instead of millennia, but the principle behind it is the same: human nature.

    This blog is my response to reading Anatomy of an Epidemic by Robert Whitaker. The subtitle is “Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America."

    The first thing that impressed me about this book was the story of the author’s involvement with the subject. He was not a counter-culture type guy. In fact, he had co-founded a publishing company to report on the business aspects of the clinical testing of new drugs. In his own words, “we wrote about this enterprise in an industry-friendly way.” Clearly Anatomy of an Epidemic is not “industry-friendly.” What changed?

    Whitaker stumbled across a story about the abuse of patients in a research setting. He did a series of articles on the subject for the Boston Globe. In one of the stories, he reported on a study which had involved withdrawing schizophrenic patients from anti-psychotic medications. Since the medication for this disorder is likened to “insulin for diabetics,” the author questioned the ethics of a study that would deprive the patient of a medication supposedly known to be essential for their health.

    In the course of researching this article, Whitaker ran across two findings that nagged at his conscience:

    1)    In 1994, Harvard researchers announced that outcomes for schizophrenia patients has worsened since 1974 and were no better than they had been a century earlier… as in 1894.

    2)    Two separate studies by the World Health Organization which found that schizophrenia outcomes were much better in poor countries like India and Nigeria, where only 16% of the patients were maintained on anti-psychotic medications.

    The point of all this is that the author of the book was a solid believer in the conventional wisdom of modern psychiatry. He believed that psychiatric researchers had discovered biological causes for mental illness and that their findings had led to the development of a new generation of psychiatric drugs to “balance” brain chemistry. He was to discover that none of these assumptions were true.

    Anatomy of an Epidemic is the story of his awakening.

    Click here for Part 2.