Book Review: Anatomy of an Epidemic
In his 2010 journalistic book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Robert Whitaker inquisitively utilizes case studies, governmental data, psychiatry research literature, and medical journals to critically provide a historical account of the increased prescribing of psychotropic medications in America and their long-term effects. Whitaker’s curiosity about the increased number of adults and children on government disability due to mental disorders sparked his investigation — often sharing examples of individuals placed on supplemental security income (SSI) and social security disability insurance (SSDI) shortly after being disabled from psychiatric drugs. Whitaker proposes that long-term psychotropic medication use is causing an influx in mental disorders and chronic illness due to its adverse effects and discontinuation difficulties. Whitaker shares tragic stories of individuals whose lives had changed tremendously due to psychotropic medications — ultimately heightening their symptoms and impairing their functioning and quality of life. Their only way back to a baseline of functioning was to taper off completely and cope with the pains of withdrawal, replace the drugs with less toxic versions, or a combination of both. The individuals in the case studies were living in a never-ending nightmare.
Moreover, Whitaker recognizes the effectiveness of psychotropic medications when prescribed judiciously in the short-term, stirring away from blanket statements that imply that all psychotropic medications are eternally bad. Psychiatry’s adoption of a medical disease model prompts an emphasis on drug treatment, which Whitaker argues creates abnormalities and chemical imbalances because the brain tries to adapt to the tampering of normal neural processes. Whitaker skillfully uses expository writing to explain biological psychiatry and pharmacological manipulation of studies and prescribing behavior, the classes of psychiatric medications and their developmental history, and the narratives of several users. Throughout the book, Whitaker callously dismantles myths about the effects of psychopharmacologic treatment.
Review of Strengths and Weaknesses
Strengths
In order to convey his captivating message, Whitaker uses the case studies to generate emotional appeal. As a result, readers are able to relate to the experiences of each case and sympathize with the mental, physical, and emotional tolls the drugs produced. In addition, he strategically interweaves qualitative and quantitative data to provide empirical evidence of his claims. The use of compelling data alludes to his credibility as a journalist — however, critical consumers of information might question some of the data presented. The biggest strength of the book is the fact that Whitaker does not exclusively blame pharmaceutical companies for the mental health epidemic, but points to multiple factors. Not once did he point fingers, he pointed to research evidence and case examples. This is important because scapegoating only distracts people from observing a larger picture and shy away from acknowledging other influences.
Weaknesses
Whitaker uses the studies to present information that validate his claims about psychotropic drugs without critically analyzing the data itself. More detailed information about how the studies were conducted, sample sizes, and study limitations would have empowered readers to take well-informed stances on the issue. In addition to omitting pertinent information, he was often one-directional in his presentation — never really addressing alternatives. What about the times where psychotropic drugs have helped people in the long-term? He does not share any information about the distressed brain before drugs nor the neurological processes that develops a disorder. Moreover, the case studies lacked diversity and did not appear to be representative of the psychotropic drug use population. Thus, Whitaker merely served as a lay witness to the epidemic — presenting a compilation of hearsay evidence (I object, your honor).
Contributions to the Field and Personal Impact
The book contributes to the field of psychiatry because it challenges the basis of prescribing behavior and medication use. Most prescribers are operating from a brain disease model which holds that the best way to treat symptoms is through single or multiple drug treatment (a drug cocktail). It is a common fallacy that reinforces a hegemonic cycle and harms many people. The book negates the “medication first” mindset and implores a careful examination of the whole person. So often, medications are prematurely prescribed due to the focus on problematic symptoms and not their function. The nature versus nurture debate torments the practice of psychiatry and the book encourages a balance. Therefore, psychotropic medications should be carefully administered, routinely monitored, and used sparingly and for the short-term. Whitaker suggests that the medications do no “treat”, which implies a cure, but merely masks symptoms. While symptoms are being masked it is important to have the necessary supports in place to help individuals thrive separately from the medications.
The book highlights the importance in maintaining a balanced perspective and touches on the need for supportive care. As a social worker, I believe that it is my responsibility to provide clients with options, psychoeducation, and access to internal and external resources. This book has helped me to see the benefit of my role in helping clients gain control over their lives and bodies. Furthermore, I feel more assured in emphasizing treatment supports for the long-term. I do believe that social workers are in a unique role in diminishing the mental health epidemic, given our experiences with human behavior and social systems. Honestly, the book has me thinking about macro-level changes in policy that could fully reshape the field of psychiatry.
References:
Whitaker, R. (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. NY: Random House.
