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on 6 May 2015
The book is a bit of a hard slog for those of us with only average intelligence, but it is well worth the slog. I think possibly that the UK medical profession is not so drug-happy as the USA in their treatment of the mentally ill, but unfortunately, the UK often follows America, which would, as the reading of this book shows, be a tragic mistake. I was convinced by the end that mental illness is not a 'disease' as we have all been conditioned to believe, and that the answer does not lie in throwing drugs at the patient. I found this comment from the book enlightening: "phychosis does not live in the head. It lives in the in between of family members, and the in between of people...it is in the relationship, and the one who is psychotic makes the bad condition visible. He or she 'wears the symptoms' and has the burden to carry them.' The revelations of deliberate suppression by the psychiatric profession and the terrible dangers of the drugs they use was quite depressing reading and I began to wonder if all was lost, so I was greatly relieved when I got to the section entitled 'Solutions'. There really is hope for those affected by depression, schizophrenia and phychosis. But it will take time and doctors who are willing to give it. I hope they read this book.
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on 23 February 2015
A compelling, easily readable and easily understood scientific, evidenced based exploration of the "benefit - harms" balance of drug use in "mainstream psychiatry". Drug toxicities are validated and analysed in individuals, and their families, as well as in terms of adverse outcomes over short, intermediate and (especially) long term in human populations. It is very painful to read for anyone who has witnessed the cumulative toxicity of medications which may be enforced despite dubious benefit. This book does not condemn the use of psychotropic drugs. On the contrary, it is a powerful advocacy for judicious and compassionate use of limited duration ( where appropriate ) of Pscho-tropic medication. It does however powerfully demonstrate Pharma "marketing masquerading as medicine". It is of particular relevance for G.P.'s /Family Physicians and for any potential patient who is given the label of "chemical imbalance".
The underlying, implied appeal is - "first do no harm."
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on 7 June 2013
Whitaker exposes Big Pharma as a purveyor of snake oil sold out the back of a covered wagon only now they've got Harvard Professors and super slick marketing strategies. Suckers of that big, scaley pecker each and every one of them. The DSM is but a glossy brochure for their tragic potions. Make up a disorder and medicate it. Watch RD Laing on Youtube talk about the DSM and check out some of its diagnoses for kids. The same people are in charge of US foreign policy. Psychopaths. Mental health in UK is a hideous farce. Most Trusts advertise for newly qualified RMNs to work on their acute wards because the poor saps don't know any better. I was used as they will be. In my experience, community and fellowship will always be much better for you. Essential.
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on 18 April 2017
Excellent reading. I Couldn't put the book down. I'm not a psychiatrist so couldn't critique or verify the facts that were presented in the book, but I was hooked from the start. If everything in this book is true, then I am left wondering why society as a whole, doesn't seem too bothered.
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on 2 May 2017
Good fairly easy read, should be compulsory for every GP /family doctor who prescribes anti-depressants. A shocking indictment of big pharma and the doctors in their pay.
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on 25 June 2017
Deeply informative. An intense wakeup call to all that an average practitioner in mental health services could be taking for granted.
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on 29 March 2017
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on 27 October 2011
Anatomy of an Epidemic is excellent. It is the best book of this type I have read. It confirms what many of us have believed about psychiatric drugs for a long time. I have been recommending this book to my students. Even for people who firmly believe the information supplied by drug companies this is still a must read book in order to understand the views of millions who have taken the drugs, experienced worsening symptoms and bad side-effects.

Prior to this book I found it difficult to explain why drugs that have never been shown to be beneficial are continuing to be prescribed. This book has made my life easier. I only need to say that the facts are explained in Anatomy of an Epidemic.

Robert Whitaker's style is excellent. It is a subject that can seem daunting yet he takes you on a journey from the first `energisers' of the 1950's to the more recent chemicals, which turn out to be surprisingly similar in action to the earliest ones.

One effect of the book is that I find I am now increasing being asked questions about coming off psychiatric medication. It makes sense to ask. Stopping quickly is almost always a bad idea, whereas finding a doctor you can work with is an excellent idea and then working with that doctor to find ways towards lower safer doses usually improves what you can achieve.
Mood Mapping: Plot your way to emotional health and happiness
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on 24 April 2010
I enjoyed his earlier book 'madness in America' this is equally good.There has been quite a few books on psychiatric medication recently but this one does bring a lot of evidence together.He looks at the amazing increases in diagnosis of mental illness over the last 20 years.He examines the usual reasons identified such as changes in diagnosis,societies changes,BIG PHARMA and medication. He is quite convincing that psychiatric medication,like all psycho active drugs seems to make changes to the brain long term which may result in future relapses.These relapses appear to be more severe and more frequent.He is especially concerned about psychiatric drug use in the young,considering the debate about cannabis causing psychosis in young people,giving them amphetamines does seem questionable.He does not argue that medication is not useful at all but thinks the dosages and length of time on them maybe creating problems for the future. The alternative of safe supported rehab care for people he acknowledges would be expensive and time consuming but may over a persons life time be cheaper than the revolving relapse door and wasted lives. It of course applies equally to any modern Western country as we have all imported America's psychiatric culture.
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on 23 August 2017
Robert Whitaker has written an extraordinary book. He starts from two astonishing findings: first, Harvard Medical School found that the outcomes for US schizophrenia patients have worsened in the last two decades. Second, the World Health Organisation’s ten-country study found that schizophrenia outcomes were much better in poor countries like India and Nigeria, where only 16 per cent of patients were regularly given anti-psychotic drugs, than in the USA and other rich countries, where this is standard practice.

He shows why drugs became the treatment of choice and how the American Psychiatric Association allied with big pharma. This new marketplace proved profitable for all concerned (except the patients).

The rationale was that chemical deficits or imbalances caused all mental illness. But as Colin Ross, an associate professor of psychiatry, wrote, “There is no scientific evidence whatsoever that clinical depression is due to any kind of biological deficit state.” Kenneth Kendler, co-editor in chief of Psychological Medicine, wrote, “We have hunted for big simple neurochemical explanations for psychiatric disorders and have not found them.”

The wrong approach generated the wrong remedy. Drug use did not cure mental illness.

Worse, as Peter Gøtzsche, a cofounder of the Cochrane Collaboration, pointed out, “There is no chemical imbalance to begin with, but when treating mental illness with drugs we create a chemical imbalance.” Peter Jensen of the National Institute of Mental Health (NIMH) found that “medication use was a significant marker not of beneficial outcome, but of deterioration.” Research showed that thorazine (chlorpromazine) and other drugs for schizophrenia did not normalise brain function, they worsened it. The higher the dose, the more likely a relapse. Whitaker explains that these drugs block dopamine activity in the brain, which leads to brain shrinkage, worsening negative symptoms and harming cognition.

Martin Harrow’s 15-year study found that manic-depressives off drugs had the best long-term outcomes, then schizophrenics off drugs, and then manic-depressives on drugs. Worst of all were schizophrenics on drugs. The patients off drugs were less psychotic, less anxious and had lower relapse rates. 40 per cent of unmedicated schizophrenia patients recovered, but only 5 per cent of the drugged patients. 87 per cent of the off drugs group had two or more sustained periods of recovery, but only 17 per cent of the medicated group had even one period of recovery.

Whitaker sums up, “Schizophrenia, of course, has long been the psychiatric diagnosis with the worst long-term prognosis. It is the most severe mental illness that nature has to offer. But in this National Institute of Mental Health (NIMH) funded study, two groups of medicated patients fared worse than the unmedicated schizophrenia patients.” He concludes that on the whole drugs worsen the long-term outcomes of people with major mental disorders. Drugs increase the chances of a person’s becoming chronically ill, and of becoming ill with new and more severe symptoms.

A similar pattern is found in mental illness in children. The number of mentally ill children in the USA has risen thirty-five fold since 1990. An estimated 3.5 million American children now take a drug for so-called ADHD (attention deficit/hyperactivity disorder).

Yet a panel of experts convened by the National Institutes of Health concluded, “After years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remains largely speculative.” The American Psychiatric Press’s 1997 Textbook of Neuropsychiatry confessed that “efforts to identify a selective neurochemical imbalance [in ADHD children] have been disappointing.” Another team of ADHD experts concluded, “The long-term efficacy of stimulant medication has not been demonstrated for any domain of child functioning.”

Alan Sroufe, a professor of psychology at the University of Minnesota’s Institute of Child Development, summed up, “No study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships, or behaviour problems, the very things we want to improve. … The drugs can also have serious side effects, including stunting growth.”

In 2003 the UK’s Medicines and Healthcare Regulatory Agency banned the use of selective serotonin reuptake inhibitors (SSRIs), except for fluoxetine, in patients under 18 years old. But in the USA, where prescribing drugs to 2-year-olds and 3-year-olds became more common a decade ago, the number of children under six years old receiving Supplementary Security Income (SSI) for mental illness has tripled since then.

But if drugs are not the answer to mental illness, what is? Western Lapland has a policy of no immediate use of drugs for first-episode patients. Professor Jaakko Seikkula worked at Keropudas Hospital at Tornio in western Lapland for nearly 20 years. He explained, “if they are medicated, because of the sedative action of the drugs, they lose this ‘grip on life’, and that is so important. They become passive, and they no longer take care of themselves.”

Since 1993 not one first-episode psychotic patient in western Lapland has ended up chronically hospitalised. Spending on psychiatric services in the region dropped by a third from the 1980s to the 1990s. Yet recovery rates stayed high. From 2002 to 2006 fully 84 per cent of Tornio’s patients had returned to work or school.

In 1961 the California Department of Mental Hygiene found that 88 per cent of first-episode schizophrenia patients who were not prescribed a drug were discharged within 18 months. Only 74 per cent of those patients who were prescribed a drug were discharged within 18 months. Another WHO study, in 1998, found that of 740 depressed people, the 480 who were not given drugs had the best outcomes.

In 2004 the UK’s National Institute for Health and Clinical Excellence decided that “antidepressants are not recommended for the initial treatment of mild depression, because the risk-benefit ratio is poor.” It urged doctors to try non-drug alternatives and to advise ‘patients of all ages with mild depression of the benefits of following a structured and supervised exercise programme’. Studies found that exercise produces ‘substantial improvement’ within six weeks and that 70 per cent of all depressed patients respond to it.

One patient recalled, “When I was ‘bipolar’, I had an excuse for any unpredictable or unstable behavior. I had permission to behave in that way, but now I am holding myself to the same behavioral standards as everyone else, and it turns out that I can meet them.” Whitaker notes, “Hers is a story of a possible iatrogenic process at work, of an otherwise normal person being made chronically sick by diagnosis and subsequent treatment. And thus we have to wonder: Do we have a paradigm of care that can, at times, create mental illness?” His book helps to answer this question.

Feeling in charge and taking responsibility are central to our lives. We should respect and treat people with mental illness as agents not as victims, as people not as patients.
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