Today, we’re joined by Sruthi Ramaraju again, this time with her wonderful review on Anatomy of an Epidemic by Robert Whitaker. Sruthi placed in the top 5 at the 2017 English Brain Bee, a national neuroscience competition for secondary school students in England. She loves to read medical literature and enjoys writing fiction and non-fiction. If you are interested in contributing to this book review series, contact Megumi Sano at firstname.lastname@example.org.
Robert Whitaker’s book Anatomy of an Epidemic explores the reasons why mental illness is on the rise in the USA. Whitaker’s chief claim is that psychiatric drugs, contrary to popular belief, are the causal factor of this increase; he argues that they hinder recovery and leave people with worse prognoses than if they were left untreated.
Suitably provocative and filled with statistics and citations interwoven amongst convincing reasoning, Whitaker’s book nevertheless came across predominantly as a very one-sided, rigid attack against medication and the legitimacy of psychiatry today. The book isn’t without its merits: it is clear from the wealth and variety of the sources of information Whitaker has utilised that he has clearly researched the topic, but that is precisely also the problem arises: it is painfully obvious how selective he is about the information. Rather than approach a very intriguing question- why mental illness is on the rise- from a comprehensive, multi-faceted direction, he begins by hypothesising that psychiatric drugs are the culprit and the next 400 pages are devoted to fleshing out this sole claim, even if it is sometimes by recycling the same evidence from the same sources. Sadly, Whitaker has presented a very biased, narrow answer to a topic with a lot of potential. He doesn’t mention other credible causes to this increase, including (in the case of schizophrenia) obstetric complication, viral infection, and social factors, all of which have equally (if not more) compelling evidence. Importantly, he doesn’t mention the numerous studies of brain physiology which do, in fact, suggest that differences in brain structures may lead to greater susceptibility to mental illnesses such as schizophrenia.
Whitaker’s selectiveness of information leads to a very warped and at times inaccurate and misleading picture of mental illness. For example, he compares pre-drug era and post-drug era mental illness figures by looking at the number of hospitalised mentally ill people before the introduction of psychiatric drugs to the number of people on SSDIs today- a very tenuous comparison at best, and one which crucially doesn’t take into account population rise, etc. In a few instances, it is clear that the statistics he presents with such confidence and style are just speculation and, in the case of side effect reports, for example, used to inflate and sensationalise the numbers to boost his claim.
Perhaps most frustrating is his tendency to find design flaws in the studies which don’t fully support his view, and yet hail different studies with the same (or sometimes even larger) flaws which do as “proof”.
Despite its drawbacks, however, some important points are undeniably raised, particularly through the WHO study and the Harrow study, both of which suggest that social therapy should be used alongside medication. Similarly alarming is the effects of medication on children with ADHD.
Although the book’s biased compilation of evidence isn’t the best reflection of psychiatry and its merits and failures, it is nevertheless one which is engagingly written and definitely provides food for thought.
— Sruthi Ramaraju