Monday, April 19, 2010

Robert Whitaker's "Anatomy of an Epidemic"

Robert Whitaker is the award-winning author of The Mapmaker’s Wife and Mad in America. His manuscript of On the Laps of Gods won the prestigious J. Anthony Lukas Work-in-Progress Award.

He applied the “Page 99 Test” to his new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, and reported the following:
Much to my delight, I turned to page 99 of Anatomy of an Epidemic and discovered that it is here that one of the major themes in the book starts to take shape. The book investigates how psychiatric medications affect the long-term course of mental disorders (as opposed to their short-term effects), and page 99 tells of the results from the first long-term study of antipsychotics conducted by the National Institute of Mental Health. In that 1960s trial, at the end of six weeks the schizophrenia patients who had been treated with an antipsychotic were faring better than the placebo patients. However—and this information appears on page 99—during the following year, researchers “were startled to discover that ‘patients who received placebo treatment [in the six-week trial] were less likely to be rehospitalized than those who received any of the three active phenothiazines.’”

This is what then follows on page 99:
Here, at this very first moment in the scientific literature, there is the hint of a paradox: while the drugs were effective over the short term, perhaps they made people more vulnerable to psychosis over the long term, and thus the higher rehospitalization rates for drug-treated patients at the end of one year. Soon, NIMH investigators were back with another surprising result. In two drug withdrawal trials, both of which included patients who weren’t on any drug at the start of the study, relapse rates rose in correlation with drug dosage. Only 7 percent of those who had been on placebo at the start of the study relapsed, compared to 65 percent of those taking more than 500 milligrams of chlorpromazine before the drug was withdrawn. “Relapse was found to be significantly related to the dose of the tranquilizing medication the patient was receiving before he was put on placebo—the higher the dose, the greater the probability of relapse,” the researchers wrote.

Something was amiss, and clinical observations deepened the suspicion. Schizophrenia patients discharged on medications were returning to psychiatric emergency rooms in such droves that hospital staff dubbed it the “revolving door syndrome.” Even when patients reliably took their medications, relapse was common, and researchers observed that “relapse is greater in severity during drug administration than when no drugs are given.” At the same time, if patients relapsed after quitting the medications, Cole noted, their psychotic symptoms tended to “persist and intensify,” and, at least for a time, they suffered from a host of new symptoms as well: nausea, vomiting, diarrhea, agitation, insomnia, headaches, and weird motor tics. Initial exposure to a neuroleptic seemed to be setting patients up for a future of severe psychotic episodes, and that was true regardless of whether they stayed on the medications.
This NIMH study is the beginning moment in a history of science that then unfolds over the course of the next 50 years, with the same startling “long-term” results appearing again and again. Page 99 in Anatomy of an Epidemic foreshadows the story, which really is tragic in kind, that is told in the next 150 pages of the book.
Read an excerpt from Anatomy of an Epidemic, and learn more about the author and his work at Robert Whitaker's website.

--Marshal Zeringue