Wednesday, September 14, 2011

The Author's Hour: Robert Whitaker's Anatomy of an Epidemic

The Author's Hour entails interviews with  authors who are already published or on their way to being published. The subjects will be wide ranging. We'll talk to experts from the fields of economics, history, sociology, political science, philosophy, literature, etc. The intent of this new series is to connect with authors whose work intersects with my own. This way, it will allow me to introduce my readers to other authors who are: 
  • concerned about the student lending crisis
  • other major societal problems
  • interested in my work as a political activist for the indentured educated class
Our next author is Robert Whitaker. Mr. Whitaker has an illustrious professional background. His website states:

Robert Whitaker has won numerous awards as a journalist covering medicine and science, including  the George Polk Award for Medical Writing and a National Association for Science Writers’ Award for best magazine article. In 1998, he co-wrote a series on psychiatric research for the Boston Globe that was a finalist for the Pulitzer Prize for Public Service. Anatomy of an Epidemic won the 2010 Investigative Reporters and Editors book award for best investigative journalism.
 He is also the author of Mad in America (Basic Books, 2010).

Before I jump into the interview with Mr. Whitaker, I want to thank one of my special readers who introduced me to Bob. The conversation was great, and I encourage all of you to buy Bob's recent book, Anatomy of an Epidemic.

Here's what we discussed:

CCJ: Not all of my readers are familiar with Anatomy of an Epidemic. Provide us with a brief hypnosis of the book, and why you decided to write it.

BW: The book investigates a puzzle: Why has the number of people disabled by mental illness soared in the past 20 years? And the hypothesis I raise is this: Is it possible that the widespread use of psychiatric medications, in one manner or another, is fueling this epidemic?

CCJ: You discuss the two histories of psychiatry and the rise of pharmacological drugs in the U.S. and in Europe. Most of us are familiar with the 'positive' side of this story, i.e., how people with mental illnesses have been cured or their bad symptoms have been diminished as a result of popping pills ('the magical bullet' theory that you mention in the beginning of the book). However, the negative side of the story is not as well known - it's much like two sides of the same coin. Tell us about the negative side of taking pills for bipolar disorder, ADHD, schizophrenia, and depression for years. What happens to some people? (And you obviously show that not everyone has a negative experience).

BW: The negative side of the coin is that many people who take the medications, particularly over the long-term, end up experiencing worse psychiatric symptoms, physical problems related to the drugs, and cognitive decline related to the drugs. In the aggregate, I think the data is pretty clear: long-term use of psychiatric worsens overall outcomes. Some people do well on the medications, but on the whole, the long-term use of medications worsens outcomes.

CCJ: I have a lot of readers who tell me that they are so overwhelmed by their student loan debt that they sought help, and have been prescribed all kinds of pills (anti-anxiety, sleeping pills, anti-depressants, etc.). How do you feel about this fact, i.e., that people who are drowning in student loan debt are being prescribed these types of medications? While some of them might have legitimate reasons for seeking medical treatment of this nature, do you think this is the best way to deal with the problem both at a societal level as well as a personal one?

BW: I would say this is precisely the wrong way to deal with this problem of student loan debt. Taking a pill won't make that debt go away, and so the underlying situation won't change. The question, I suppose, is whether taking a pill will help that person cope with the distress better, and thus perhaps pursue a better course (in terms of getting a job, etc.) Taking a pill may somewhat alleviate the emotional distress, at least for a time, but I don't think there is any evidence it helps people come up with a long-term solution to this problem. This is a problem that requires a societal fix, and that is providing youth with an opportunity to go to college without ringing up large amounts of debt.

CCJ: In your reporting, what were the most disturbing aspects of the interviews you had with people who began to question the benefits of taking these sorts of drugs? Does any particular story haunt you?

BW: Many stories haunt me. The ones that lingered were those instances when people suffered greatly trying to get off the medications, or never could get off, and ended up feeling trapped. People who began questioning the merits of the drugs often ended up being shunned by family and by their doctors, and had to go down this medication withdrawal path alone (when they decided to do so.) We have a system that encourages people to get on the drugs, but there is nothing in the system that helps those who want to get off them do so.

CCJ: These are powerful drugs. What happens when you mix them with alcohol or other recreational drugs?

BW: This isn't something I studied. But any time you mix drugs that act on the mind, whether illicit or licit, you obviously are courting danger. There is a risk to ingesting such a mix of drugs.

CCJ: As you indicate in your book, many experts in the field believe the theory of serotonin is just that - a theory - and many have hoped to debunk it. Why is this idea, that the 'mentally ill' brain has a 'chemical imbalance' still so popular, even among psychiatrists and clinicians?

BW: It's a myth that has been promoted by commercial interests, and one that is neat and simple and comforting. And people have difficulty giving up neat, comforting myths, particularly when those myths fit an ideological or commercial agenda. Plus, imagine if mainstream psychiatry were to now say, hey, that chemical imbalance story we have been telling you about, turns out it's not real! Psychiatry doesn't want to have to confess that story, and so,  among the leaders of psychiatry, I think there is a hope it will now gradually fade away.

CCJ: The book was very insightful about the history of psychiatry and the rise of pharmacological drugs. What projects are you currently working?

BW: Since Anatomy of an Epidemic was published in the spring of 2010, I have been regularly traveling to give talks, both in the United and in a number of other countries, about this topic. That has consumed most of my time. I have also written a bit more on the subject--magazine pieces, book chapters, etc. I would like to get to the point I can start working on a new book, but I haven't made it there yet.

If you are an author and interested in being featured in AEM's new series called, "The Author's Hour," please send me an email - ccrynjohannsen (at) gmail (dot) com. 

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Anonymous said...

Well, our thanks to Mr. Whitaker for examining the matter in relation to debt, but it's interesting that even he is sucked into the notion that a "societal fix" to the problem is to ensure access to education without anyone having to incur large debt.

Again, our refrain - what about CURRENT borrowers, those of us who are already lugging around huge balances that actually set us off balance?

Cryn Johannsen said...

@Anonymous 4:31 PM - I spoke to Mr. Whitaker by phone, and we discussed the dire situation. He praised my work and told me that it was a very important cause. He too is shocked by what a mess it is for people, and he is aware that I advocate for current borrowers.

Anonymous said...

Hi everyone! I'm the guy who suggested Cryn speak with Mr. Whitaker, and I'm eternally grateful to both for their cooperation!

I myself have a long and sad history with SSRI medication. I say sad because my medicating (beginning with Paxil at age 14!) was entirely unnecessary in hindsight. I was just a scared kid who was frightened over his dad's cancer diagnosis. But that didn't stop my idiot therapist from dumping SSRIs on me.

And here I am, over 10 years later, still on this crap. I'm only still on it because, as Bob mentions in the interview, I, like many, fell into a trap of dependence because the withdrawals were awful. Seriously, people, if you think withdrawing from street drugs is bad, try this.

I am only now tapering off my antidepressant because I learned how to do it ON A MESSAGE BOARD. No doctor had any advice for me on how to taper so I wouldn't have withdrawal effects. To date, there hasn't been any research into how to taper people off psych meds, or how to predict what kind of a reaction people will have to them.

Now, I'm not saying everyone will go through terrible withdrawals (a surprising amount can cold turkey with little to no symptoms), but a larger percentage of the population than previously thought has a moderate to very, very difficult time getting off these things. In extreme cases, withdrawal can last FOR YEARS. The woman who runs the SSRI withdrawal support site has been suffering with withdrawal symptoms for seven years.

There is also some very scary anecdotal evidence (as well as some animal studies) that point to the awful possibility that yes, indeed, SSRI use (not even necessarily long-term SSRI use) can, in some people, cause permanent sexual dysfunction and emotional blunting. I know of some people who still have erectile dysfunction, numb genitals, and little-to-no libido 10 years after stopping SSRIs. In addition, these people have very little ability to feel emotion and have wrecked their marriages because they no longer have the capacity to feel love for their partners. There is a term for persistent sexual dysfunction following SSRI withdrawal. It's called PSSD, and it's only now starting to get some attention in journals. To date, there is no cure or scientifically researched protocol for treatment for PSSD. Women suffer from PSSD as well. And, tragically, it affects men and women as young as their late teens. Youthful health doesn't seem to protect against it at all. Can you imagine living out the formative years of your life with PSSD?

I got the idea for the interview because I was struck by how similar student loan debt and psychiatry are. There's a tremendous sense of betrayal for student loan debtors and patients of psychiatry: student loan debtors feel betrayed by false statistics given out by colleges as well as horrific loan terms rigged to make students default, and psych patients feel betrayed by one of society's most trustworthy institutions (medicine) that talked them into taking drugs they didn't need and were poorly understood, and then were hung out to dry when they tried to withdraw or were stuck with terrible symptoms that persisted even after the drugs were withdrawn.

And, of course, there is the similarity of how both psychiatry and debt are a kind of quicksand that can ruin your life before you know it. With student loan debt, and psychiatry, it's easy to get in, but near impossible to get out.

Which brings me to the next similarity: both loan companies (and higher ed in general to a degree) and pharmaceutical companies (and psychiatry in general to a degree) want you to belong to them FOR LIFE so they can suck your pockets dry until you die. It is a shameful tragedy that some of our most respected social institutions (education and medicine) have been so thoroughly corrupted. I think it's the sign of an empire in decline, but that's just my opinion.

To be continued...

Anonymous said...

...Part II:

Finally, the last similarity is a wide society denial of the problem. So many people who haven't been burned by student loan debt or psych meds simply can't believe it's that bad. They come up with all kinds of excuses and lame suggestions ("Can't you just declare bankruptcy to get rid of the debt?" "Aw come on, nobody ever said college was a guarantee of anything," "I honestly don't thin a med could still be causing those side effects years after you've been off it," "The FDA wouldn't approve a med if it did that to you," "Some doctor must be able to treat you,"). None of it helps, of course. It just makes it worse. In my opinion, it's the social denial that is the worst thing of all. It's almost impossible some days to hope things will get better when we're not even close to acknowledging the problem even EXISTS.

I totally understand what anon 4:31 is saying about Whitaker not addressing current borrowers. In fact, that is yet ANOTHER similarity between student loan debtors and psych patients! Us psych patients who were screwed by the drugs fear being left behind to pick up the pieces on our own whenever new psychiatric prescribing protocols are introduced. Yes, it's great that there is now talk about limiting SSRI use to 6 months (except for the most serious cases) to avoid the kind of symptoms that occur with long-term use, but WHAT ABOUT US? What about the people who were guinea pigs for long-term use and are suffering from awful symptoms? Where's the research FOR US?

So I know very well what anon is saying. It's awful to be left behind and feel invisible.

But I wanted to have Bob speak here to make people be informed patients and know all their options before they decide to take that fateful step of swallowing that first pill. Basically, I want people to avoid making a bad situation worse by taking psych meds unless they absolutely have to. I'm no doctor and obviously can't give medical advice, but what I CAN do is implore everyone on this blog who's felt depressed over their student loan situation to read books like ANATOMY OF AN EPIDEMIC before taking meds, so at least they'll have the benefit of real research that us long-term SSRI users didn't have at the time. I guess it would be like student loan debtors warning prospective law students to read the scam blogs before going to law school.

Bottom line: the government, college, and medicine largely doesn't give a shit about you. The only way they care about you is if you can give them money. There are exceptions, of course, but it's looking more and more like a minefield every day, and the only way to navigate it and not get your body blown in half is to read, read, read and arm yourself with unbiased knowledge. It's a jungle out there. And don't ever, EVER, think "Nah, that won't happen to me." You'd be surprised what can happen to you in this country.

PS: If anyone's interested in reading my full story on SSRIs, I made a blog submission on Bob's blog. Here is the link: