Two views: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Will reading Robert Whitaker's Anatomy of an Epidemic interest you or make you angry? My guess: this book will do both. Whitaker is an investigative journalist best known for his writing on the treatment of the mentally ill population in America and the growing influence of the pharmaceutical industry in the practice of medicine and psychiatry. His latest book combines these topics. These intertwined issues deserve our attention and are generally good for provoking loud debates, if not genuine placard-carrying protests.

I am unable to fully bridle my enthusiasm to point out the flaws in Whitaker's theories. His primary premise is that the reason so many more people are now on disability rolls for mental illness than was the case in the halcyon days of the 1950s is because they were exposed to psychotropic medication. There are a host of logical errors in his analysis that I painfully learned earning a B in Logic 101 as a college sophomore, most notably post hoc reasoning and the appealing slippery slope.

Like a skillful prosecutor presenting a circumstantial case, Whitaker “connects the dots” to “expose” the pharmaceutical industry-American Psychiatric Association-National Institute of Mental Health-National Alliance on Mental Illness conspiracy (yes, even NAMI is a co-conspirator) to put every man, woman, and child on the planet on one psychotropic drug or another. The inclusion of heartbreaking stories of people mired in debilitating situations at the end of each chapter is a rather obvious ploy to appeal to emotion, increasing the likelihood of a conviction in the court of public opinion. Sadly, witnesses to the often life-improving, if not life-saving, benefits of properly applied medical treatments for mental illness barely find a voice in the transcript of this trial.

This said, I cannot disagree with Prosecutor Whitaker that behaviors of the pharmaceutical industry and its speakers' bureaus, the practitioners of footloose diagnosis and fancy-free polypharmacy (especially for the young), the too cozy relationships between big pharma and big academia, and dare I say certain decisions the APA has made all provide enough evidence for an adverse verdict, especially by a lay reader. The author makes important points about overvalued theories, misplaced treatments, and bad behaviors of some engaged in the often messy, uncertain practice of medicine and psychiatry. Unfortunately, this book is more indictment than honest critique—an example of confirmation bias pretentiously devoid of any balance in the attack.

This book provokes thought, discussion, and strong emotions. It will force you to reflect on the strength of the evidence for psychiatry's convictions about the nature and proper treatment of mental illness, to evaluate your personal professional practices, and to renew the oath that you as a physician once took to “first do no harm.” These are all good things. You should read this book; patients and their families will, and you should be ready with some answers to their questions. My copy is full of margin notes to prepare responses that I hope will not sound too defensive when delivered.