"Mad in America" book critical of psychiatry

March 7, 2002 - Source: www.psycport.com

Robert Whitaker doesn't mince words in arguing that the American medical establishment has failed in its treatment of people with schizophrenia in his new book, ``Mad in America'' (Perseus; 304 pages; $27).

The book's subtitle lays out his scorching indictment: ``Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill.''

``Why should living in a country with rich resources, and with advanced medical treatments for disorders of every kind, be so toxic to those who are severely mentally ill?'' Whitaker writes in the preface.

The answers he finds are harrowing. Whitaker describes early methods of controlling the insane by removing teeth, ovaries and intestines; dunking them in freezing water; spinning them on mechanical devices until they grew weak and nearly passed out; electroshock therapy; forced lobotomies; and the assault of so-called miracle drugs such as thorazine with dangerous side effects and poor results.

Whitaker, 49, a former Times Union medical writer who now lives in Cambridge, Mass., expanded a 1998 series of articles he co-wrote for The Boston Globe that received a prestigious Polk award for medical writing and was named a finalist for the Pulitzer Prize.

``This book is the result of a long educational process, in which I've learned that money plays a big role in influencing medical treatment and the public doesn't get the whole story,'' Whitaker says by phone from Cambridge.

Bolstered by a historical overview of horrific methods used to restrain the insane across the United States in the 19th and early 20th centuries, Whitaker builds to a crescendo of outrage against large pharmaceutical companies and their tactics in the 1980s and 1990s to capture a lucrative market for new antipsychotic drugs.

Whitaker shows how ``big pharma,'' as it's known, skewed clinical trials, obscured dangerous side effects, hired sham scientists to report results and encouraged patients to take powerful drugs that increased their delusions as fodder for research.

While Whitaker's book has come under attack by some psychiatrists and those who work for the drug multinationals he criticizes, advocates for the mentally ill have praised the work.

David Oaks, director of Support Coalition International, an advocacy group for people with mental illnesses, called Whitaker's investigation ``a dose of truth therapy'' about the ``secret underside of the psychiatric establishment.''

Whitaker, who was assigned the medical beat after joining the Times Union in 1989, didn't start out looking for trouble.

``At first, I wrote a lot of gee-whiz, pro-science pieces,'' Whitaker says. ``But then I started seeing how the bottom line really drives medicine and that a lot of fabrications were being woven around clinical trials to protect profits.''

Whitaker wrote an award-winning series at the Times Union in 1992 about bungled operations by inadequately trained surgeons. That led to a Knight Science Journalism Fellowship at the Massachusetts Institute of Technology in 1993.

He returned to the Times Union briefly in 1994, but left later that year to become director of publications at Harvard Medical School. He departed Harvard to start up Center Watch, a journal that covered the business of clinical trials in the development of new drugs.

``That's when the influence of corporate money on the process and science of testing drugs became painfully clear,'' Whitaker says.

Using investigative journalistic techniques, Whitaker exposed a drug research corporation that was employing Enron-esque subterfuge to hide losses and inflate earnings. Whitaker's reporting helped eventually to send the president of that failed company to jail.

Whitaker honed his research skills and developed a thick skin at the helm of Center Watch. ``I had a lot of angry CEOs screaming at me and threatening lawsuits because negative publicity caused their stock price to drop,'' Whitaker says. ``Our badge of honor among analysts was that we weren't just an industry mouthpiece.''

An article for Fortune magazine about Zonagen Inc., a biopharmaceutical company that produced a drug for male sexual dysfunction, received the National Association of Science Writers' award for best magazine article in 1998.

``We laid out how the public was being misled about the drug trials to pump up the stock price,'' says Whitaker, who co-wrote the story with Fortune staff writer David Stipp.

That same year, Whitaker sold his stake in Center Watch to devote himself to researching and writing ``Mad in America,'' his first book.

During his Center Watch days, Whitaker stumbled upon psychiatric research in which American scientists gave the mentally ill chemical agents intended to heighten their psychoses. More digging revealed that outcomes for people with schizophrenia in the United States have actually gotten worse in the past 25 years. Schizophrenia outcomes in developing countries such as India and Nigeria are better than in the United States.

Whitaker's main goal in writing ``Mad in America'' was to take a fresh look at the suffering of more than 2 million Americans diagnosed with schizophrenia and to spur a national debate about how best to bring them relief.

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Comment from: Sharan M. Ramsauer, Ph.D, University of Kansas, United States

Date: June 4, 2002

I have to say that I have been "mad" in America and am now really mad in America. I have a Ph.D. in Physiological Psychology (1977) from the University of Kansas, Lawrence, Kansas, USA.

My dissertation work was done in a multidisciplinary chemistry laboratory associated with Menniger's clinic in research and in some joint seminars. My dissertation was an attempt to demonstrate that stress early in life leads to permanent biochemical changes in the brain. I was somewhat successful, but there is now animal research showing that, in fact, biological reactivity is increased with stress (child abuse) in childhood - permanent brain changes do occur.

I left my original area for clinical because I felt personally
satisfied that my "oversensitivity" had a biochemical basis. I had answered my question.

After my post-doctoral training, I worked as a psychologist at the South Carolina State Hospital, first on a child and adolescent ward and then on a back ward of older people who had been exposed to every "modern" treatment from lobotomy to shock to huge doses of totally incapacitating meds.

These folk sat around the edge of the ward all day, essentially decommissioned as human beings. Frankly, I spent most of my time reading every single record from the beginning to the end for every single patient, male or female, looking for any indication of something important to each individual that I could somehow use to help them socially.

I also spent some time just crying in my office at what I read. When I begged for the enclosed courtyards to be cleared of dangerous debris, so that these folks could at least go outside, that swings be built (records indicated several had enjoyed swinging), all of which could be done with no cost whatsoever to this institution, I was laughed out of the administrative office.

When offered the chance, I fled to an outpatient center to do psychological evaluations and psychotherapy (which our system here in South Carolina no longer offers at all!!!).

I began, for myself, to take lithium carbonate, which did, in fact, keep me from feeling emotional pain (I'm not sure that is good). It also permanently damaged my memory, a now acknowledged frequent side effect. I was not bipolar, however, and had to stretch the description of my problems to even get a trial on lithium.

At the time, I thought that memory for some peace was a good trade (not knowing it was permanent). I also took antidepressants for a sleep disorder, not for depression. I worked for 10 years before, under really difficult circumstances, I had a full breakdown - dissociative elements, schizophrenic symptoms and a whole hodgepodge of stuff.

Technically, I have "schizoaffective disorder, bipolar type with DID" . I was hospitalized for about a year and in the next ten years, had over 20 hospitalizations. I was at times very delusional, sometimes with great organization and unsuspected by my psychiatrist, sometimes with considerable disorganization if I had not eaten or slept for days (a rebound effect from preferring to talk with my voices leading to me not taking my nighttime Tegretol).

After 8 hospitalizations in 7 months, all of them very frightening, I decided that I would rather face any reality than go back into a hospital.

I sat down and told my voices that I was no longer going to believe them and the delusional stuff they had been feeding me (they were "real" people talking to me with ESP) and that I was out of the insanity business.

With no change in medication at all, I simply stopped being schizophrenic in my adjustment to the world.

That was five years ago and I have had no incidence of anything but outstanding adjustment. I have worked for 6 years for the Mental Health Association as a peer group support leader, consumer advocate, etc.

I also, interestingly, use Pat Deegan's (National Center for Empowerment) tapes on working with people who appear unmotivated, which address the drug issue head-on, to train employees at SCDMH several times a year - it is their most popular workshop - folks leave it feeling that they, personally,
can make a difference in our lives.

I talk a heck of a lot about my own recovery and the fact that the main thing that helped was people, not the meds. I also do a lot of speaking, both in mental health centers and for
other groups.

Almost immediately when I made my decision to face anything (career failure, whatever) without becoming psychotic, I started getting off the tons of meds I'd been placed on - slowly, but over my doctor's objections.

My doctor now tells me that he refuses to put me back on any of those meds because I am so much better since I went off of them. I have been taking only 2 mg. of Haldol daily and an antidepressant for sleep. The Haldol helps me be more
comfortable socially, but I can't feel a damned thing emotionally, even though intellectually, I know what I feel.

I was seriously considering coming off all meds before I read Mad in America and now I feel that it may be essential that I do so for my continued health.

It is just a question of learning, again, to live with somewhat strong emotions. I will have serious rebound effects in coming off of them - that will be hard.

However, the meds in some way damage my sense of my own soul. It may be that there is already so much damage from them that I can't adjust without them - I can't know until I try.

I am a highly trained research scientist and frankly, Mad in America is about the best documented book I have ever read. I am very familiar with the biochemical research that is going on and this guy does a fantastic job of dealing with the realities of how poorly it is done.

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