Mad in America (2002)

By Robert Whitaker - 30 Q&As - Book Summary

Schizophrenia outcomes in the United States today are no better than they were in 1900, when needle showers and prolonged baths were the preferred treatments. Patients in India, Nigeria, and Colombia recover at roughly twice the rate of patients in the developed world, and the variable that separates the two populations is medication: sixteen per cent of patients in the poor countries are regularly maintained on neuroleptics against the majority in the West. The 1994 Harvard meta-analysis by Hegarty and colleagues established the long-term trajectory plainly — outcomes have worsened across the second half of the twentieth century, the period in which American psychiatry was telling its patients that breakthrough medications had transformed their prognosis. Mad in America, published in 2002 and reissued with an updated afterword in 2010, traces the documentary record of how this happened.

Robert Whitaker came to the subject as a medical journalist, not as a psychiatric critic. His earlier work had won the George Polk award for medical writing and the National Association of Science Writers prize, and a 1998 Boston Globe series he co-wrote with Dolores Kong on abuses in psychiatric research was named a Pulitzer finalist. The reporting that led to the book began with two findings he encountered in the published literature — the 1994 Harvard meta-analysis and the WHO outcome studies — which contradicted what he had been told was settled. His method throughout the book is documentary: FOIA releases, regulatory filings, contemporaneous medical-journal articles, court records, patient files. Mad in America was followed in 2010 by Anatomy of an Epidemic, which traced the disability trajectory the first book had identified and extended the analysis to antidepressants, stimulants, and the broader expansion of psychiatric diagnosis. The Lieberman review in the Chapel Hill News called Mad in America "misguided and dangerous fabrications"; the American Scientist called it "serious and well-documented"; Marcia Angell, former editor-in-chief of the New England Journal of Medicine, called it fascinating and provocative. The diametric reception is itself part of the record.

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (2010)

The book appeared into a market in which antipsychotics were on track to become, by 2008, the top-revenue-generating drug class in the United States, exceeding even the cholesterol-lowering drugs. The dominant story at the time of publication held that schizophrenia resulted from a dopamine imbalance, that the new “atypical” antipsychotics introduced in the 1990s represented a breakthrough comparable to penicillin, and that lifelong medication was as necessary for psychiatric patients as insulin for diabetics. The dopamine hypothesis had been scientifically dead since the mid-1980s — Arvid Carlsson, who first proposed it, had publicly withdrawn the claim — but a consortium of pharmaceutical companies placed a New York Times advertisement on 18 August 1996 telling the public that the imbalance was real and that the drugs corrected it. The Soteria findings had been buried in 1977. The WHO findings had been published and ignored. The book gathered what was already in the literature and put it in one place. Jeffrey Lieberman, then professor of psychiatry at the University of North Carolina and later president of the American Psychiatric Association, responded in print that the drugs represented “scientific breakthroughs comparable in significance to the discovery of antibiotics.”

The acute-to-chronic mechanism that Shelton described — symptom suppression generating new symptoms which are suppressed in turn, driving a progression from acute illness to chronic disease — is visible across the book’s two-hundred-year span, and is the structural finding that makes the documentary record cohere. The full summary unpacks the dopamine supersensitivity sequence by which neuroleptics manufacture the chronic course they are prescribed to prevent; the Tornio data from Western Lapland, where Open Dialogue treatment has produced five-year outcomes in which 79 per cent of first-episode patients are asymptomatic, 80 per cent are working or studying, two-thirds have never been exposed to antipsychotics, and new cases of schizophrenia have fallen 90 per cent; and the documented record of NIMH-funded researchers giving amphetamines, ketamine, and methylphenidate to schizophrenic patients for half a century to deliberately worsen their psychosis, while telling those patients in consent forms that the experiments were designed to help. Walter Freeman included in one of his books a photograph of a naked woman being dragged screaming to the lobotomy table. He did not consider the image disqualifying.

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