Subject: Re: Anatomy of an Epidemic
Dear Mr. Benedict
Looks like I missed an interesting discussion.
The difficulty here, and I am not going to get into this, is that I could get one- if not more- reference to contradict these.
Our clinical practices are based on preponderances of evidence and not one trial that shows this or that. The process isn't perfect, but our current treatments help many people.
Again, we can do better, and we need to continue to work on new and more effective treatments with fewer side effects.
Dr. Smith
___________________________________
Dr. Smith - Thanks so much for responding to my message to the Wisconsin Council on Mental Health. I should say first that unfortunately there was no time available for any discussion of Whitaker's book other than my brief recommendation that these new long-term outcomes studies are now more conveniently available to the public and to all mental health care stakeholders.
As you no doubt know these long-term outcome studies are in stark contrast to the FDA phase three clinical trials for new medications. The former tend to be more short-term and narrowly conceived and only report on the volunteer patient's short term clinical response to the particular medication under review.
Long-term studies are usually designed much more broadly -- from the onset of treatment to 2, 4, 6, 10+ year follow-ups -- to examine the patients' actual community functioning while or after they stop taking the medication. These are usually based on global functioning rating scales and a set of quality of life indicators including degree of financial independence, over all health, family functioning, education/training, affiliations, etc...
While the federal government has recently made available to NIH and FDA for such long-term outcome mental health research funding, both groups have been slow in making use of such funding.
If you are aware of any such long-term studies beyond what Whitaker has given us, we would very much appreciate seeing even one of them.
I should also add that such studies are much more systemic and go beyond the clinical safety and efficacy of a single drug or regimen. The focus of my particular advocacy is toward encouraging concerned citizens to simply become more aware that such studies now are available to the public.
Again, it was so nice of you to respond to me. I would very much like to continue our discussion.
Most respectfully,
Bill Benedict
(Reader names are fictitious to protect the confidentiality of the reader)
Friday, November 19, 2010
Friday, November 12, 2010
Brief Excerpts from Anatomy of an Epidemic
Sixteen outcome studies
Perhaps you have not yet had the opportunity to read Robert Whitaker’s latest book, Anatomy of an Epidemic which deals with the history of mental illness in the United States through the prism of long-term scientific follow-up study results.
Whitaker asks us to imagine what our beliefs would be today if, over the past twenty years, we had opened our newspapers and read about the following findings, which represent but a sampling of the long-term outcome studies recently retrieved from medical archives by Robert Whitaker.
A brief summary of the following 16 long-term mental health outcome studies appear below and were taken from pages 307-309 of Whitaker’s book. Each summary is then followed with that study’s page and specific citation number.
1990 - In a large, national depression study, the eighteen-month the eighteen month stay-well rate was highest for those treated with psychotherapy (30 percent) and lowest for those treated with an antidepressant (19 percent).
NIMH Go to page 374; citation number 35.
1992 - Schizophrenia outcomes are much better in poor countries like India and Nigeria, where only 16 percent of patients are regularly maintained on anti-psychotics, than in the United States and other rich countries where continual drug use is the standard of care.
World Health Organization Go to page 370, citation number 45.
1995 - In a six-year study of 537 depressed patients those who were treated for the disorder were nearly seven times more likely to become incapacitated than those who weren’t, and three times more likely to suffer a “cessation” of their “principal social role.”
NIMH Depression study. Go to 375, citation 61.
1998 - Antipsychotic drugs cause morphological changes in the brain that are associated with worsening of schizophrenia symptoms.
University of Pennsylvania Go to page 370, citation number 52.
1998 - In a World Health Organization study of the merits of screening for depression, those diagnosed and treated with psychiatric medications fared worse---in terms of their depressive symptoms and their general health---over a one-year period than those who weren’t exposed to the drugs.
WHO depression screening study. Got to page 375, citation number 59.
1999 - When long-term benzodiazepine users withdraw from the drugs, they become “more alert, more relaxed, and less anxious.”
University of Pennsylvania Benzo study. Go to page 372, citation number 37
2000 - Epidemiological studies show that long-term outcomes for bipolar patients today are dramatically worse than they were in the pre-drug era, with this deterioration in modern outcomes likely due to the harmful effects of antidepressants and antipsychotics.
Eli Lilly; Harvard Medical School Long-term bipolar outcomes. Page 379, citation number 53
2001 - In a study of 1,281 Canadians who went on short-term disability for depression, 19 percent of those who took an antidepressant ended up on long-term disability, versus 9 percent of those who didn’t take the medication.
Canadian Investigation bipolar depression study, See page 373, citation on page 167
2001 - In the pre-drug era, bipolar patients did not suffer cognitive decline over the long term, but today they end up almost as cognitively impaired as schizophrenia patients.
Sheppard Pratt Health System in Baltimore bipolar cognitive study, Page 379, citation 60.
2004 - Long-term benzodiazepine users suffer cognitive deficits “moderate to large” in magnitude.
Australian scientists’ benzo study. See page 372, citation 43.
2005 - Angel dust, amphetamines, and other drugs that induce psychosis all increase D2 HIGH receptors in the brain; antipsychotics cause this same change in the brain.
Angel dust reference. See page 370, citation 53
University of Toronto
2005 - In a five-year study of 9,508 depressed patients, those who took an antidepressant were, on average, symptomatic nineteen weeks a year, versus eleven weeks for those who didn’t take any medications.
Depression patients, See page 375, page 58
University of Calgary
2007 - In a fifteen-year study, 40 percent of schizophrenia patients off antipsychotics recovered, versus 5 percent of the medicated patients.
See page 371, citation 58
University of Illinois
2007 - Long-tem users of benzodiazepines end up “markedly ill-to extremely ill” and regularly suffer from symptoms of depression and anxiety.
Study of benzo users. See page 372, citation 40
French Scientists
2007 - In a large study of children diagnosed with ADHD, by the end of the third year “medication use was a significant marker not of beneficial outcome, but of deterioration.” The medicated children were also more likely to engage in delinquent behavior; they ended up slightly shorter, too.
Study of ADHD. See page 381, citation 36 & 39.
NIMH
2008 - In a national study of bipolar patients, the major predictor of a poor outcome was exposure to an antidepressant. Those who took an antidepressant were nearly four times as likely to become rapid cyclers, which is associated with poor long-term outcome.
Bipolar study. See page 378, citation 46 &47
NIMH
Perhaps you have not yet had the opportunity to read Robert Whitaker’s latest book, Anatomy of an Epidemic which deals with the history of mental illness in the United States through the prism of long-term scientific follow-up study results.
Whitaker asks us to imagine what our beliefs would be today if, over the past twenty years, we had opened our newspapers and read about the following findings, which represent but a sampling of the long-term outcome studies recently retrieved from medical archives by Robert Whitaker.
A brief summary of the following 16 long-term mental health outcome studies appear below and were taken from pages 307-309 of Whitaker’s book. Each summary is then followed with that study’s page and specific citation number.
1990 - In a large, national depression study, the eighteen-month the eighteen month stay-well rate was highest for those treated with psychotherapy (30 percent) and lowest for those treated with an antidepressant (19 percent).
NIMH Go to page 374; citation number 35.
1992 - Schizophrenia outcomes are much better in poor countries like India and Nigeria, where only 16 percent of patients are regularly maintained on anti-psychotics, than in the United States and other rich countries where continual drug use is the standard of care.
World Health Organization Go to page 370, citation number 45.
1995 - In a six-year study of 537 depressed patients those who were treated for the disorder were nearly seven times more likely to become incapacitated than those who weren’t, and three times more likely to suffer a “cessation” of their “principal social role.”
NIMH Depression study. Go to 375, citation 61.
1998 - Antipsychotic drugs cause morphological changes in the brain that are associated with worsening of schizophrenia symptoms.
University of Pennsylvania Go to page 370, citation number 52.
1998 - In a World Health Organization study of the merits of screening for depression, those diagnosed and treated with psychiatric medications fared worse---in terms of their depressive symptoms and their general health---over a one-year period than those who weren’t exposed to the drugs.
WHO depression screening study. Got to page 375, citation number 59.
1999 - When long-term benzodiazepine users withdraw from the drugs, they become “more alert, more relaxed, and less anxious.”
University of Pennsylvania Benzo study. Go to page 372, citation number 37
2000 - Epidemiological studies show that long-term outcomes for bipolar patients today are dramatically worse than they were in the pre-drug era, with this deterioration in modern outcomes likely due to the harmful effects of antidepressants and antipsychotics.
Eli Lilly; Harvard Medical School Long-term bipolar outcomes. Page 379, citation number 53
2001 - In a study of 1,281 Canadians who went on short-term disability for depression, 19 percent of those who took an antidepressant ended up on long-term disability, versus 9 percent of those who didn’t take the medication.
Canadian Investigation bipolar depression study, See page 373, citation on page 167
2001 - In the pre-drug era, bipolar patients did not suffer cognitive decline over the long term, but today they end up almost as cognitively impaired as schizophrenia patients.
Sheppard Pratt Health System in Baltimore bipolar cognitive study, Page 379, citation 60.
2004 - Long-term benzodiazepine users suffer cognitive deficits “moderate to large” in magnitude.
Australian scientists’ benzo study. See page 372, citation 43.
2005 - Angel dust, amphetamines, and other drugs that induce psychosis all increase D2 HIGH receptors in the brain; antipsychotics cause this same change in the brain.
Angel dust reference. See page 370, citation 53
University of Toronto
2005 - In a five-year study of 9,508 depressed patients, those who took an antidepressant were, on average, symptomatic nineteen weeks a year, versus eleven weeks for those who didn’t take any medications.
Depression patients, See page 375, page 58
University of Calgary
2007 - In a fifteen-year study, 40 percent of schizophrenia patients off antipsychotics recovered, versus 5 percent of the medicated patients.
See page 371, citation 58
University of Illinois
2007 - Long-tem users of benzodiazepines end up “markedly ill-to extremely ill” and regularly suffer from symptoms of depression and anxiety.
Study of benzo users. See page 372, citation 40
French Scientists
2007 - In a large study of children diagnosed with ADHD, by the end of the third year “medication use was a significant marker not of beneficial outcome, but of deterioration.” The medicated children were also more likely to engage in delinquent behavior; they ended up slightly shorter, too.
Study of ADHD. See page 381, citation 36 & 39.
NIMH
2008 - In a national study of bipolar patients, the major predictor of a poor outcome was exposure to an antidepressant. Those who took an antidepressant were nearly four times as likely to become rapid cyclers, which is associated with poor long-term outcome.
Bipolar study. See page 378, citation 46 &47
NIMH
Wednesday, November 3, 2010
Council Presentation Rationale
Originally presented at the Adult Quality Committee of the Wisconsin Council on Mental Health, Madison, WI
Wednesday, October 20, 2010
Rationale as to why mental health stakeholders should become more knowledgeable regarding the long-term mental health findings in Robert Whitaker’s 2010 book, Anatomy of an Epidemic.
Today, most mental health professionals rely on medications to meet treatment objectives. Probably this results from two factors.
First, the medical model has a long history of medication usage to meet treatment goals. Second, budgetary considerations reduce reliance on worker-intensive patient services. Workers include social workers, psychiatrist, psychologist and other related mental health practitioners.
As we have noted in the field of health services in general, much attention is placed on the fiscal costs of treatment services rather than the long-term salutary effects on patients.
Medication certainly has its place; however, studies of treatment effectiveness indicate that questions may be raised as to effects of extensive medications on patients being treated for mental illness.
The author of this book strongly questions what is happening today and suggests re-evaluation of the current treatment paradigm and probable changes in mental health funding and practice policy.
Wednesday, October 20, 2010
Rationale as to why mental health stakeholders should become more knowledgeable regarding the long-term mental health findings in Robert Whitaker’s 2010 book, Anatomy of an Epidemic.
Today, most mental health professionals rely on medications to meet treatment objectives. Probably this results from two factors.
First, the medical model has a long history of medication usage to meet treatment goals. Second, budgetary considerations reduce reliance on worker-intensive patient services. Workers include social workers, psychiatrist, psychologist and other related mental health practitioners.
As we have noted in the field of health services in general, much attention is placed on the fiscal costs of treatment services rather than the long-term salutary effects on patients.
Medication certainly has its place; however, studies of treatment effectiveness indicate that questions may be raised as to effects of extensive medications on patients being treated for mental illness.
The author of this book strongly questions what is happening today and suggests re-evaluation of the current treatment paradigm and probable changes in mental health funding and practice policy.
Monday, November 1, 2010
Excerpt From Anatomy of an Epidemic
(Below is an example of just one of the long-term mental health outcome studies reviewed by author Mark Whitaker in his new book, Anatomy of an Epidemic. It is just one of 16 major outcome studies conducted and reported in the scientific literature from 1990 to 2008. These and dozens more appear in his book going back to 1950. This abstracted piece below was prepared by William R. Benedict and he is responsible for any errors or mistakes in this summary.)
Fifteen Year Long-term Schizophrenia Outcome Study
by Martin Harrow at the University of Illinois College of Medicine
From 1975-1983 Harrow enrolled 64 young schizophrenics in a long-term study
Funded by the National Institute of Mental Health.
In 2007 Dr. Harrow published a report on the patients’ fifteen-year outcomes in the Journal of Nervous and Mental Disease, and he has further updated this review in his presentation at the APA’s 2008 meeting.
In order to have an economically diverse sample he recruited his patients from two Chicago hospitals. One was private and the other public. Ever since then he has regularly assessed how well they are doing.
Are they symptomatic?
Are they in recovery?
Employed?
Do they take antipsychotic medications?
His results provide an up-to-date look at how schizophrenic patients in the United States are faring.
Hypothesis – If the conventional wisdom is to be believed, then those who stayed on antipsychotics should have had better outcomes. Conversely, if the scientific literature reviewed in Whitaker’s work is to be believed, then it should be the reverse.
Here are Dr. Harrow’s findings which were published on his fifteen-year outcomes in the Journal of Nervous and Mental Disease, and further updated in 2008 at the APA’s annual meeting.
Findings at the end of two years:
The non-antipsychotic group were doing slightly better on a global assessment scale than the group on the drugs.
Findings at the end of two and half more years or at 4.5 years - the group not on antipsychotics were now doing dramatically diverging from the group still on drugs. Now the off-med group began to improve significantly, and now 39 percent of this group were in “recovery” and more than 69 percent were working.
In contrast, outcomes for the medication group worsened during this same period. As a group their global functioning declined slightly, and at the 4.5-year mark, only 6 percent were in recovery and few were working.
Stark divergence in outcomes remained for the next ten years.
Findings at the fifteen-year follow-up - 40 percent of those off drugs were in recovery, more than half were working, and only 28 percent suffered from psychotic symptoms.
In contrast, only 5 percent of those taking antipsychotic were in recovery, and 64 percent were actively psychotic.
Dr. Harrow’s conclusions were:
“I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than thus on antipsychotics,” Harrow told the APA audience in 2008.
Analysis of the findings – Indeed, it wasn’t just that there were more recoveries in the un-medicated group. There were also fewer terrible outcomes in this group. There was a shift in the entire spectrum of outcomes. Ten of the twenty-five patients who stopped taking antipsychotics recovered, eleven had so-so outcomes, and only four (16 percent) had a “uniformly poor” outcome. In contrast, only two of the thirty-nine patients who stayed on antipsychotics recovered, eighteen had so-so outcomes, and nineteen (49%) fell into the “uniformly poor” camp.
Medicated patients had one-eighth the recovery rate of un-medicated patients, and a threefold higher rate of faring miserably over the long term.
This outcome's picture is revealed in an NIMH-funded study, the most up-to-date one we have today. It also provides us with insight into how long it takes for the better outcomes for non-medicated patients, as a group, to become apparent. Although this difference began to show up at the end of two years, it wasn’t until the 4.5 year mark that it became evident that the non-medicated group., as whole, was doing much better.
Furthermore, through Harrow’s rigorous tracking of patients, he discovered why psychiatrists remain blind to this fact. Those who got off their anti-psychotic medications left the system, he said. They stopped going to day program they stopped seeing, therapists, they stopped telling people they had ever been diagnosed with schizophrenia, and they disappeared into society.
Fifteen Year Long-term Schizophrenia Outcome Study
by Martin Harrow at the University of Illinois College of Medicine
From 1975-1983 Harrow enrolled 64 young schizophrenics in a long-term study
Funded by the National Institute of Mental Health.
In 2007 Dr. Harrow published a report on the patients’ fifteen-year outcomes in the Journal of Nervous and Mental Disease, and he has further updated this review in his presentation at the APA’s 2008 meeting.
In order to have an economically diverse sample he recruited his patients from two Chicago hospitals. One was private and the other public. Ever since then he has regularly assessed how well they are doing.
Are they symptomatic?
Are they in recovery?
Employed?
Do they take antipsychotic medications?
His results provide an up-to-date look at how schizophrenic patients in the United States are faring.
Hypothesis – If the conventional wisdom is to be believed, then those who stayed on antipsychotics should have had better outcomes. Conversely, if the scientific literature reviewed in Whitaker’s work is to be believed, then it should be the reverse.
Here are Dr. Harrow’s findings which were published on his fifteen-year outcomes in the Journal of Nervous and Mental Disease, and further updated in 2008 at the APA’s annual meeting.
Findings at the end of two years:
The non-antipsychotic group were doing slightly better on a global assessment scale than the group on the drugs.
Findings at the end of two and half more years or at 4.5 years - the group not on antipsychotics were now doing dramatically diverging from the group still on drugs. Now the off-med group began to improve significantly, and now 39 percent of this group were in “recovery” and more than 69 percent were working.
In contrast, outcomes for the medication group worsened during this same period. As a group their global functioning declined slightly, and at the 4.5-year mark, only 6 percent were in recovery and few were working.
Stark divergence in outcomes remained for the next ten years.
Findings at the fifteen-year follow-up - 40 percent of those off drugs were in recovery, more than half were working, and only 28 percent suffered from psychotic symptoms.
In contrast, only 5 percent of those taking antipsychotic were in recovery, and 64 percent were actively psychotic.
Dr. Harrow’s conclusions were:
“I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than thus on antipsychotics,” Harrow told the APA audience in 2008.
Analysis of the findings – Indeed, it wasn’t just that there were more recoveries in the un-medicated group. There were also fewer terrible outcomes in this group. There was a shift in the entire spectrum of outcomes. Ten of the twenty-five patients who stopped taking antipsychotics recovered, eleven had so-so outcomes, and only four (16 percent) had a “uniformly poor” outcome. In contrast, only two of the thirty-nine patients who stayed on antipsychotics recovered, eighteen had so-so outcomes, and nineteen (49%) fell into the “uniformly poor” camp.
Medicated patients had one-eighth the recovery rate of un-medicated patients, and a threefold higher rate of faring miserably over the long term.
This outcome's picture is revealed in an NIMH-funded study, the most up-to-date one we have today. It also provides us with insight into how long it takes for the better outcomes for non-medicated patients, as a group, to become apparent. Although this difference began to show up at the end of two years, it wasn’t until the 4.5 year mark that it became evident that the non-medicated group., as whole, was doing much better.
Furthermore, through Harrow’s rigorous tracking of patients, he discovered why psychiatrists remain blind to this fact. Those who got off their anti-psychotic medications left the system, he said. They stopped going to day program they stopped seeing, therapists, they stopped telling people they had ever been diagnosed with schizophrenia, and they disappeared into society.
Long Term Outcome Studies On Long Term Mental Health Care
Introduction -
Today, most mental health professionals rely on medications to meet treatment objectives. Probably this results from two factors.
First, the medical model has a long history of medication usage to meet treatment goals. Second, budgetary considerations reduce reliance on worker-intensive patient services. Workers include social workers, psychiatrist, psychologist and other related mental health practitioners.
As we have noted in the field of health services in general, much attention is placed on the fiscal costs of treatment services rather than salutary effects on patients.
Medication certainly has is place; however, studies of treatment effectiveness indicate that questions may be raised as to effects of extensive medications on patients being treated for mental illness.
Robert Whitaker in his book Anatomy of an Epidemic strongly questions what is happening today and suggests re-evaluation of the current treatment paradigm and probable changes in practice policy.
It’s just off the press this year. Some of you may have read his first book called Mad in American which also dealt with psychiatric policy issues.
Why has the number of disabled mentally ill in the US tripled over the last two decades in spite of all the new miracle medications now in the market place?
In 1955 there were 355,000 adults in state and county mental hospitals with a psychiatric diagnosis. During the next three decades (the era of the first generation of psychiatric drugs) this number rose to 1.25 million. As all of you know, Prozac arrived on the market in 1988, (along with the dawn of the second new generation of drugs) and during the next 20 years, the number of disabled mentally ill grew to more than four million adults (4 million) in 2007)
Every day over 850 adults and 250 children are added to the government’s disability list - Supplemental Security Income or Social Security Disability Insurance. That is, over eleven hundred American citizens become newly disable each day.
During this latter period the prescribing of psychiatric medications to children and adolescents took off (1987 to 2007), and as this new medical practice took hold, the number of youth in America receiving a government disability check due to mental illness leapt from 16,200 in 1987 to 561,569 in 2007 (a 35–fold increase.)
Whitaker asks, What is going on? He challenges his readers to think through the question themselves. In the first part of Whitaker’s investigation he discusses what is known today about the biological causes of mental illness. He asks, “Do psychiatric medications fix “chemical imbalances” in the brain or do they in fact create them?”
He provides Magnetic Resonance Imaging (MRI) evidence that the brain after extensive drug treatment physiologically adapts and soon morphs or changes as a response to the guest chemicals.
He provides official court testimony which shows that in an effort to market Prozac the marketers intentionally tried to say that certain negative drug reactions were simply symptoms of the disease.
As you all know researchers have spent decades studying this question and by the late 1980s they had the answer. If you read this book, and if you are anything like me you will be as startled and dismayed as I was about what Whitaker actually found in the scientific journals as opposed to what you and I, and all American citizens, have received from our public media.
I believe you will be both astonished and outraged at how the drug industry, including the American Psychiatric Association, have made a science of false marketing.
While Whitaker’s description of the development and marketing of drugs in the 21st century will be fascinating and in some ways remarkably ingenious, don’t let it distract you from his core message.
Mainly, what the scientific researchers have learned over the last 60 years about how psychiatric drugs have affected long-term mental health outcomes, and especially what these outcome findings have to say about people with serious and persistent mental illness.
In his meticulous investigation into the long-term antipsychotic treatment research literature Whitaker asks, “Did they discover that the drugs helped people stay well?” Function in the community better? Enjoy good physical health? Or, did these medications actually increase the likelihood that people will become chemically ill, less able to function and more prone to physical illness?
To each of the above questions, drug-based treatment, in these long-term studies, was proven by robust evidence to be either less effective or actually potentially contribute to increased recovery time, and more prone to physical illness.
Whitaker also asks, are antipsychotics effective when schizophrenia patients are in crisis? His answer, psychiatric medication has been proven to be effective when patients are in crisis and for reducing target symptoms for short-term treatment. Are long-term recovery rates significantly higher for non-medicated schizophrenia patients? Time and time again the research from these long-term studies answered this question in the affirmative.
Does taking antidepressants decrease or increase the risk that a depressed person will become disabled by the disorder? The preponderance of the evidence shows that antidepressants increase the risk that they will become disabled.
Conclusion:
Now, before closing, I would like say a few words about my recommendation to the Council to conduct an examination into these long-term outcome studies and prepare a report regarding the implications that these findings have for reforming the Wisconsin mental health system.
I am convinced that Robert Whitaker’s book will be this century’s definitive
source when people gather to discuss long-term outcome evaluation studies. I believe that hereafter mental health researchers will use and refer to this text whenever they turn their attention to the latest scientific findings having to do with long-term mental health outcome studies.
Hereafter when ever questions of long-term treatment efficacy are raised in mental health care, researchers and administrators, and all stakeholders, the world over, will turn to Whitaker’s book.
Because I feel so strongly about this, I have requested that Wisconsin’s Council on Mental Health become informed of this scientific information and reconcile it with their future long-range planning for this state’s mental health system.
One implication is clear and that is that existing assumptions about what best constitutes the most effective treatment paradigm needs to be reexamined.
To continue as usual in the face of this overwhelming evidence would be ethically and professionally irresponsible. Whitaker’s findings demand that all mental health stakeholders, but especially this citizen council, our Governor’s oversight body, carefully consider these findings and document their own findings in response to their own study of this work.
Thanks you again so much for allowing me to talk with you today. I hope we still have a few minutes for questions or comments.
Warning/Disclaimer – This presentation and the content and scope therein is not intended to be applicable to any individual and his/her doctor or prescriber. I strongly recommend that any questions that might arise from this presentation relating to your particular medical situation, be discussed between you and your doctor.
(For more about this presenter’s evaluation work, see “Goal Attainment Scaling: Applications, Theory, and Measurement”, Mental Health and Social Service Applications, p. 81 which was edited by Thomas M. Kiresuk, Aaron Smith and Joseph E. Cardillo.)
For more information on this subject see my blogs by clicking on mental health reform in the left column.
Today, most mental health professionals rely on medications to meet treatment objectives. Probably this results from two factors.
First, the medical model has a long history of medication usage to meet treatment goals. Second, budgetary considerations reduce reliance on worker-intensive patient services. Workers include social workers, psychiatrist, psychologist and other related mental health practitioners.
As we have noted in the field of health services in general, much attention is placed on the fiscal costs of treatment services rather than salutary effects on patients.
Medication certainly has is place; however, studies of treatment effectiveness indicate that questions may be raised as to effects of extensive medications on patients being treated for mental illness.
Robert Whitaker in his book Anatomy of an Epidemic strongly questions what is happening today and suggests re-evaluation of the current treatment paradigm and probable changes in practice policy.
It’s just off the press this year. Some of you may have read his first book called Mad in American which also dealt with psychiatric policy issues.
Why has the number of disabled mentally ill in the US tripled over the last two decades in spite of all the new miracle medications now in the market place?
In 1955 there were 355,000 adults in state and county mental hospitals with a psychiatric diagnosis. During the next three decades (the era of the first generation of psychiatric drugs) this number rose to 1.25 million. As all of you know, Prozac arrived on the market in 1988, (along with the dawn of the second new generation of drugs) and during the next 20 years, the number of disabled mentally ill grew to more than four million adults (4 million) in 2007)
Every day over 850 adults and 250 children are added to the government’s disability list - Supplemental Security Income or Social Security Disability Insurance. That is, over eleven hundred American citizens become newly disable each day.
During this latter period the prescribing of psychiatric medications to children and adolescents took off (1987 to 2007), and as this new medical practice took hold, the number of youth in America receiving a government disability check due to mental illness leapt from 16,200 in 1987 to 561,569 in 2007 (a 35–fold increase.)
Whitaker asks, What is going on? He challenges his readers to think through the question themselves. In the first part of Whitaker’s investigation he discusses what is known today about the biological causes of mental illness. He asks, “Do psychiatric medications fix “chemical imbalances” in the brain or do they in fact create them?”
He provides Magnetic Resonance Imaging (MRI) evidence that the brain after extensive drug treatment physiologically adapts and soon morphs or changes as a response to the guest chemicals.
He provides official court testimony which shows that in an effort to market Prozac the marketers intentionally tried to say that certain negative drug reactions were simply symptoms of the disease.
As you all know researchers have spent decades studying this question and by the late 1980s they had the answer. If you read this book, and if you are anything like me you will be as startled and dismayed as I was about what Whitaker actually found in the scientific journals as opposed to what you and I, and all American citizens, have received from our public media.
I believe you will be both astonished and outraged at how the drug industry, including the American Psychiatric Association, have made a science of false marketing.
While Whitaker’s description of the development and marketing of drugs in the 21st century will be fascinating and in some ways remarkably ingenious, don’t let it distract you from his core message.
Mainly, what the scientific researchers have learned over the last 60 years about how psychiatric drugs have affected long-term mental health outcomes, and especially what these outcome findings have to say about people with serious and persistent mental illness.
In his meticulous investigation into the long-term antipsychotic treatment research literature Whitaker asks, “Did they discover that the drugs helped people stay well?” Function in the community better? Enjoy good physical health? Or, did these medications actually increase the likelihood that people will become chemically ill, less able to function and more prone to physical illness?
To each of the above questions, drug-based treatment, in these long-term studies, was proven by robust evidence to be either less effective or actually potentially contribute to increased recovery time, and more prone to physical illness.
Whitaker also asks, are antipsychotics effective when schizophrenia patients are in crisis? His answer, psychiatric medication has been proven to be effective when patients are in crisis and for reducing target symptoms for short-term treatment. Are long-term recovery rates significantly higher for non-medicated schizophrenia patients? Time and time again the research from these long-term studies answered this question in the affirmative.
Does taking antidepressants decrease or increase the risk that a depressed person will become disabled by the disorder? The preponderance of the evidence shows that antidepressants increase the risk that they will become disabled.
Conclusion:
Now, before closing, I would like say a few words about my recommendation to the Council to conduct an examination into these long-term outcome studies and prepare a report regarding the implications that these findings have for reforming the Wisconsin mental health system.
I am convinced that Robert Whitaker’s book will be this century’s definitive
source when people gather to discuss long-term outcome evaluation studies. I believe that hereafter mental health researchers will use and refer to this text whenever they turn their attention to the latest scientific findings having to do with long-term mental health outcome studies.
Hereafter when ever questions of long-term treatment efficacy are raised in mental health care, researchers and administrators, and all stakeholders, the world over, will turn to Whitaker’s book.
Because I feel so strongly about this, I have requested that Wisconsin’s Council on Mental Health become informed of this scientific information and reconcile it with their future long-range planning for this state’s mental health system.
One implication is clear and that is that existing assumptions about what best constitutes the most effective treatment paradigm needs to be reexamined.
To continue as usual in the face of this overwhelming evidence would be ethically and professionally irresponsible. Whitaker’s findings demand that all mental health stakeholders, but especially this citizen council, our Governor’s oversight body, carefully consider these findings and document their own findings in response to their own study of this work.
Thanks you again so much for allowing me to talk with you today. I hope we still have a few minutes for questions or comments.
Warning/Disclaimer – This presentation and the content and scope therein is not intended to be applicable to any individual and his/her doctor or prescriber. I strongly recommend that any questions that might arise from this presentation relating to your particular medical situation, be discussed between you and your doctor.
(For more about this presenter’s evaluation work, see “Goal Attainment Scaling: Applications, Theory, and Measurement”, Mental Health and Social Service Applications, p. 81 which was edited by Thomas M. Kiresuk, Aaron Smith and Joseph E. Cardillo.)
For more information on this subject see my blogs by clicking on mental health reform in the left column.
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