Review by E. Fuller Torrey, MD
Treatment Advocacy Center founder
Stanley Medical Research Institute executive director
In 2010 Robert Whitaker published Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (New York: Crown Publishers). The book has circulated widely, in large measure due to Marcia Angell’s surprisingly uncritical review of it in the New York Review of Books (Angell, 2011). In its 396 pages Whitaker got many things right, including criticism of the broad DSM diagnostic criteria for mental illnesses; the reckless prescribing of psychiatric drugs for children; and the prostitution of many psychiatric leaders for the pharmaceutical industry. Indeed, regarding the last, Whitaker may have understated the problem, based on recently released court documents detailing how the pharmaceutical industry secretly controlled the Texas Medication Algorithm Project.
When it came to schizophrenia and antipsychotic drugs, however, Whitaker got it mostly wrong. He made so many errors it is difficult to know where to begin, so I will begin where he did.
(From the conclusion) Anatomy of an Epidemic is not without merit, however. In addition to detailing the many wrongs of American psychiatry, it reminds us what good psychiatric practice should be regarding the use of antipsychotic drugs. Use them in as low a dose as possible for no longer than necessary. Patients with a first episode of psychosis should be taken off the drugs several months after they go into remission to ascertain whether they are among the subgroup of patients who will not need maintenance medication. As patients age their medication can often be reduced and sometimes discontinued. And we need better research to be able to identify which patients need which drugs, who will develop which side effects, and who no longer needs medication. As psychiatrists we shouldn’t need to have a journalist remind us of these things; we should already be doing them.