Opinion
Who exactly has the frontal lobe damage?
Reading Robert Whitaker’s book Anatomy of an Epidemic (Broadway, 2010) was quite a disturbing experience.
His major premise appears to be that ingesting large amounts of anti-psychotics and antidepressants is actually making people sicker including potentially giving rise to serious side effects such as cognition impairment.
On the one hand I applaud him for raising the issue: Are our medications bad for us? But on another level I feel as if he may be just giving rise to anxiety in the mental health community for no good reason.
Having ingested anti-psychotics namely Risperidone, for about three years and finding them quite wonderful in terms of almost immediately stopping the psychosis, I did feel a bit concerned about the potential for the frontal lobe damage and loss of grey matter implied in Whitaker’s book.
However even I with my potentially impaired brain could pick up the howler which afflicts Whitaker’s major premise. On page 6 in the chapter titled A Modern Plague he notes that in 1955 there were 566,000 people in state and county mental hospitals in the USA.
“However only 355,000 had a psychiatric diagnosis”. He goes on to say that in 1987 this number had grown and there were 1.25 million people in the USA receiving a disability payment because of mental illness. This is the epidemic referred to in the title.
He calculates this as an increase from 1 in every 468 Americans hospitalized by mental illness in 1955 to 1 in every 184 Americans on disability payments for mental health problems n 1987. Indeed if these figures are correct then there really is an epidemic.
However a bare 45 pages later he notes :
“During the war, (World War 11) psychiatrists had been charged with screening draftees for psychiatric problems and they had deemed 1.75 million American men mentally unfit for service. While many of the rejected draftees may have been feigning illness in order to avoid conscription, the numbers still told of a societal problem.”
There is only slightly more than a decade between the war years and 1955 when Whitaker notes there were only half a million people in state and county mental hospitals in the USA. If there were 1.75 million men rejected from military service during the war because of mental health problems isn’t it more likely that in 1955 there was a huge number of people, both men and women, who didn’t fess up to mental problems?
This is certainly the case today where comprehensive door knock studies have shown that some two thirds of people with mental health problems in Australia for example, don’t seek treatment.
The fact that none of the experts and opinion makers who read this book including a critique from New Scientist, failed to point out this obvious problem causes me to wonder who is potentially cognitively impaired here? I can pick up this inconsistency and I have been on anti-psychotics, anti-depressants and lithium for many years whereas all these other non-medicated people haven’t spotted the problem. I leave it up to the reader to make up their own mind.
Another part of Whitaker’s thesis which doesn’t really hold water is when he argues that the increase in numbers on disability support is an indication that present medical treatments for mental illness are making us sicker.
The increase in those on disability pensions can be due to a number of other historical and political factors other than just medical treatments.
The overall increase in numbers on disability pensions in Australia is really a function of the ageing population. In a May 2011 article in Inside Story, Peter Whiteford, Professor in Social Resarch Policy at the University of New South Wales pointed out that at least half of the vaunted “explosion” in disability pensioners in Australia is attributable to the gradual increase in ageing .
Stressing that disability rates are strongly related to ageing, Professor Whiteford said that the steady increase in the disability pension rates that so alarmed Australian politicians is significantly affected by the ageing of baby boomers.
“The first of the baby boomers started to turn fifty in 1996, so from that point changes in the age structure of the population became likely to increase levels of receipt of the DSP.”
This fits in with Whitaker’s statement that “… during the 1990s people struggling with depression and bipolar illness began showing up on the SSI and SSDI rolls in ever increasing numbers …”
Professor Whitford goes on to say:
“This means that about half of the total increase in numbers (on disability support pension) was the result of population ageing unrelated to any changes in the labour market, to the incidence of disability or to individual behavior.”
As persons with mental health problems comprise the largest sector of those on disabilities, some 25%, this sector will naturally increase with the baby boomer effect.
Other reasons in Australia for the growth of the disability sector are the presence of people on the disability rolls who moved to the sector after other forms of support were closed. For example single mothers with mental health issues moved to the disability support pension when tougher entitlement conditions were applied to the Parenting Payment by the Howard Government.
While this is the situation in Australia, in order to prove his hypothesis Whitaker would have had to address some of these historical and political factors in the USA in order to eliminate them, and this he has not attempted to do.
Leaving aside the questions of whether there is an epidemic or not Whitaker poses some important questions. Among these questions is the leading one; are our psychotropic medications making us sicker? He provides some interesting research including that by Dr Martin Harrow.
Harrow enrolled 64 young schizophrenics in a long term study. Some of this cohort were using anti-psychotics and others were not. Harrow published saying that “At the end of two years, the group not on antipsychotics were doing better on a “global assessment scale” than the group on the drugs.”
By the end of 4.5 years 39% of the off-medication group were “in recovery” and more than 60 % were working.
In contrast, outcomes for the medication group worsened during the thirty month period. At the 4.5 year mark, only 6 percent were in recovery and few were working.
At the 15 year follow-up, 40 % of those off drugs were in recovery, more than half were working, and only 28% suffered from psychotic symptoms. In contrast only 5% of those taking antipsychotics were in recovery, and 64% were actively psychotic.
Whitaker says: “Afterward I asked Dr Harrow why he thought the non-medicated patients did so much better.”
Dr Harrow attributed some of the better performance of the non-medicated group to “stronger internal sense of self” but added:
“It’s not that those who went off medications did better, but it was rather those who did better (initially) went off the medication.”
This all makes perfect sense, and it reflects what happens in real life, people who have a strong response are more likely to ditch the medication, however Whitaker seems to not take this logical interpretation on board.
He describes Dr Harrow as becoming “testy” when he pressed on with questions about whether there could be a different interpretation – that the antipsychotics were making the on-medication group sicker.
Harrow rejected Whitaker’s suggestion and said the data of his study proves that people who experience psychotic symptoms need not be on anti-psychotics all their lives. This is the take home message from this study for people who experience psychosis rather than that the anti-psychotics were making people sicker.
Whitaker’s book is still a must-read however and his passionate plea for less emphasis on drugs and more people centred therapies at the end of the book makes for great reading. His indictment of the treatment of children with psychotropic medication is also right on target. His mention of the fact that schizophrenia researcher and author of The Broken Brain, Nancy Andreasen has said that she has unpublished findings from MRI scans that the more drugs taken the bigger loss of brain tissue is a wake-up call:
“Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.” Andreasen said in an article in the New York Times in September 2008.
She says she has not released the data because she fears people may go off their medication. It is quite possible that Dr Andreasen has herself experienced a “quick rush of blood to the head” or cognitive impairment (I say this tongue in cheek as I have over the years been getting rather sick of Dr Andreasen and her concentration on “disease” and “cognitive impairment” in people with “schizophrenia”) as she has not published her findings.
Indeed her stated reason for not publishing (worrying patients) does not seem entirely consistent with her decision to make such a frightening statement in the New York Times. More people on antipsychotics would be reading the New York Times than would ever read one of her articles in a scholarly journal.
While Andraesen might have data that shows a trend towards greater loss of brain tissue with a longer time on medication the damage might be arising from the “disease” itself. Indeed Andraesen has previously argued that schizophrenia is a “disease” because of changes to the brain. To prove antipsychotic damage conclusively, and also to prove disease, she would need to compare brain scans of psychotic people on long term medication with those of psychotic people who have never been on medication.
Unfortunately this type of research into whether anti-psychotics or indeed anti-depressants can hurt us is the type of research that Big Pharma would probably not undertake, therefore Governments need to step in and make sure this essential long term research is carried out.
Consumers should really get together and push for a study on antipsychotics and loss of brain tissue. Perhaps those consumer/survivors with long term psychotic symptoms who don’t take medication could volunteer for such a comparative study.
As far as I was concerned the anti-psychotic Risperidone certainly acted rapidly to stop psychosis in its tracks, however people who experience psychosis are all different and I have met many people for whom this drug did nothing at all. What works for one person does not necessarily work for another. You can only really tell by trial and error.
The key element here is consumer choice. People, no matter how “crazy” and lacking in insight they appear to be, know whether drugs are working for them or not and they know when the side effects are worse than the actual mental health problem. The practitioner who has a light hand with the drugs and listens carefully to his patient is the one who is likely to be most successful in dealing with these difficult problems.
Any question of potential damage also raises serious ethical questions about Compulsory Treatment Orders therefore while there are questions about safety such compulsory treatment needs to be subjected to much more serious scrutiny than is the case at present.
Whitaker covers these issues very well with some illuminating case histories and also a comprehensive history of the development of the major psychotropic drugs.
Robert Whitaker’s book is available on Amazon for the very low price of $10.