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Transforming our thinking about psychiatric medications

July 20, 2011
by Lori Ashcraft, PhD and Bill Anthony, PhD
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What if many popular medications aren't as beneficial and effective as we once thought?

After interviewing Robert Whitaker, we found ourselves reminiscing about Toto in The Wizard of Oz. You remember, don't you? How Dorothy and her friends follow the yellow brick road to Oz in hopes that the Wizard will fix them? How they approach the Wizard, who cloaks himself in fearsome smoke and flames, mesmerizing images and sounds?

And then, how Toto trots over, innocently pulls the curtain, and exposes the Wizard? The Wizard of Oz proves to be nothing more than an ordinary little man who moves levers, creating an illusion of power great enough to fix everything for everyone.

The main difference between Toto and Robert is no one disagreed with Toto-his findings were indisputable. And, in the movie, it is safe to say that Dorothy and the others were relieved to know the truth, even when it didn't validate their assumptions. Robert on the other hand, has started a conversation about the true effectiveness of psychiatric medications, and has opened considerable disagreement about where that truth lies. You'll see how this unfolds as we ask Robert questions about his work.

Bill and Lori: The point that captures our attention immediately Robert is this: You seem to think that psychiatric medications don't work as well as we have been led to believe. We both take lots of medication, Bill for symptoms of MS, and Lori for symptoms of anxiety and depression. We're now wondering if all this medication is a good idea. Maybe we've been over sold on the value and uses of medications and have been ignoring their adverse effects. How did this happen?

Robert: Your question gets at the heart of my concern. Basically, I think this is a commercial story that begins in the 1970s. As a field, psychiatry found itself in competition with a rising number of therapists (psychologists, social workers, etc.), and it embraced the medical model of psychiatric disorders in 1980 with the publication of DSM III partly to counter that competition. Psychiatrists had prescribing powers and their competitors did not, and if psychiatry told a story of how medications fixed a disease, like insulin for diabetes, then those prescribing powers would have greater commercial value.

Once psychiatry published DSM-III and became committed to their story, then naturally it became more closely linked to the pharmaceutical industry and there was a joining of interests. Pharmaceutical companies began paying psychiatrists at academic medical centers to be “advisors,” “speakers” and “consultants”, which strengthen the partnership designed to sell the medical model and promote the medications. Desperately seeking answers, NAMI's support of the story provided the moral authority that lent credibility to the process.

Bill and Lori: Sounds like your major concern is that it hasn't been in the best interest of the story tellers to be honest about effects of medications.

Robert: In my opinion, this is the biggest problem we have. The drugs have an obvious use, but in order to make best use of this tool we need to have honest storytellers. And that means they tell of what is and isn't known about the biology of psychiatric disorders; and that they fairly design their studies and honestly report their results. But it's quite easy to show that there has not been honest storytelling in this field of medicine for 25 years, and that is the fundamental problem that needs to be fixed.

Bill and Lori: Do you think this is a purposeful misrepresentation?

Robert: I think psychiatry came to believe its own storytelling about how it was making great progress in uncovering the biology of mental disorders, and how the second-generation drugs were so much better than the first.

Bill and Lori: It's probably not unusual for any of us to fall under the spell of our own mythmaking so why would psychiatry be any different? Perhaps we haven't questioned the truth enough because of the faith we as a culture put in the medical profession.

Robert: Yes. That's how we got so far down this road. And unfortunately I'm afraid psychiatry no longer knows how to get back on track with honest reporting of what it does and does not know, and honest investigations of psychiatric medications.

Bill and Lori: In your latest book you revisit the research that has been done on each class of medication. You point out that each class seems to have benefits, but also drawbacks. Can you give us a quick review of the research you found on the main classifications?

Robert: Sure. The data shows that antipsychotics can have “robust” short term effects in terms of knocking down psychotic symptoms. But their long-term effects can be very problematic, and frankly I think the literature shows they are iatrogenic agents over the long-term, even for patients with schizophrenia. In the aggregate, they lead to functional impairment, cognitive decline, and poor physical health over the long-term. There is evidence that they even increase the risk that people diagnosed with psychotic disorders will continue to have psychotic symptoms long term. Considering all this information, I think these are probably the most problematic class of psychiatric drugs over the long term.

Lori: I've taken both benzodiazepines and antidepressants for a long time. I'm afraid to ask what the long term effect of this is, but go ahead, I'm ready for the answer.

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