Anatomy of an epidemic : magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America
The history of psychiatry and its treatments can be a contentious issue in our society, so much so that when you write about it, as I did in an earlier book, Mad in America, people regularly ask about how you became interested in the subject. The assumption is that you must have a personal reason for being curious about this topic, as otherwise you would want to stay away from what can be such a political minefield. In addition, the person asking the question is often trying to determine if you have any personal bias that colors your writing.
In my case, I had no personal attachment to the subject at all. I came to it in a very back-door manner.
In 1994, after having worked a number of years as a newspaper reporter, I left daily journalism to cofound a publishing company, CenterWatch, that reported on the business aspects of the clinical testing of new drugs. Our readers came from pharmaceutical companies, medical schools, private medical practices, and Wall Street, and for the most part, we wrote about this enterprise in an industry-friendly way. We viewed clinical trials as part of a process that brought improved medical treatments to market, and we reported on the financial aspects of that growing industry. Then, in early 1998, I stumbled upon a story that told of the abuse of psychiatric patients in research settings. Even while I co-owned CenterWatch, I occasionally wrote freelance articles for magazines and newspapers, and that fall I cowrote a series on this problem for the Boston Globe.
There were several types of “abuses” that Dolores Kong and I focused on. We looked at studies funded by the National Institute of Mental Health (NIMH) that involved giving schizophrenia patients a drug designed to exacerbate their symptoms (the studies were probing the biology of psychosis). We investigated the deaths that had occurred during the testing of the new atypical antipsychotics. Finally, we reported on studies that involved withdrawing schizophrenia patients from their antipsychotic medications, which we figured was an unethical thing to do. In fact, we thought it was outrageous.
Our reasoning was easy to understand. These drugs were said to be like “insulin for diabetes.” I had known that to be “true” for some time, ever since I had covered the medical beat at the Albany Times Union. Clearly, then, it was abusive for psychiatric researchers to have run dozens of withdrawal studies in which they carefully tallied up the percentage of schizophrenia patients who became sick again and had to be rehospitalized. Would anyone ever conduct a study that involved withdrawing insulin from diabetics to see how fast they became sick again?
Part One: The Epidemic
1. A Modern Plague
2. Anecdotal Thoughts
Part Two: The Science of Psychiatric Drugs
3. The Roots of an Epidemic
4. Psychiatry’s Magic Bullets
5. The Hunt for Chemical Imbalances Part Three: Outcomes
6. A Paradox Revealed
7. The Benzo Trap
8. An Episodic Illness Turns Chronic
9. The Bipolar Boom
10. An Epidemic Explained
11. The Epidemic Spreads to Children
12. Suffer the Children Part Four: Explication of a Delusion
13. The Rise of an Ideology
14. The Story That Was … and Wasn’t Told
15. Tallying Up the Profits Part Five: Solutions
16. Blueprints for Reform
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