Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
A key core competency for medical students, residents, fellows, and practicing physicians is "lifelong learning." Scholarly works such as Anatomy of an Epidemic represent a prime reason that we master this competency. A main stated purpose of the book is to challenge the reader to think about the biological base of mental illness and to come to conclusions about the author’s assertion that there is a hidden epidemic that has been caused by rather than successfully treated through biological agents, eg, psychotropic medications and electroconvulsive therapy. The author succeeds by this well-written and easily understood work to force the reader to take a new look at the cherished tenets of our profession and how they developed. This is accomplished through predominantly negative anecdotes of the destructive power of biological treatments and what appear to be carefully selected citations that explain how the prescribing of medication results in fostering the often irreversible chronicity of the more severe psychiatric disorders and the negative adverse effects of current and past psychotropics.
The book is divided into 5 parts: The Epidemic, The Science of Psychiatric Drugs, Outcomes, Explication of a Delusion, and Solutions. The work is comprehensive, but this review will focus on the argument as it pertains to the pediatric population. Under Outcomes, the chapter "The Epidemic Spreads to Children" considers, among other topics, "The Rise of ADHD" (attention-deficit/hyperactivity disorder), "Stimulants Flunk Out," "Tallying up the Harm" (of stimulant medications), "Creating the Bipolar Child," and "The Disability Numbers." As is done throughout the book, the challenge is raised as to the established biological basis of psychiatric disorders and the conclusion drawn that no evidence exists for such a concept. The author seems to ignore the past decade of neuroimaging results that clearly demonstrate, for example, the differences between children and adolescents with ADHD and those without as well as comparisons in those treated with stimulant medications and those who are treatment naive. Moreover, the cost-benefit ratio of stimulants is asserted to be heavily weighed to their detrimental effects without reference to significant epidemiologic data to the contrary. There is similarly no reference to the documented biological underpinnings of clinically depressed or at risk individuals and the well-designed though limited studies of the comparison treatments for pediatric depression. The book fails to take into account current thinking on the interaction between biological vulnerability and the environment for the basis of psychiatric disorders that dates back to George Engel’s biopsychosocial model of disease1 and models, eg, Akiskal and McKinney’s ,2 for melancholia taught to medical students and psychiatry residents.
Overall, Anatomy of an Epidemic is a well-, but highly selectively, referenced, useful polemic that provides a comprehensive but biased and dated effort to explain the rise of mental illness in our society to the level of an "epidemic" of pain and suffering. It is must reading for mental health professionals because it exposes us to a different perspective on one of the cornerstones of modern psychiatry and forces us to appreciate how patients and their families can get skewed views of psychotropic medications and their acceptability to society. It is unfortunate that key advances to understanding the more severe or prevalent psychiatric disorders are omitted. Being aware of the spurious arguments that provide the base for such negative and potentially destructive views will allow readers a greater sympathy for those fearful of psychotropic medications and foster motivation to maintain familiarity with advances in the field as the best way to deal with such an attack in a thoughtful and nondefensive response to anxious questions concerning safety, efficacy, and effectiveness.
References
1. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129-136.
2. Akiskal HS, McKinney WT Jr. Overview of recent research in depression. Integration of ten conceptual models into a comprehensive clinical frame. Arch Gen Psychiatry. 1975;32(3):285-305. PubMed
Author affiliation: Robert Wood Johnson Medical School-University of Medicine and Dentistry in New Jersey, Piscataway. Potential conflicts of interest: None reported.
doi:10.4088/JCP.10bk06694
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