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	2012 Newsletters

CVA Weekly Newsletter
November 7, 2012

Upcoming Activist Opportunities

Review Essay: Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker (2010) [long]

This Week’s Sermon from Rev. Frank and Mary Hoffman

1. Upcoming Activist Opportunities

11/10 MT Bozeman Leeland Christian Rock Concert
11/11 MT Billings Leeland Christian Rock Concert
11/16-17 MT Billings Acquire the Fire Christian Youth Conference
11/17 NY Albany TABLE NY's Capital Region Vegetarian Expo
11/24 NC Greensboro The Story Tour by Mathew West
11/26 FL Tampa The Story Tour by Mathew West
11/29 MI Grand Rapids The Story Tour By Matthew West.
11/29 MN Duluth Kutless Christian Rock Concert
11/30 MN St. Paul Kutless Christian Rock Concert
11/30 TX Plano Women of Faith Christmas!
12/1 MO Independence The Story Tour by Mathew West
12/1 MN Brainerd Kutless Christian Rock Concert
12/2 MN Saint Paul The Story Tour by Mathew West
12/3 SD Sioux Falls The Story Tour by Mathew West
12/4 IL Hoffman Estates The Story Tour By Mathew West
12/6 TX Cypress The Story Tour by Mathew West
12/7 TX Dallas The Story Tour by Mathew West
12/8 TX San Antonio The Story Tour By Matthew West

Contact Paris at christian_vegetarian@yahoo.com if you can help. To find out about all upcoming leafleting and tabling opportunities in your area, join the CVA Calendar Group at:
http://groups.yahoo.com/group/christian_vegetarian/.

2. Review Essay

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker (2010)

This provocative book asserts that the explosion in mental illness in the United States over the last few decades is largely due to the use of psychoactive medications claimed to treat mental diseases. Prior to the advent of these psychopharmaceuticals, conditions such as severe depression, bipolar disorder, and even schizophrenia typically responded well to rest and psychotherapy. Most patients were discharged from mental institutions after 3-12 months and returned to their prior social function. Recurrences could occur, and their mental condition could restrict social and employment options, but most returned to their families and their work. However, in tandem with the growing use of psychopharmaceuticals, the number of people diagnosed with mental disorders has skyrocketed, the readmission rate to mental institutions is far higher than in former times, and a much greater fraction of people with mental disorders are socially incapacitated by their disease and unable to resume gainful employment. Whitaker asks, if these drugs are so effective, why are so many more people sick?

The answer, Whitaker argues, is that the drugs are turning acute, self-limited conditions into chronic diseases. He acknowledges that psychopharmaceutics probably can help manage some patients’ psychiatric disorders, but they should be used with far more caution than is today’s standard. These drugs alter brain physiology, because the brain adapts to drugs that enhance or inhibit various neurotransmitters. This can cause dependence on drugs, induce new psychiatric disorders, or result in long-term worsening of the original condition. Many patients end up on a cocktail of medications, each aiming to curb new symptoms that appear to be side-effects of other medications. Many of these medications tend to dull feelings and thinking, much to the dismay of patients. Further, many psychotropic medications have severe medical side-effects, including obesity and diabetes. As one might expect, psychiatrists rarely acknowledge that they might have induced mental diseases in their patients – they generally assert that those who have become sicker while on the drugs have had other underlying conditions “unmasked” by the drugs, but in general there is no evidence that this is indeed the case.

In fact, Whitaker notes that, despite extensive efforts to identify the “chemical imbalances” that psychiatrists and their friends in the pharmaceutical industry routinely claim are responsible for psychiatric illnesses, such imbalances have never been found. While psychotropic medications might alleviate the symptoms of mental disorders (for example, by sedating a person suffering from mania), they don’t necessarily address the underlying diseases. Using backward reasoning, psychiatrists conclude that, if medications that change brain chemistry seem to make people better, then the problem must be with the brain chemistry. But, as one reviewer noted, this is like saying that chronic pain conditions are due to a deficiency of opiates, since narcotics activate opiate receptors in the brain. While the chemical imbalance theory of psychiatric disease is dubious, researchers have been able to document chemical imbalances that emerge when people are put on psychotropic medications.

Do these medications really make people better? People in studies randomized to those given a sugar pill and those given a psychotropic medication (which is the standard for FDA approval) quickly recognize which one they are getting by the non-psychiatric side-effects that many of these drugs induce. So, those who experience side-effects know they are getting active drugs, and they might experience a placebo effect. To test this hypothesis, there have been multiple studies that have compared psychotropic drugs to other drugs that have side-effects but no known psychiatric effect (i.e., “active placebo”). Particularly for the treatment of depression, these studies consistently show little if any benefit from the psychotropic medication over active placebo. Many of these medications have sedative, tranquilizing, or other effects that, in typical industry-sponsored short-term drug trials of 6 or 8 weeks, reduce symptoms such as psychosis. However, there are far fewer long-term studies, and those that have been done indicate that patients generally do much better if they have not received medications.

Whitaker’s tone is sometimes polemical, and he reserves his harshest words for the widespread treatment of children with attention deficit hyperactivity disorder (ADHD) and bipolar disease (a condition that was once virtually nonexistent in teenagers before the advent of psychopharmaceuticals). Now, Whitaker estimates, about 3.5 million American children are on stimulants such as Ritalin, and children as young as two years old are being diagnosed as bipolar. Whitaker shows that there is compelling scientific evidence that the explosion of bipolar disease among children is largely due to the use of drugs to treat ADHD and depression. Further, rapid cycling between depression and mania, sometimes even in the same day, is a new phenomenon that, evidently, is a byproduct of brains destabilized by psychotropic medications.

Why are children put on drugs? Busy parents and over-worked teachers with too many students find it far easier to medicate children who have difficulty sitting still than to disciple them. And, with modern-day prohibitions on restraint and physical punishment, chemical restraint with drugs might often seem like the only way to handle children who have trouble sitting still for hours on end or are otherwise problematic. Proponents of drug use note that many children diagnosed with ADHD often do better in classroom tasks if they take the stimulant Ritalin. However, the children’s ability to perform simple classroom tasks comes at a price, because there is strong evidence that the drug dulls the mind and inhibits creativity and critical thinking. Once on these brain-altering drugs, many children with ADHD treated with Ritalin need additional medications for “unmasked” bipolar disease or other conditions, and many if not most of these kids face a lifetime of drug use. I wonder what my life would have been like if my elementary school teachers had responded to my misbehaving in class – which was probably related to boredom – by insisting that I take medications.

The book is replete with anecdotes that put human faces on the massive numbers of children and adults now crippled by what appears to be iatrogenic (physician-induced) psychiatric disease. One of the more heartbreaking stories is a normal, healthy, active girl who, prior to going into 5th grade, was prescribed an antidepressant to address her occasional bedwetting prior to her going to going to camp. It induced homicidal thoughts, for which she was put her on a cocktail of psychotropic medications. She became obese, and in the 11th grade, feeling that her doctor was taking her complaints about side-effects seriously, she abruptly stopped taking Zyprexa. She experienced withdrawal psychosis leading to a crippled mental status from which she has not recovered.

Why don’t ethical psychiatrists speak out? In general, psychiatrists make more money seeing patients briefly and prescribing drugs than by engaging in “talking therapy.” Further, the “chemical imbalance” theory is professionally convenient for psychiatrists, because only they with their MDs can prescribe psychopharmaceuticals, while non-psychiatric providers such as psychologists and social workers can only do various kinds of psychotherapy. The financial conflicts of interest are far greater for academic leaders (known by the drug industry as “thought leaders”), whose opinions carry considerable weight with their colleagues, journalists, and the general public. Nearly all these people receive large payments from pharmaceutical companies as consultants and speakers, and often their research labs are lavishly supported by unrestricted grants from their friends in industry. They are rarely told what to say, but they know who butters their bread. In addition, the American Psychiatric Association and patient advocacy groups such as National Alliance on Mental Illness, receive generous support from the pharmaceutical industry.

Meanwhile, Whitaker shows, those academicians who have raised questions or concerns about pharmacological treatment of psychiatric disorders have suffered severe professional penalty, which means that those who survive in academia either endorse the biological model of psychiatric disease and its pharmaceutical management or keep their reservations to themselves. Critics from outside academia are dismissed as academic lightweights, and the drug industry and its allies in academia are fond of attributing most concerns to the anti-psychiatry Church of Scientology, which is widely regarded as cultish and repressive.

Whitaker readily acknowledges that many of the studies challenging the widespread use of psychopharmaceuticals have had significant limitations. The biggest problem is that it is hard to have good control groups of medicated versus nonmedicated patients. For example, studies that compared people with depression who received medications to those who declined medications might not be valid, because those who declined might have personal or social resources that made them more resilient to depression’s effects.

Many more people are diagnosed with mental disease today in part because, arguably for the benefit of mental health professionals, the range of mental “disorders” has expanded greatly. For example, the FDA approved Paxil for use in “social anxiety disorder” (i.e., shyness), which promoters of Paxil claim afflicts 13% of Americans. Similarly, the explosion of people on disability for mental disorders could reflect, at least in part, the facts that disability payments exceed welfare payments and that claims of psychiatric diseases are difficult to disprove. And, a claim of disability is far more likely to succeed if one is taking psychotropic medications.

There are inherent difficulties of drawing scientific conclusions from historical data, in contrast to the scientific “gold standard” of randomized, prospective, controlled trials. Importantly, Whitaker details several recent prospective studies that have provided strong evidence that most patients admitted to psychiatric facilities fare better when they receive various forms of psychotherapy than when they receive drugs.

Unless I’m mistaken, Whitaker overlooked what seems to me an important factor contributing to the preference of drugs for long-term hospitalization and psychotherapy. When there is government-sponsored health care, as in many European countries, the long-term costs of one or a few extended hospitalization and psychotherapy can be less than the costs of repeated hospitalizations over a lifetime, lifetime use of expensive drugs, and lifetime enrollment on disability. In contrast, people are rarely on a given insurance plan for a long duration, so insurance companies favor treatments that are less expensive in the short term. Consequently, their plans typically offer only short-term hospitalization, very limited hours of psychotherapy, and use of drugs that reduce the symptoms but do not necessarily address the sources of psychiatric disease.

Overall, Whitaker makes a compelling case that overuse of psychopharmaceuticals has harmed many children and adults. I suspect that few readers of his book will connect the dots and recognize how harm from psychopharmaceuticals relates to animal abuse. First, I think it shows that humans are just as vulnerable as nonhumans to abuse at the hands of those with power and authority. Second, there are good reasons not to trust researchers, academicians, and health care professionals who have financial conflicts of interests. We should be very skeptical of those with conflicts of interest who say that vivisection is necessary, that animal-based foods are wholesome and nutritious, and that people with mental disorders need drugs. Third, since researchers can defend virtually any conclusion by choosing the “right” animal model and the “right” experimental protocol, vivisection plays an important role in the profitable campaign to increase the use of drugs.

Stephen R. Kaufman, M.D.

3. This Week’s Sermon from Rev. Frank and Mary Hoffman

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