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Life


Journalist finds flaws in mental-health care
SCHIZOPHRENIA: Alaska board invites author to speak about his controversial book.


By ANN POTEMPA
Anchorage Daily News

(Published: December 17, 2002)

This country's method of treating schizophrenia with medication promotes more relapses, a medical journalist told the Alaska Mental Health Board on Friday.

"Is our paradigm ... of medical care in some way pushing people into chronic illness?" asked Robert Whitaker, who has written medical articles for the Boston Globe and the Albany Times Union in New York.

Whitaker came to Alaska to talk about his book "Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill."

Board member Jim Gottstein invited Whitaker after reading his book.

"I just felt it was so compelling and so basically, unassailably credible and has such implications for our mental-health system," Gottstein said in introducing Whitaker to the board.

The Law Project for Psychiatric Rights sponsored Whitaker's visit, and the mental health board invited him to give a presentation at its regular meeting. Richard Rainery, executive director of the board, said it wasn't endorsing Whitaker's message; instead, the presentation was meant to educate.

"It's something that we need to do more often: Get different perspectives of mental-health services out to the public," Rainery said.

Whitaker said he didn't start out wanting to a write a book that spoke against current medical treatment.

"When I started this story, I believed wholeheartedly in the common wisdom, the common wisdom being that we were improving our outcomes with schizophrenia patients," he said.

He thought the drugs made available to patients enduring psychosis were as helpful as insulin for diabetics.

"What happened was this: As I was reporting for the Boston Globe on psychiatric research, I kept coming upon outcome studies that didn't match with our common beliefs, with our society's beliefs," he said.

Whitaker wrote a book about those studies. He outlined their outcomes for the mental health board.

A Harvard Medical School study concluded that outcomes for schizophrenic patients in the United States had declined during recent decades so that treatment was no better than it was in the early 1900s. Studies conducted by the World Health Organization in the late 1960s showed that outcomes were better in poor nations like India, Columbia and Nigeria than in the United States and other rich countries.

"I know of no other failure like that in Western medicine, where we say we have this modern medicine yet the outcomes, long-term outcomes, are much worse than in the poorest countries of the world," Whitaker said.

"They concluded that living in a developed country was 'a strong predictor that a patient would never fully recover,' " he said. "And that was absolutely mind-boggling to me."

Furthermore, the World Health Organization learned that the poorest countries used medication far less than the richer countries did yet had better outcomes for their schizophrenic patients.

Whitaker talked about more studies showing that medication offers short-term relief from schizophrenia symptoms, but patients who took a placebo instead of drugs were least likely to be rehospitalized a year after the study. Other studies also showed higher relapse rates for patients who had been medicated, he said.

Whitaker stressed that his message wasn't to say drugs have no purpose in treating psychosis. Research has shown that about half of patients can get through psychotic episodes without drug treatment. Other patients who were still suffering three or four weeks later could be started on low-dose medication, he said.

Several medical journals have reviewed Whitaker's book, including the Journal of the American Medical Association. JAMA concludes that "Mad in America" is flawed, citing Whitaker for one-sided review of scientific studies. Even so, the journal acknowledges that the author brings attention to the country's troubling use of anti-psychotic medication.

"It is peculiar that a physician can easily prescribe a new generation of anti-psychotic drugs that will cost more than society is otherwise willing to pay for programs to meet patients' needs for food, shelter and vocational rehabilitation," JAMA concluded.

Despite all the money invested in new drugs, the mentally ill in this country have been turned into an "underclass with staggering rates of unemployment, substance abuse, criminal system involvement and homelessness," the journal said.

Daily News reporter Ann Potempa can be reached at 907 257-4581 or apotempa@adn.com.




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