Anchorage Daily News
December 17, 2002)
country's method of treating schizophrenia with medication promotes more
relapses, a medical journalist told the Alaska Mental Health Board on
"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
"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 email@example.com.