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home / 世界杯决赛2022

we need to rethink how we treat psychiatric illness: author

the way drugs shape long-term outcomes must be understood against our natural capacity to recover, says author robert whitaker ahead of his public lecture in montreal.

by susan schwartz

nov 8 2022
read time 4 minute read
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for decades, the prevailing wisdom was that psychiatric illnesses were diseases of the brain — biological disorders caused by chemical imbalances.
that model was a “story of people having a chronic condition, something amiss inside your brain, and the best you could do is take drugs long-term, like with diabetes,” as award-winning american journalist and author robert whitaker told the montreal gazette — and recovery meant stabilizing within that model of care.
that model has collapsed.
despite decades of research, there are no findings to show that people with psychiatric illnesses necessarily suffer from a biological abnormality — and, furthermore, there is no evidence that psychiatric drugs have any long-term benefit, said whitaker, who has written extensively about psychiatry and the history of psychiatry.
the understanding now is that causes of such conditions as depression, psychosis and mania are varied and include life events and setbacks, trauma and other factors — and that many people suffer an “episode” of an illness that resolves over time. this opens new avenues for promoting a robust recovery from psychiatric disorders, he said.
“you are not on medications, but functioning in a full-bodied way: employment, social functioning, sexual functioning, marriage,” he said.

“that is where i am presuming we are heading,” said whitaker, who will give a public lecture thursday in montreal organized by ami-quebec.

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“this crumbling of the old disease model leads to this lovely, optimistic, evidence-based story that, so often, specific difficulties can be episodic in nature, not chronic — and so we need a paradigm of care to address that.”

although psychiatric drugs are approved based on short-term trials, many people stay on them for the long term, said whitaker, founder and publisher of mad in america, a webzine that presents critical perspectives on modern psychiatry.

the way in which drugs shape long-term outcomes must be understood against our natural capacity to recover, he said, “and, on the whole, they worsen long-term outcomes.”
journalist and author robert whitaker will give a public lecture in montreal organized by ami-quebec on nov. 10.
journalist and author robert whitaker will give a public lecture in montreal organized by ami-quebec on nov. 10. b. d. colen / adiol
in anatomy of an epidemic: magic bullets, psychiatric drugs, and the astonishing rise of mental illness in america (crown, 2010), whitaker examined the drug-focused paradigm of care — and found that the burden of depression and psychiatric disorders over the previous two decades, as measured by the number of americans receiving government disability for mental illness, had skyrocketed.
in a presentation to the parliament of the united kingdom in 2017, whitaker looked at antidepressant use and disability in the u.k., sweden, australia and new zealand — and found a sharp increase in disability in lockstep with increased prescribing of drugs.
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in examining the course of psychiatric disorders in anatomy of an epidemic, he found that “outcomes have deteriorated notably,” and that affective disorders such as depression and bipolar disorder have gone from being episodic to chronic problems.
at the time the book was published, the prevailing societal and professional belief was that these psychiatric drugs were essential and had improved outcomes, said whitaker, “part of a psycho-pharmacological revolution.”
initially, then, his findings were considered a form of heresy, he said — “and whenever you commit an act of heresy, you upset people and you get attacked.”
but if he was dismissed as a crank then, today “there is an admission that, on a societal level, a drug-first approach has not lessened the burden of mental health on society,” whitaker said, and leading psychiatrists are rethinking the paradigm.

he cited a 2022 paper by nassir ghaemi , professor of psychiatry at the tufts university school of medicine, who said there is no evidence that psychiatric drugs have any long-term benefit: they do not bring about cure but, rather, act on symptoms and should be used only in the short term and in doses as low as possible, he said. (the exception is lithium, which provides a benefit by reducing risk of suicide.)

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former united nations special rapporteur dainius pūras said in a 2020 report that “structural conditions such as poverty, discrimination and violence are the root causes of mental distress and suffering” and that mental health services suffer from an excessive focus on outdated approaches, including use of psychiatric drugs, whereby the majority of resources are allocated to individual treatment for mental health conditions.

“good mental health and well-being cannot be defined by the absence of a mental health condition, but must be defined instead by the social, psychosocial, political, economic and physical environment that enables individuals and populations to live a life of dignity, with full enjoyment of their rights and in the equitable pursuit of their potential,” said pūras, a physician with expertise on mental health and children’s health.
in a podcast soon after anatomy of an epidemic was published, whitaker told rob whitley, associate professor in mcgill’s department of psychiatry and an investigator at the douglas research centre: “i think science is telling us with great clarity that we humans are social beings, that mental health and the capacity to thrive happens within a social context — having friends, finding meaning in life, having relationships — and that we need to provide this intensive psycho-social care to help people maintain friendships, find meaning, find physical wellness, that sort of thing.”

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at a glance
robert whitaker gives a public lecture thursday, nov. 10 at 7 p.m. at oscar peterson concert hall, concordia university, 7141 sherbrooke st. w. admission is free and reservations are not needed. those attending are encouraged to wear masks and to practise social distancing. to watch online, go to amiquebec.org/rethinking. on friday, nov. 11, whitaker will give psychiatry grand rounds at the mcgill university health centre.
sschwartz@postmedia.com
susan schwartz, montreal gazette
susan schwartz, montreal gazette

we used typewriters when i started at the gazette, and big black rotary phones. nearly everyone smoked. today’s newsroom looks different but the work – reporting and informing my readers – remains constant and rewarding. i am grateful to my adviser at mcgill, where i was a neurobiology major, for steering me to journalism. undoubtedly, he realized i wasn’t cut out for neurobiology.

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