Anatomy of an Epidemic Summary

“What does it mean when millions of people rely on psychiatric medications, and yet mental health outcomes worsen over time?”

1. The Birth of Psychoactive Drugs Lacked Sufficient Testing

Psychoactive drugs, now commonly used to treat mental illnesses, weren’t developed for that purpose. They originated from research aimed at curing infectious diseases. During the post-World War II era, researchers inadvertently discovered compounds that affected the central nervous system.

These compounds weren’t thoroughly evaluated for mental health applications. For example, Smith, Kline & French launched Thorazine in 1954 after testing it on fewer than 150 psychiatric patients. The drug was advertised as a treatment for schizophrenia, bipolar disorder, and anxiety despite limited data. Researchers, in their pursuit of a "magic bullet," bypassed the usual development process focused on identifying and addressing the root cause of conditions.

The result was a rushed entrance of psychiatric medications into the market. While initially lauded as transformative, these medications had unexamined long-term effects that would later come to light.

Examples

• Thorazine was approved after minimal patient testing.
• The normal procedure of linking drug design to specific ailments was bypassed.
• Advertising for these drugs highlighted their supposed benefits without specifying risks.

2. Psychiatric Medications Cause Severe Side Effects

The widespread use of psychoactive drugs comes at a cost: long-term side effects and dependency. For example, selective serotonin reuptake inhibitors (SSRIs), commonly used for depression, can induce mania due to elevated serotonin levels. Similarly, antipsychotics, which block dopamine, can cause movement issues resembling Parkinson's disease.

Not only do such medications alter brain functions, but withdrawal poses additional challenges. Discontinuation can cause biochemical imbalances, leading to apathy, suicidal thoughts, or relapse into the pre-treatment condition. This often leads doctors to put patients back on medication, perpetuating a cycle of dependency.

For many, the brain's chemistry changes irreversibly, worsening symptoms over time. Nancy Andreasen’s research showed that antipsychotics correlated with brain shrinkage, revealing the drugs' damaging impact.

Examples

• SSRIs can cause manic episodes due to increased serotonin.
• Antipsychotic medications lead to tremors and impaired motor skills.
• Withdrawal symptoms make stopping psychiatric drugs nearly impossible for many.

3. Mental Disabilities Have Increased Dramatically

Since the introduction of psychiatric drugs in the 1950s, America has seen an explosive rise in mental health diagnoses. Between 1955 and 2007, there was a dramatic increase in reported mental disability, with diagnoses becoming more frequent, varied, and encompassing.

Federal assistance claims, such as Social Security Disability Insurance, doubled in two decades, reflecting the growing prevalence of mental health issues. Particularly alarming is the rise in childhood mental illnesses. ADHD is now so commonly diagnosed that approximately 10 percent of 10-year-old boys in the U.S. take medication for it.

This evolution reveals a concerning pattern: as medications become more widely available, diagnoses—and dependency—expand.

Examples

• Social Security Disability claims related to mental health doubled between 1987 and 2007.
• The National Institute of Mental Health found that nearly half of Americans qualify as mentally ill under psychiatric guidelines.
• By 2007, children as young as two were being medicated, highlighting the trend’s early onset.

4. Overprescription Creates New Problems

Psychiatric medications were once heralded as solutions to complex mental health issues. However, over time, overprescription has backfired for many patients. Instead of resolving people’s conditions, repeated prescriptions often worsen or prolong symptoms.

Many patients receive drugs for off-label uses, especially children. Treatments that offer short-term relief create long-term dependency. For disorders like schizophrenia, untreated episodes would historically subside after six months. But medicated episodes often persist for a lifetime.

Even professionals like Jonathan Cole, a prominent psychopharmacologist, acknowledge the harm of prolonged drug use. His findings, along with those of the World Health Organization, suggest that psychiatric medicine can exacerbate rather than improve chronic conditions.

Examples

• Schizophrenic episodes lasting years instead of subsiding within six months post-medication.
• Widespread prescribing of non-FDA-approved drugs for children.
• World Health Organization studies linking antidepressants to increased long-term depression risks.

5. Psychiatry’s Transformation Shifted Treatment Focus

Before the rise of psychoactive drugs, psychiatry revolved around psychoanalysis and talking through unconscious conflicts. The success of these medications led psychiatry to pivot sharply towards brain chemistry, sidelining understanding patients’ life stories.

From the 1950s onward, mental health professionals began relying on symptom-oriented diagnoses. They prescribed drugs to cover up symptoms rather than address root emotional causes. This shift created a divergence in the mental health field, leaving some professionals critical of the industry’s new approach.

Ultimately, psychiatrist unity weakened, and public trust in psychiatry began to erode by the 1970s.

Examples

• Freudian methods were abandoned in favor of drug-centric treatments.
• Anti-psychiatry sentiment gained traction after Ken Kesey’s "One Flew Over the Cuckoo’s Nest."
• Growing competition from psychologists and social workers further eroded psychiatry’s standing.

6. Rebranding Saved Psychiatry’s Reputation

Facing a loss of legitimacy, psychiatry re-invented itself during the 1970s and 1980s. The publication of DSM-III in 1980 solidified this transformation. This new edition categorized mental illnesses using a symptom checklist, which formalized psychiatric diagnosis procedures.

This manual helped psychiatrists appear more scientific and aligned with broader medical practices. It also positioned them in the pharmaceutical industry’s favor, as the DSM-III supported drug-based treatments.

The rebranding campaign allowed psychiatry to recover some of its professional standing, albeit through a closer relationship with pharmaceutical companies.

Examples

• DSM-III expanded mental illness definitions by 45 percent, increasing opportunities for diagnoses.
• Psychiatry became viewed as more scientific thanks to its focus on brain chemistry.
• The APA’s media campaigns portrayed psychiatry as an authoritative medical field.

7. Partnerships With Drug Companies Benefit Psychiatry

Pharmaceutical companies quickly aligned with psychiatrists, solidifying a symbiotic relationship. Sponsoring advertising in medical publications and funding professional conventions, they helped promote drug usage among healthcare providers. They also paid top psychiatrists handsomely in exchange for promotional speaking engagements.

Although these partnerships benefited psychiatry and drug companies, they burdened everyday Americans. Between 2001 and 2008, mental health expenditures in the U.S. grew from $85 billion to $170 billion, with taxpayers covering a large part of the cost through government-backed programs.

This highlights how the financial incentives behind psychiatric medications often overshadow patient well-being.

Examples

• Drug companies funded APA symposiums featuring promotional testimonials.
• Doctors’ incomes rose sharply due to their authority to prescribe costly medications.
• The percentage of mental healthcare costs funded by taxpayers reached 60 percent.

8. DSM Expansion Adds More Diagnoses

Each edition of the DSM introduced more diagnostic labels, increasing the number of people qualifying for a mental health diagnosis. The broader categories fueled a chain reaction: more people identified as mentally ill, more prescriptions written, and more profits for both psychiatrists and drug corporations.

For example, the DSM’s expanded criteria for conditions like depression and anxiety paved the way for skyrocketing drug use. Instead of narrowly defining illnesses, vague and broadly applicable symptoms were included.

Examples

• DSM-III raised recognized mental illnesses from 182 to 265.
• Insurance companies and schools widely adopted the DSM for consistent diagnostics.
• Broader criteria captured millions of patients under the depression umbrella.

9. The Public Pays the Price

As mental health treatments shifted toward medications, the American public bore increasing financial costs. Psychiatric services became the fastest-growing medical expense category, doubling in cost in just seven years from 2001 to 2008.

Public programs like Medicaid and Medicare paid most of these costs, effectively spreading the burden to taxpayers, even those who didn’t utilize mental health services.

These rising costs highlight the financial strain caused by overprescription, raising questions about the system’s sustainability.

Examples

• From $10.5 million in APA revenues in 1980 to $21.4 million in 1987, funded largely by partnerships with pharmaceutical companies.
• The number of children prescribed ADHD medications rose sharply.
• Medicaid covered 60 percent of these mounting expenses by 2008.

Takeaways

1. Promote alternative treatment methods such as therapy to reduce dependency on medications.
2. Raise awareness about the long-term costs and side effects of psychiatric drugs to encourage informed decision-making.
3. Advocate for stricter testing and regulation of medications before they reach the market to ensure safety and efficacy.