In April, journalist Robert Whitaker wrote an article titled, “The New Yorker Peers into the Psychiatric Abyss… And Loses Its Nerve.” Whitaker, who personally knows the woman featured in a recent New Yorker article about her psychiatric treatment, was bothered because the publication omitted the most important aspects of her story: her discovery that psychiatry’s paradigm of care did great harm to people such as herself, and how this realization resulted in her rejecting that narrative, recovering and becoming an activist highly critical of psychiatry. I was curious to hear Whitaker’s thoughts on the general state of mainstream media’s coverage of psychiatry.
I previously interviewed Whitaker and psychologist Lisa Cosgrove for Truthout in 2015, following the publication of their book Psychiatry Under the Influence, which investigates how drug company money and psychiatry’s own gilded interests have corrupted the profession over the past 35 years.
Whitaker has now been covering psychiatry for more than two decades and is currently the publisher of the webzine Mad in America, which reports news on research in psychiatry and provides a forum for mental health professionals, disability justice activists and those who have experienced psychiatric treatment.
He has won numerous awards covering medicine and science, including the George Polk Award for Medical Writing and a National Association for Science Writers’ Award for best magazine article. For the Boston Globe in 1998, he co-wrote a series on the abuse of subjects in psychiatric research that was a finalist for the Pulitzer Prize for Public Service.
His first book, Mad in America, was named by Discover magazine as one of the best science books of 2002. His book Anatomy of an Epidemic won the 2010 Investigative Reporters and Editors book award for best investigative journalism. The following interview has been edited lightly for clarity and length.
Bruce Levine: I recall that in 2008, following the congressional investigation of the corrupting influence of drug company money on the American Psychiatric Association (APA) and on “thought leader” psychiatrists, The New York Times finally ran a piece reporting on the congressional investigation. As you document in Psychiatry Under the Influence, by the 1980s, there had been a huge increase in drug company money pouring into the APA, but instead of the Times itself exposing this conflict of interest and such an exposure compelling Congress decades earlier to hold hearings on the topic, the Times waited for the congressional investigation to take place in 2008 and then simply reported on it. So, the general public heard about this important issue decades after they should have been made aware of it. What do you think are the causes of the mainstream media’s failure to do its job with respect to the institution of psychiatry?
Robert Whitaker: I think there are several factors that have led to this enduring failure.
In the early 1980s, the APA launched an effort to sell its DSM III “disease model” to the public, and that meant telling its story through the media. It held media days and gave out awards to reporters who best echoed the story that the APA wanted told, and so, soon the public was learning that psychiatric researchers were making great advances in identifying the biological causes of major mental disorders. They were discovering that depression, schizophrenia and other disorders were caused by chemical imbalances in the brain, and then, starting with the arrival of Prozac on the market in 1988, we heard that a new generation of psychiatric drugs fixed those imbalances, and thus were like “insulin for diabetes.”
That was a story that told of an extraordinary medical discovery and advance. Think about how astonishingly complex the human brain is, and yet we were learning that psychiatric researchers had identified the very molecule that causes mental illness, identified the very molecule that causes depression, and so forth.
This fit into a much larger narrative of advances in medicine that the mainstream media is poised to run with. In 1985, the Baltimore Evening Sun won a Pulitzer Prize for telling of these amazing advances. When Prozac was brought to market, the pill itself was featured on the covers of Newsweek and New York magazine. It could make depressed people feel “better than well!”
This story, of course, was totally unhinged from any scientific reality, and in the early 1990s, various individuals and groups began raising a concern that Prozac could increase the risk of suicide. The Prozac trial data submitted to the Food and Drug Administration (FDA) revealed this risk; there were case reports of Prozac suicides that have been submitted to the FDA’s MedWatch program; and a study of healthy volunteers revealed that Prozac could induce suicidal thoughts even in this group.
However, while the concern was a real one, the most prominent group raising it was Citizens Commission on Human Rights, which is affiliated with Scientology. That presented Eli Lilly [the manufacturer of Prozac] and its academic “thought leaders” with an obvious strategy for dismissing this risk. They told the media that this was a charge raised by Scientologists, and thus, from the media’s perspective, you had academic psychiatrists on one side and cultists on the other, and who was the media going to believe? Going forward, this was a strategy that was bound to intimidate reporters, for their careers could be at risk if they were seen as lending credence to Scientologists. The Scientology card was psychiatry’s ace in the hole; it helped still media criticism for decades.
Next, there was a great expansion in the use of psychiatric drugs in our society in the 1990s, which touched the mainstream media at a personal level. At any newspaper or magazine or publishing house of any size, there would be editors or reporters who were taking a psychiatric drug, or members of their family who were. That regularly made them personally invested in psychiatry’s narrative of progress and resistant to criticisms of the drugs. If you have a child diagnosed with ADHD and taking a stimulant, you probably aren’t going to want to hear that ADHD is a “construct” and that stimulants may have long-term adverse effects.
Finally, there was the influence of money. Pharmaceutical companies marketing their psychiatric drugs poured money into television and print ads, and that flow of money inhibited critical coverage of psychiatry too. Add all these factors together, and you have a mainstream media primed to embrace the conventional narrative of progress, as told by academic psychiatrists, and primed to discount research and critiques that challenged it.
In addition to the corrupting effect of drug company money on drug research and prescribing practices, what are other major stories about psychiatry that mainstream journalists should have been reporting many years prior to when they finally reported it? And what important news is still not being reported by the mainstream media?
The most obvious story that the mainstream media failed to cover was the claim that major psychiatric disorders were due to chemical imbalances in the brain, and that the new psychiatric drugs fixed those imbalances.
We really should pause and think about this for a moment. That was a soundbite that changed our society. It changed our sense of self, it changed how we viewed childhood, and it turned us into regular consumers of psychiatric drugs. Yet — and this is the most stunning part of this story — if you dive into the relevant scientific literature, you find that researchers in the late 1970s and early 1980s were regularly failing to find evidence to support the chemical-imbalance hypothesis. In 1998, the APA’s own textbook declared the low-serotonin theory of depression to be dead. Yet, presidents of the APA, in their public declarations over the next few years, would state that it was now known that depression was caused by a chemical imbalance in the brain.
Today, as you know, the chemical imbalance story has collapsed. Ronald Pies, the former editor-in-chief of Psychiatric Times, has even written several blog posts maintaining that psychiatry never promoted that story, which tells you of how eager psychiatry, as an institution, is to wash its hands of the entire affair. But here is what I don’t understand: Why isn’t the mainstream media now holding psychiatry to account for having told us this false story about chemical imbalances for so long? A medical specialty isn’t supposed to lie to patients. So why isn’t the media asking Pies and others why this story was peddled to the public in the first place?
The failure to ask such questions is an example of how the mainstream media remains remarkably timid in its coverage of psychiatry. Indeed, the mainstream media is still not reporting scientific findings that are of obvious importance to our society.
There now have been numerous long-term studies that have found that psychiatric drugs increase the risk that people who take the medications will become chronically ill and impaired in their functioning. That doesn’t mean that everyone who takes these drugs fares poorly, but it does mean that research is finding that such medication use, on the whole, worsens long-term outcomes. But try to find any mention of that research in mainstream media publications or broadcasts. You won’t. Yet, it is hard to imagine any finding that would be of more interest to the public and to users of these drugs.
Here is another example of a topic that the mainstream media won’t touch. It is well-known that antidepressants cause some degree of sexual dysfunction in a high percentage of patients. There has been some mention of this in the mainstream media. But what hasn’t been reported in the mainstream media is the fact that a significant percentage of antidepressant users remain impaired in their sexual function even after withdrawing from the medication, with this impairment persisting for months and even years. This dysfunction even has a name — post-SSRI sexual dysfunction (PSSD). Yet, I don’t think you can find any mention of PSSD in any mainstream American newspaper or popular magazine. If you were considering taking an antidepressant, wouldn’t you want to be informed of this long-term risk?
So what you see is this: The media [are] still failing to cover psychiatry in a way that would serve the public interest. Yes, increasingly the public is coming to understand that the chemical imbalance story is dead and that pharmaceutical money has corrupted psychiatric research. But the public knows little of research that tells of psychiatric drugs that worsen long-term outcomes.
Let’s talk about your April 2019 piece “The New Yorker Peers into the Psychiatric Abyss… And Loses Its Nerve,” which was your reaction to the lengthy New Yorker article “The Challenge of Going Off Psychiatric Drugs” that was published a few weeks earlier. After decades of psychiatry as an institution ignoring the research showing the serious problem of psychiatric drug withdrawal, and after decades of mainstream journalists failing to report this story, the New Yorker and the rest of the mainstream media are now finally reporting it. The New Yorker piece, written by Rachel Aviv, focused on the psychiatric treatment for one young woman, Laura Delano, and Aviv mentions your book Anatomy of an Epidemic with respect to Laura’s rethinking her treatment and that Laura connected with you, and Aviv also notes that she talked to you for the article. What bothered you about the article that the New Yorker ultimately published?
I think of that New Yorker article as a “glass-half-full” effort. On the one hand, it did represent a step forward in the media’s coverage of the possible harmful effects of psychiatric drugs. At the same time, it hid Laura’s full story from the reader, and in ways that were protective of the conventional narrative.
I know Laura well. Hers is a story that tells of the pathologizing of children and teenagers in this country, and of the extraordinary harm this can cause.
When Laura was in eighth grade, she was having a “Who am I?” existential crisis, and that led to a trip to the psychiatrist and to a bipolar diagnosis, which in turn led to an ongoing life as psychiatric patient — multiple diagnoses, and a potpourri of psychiatric drugs. Eventually, this led to a near-fatal suicide attempt.
Such was the course of Laura’s life — while she and her family believed in the conventional narrative. But, as Laura told Aviv, after she read Anatomy of an Epidemic, she came to see herself as having been turned into a mental patient by psychiatry and its diagnoses. Her conceptualization of her past changed. As Laura often wrote in blogs for Mad in America, it was her rejection of the conventional narrative and embrace of the narrative told in Anatomy of an Epidemic that provided her a path to recovery.
After my interview with Aviv, I thought that was indeed the story Aviv was poised to tell. Yet, both Laura and I wondered: Would she really dare to do so? Would the New Yorker dare to publish it? After all, Laura’s story told of a paradigm of care that did harm. The telling of her story would mark the moment that the mainstream media finally dared to question the entire narrative that has governed societal thinking for nearly 40 years.
The New Yorker piece was 9,000 words long (or so), and for the first half of the story, up until the moment that Laura tells of reading Anatomy of an Epidemic, it seems that Aviv is indeed going to tell Laura’s story in full. This will be a story that tells of how her recovery began when she rejected the conventional narrative. But then, as it comes to this pivotal moment in Laura’s life, the New Yorker article loses its nerve. It doesn’t tell why reading Anatomy was so important to Laura, and instead segues into a story about how much difficulty Laura and others have had trying to taper from antidepressants.
In short, the article leaves out the heart of Laura’s story. It doesn’t tell of how her recovery began when she rejected the conventional narrative, and how she then saw herself as a “psychiatric survivor,” and how she became a fiery critic of psychiatry and its treatments. It doesn’t tell of how she worked for Mad in America and wrote fierce blogs telling of her personal story, and how she became well-known in the United States and abroad for her criticisms. That story couldn’t be told, and in its place is a story of “overmedication” and “misdiagnosis,” and of how Laura has started a website that helps people struggling with getting off antidepressants.
The article did break new ground for a mainstream publication by so fully detailing Laura’s suffering and worsening after she was first diagnosed and treated, and also by discussing in detail the difficulties many people have coming off antidepressants. That is the glass-half-full part. But it didn’t dare to fully tell a story that illustrates how psychiatry’s current “disease model” of care can do such harm, and how, for many people, rejecting that model of care is the path to recovery. That is the glass half-empty part.