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The Atlantic Monthly
Tuesday, April 9th, 2002


Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill

by Robert Whitaker

A review by Daniel Smith

People who concern themselves with the treatment of the mentally ill can generally be put into one of two categories: those who push drugs, and those who push therapy. In this historical philippic the medical reporter Robert Whitaker firmly sides with the latter. He marshals all the attributes of investigative journalism the liberal use of quotation marks, the tireless attention to malfeasance, the deep-rooted mistrust of authority to argue that what he stubbornly calls "mad medicine" is and always has been misguided in its emphasis on physical therapies. His narrative begins in the "unheated, dingy" asylums of the eighteenth century and goes on to describe such ingenious innovations as bleeding, forced sterilization, organ removal, induced coma, and lobotomy. But the author's main concern and the subject of more than half of this book is the drug revolution, sparked by the introduction of Thorazine, in 1954. From that moment, Whitaker argues, psychiatrists picked up their prescription pads and dropped their patients, distracted by a need for acceptance from the medical community and by the lavish attention of pharmaceutical companies.

Whitaker's book, though marred by a lack of focus and by an overeagerness to ascribe unattractive motives to well-meaning scientists, scores a few valuable points. It is most damning in the evidence it gathers of the collusion between pharmaceutical companies and medical researchers an unholy relationship if ever there was one. The book is most sensible in its call for humility. Biological psychiatry has made tremendous and valuable strides in the past fifty years (most of which Whitaker doesn't acknowledge), but the field is still an infant that acts like a grandfather. What we don't know about the causes of mental illness dwarfs what we do know, so an abiding concentration on the experience of the patient, which this book advocates above all else, is in itself a valuable prescription.

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