Letters from the Front Lines



An encounter from this week:

I saw a 24 year-old theater actress who was started on Lexapro nine months ago for a one-time “panic attack” and has gained sixty pounds since.  This is extremely distressing to her as her physical appearance and fitness is essential to her job.  She suspected the weight gain was being caused by the medicine, and so she went to her prescribing family doctor and he said that, no, it wasn’t from the Lexapro.  She couldn’t account for any other lifestyle changes that would cause such dramatic weight gain.  He checked her thyroid and said it was fine, and so he told her to exercise more and eat less.

At a subsequent visit, she asked him straight-up if she could stop the medicine, and he said no, because it was working so well to control her panic attacks that she should stay on it at least a year and maybe indefinitely.  He reassured her it was a very safe medicine and it was not causing her any side effects.  She tried to stop it on her own anyway, and after three days without it felt dizzy and then had a horrible panic attack.  This confirmed to her that he was right:  she had a disease and needed the drug.

Later, she told him she couldn’t concentrate anymore (unable to memorize lines), and he diagnosed her with ADD and started her on a stimulant.  In all of this, he never recommended any remedies for her mood or thought disturbances except drugs.  She lost a little of the weight after starting the stimulant and found she could concentrate better, but started having insomnia.  So he started her on Ambien.  It worked to help her sleep, but the daytime fogginess got worse, so he increased her to the maximum dose of the stimulant.  At this point, she became frustrated that he wasn’t really listening to her, sick of taking pills, but she didn’t know where else to turn.

A friend recommended that she try a new doctor, so she happened to come see me, not knowing anything about my take on mental health alternatives.  When she saw me, she was disheveled and tearful.  She now carried the diagnosis of three diseases (panic disorder, ADD, and insomnia), was taking three medications, had become suddenly obese, and most distressingly, was feeling mentally worse than ever.  She said she felt like her head was in a fog all the time.  Her panic attacks had returned along with chest pain, she couldn’t concentrate, she was moody and volatile, she couldn’t sleep at night, and the theater manager told her she had to figure out what was wrong soon or she would lose her job.  She didn’t know what was wrong with her, but felt like in a year her life had fallen completely apart.

After a long discussion and a medical evaluation, I told her that I was worried that all of her problems had been caused or worsened by the medications, and that we seriously needed to consider coming off of them.  We came up with a plan to taper over the next three months, one medicine at a time, supplementing with lifestyle changes, acupuncture and counseling.  We’ll hope for the best for her.

So the questions I ask are these:  why did her primary care doctor, who I assume had the best of intentions and did not intend to harm this young woman, jump to the conclusion that she needed drugs after she had one panic attack?  Why did he not question the need for the medicine once she started showing such known side effects?   Why did he continue diagnosing her with more diseases and adding more drugs?   Why is there no safety net to catch patients like this, who are being slowly drowned by the system, or to catch recklessly prescribing physicians?

I was fired from my employed position last year in part because I had started cautiously helping patients withdraw from drugs that seemed to be hurting them.  The hospital was concerned that my methods fell outside of the standard of care, could be harmful to patients, and thus did not represent the hospital’s interests well.  But do you think this patient’s original doctor will ever be questioned by any employer or licensing board for diagnosing and prescribing with such abandon?  No, he won’t be.  You would think it would be in the best interest of her insurance company to ask this question:  “How come this previously healthy, active young woman, in the course of nine months, now requires three medications at over $200/month, in addition to multiple office visits and blood testing?”

In short, why do we primary care doctors, who prescribe over 75% of psychiatric drugs in America, practice the way we do?

In my next letter, I’m going to offer an answer to this by offering examples of recent “Continuing Medical Education” activities that I have received, which are thinly disguised, unchallenged propaganda for the biomedical model, all coming from expert psychiatrists who have multiple ties to drug companies.

Best regards,


Editor’s note: These letters are selected from an exchange that Dr. Foster and Robert Whitaker have had since he read Anatomy of an Epidemic. They describe his interactions with his patients, and his changing thoughts about the prescribing of psychiatric medications. In all of these letters, the specific patient situations he describes are real, but all identifying characteristics have been altered or obscured, or permission has been sought, in order to protect patient privacy.






Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. I really love the real life situations you describe on your blog. Occasionally, I get frustrated and think, well,why can’t people exercise a little common sense when it comes to (a) trusting their doctors and (b) downing multiple meds for a plethora of mental health conditions, most of which have only been invented in the past 20 years. But, the meds and fake diagnoses (in many cases) have crept their way into the public consciousness. People trust their doctors, which is a huge mistake in the absence of personal vigilance. Keep up the excellent work you are doing.

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  2. I’m sorry, but I read this and I want to shout, “Custard Pie her original Dr!” I have no idea why I’m apologising…. I’d expect similar treatment from my local street drug dealer as she got from her GP.

    This really deserves a mass movement with people picketing surgeries who practice this kind of mass drugging of the population with these dangerous drugs.

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  3. “In short, why do we primary care doctors, who prescribe over 75% of psychiatric drugs in America, practice the way we do?”

    Love your articles Mark.
    Some folks in Ohio have been asking physicians just this question. We believe them when they tell us that they would rather NOT treatment mental illnesses since they have no training but feel “compelled” when clients bring it up during their 8-9 minute office visit. Most doc’s aren’t aware of local alternatives to meds but even if they can/want to refer the person the person may not follow thru or would prefer something more immediate (talk therapy is time consuming and difficult afterall). In short, there can be only one outcome/result of a 8-9 minute visit around treating mental illness. “Every system is perfectly designed to achieve exactly the results it gets.”

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  4. Thank you for your intuitive blog on the dangers of sudden drug prescriptions for a seemingly one time episode. I had told my physician I’d had a horrible panic attack and when it had happened. He said the medical procedure I’d gone through earlier that day was enough to cause it. He listened and realized yes she did have a panic episode but it was warranted.

    I am so glad you are helping clients reduce and carefully taper off drugs you both had found were not needed.

    It’s hard to understand your former employer saying reducing or eliminating unnecessary drugs is outside of the standard of care. Makes me wonder about the politics that came into play.

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  5. Here is a thought. A definition of a cult is a group of people with clear leadership who uses specific methods to gain and keep control over others. In this case pharmacological companies and certain doctors with clear knowledge to the contrary who stands to benefit financially by not being honest are the cult leaders.

    The cult members are the unfortunate patients, and certain doctors being kept in the dark who follow blindly where authority leads.

    In his book Combatting Cult Mind Control, Steven Hassan describe his BITE model of how cult leaders control their membership. The methods to keep cult members under control include –

    Behavioral Controls – Certain behaviors are rewarded others are punished or a person is threatened with dire consequences if the behavior is not continued. In this case behavioral control could easily be the push towards taking medications by an authority. Behavioral control also includes the rewards drug companies give doctors who are good pre-scriber’s, the rewards doctors give patients who faithfully swallow the pills and the “you are very sick” ideology.

    Information Control – Certain information is deliberately with held, distorted or invalidated. IE, drugs are described incorrectly. Side effects are deliberately ignored and swept under the carpet. Effectiveness of drugs is lied about, and off label prescribing encouraged.

    Thought Control – certain ideas and dogmas are heavily advocated for. Threats such as you or your family will get sick, die, not live to your potential etc are used to keep the person’s thoughts under control. Previously “normal” things are redefined. IE, I am having a bad day, feeling sad and tearful can become you are severely mentally ill and need medications. Or, the promotion of the “sick brain” idea to the exclusion of all other ideas. Testing other hypothesis strongly discouraged – IE, I wonder what will happen if the doctor help me to get off the medication is a hypothesis that is discouraged. There can often be a clear difference in use of language. For instance someone might start to refer to a disease rather than an experience of feeling sad.

    Emotional Control – Phobia indoctrination – IE if you stop the medication you will get very sick and terrible things can or will happen. Emotional experiences engineered to validate incorrect ideas. In this case, a patient who is not helped to taper off drugs might go off the drugs all at once and have withdrawal symptoms thus incorrectly validating the doctors dx. Emotional control can also include a doctor being threatened with discharge from a job if he doesn’t prescribe according to ideology, or if he questions the status quo.

    This of course is a very quick overview of some of the controls in cults – all controls exist throughout our society but are increased in cults. I would expect some of it in the medical field, but has it gone too far? Are we dealing with a very large scale destructive organization in the medical field?

    Ohh, and cult members in this case could even be Doctors who are indoctrinated to prescribe – Cognitive Dissonance will keep them obedient to their training. (Dr. Steingard, this is one for you) Cognitive dissonance is a huge part of what keeps cult members in their respective groups for so long. Think of Heavens Gate. First the members were isolated and waited for the aliens to transport them to outer space. Then their thinking and language as it related to the aliens were completely controlled. Sexual thoughts were not allowed – so, the men were encouraged to castrate themselves. First they allowed the isolation to happen. Then they rejigged their thinking to the extreme. Finally, suicide didn’t seem so extreme. Each successive step made it more likely that cognitive dissonance would keep them taking the next step.

    Listed control taken from the book: Combatting Cult Mind Control by Steven Hassan. http://www.freedomofmind.com.

    Sorry I didnt take the time to do a full accurate quotation deal, I am not (currently) in school and not a scientist.


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