It’s been a couple of weeks since The New Yorker published a lengthy article on Laura Delano and the difficulties of going off psychiatric drugs, and since then I have been trying to assess, in my own mind, whether it marked a step forward in terms of the media’s coverage of psychiatry and its treatments, or, oddly, a reminder of how, when push comes to shove, the media will reinforce conventional beliefs.
In the weeks prior to April 1, which was when the online article was posted, I had my doubts about whether the magazine, arguably the most prestigious general interest magazine in the United States, would tell Laura’s story in full. I knew that the writer, Rachel Aviv, had been working on the story for close to a year, and yet Laura’s story—of how she had been harmed by psychiatry and its drugs, and how her journey back to a robust life centered on rejecting conventional psychiatry and its beliefs—was one that the mainstream media had always avoided.
Aviv surely knew her full story well, and had gotten editorial approval to invest months of work reporting it, and so I dared to wonder: would this be the time that the taboo was broken? And if so, would the dam then break, with articles now appearing in the mainstream press questioning the conventional “disease model” narrative that psychiatry, as an institution, has told to the public for the past 35 years? This would make for an astonishing turn in the public narrative that governs our society’s thinking about psychiatry and its treatments.
Indeed, as another New Yorker writer, Malcolm Gladwell, famously wrote about how dramatic societal changes occur, this article could become a “tipping point,” and perhaps soon the public discussion would be focusing on how psychiatry’s disease model has been a public health disaster, and how psychiatry, as an institution, sold us a narrative out of sync with its own science.
It seemed our society’s future discussion on this topic was at stake in this article, and this is why, a couple weeks after its publication, I think it is worthwhile to take a closer “deconstructionist” look at it.
Laura in Her Own Words
Laura’s personal story is well known to most MIA readers. In fact, it was Laura’s desire and willingness to tell her story that was a seed for the creation of this Mad In America website as a “webzine,” with a stated mission of serving as a public forum for “rethinking psychiatry.”
Laura wrote to me in 2010 shortly after my book Anatomy of an Epidemic was published, and after we met at a Cambridge coffee shop, I invited her to write a guest blog on my personal website, madinamerica.com. I’d had this website ever since 2002, when I published my first book on psychiatry and its history, Mad in America. Laura did so, and soon a physician who had read Anatomy of an Epidemic, Mark Foster, was writing a guest blog as well, and from there it was a small step to turning my personal website into a webzine.
Laura was the first person to publish her personal story on our new webzine, and, in addition to writing regularly on Mad in America, she worked for MIA for a number of years and organized our international film festival in 2014.
Like so many young people today, Laura stumbled into the world of psychiatry as a teenager, when she was experiencing some of the existential “Who Am I” anguish common to that age in life. At first, she resisted seeing herself through a “mental illness” lens, but after several years of taking psychiatric drugs, she accepted that she was “bipolar.” She wrote:
When Psychiatry had first attempted to indoctrinate me as a young teenager, I was not yet vulnerable or hopeless enough. When I eventually reached such a state, I surrendered myself immediately to a psychiatrist at America’s most prestigious private psychiatric institution, and became a full-blooded patient, passive and dependent and convinced of her brokenness, in a matter of weeks. I believed him when he said I’d “meds” for the rest of my life, and would have to learn how to “manage my symptoms” and “set realistic expectations” for myself. I was sure that the “Bipolar” diagnosis was the explanation for all my problems, and that the prescribed “treatment” would be my solution. I needed to be “Bipolar,” and I needed to want the antipsychotic, antidepressant, and sleeping pill prescriptions that were written for me at the end of that first session, because they gave me hope that something could, and would, change.
All told, Laura spent 13 years wandering lost in this psychiatric world of diagnosis and treatment, and it ultimately led to her nearly dying by suicide, and an ever greater number of psychiatric prescriptions. Then, in 2010, she stumbled upon Anatomy of an Epidemic, and suddenly she came to see herself—and her past—in a new light.
And how, just how, did I wake up? How did I awaken to, and from, this powerful indoctrination [into the “cult of psychiatry”]? Let me focus, for the time being, on The Moment. That is, the moment in which I began to wake up from 13 years of drugged, numbed, disconnected, psychiatrically labeled sleep. The moment in which I began to recognize and realize that everything I’d been told to believe about myself by Psychiatry was not necessarily true . . . You see, in that critical moment in May 2010, the spark that years ago had been fiery and bright in me was once again rekindled, the fuel, Robert Whitaker’s Anatomy of an Epidemic. Upon seeing its hardcover face looking at me from a “New Release” shelf in a Vermont bookstore, I couldn’t have predicted in my wildest imaginings that the result would be an awakening; indeed, I was so anesthetized by Psychiatry’s spell that I didn’t even know I was asleep. But something in the deepest parts of me—my life force, my élan vital—was stirring, and desperate for change. I was in an existential survival mode, although I didn’t know it consciously, and I was ready for something to be the catalyst. The timing was just right for it to be Anatomy, and despite how incredibly disconnected and sedated my mind was from five psychotropic drugs, my human spirit, still in me after all those years under the care of Psychiatry, began to stir.
In the years since, Laura has written about her transformation in any number of blogs, and how it began when she rejected psychiatry—its conceptions and its treatments. In her writings for Mad in America, she told of rediscovering “an authentic connection to self and world.” She wrote about “escaping” from diagnostic labels, waking up from a “pathologized adolescence,” the pursuit of “freedom” by leaving psychiatry behind, and psychiatry’s abuse of “human rights.” Indeed, she became a leading voice in the psychiatric survivor movement, speaking powerfully about these fundamental themes, all of which told of a paradigm of care that was doing great harm, particularly to adolescents getting caught up in its web.
Hers is a powerful story, and when Rachel Aviv called me up, all she really wanted to talk about was the moment that Laura and I had met in the coffee shop. Did I remember what we said? And in what way did I see Laura’s story as emblematic, or common to other adolescents who were diagnosed and treated with psychiatric drugs?
Laura and I spoke several times in the weeks before the story was published. We both wondered the same thing: was it really possible that The New Yorker was going to tell this story? If so, it would surely send shock waves through psychiatry and unsettle the public mind, for this would be the moment that a mainstream American publication was finally giving credence to a narrative that, in the past, had always been banished from mainstream media.
From my perspective, this was my own “moment” I had been waiting for. This could be the moment that our societal thinking about psychiatry and its treatments changed.
Deconstructing the “Moment” in The New Yorker
From a journalist’s (or novelist’s) perspective, Laura’s story follows a classic arc: Early good fortune, then a fall into a dark world, and then, following a dramatic turn in her life, she re-emerges into the light. And it is easy to see that Rachel Aviv’s article, for the first 4500 words or so, is following that script. She writes about how Laura was born into a wealthy family, then comes Laura’s existential “who am I” crisis as a teenager, which leads to diagnosis, drugs, and years lost wandering in psychiatry’s wilderness. And then—cue the drumroll here—comes Aviv’s telling of the “Moment.”
In May 2010, a few months after entering the “borderline” clinic, [Laura] wandered into a bookstore, though she rarely read anymore. On the table of new releases was Anatomy of an Epidemic, by Robert Whitaker, whose cover had a drawing of a person’s head labelled with the names of several medications that she’d taken. The book tries to make sense of the fact that, as psychopharmacology has become more sophisticated and accessible, the number of Americans disabled by mental illness has risen. Whitaker argues that psychiatric medications, taken in heavy doses over the course of a lifetime, may be turning some episodic disorders into chronic disabilities. (The book has been praised for presenting a hypothesis of potential importance, and criticized for overstating evidence and adopting a crusading tone.)
Laura wrote Whitaker an e-mail with the subject line “Psychopharms and Selfhood,” and listed the many drugs she had taken. “I grew up in a suburban town that emphasized the belief that happiness comes from looking perfect to others,” she wrote. Whitaker lived in Boston, and they met for coffee. Whitaker told me that Laura reminded him of many young people who had contacted him after reading the book. He said, “They’d been prescribed one drug, and then a second, and a third, and they are put on this other trajectory where their self-identity changes from being normal to abnormal—they are told that, basically, there is something wrong with their brain, and it isn’t temporary—and it changes their sense of resilience and the way they present themselves to others.”
At her appointments with her pharmacologist, Laura began to raise the idea of coming off her drugs.
The first thing you’ll notice about this passage is that there is no comment or explanation from Laura about why she found reading the book so transformative. Indeed, as written here, it would seem that Anatomy simply provided Laura with reason to consider the possibility of tapering from her medications. But why? We don’t really know. There is no mention that Anatomy enabled her to see herself in a new light, and that she now saw herself as having been turned into a mental patient by psychiatry. Her recovery would begin when she rejected all that psychiatry had told her about herself—and yet that is missing from this account.
Then there is Aviv’s treatment of Anatomy. Given that this is an article about Laura Delano, and how reading the book was transformative for her, the only journalistic need here is to have Laura explain why that was so. But instead of writing about that, Aviv veers off into a brief discussion of Anatomy, and she does so in a way that could be expected to bring comfort to those who would defend the conventional narrative.
Anatomy of an Epidemic puts the conventional narrative under a microscope, and it does so by relying on psychiatry’s own published research. Anatomy tells of how researchers, dating back to the late 1970s and early 1980s, were failing to find that simple “chemical imbalances” were the cause of major psychiatric disorders, and how, in fact, they were finding instead that the drugs, over time, induce the very chemical abnormalities hypothesized to cause the disorders in the first place. Anatomy then focuses on research regarding the long-term effects of psychiatric drugs, and makes a case that these medications, over the long-term, increase the chronicity of psychiatric disorders. It tells too of how the diagnosis of ADHD, adolescent depression and juvenile bipolar took off in the 1990s, helping to expand the market for psychiatric drugs,and how this “pathologizing” of childhood was turning adolescents into lifelong mental patients.
But that book is not to be found in Aviv’s piece. In its place is a book that is much less threatening to the conventional narrative. In Aviv’s description, Anatomy of an Epidemic “tries to make sense” of a paradox, and it does so by presenting a “potential hypothesis,” which is that psychiatric drugs, when taken at “heavy doses over a lifetime,” may turn some episodic disorders into chronic conditions. In other words, the book’s focus is about the “overmedicating” of some patients (as opposed to a book that tells of a paradigm of care that has done great harm), and it probably shouldn’t be taken too seriously anyway, because critics say that I “overstate the evidence” and write with a “crusading” tone.
At that point, defenders of psychiatry—unnerved by Laura’s story that led up to these two paragraphs—could breathe a sigh of relief. Laura’s story was now being shoehorned into one about the difficulties of coming off drugs, with psychiatrists and others then commenting about how this was a concern that the profession needed to tend to, and not one, if Laura’s story had been fully told, about how her recovery began when she rejected the conventional narrative, seeing it as both false and harmful.
In that way, the Tipping Point bullet was neatly dodged.
Part Two of the New Yorker Article
With the article now having pivoted into a new subject, it doesn’t tell anything about Laura’s fierce psychiatric survivor writings, or her working for MIA. Instead, the article becomes, as the title for the online story indicated, a story about “The challenge of Going Off Psychiatric Drugs,” with Laura’s struggles detailed in that regard.
This does serve to give much-needed attention to a problem that, for the most part, has long been ignored by the media and downplayed by the psychiatric profession. The New York Times wrote about this a year ago in an article titled “Many People Taking Antidepressants Discover They Cannot Quit,” and recently it has become a subject of much discussion in the UK media. This New Yorker article will help push along public recognition of this problem, and as such, it serves as a crack in the conventional narrative, and thus might open the door to further investigations of the problems with our current “disease model” paradigm of care.
At the same time, The New Yorker article, even as it told of Laura’s difficulties coming off the drugs, drops in a number of reminders of the good that psychiatric medications can do, and how Laura’s experience may be seen as an exception to the rule. In other words, it places Laura’s story within a context that preserves the core of the conventional narrative.
Here are some of the “facts” dropped into the piece that come from the conventional narrative:
- Roughly a third of patients who take antidepressants do not respond to them (which is to say that two-thirds do.)
- The drugs provide a “relief of suffering (that) is of a different order of magnitude than the symptoms when you stop taking them.”
- “Most people who discontinue antidepressants do not suffer from withdrawal symptoms that last longer than a few days. Some experience none at all.”
- Journals may be hesitant to publish articles about withdrawal “because no one wants to deter people from taking drugs that may save their life or lift them out of disability.”
One wishes that The New Yorker’s vaunted fact-checking process would have investigated these claims. Here is what they would have found:
The notion that 67% of “real-world” patients “respond” to antidepressants is one that has been promoted before in The New Yorker, with the STAR*D trial cited as the evidence for it. While it is true that the STAR*D investigators did indeed report that 67% finding in the abstracts of their published articles, we now know that nothing like that actually happened in the study. This was the largest antidepressant trial ever conducted, with the “real world” patients given four chances to respond to treatment, and, as a reanalysis of the data recently found, only 33% “responded” to the treatment. A smaller study of antidepressants in real-world patients reported that only 19% had responded to an antidepressant. Industry-funded trials do report much higher response rates (60%), but those trials enroll a select group of patients more likely to respond to the drug, and of course what the public would like to know is the response rate in the real world.
The magnitude of “relief” provided by antidepressants is, as seen in RCTs of the drugs, vanishingly small. In industry-funded trials, the “relief” provided by antidepressants is of such a small magnitude—a three point difference on the Hamilton rating scale for depression (HAM-D) between the medicated and placebo groups—that it is too small to even be clinically noticeable, as it takes a seven point difference on this scale before clinicians can recognize that a patient has even marginally improved.
As for the claim that “most people” who discontinue antidepressants do not suffer withdrawal symptoms, in 2018 researchers who analyzed 17 withdrawal studies concluded that 56% of antidepressant users experience withdrawal symptoms, half of whom described the symptoms as “moderate or severe.” Forty percent of those who experienced withdrawal effects suffered them for at least six weeks. This would also suggest that the “magnitude” of the suffering from withdrawal symptoms is, in fact, much greater than the relief of suffering provided by antidepressants in the first place.
Finally, there is ample data that antidepressants, rather than “lift” many people out of disability, dramatically increase the risk that a person with depression will become disabled. A Canadian study found that use of antidepressants doubled the likelihood that a person will go on long-term disability. In a similar vein, an NIMH-funded study of depressed patients found that the “treated” group were seven time more likely to become “incapacitated” than those who did not get treatment. And in country after country that has adopted widespread use of antidepressants, the number of people on disability due to mood disorders has dramatically increased as well.
This quick review of these four claims made in The New Yorker article is an example of the kind of analysis that sustains the counternarrative and can be found in Anatomy of an Epidemic, which provided Laura with a way to see herself in a new light. But The New Yorker article didn’t dare go there.
A Glass Half Full, or Half Empty?
So what are we to make of the New Yorker article? On the one hand, it does provide an account of a bright young woman who fell into the world of psychiatry, with its diagnoses and drugs, and fared poorly there, nearly dying from a suicide attempt. And it does tell of how once she withdrew from her medications, she regained a full and meaningful life. In that regard, it does break new ground, and opens the door to other more critical examinations of our current paradigm of care.
However, The New Yorker didn’t dare tell Laura’s story in full, which is that her recovery resulted from seeing herself within a counter-narrative that tells of the harm that psychiatry can do with its diagnoses and drugs, and of how the conventional narrative is built from claims that are belied by a close examination of its own science. Instead, by the article’s end, it had located Laura’s story within a conventional narrative, a world where antidepressants help two-thirds of all users and most people don’t suffer withdrawal symptoms, with psychiatrists now tending to this problem that afflicts a minority of users.
Given the dual nature of the article, I do wish I knew more about the editorial process that governed its publication. My own guess—and this is indeed a guess—is that the writer, Rachel Aviv, may have set out to tell Laura’s story full story, or at least to give an account that was closer to it. But newspapers and magazines have their institutional boundaries, and so I wouldn’t be surprised if the sudden pivot of the article—from a personal article about Laura into one about coming off psychiatric drugs—came about during the editing process, with the little digs at Anatomy dropped into the piece that way as well.
I have heard from many people about the article, and their reactions have been quite varied. Some focused on the fact that it did break new ground, with its report on how, in Laura’s case, diagnosis and treatment led her to such a despairing point. A couple of journalist friends noted the bizarre turn it took partway through, from an article that was chronicling Laura’s life to one on the travails of psychiatric drug withdrawal. Several noted the sly dig at me and Anatomy, with a text from my daughter my favorite: “I was reading one moment about dinosaurs and the next about how my father has been on a crusade!”
All of which is to say, I think the article does show that the “general media” boundaries regarding what is permissible to write about psychiatry are expanding, and that is a very good thing. However, that doesn’t mean that you’ll be reading any time soon in any general interest magazine or newspaper a story that entirely breaks with the conventional narrative that psychiatry and its drugs, on the whole, provide relief to a great many people suffering from “illnesses” of the brain. The thought that psychiatry’s “disease model” has produced a public health disaster remains beyond the pale.