Quotes of the Day

Ever since his coruscating book Mad in America was published in 2002, American Robert Whitaker has been a poster boy for the anti-psychiatry movement. In Mad in America (Perseus Books), he argued that the assumption of a physical cause for schizophrenia had given rise to many wrongheaded treatments, from ice-water immersion to today's antipsychotic drugs. These days, the Pulitzer Prize finalist makes a similar case against psychiatry over its approach to the treatment of depression.

No one knows for sure whether serotonin has a role in depression, let alone exactly what that role might be. But many doctors pretend they're sure, Whitaker says, because "psychiatry for a long time had a bit of an inferiority complex. It wanted magic bullets like everybody else." Trouble is, the magic bullets, including the SSRIs, don't work very well. By perturbing neurotransmitter activity they can make patients chronically ill, says the Boston-based author.

Is he alleging a conspiracy among psychiatrists? Not exactly. Psychiatrists are taught the biological models of mental illness and come to believe in them, he says. He recalls a recurring exchange he had with doctors while researching Mad in America:

Psychiatrist: The (schizophrenia) drugs are like insulin for diabetes.
Whitaker: No, they're not - you have no confirmed biological problem.
Psychiatrist: O.K., that's true.
Whitaker: So why say it?
Psychiatrist: Well, it gets people to take their drugs.

"So what they're doing is a little fudging to pursue what they believe is a good end," says Whitaker. "But at the same time they feel vulnerable because they don't have the science behind it and they don't have the outcomes, either." Those psychiatrists who break ranks and publicly question the biological models and the efficacy of psychiatric drugs, he adds, "get clobbered. They basically have their careers ruined."

The SSRIs, in his view, are a story of a "massively successful capitalistic enterprise" - and the idea that in countries like Australia there's still a multitude of people with undiagnosed depression should be considered in that context. These people are "not clinically depressed, anyway," he says. "The drug companies are setting forth an unrealistic vision of what it is to be human. They're defining normal stresses and worries as pathological, and the only reason they're doing it is that it leads to more business."

• Daniel Williams
• Ever since his coruscating book Mad in America was published in 2002, American Robert Whitaker has been a poster boy for the anti-psychiatry movement.