Reviewing Whitaker's Anatomy of an Epidemic.

Medical Concept

Robert Whitaker wrote the book called “The Anatomy of an Epidemic.” The book addresses the challenges concerning the medical model of mental health diagnosis and treatment. Whitaker outlined the history of the psychopharmacology era. He wrote that the government and early researchers tried to find a magic bullet to cure mental illness. In this journey, they found many misdiagnoses and discrepancies. He found that early researchers and pharmaceutical companies misguided the public about medication; that is, he found test results being misconstrued. For example, Whitaker found that there is no evidence that brain dysfunction is the reason for mental illness. Whitaker explains that research has proven that some medication blocked the neurotransmitter thus causing the mental illness rather than curing the mental illness. He focuses on military recruitment efforts and how the government influenced the mental health industry. His book explains the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) from the American Psychiatric Association and how it came about to establish the industry of psychiatry. Whitaker argues that the DSM III saved the industry by clearly outlining the symptoms from professionals' observation. Even though there was no definite cause of mental illness, the DSM III verified that it exists and should be known.

Whitaker explains how the government and lobbyists detour “the paradigm of care,” which emphasizes that the medical model has to be more than medication and medication should only be half of the treatment. For example, Whitaker (2015) states that "60 % of those with a bipolar diagnosis said they had initially fallen ill with major depression and had turned bipolar after exposure to an antidepressant” (p. 181). This shows the paradigm of care has not been used by the government influenced by lobbyists. Lobbyists and paid contributors would talk about the good of medicine to profit themselves. Another source influencing the paradigm of care is the product's manufacturers who hire celebrities to talk about the effectiveness of a product such as Thorazine from their experience and thus promote the pharmaceuticals’ product. Even pharmaceutical professionals were given millions of dollars to approve of products that were not safe and harmless. For instance, Whitaker states “as for the drugs, we discovered that there is no scientific breakthrough that led to the introduction of Thorazine and other first-generation psychiatric medications” (Whitaker, 2015, p. 206). Whitaker shows the scandal of the industry and the lack of honesty. He explains that even when he was writing the book, some experts wanted a good recommendation about their services.

Thus, Whitaker claims seeking a cure is too ambitious. He explained how the scientists, in the beginning, came up with the idea of isolating the illness and how this leads to discoveries. These discoveries were created to solve mental illness but instead, some of the effects of medication made the crisis worse. While examining the mental health crisis, Whitaker offered hope. He interviewed clients, who understood that medication was not the only answer for their recovery. In his book, Whitaker (2013) explains Cathy Levin’s case, which shows the drugs only stabilized her for a short-term. She was not told if the drugs would stabilize over a long period, which made her life chaotic. This example shows even though medication is critical to her recovery, it is not stable. Some clients detailed the horror stories of their treatment. For example, Whitaker discusses the case of Scott Sexton, who took Zxprexa, which later caused pancreatitis, “but the doctors at St. Luke’s didn’t connect the dots” (Whitaker, 2015, p. 215). That is, doctors did not find the side effects of Zxprexa. As a result, clients may experience serious side effects and sometimes death. Still, others may recover without the medication and clients should control their recovery. In this paper, I will reflect on the person-centered perspective based on Whitaker’s book and finally conclude with implications and reactions to Whitaker’s book with research.

Reflections on Person-Centered Perspective as the Medical Model

Whitaker argues that politics shaped the person-centered perspective as the medical model. Politics created many problems for people with mental illness. The military recruiters placed many people into the mental illness category because the government considered homosexuals as mentally ill. This fuels public stigma for people with mental illness. The DSM III even stated that people who are homosexual were mentally ill until positive politics and the changing of the times caused the American Psychiatric Association to permanently remove this diagnosis. The first mental health institute was created out of political motivation because it was “enacted by law through Congress created the National Institute of Mental Health (NAMI) to oversee reform for prevention, diagnosis, and treatment of mental disorders” (Whitaker, 2015, pp. 45-46). This is significant because it shows the government recognizing mental illness as an epidemic. However, Whitaker (2015) explains that the government rid the Freudians out of the research for NAMI when the government’s primary researcher removed their leader, Loren Mosher and restricted the industry to accept the biomedical model (p. 272). Freudians believed that talk therapy is the key to recovery for individuals with mental illness. However, the government should reduce stigma and be neutral in the research process. Politicians and the government should better regulate the money issue with mental health and make sure that pharmaceutical companies are not hiding and exploiting the mental health community. Whitaker shows that there is hope because of politics. For instance, the book shows that mental health lobbyists threatened to go on a hunger strike if the Surgeon General did not declare that there was no brain abnormality and no real cause to mental illness, which the Surgeon General did. This shows that politics are important to a person-centered perspective and can aid or challenge the medical model.

Secondly, biological factors are a part of the medical model for a person-centered perspective. Whitaker has many anecdotes and conclusions about biological effects. Most importantly, clients know their bodies better than clinicians. Their reactions should be considered imperative to the process. Whitaker (2015) explains that clients can recover reducing medication in the case of George Badillo, who had a mental illness such as schizophrenia. George Badillo was able to exercise and live a normal life when his doctors reduced his medication and how he only used medication to sleep at night now. In a case, Whitaker described how the long-term effects of schizophrenia can clear up over time without medication. Clients might not understand the potential side effects and that some of their issues can be resolved if they received talk therapy. Furthermore, medication should not be given without noting their side effects. Clinicians have to do more than provide medication. Clinicians must provide overall care. Clinicians must listen to the effects on clients and believe what clients say. Whitaker introduced the idea of exercise therapy and natural alternatives. These alternatives can be healthy and help reduce side effects. Some people died because they took medication alone. Therefore, clinicians should stress healthy living along with medication. They should have open communication about medication and keep clients in control over their health process. Clients should know the effects of medication on their minds and what it could do to them. For example, in Whitaker’s book, some people lost their livelihood and capacity to function due to a lack of understanding and proper care.

Thirdly, the environmental factor is part of the person-centered perspective on the medical model. Whitaker tries to understand the effect that hospitalization has on clients. It can determine whether they succeed or if they are defeated. It can determine their goals and be a part of their recovery. Their environment should be assessed for safety and comfort to prevent a relapse. Certain environments may be traumatizing to clients and may cause a negative reaction. Clients need to feel that their home is secured. Whitaker (2015 found “a group of young children in a residency program in the Seneca Centers homes, who stopped their residents from taking medication and who helped severely troubled children” (p. 346). The young children’s environment created the necessary atmosphere for them to experience recovery without medication. Clients must be able to set goals and be around others who believed in them to complete goals. Whitaker explained that group homes can be setbacks too when there is a negative influence. Whitaker explained that an environment can make or break the client. The clinician must thoroughly examine the environment of the client and provide the means for a client to stabilize the client's life. Clients may have an emotional attachment to the environment and the clinician must dismantle the reliance. Clinicians should not be afraid to meet clients in their environment and structure their environment to make the client feel comfortable and safe. Therefore, the environment is a major influence on person-centered perspective because it can be a goal or a challenge to the client.

Lastly, the social factor plays a role in the person-centered perspective on the medical model. Whitaker found that family can be a protective factor in determining whether the medication is working. Family can be motivation for the client as Whitaker detailed in the book. For example, George Badillo suffering from schizophrenia “benefited by gaining custody of his daughter”, which helped him in his recovery by giving meaning and purpose (Whitaker, 2015, p. 23). That is, family support can be helpful for clients as they recover. Friends can also be helpful for clients; they can be there if the family is not around. Friends can be found in group homes or clinics. Whitaker states that clients need outside support of their recovery process as a resource. Social support can reduce the stigma because it lets clients know that they are not alone in their crisis. They need doctors and clinicians that believe in them and support their treatment and choices. Clients and clinicians need to build a relationship that is beneficial to their client. Friends and family can provide immediate support. This can also be a part of the client's goal. Therefore, social supports are an important part of a person-centered perspective.

Political, biological, environmental, and social factors were detailed by Whitaker in his book. Government and politicians can fight stigma. Politicians and the government have to make sure that the research is not influenced by money. Clients benefit from a reduction in stigma and must lobby politicians to provide productive change. Biological factors deal with the influence of the client recognizing that medication is not the answer to every problem. Clients should be the center of the process of managing their health. Clients should be free to choose their environment and they should not be locked down in hospitals without solid reasons. Social factor deals with family and friends. They should be seen as extra support and to validate the health of the client. The social factor can be a part of the goals and wants of the client. Doctors and clinicians can be a part of social support if they are beneficial to the client and effective support.

Implications

Clinicians should tell a client that asks them the cause of mental illness that the causes are unknown. The American Psychiatric Association created the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) to state that mental illnesses existed. Clinicians should reassure them that mental illness is real and prevalent. I would use the manual to describe to them the symptoms of their illness. I would insist that the manual changes with evolving social norms and that the expanding range of behaviors, emotions, mental states, and human conditions came to be labeled as a deficiency (Saleeby, 2001). Clinicians should try to identify client’s strengths and build a recovery based on it. Clinicians should ask clients specific questions to verify their illness and ask them for consent before doing any further testing. Clinicians should ask clients for consent to speak to their social support to validate their concerns and to speak with previous counselors. Clinicians must say that DSM-5 does not consider “assets, capacities, knowledge, survival skills, or personal virtues” (Saleeby, 2001, p. 184). This statement helps clients understand that they are still valuable and worth care in spite of the client’s mental illness. This information would help ease the effects that mental illness has on clients if they are confident in clinicians. Clinicians should reassure clients that medication and healthy living can be helpful and that others used these processes before. I would maintain that the client has full control over their recovery. I would use talk therapy and a person-centered perspective in my approach. I would mainly examine biological, political, social, and environment affect. Clinicians should examine the client’s thoughts and feelings about the disorder (Walker, 2006). I would check for imbalances and making sure their recovery overcome the pathology. I would work with them to set goals to construct their recovery. I would explain to the client about the prevalence in the manual and the cultural implications. I would relate the manual to their current symptoms. I would ask for more detail on specific symptoms that are listed within the manual. Clinicians should say that the DSM-5 disregards achievement such as “environmental, quality of life, dignity, and stressful situations”, which are a part of recovery and the medical concept (Saleeby, 2001, p.184). Clinicians should say that they can live 30 years or more if they stay on recovery and that their mental illness does not define them (Whitaker, 2010). Even medication can be altered to fit their lives and keep them healthy.

Additionally, other thoughts about Whitaker’s book and its implications were as followed. I did not know all about the influence of lobbyists. I did not know all the people that were paid to make a product look good in the eyes of the public. They had untrained people and celebrities approved dangerous products based on their experience. They also had experts who were paid millions. However, I was glad that there was hope in this book for the medical model. There was hope for the idea of a paradigm of care. Clients need to know that medication is not the only way for recovery. They should be told all the avenues for recovery and their recovery should be a health-focus and person-centered focus. Whitaker revealed other methods of supporting recovery such as exercising. I was disturbed by the undiagnosed children. It took until the 1980s for children to be diagnosed. The medication was causing an increase in the epidemic of mental illness because more people were getting ill due to medication. It makes me think carefully about depending on medication for client’s recovery because of its influence from pharmaceutical companies.

Finally, there are important matters that clinicians should note in their practice based on Whitaker’s book. In practice, we must maintain a level of credibility. We have to rely on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition for reference. Clinicians also must take into consideration the limitations and history of the manual. We cannot lie to our clients. Clinicians have to relate to them through a person-centered perspective. We have to analyze every part that relates to them to find out their wants. We have to make sure that there are no setbacks that may be caused by such effects as the environment. We have to analyze social interaction and relations. Clinicians have to be politically aware of the influence of money and resist giving medication based on it. We must be constantly aware of the effect of a biological factor. Clinicians must let them know that there is hope in person-centered perspective letting them choose the purpose. We need clients to connect to their sense of self and inner resilience. These are the keys to a secured recovery and will strengthen the medical model.

References

Saleeby, D. (2001). The diagnostics strengths manual. Social Work, 46(2), 183-187.

Walker, M. T. (2006). The social construction of mental illness and its implications for the recovery model. International Journal of Psychosocial Rehabilitation, 10(1), 71-87.

Whitaker, R. (2015). Anatomy of an epidemic. New York: Crown Publishing.