Robert H. Belmaker’s review of Robert Whitaker’s Anatomy of an Epidemic
Edward Shorter’s comment


          Bob Belmaker is one of the most distinguished senior figures in psychopharmacology -- a scientist of real distinction -- and it would be imprudent to attack him on trivial grounds (he found Whitaker "enchanting," the evening together with him "magical," etc.). I do, however, have two comments, one about Belmaker, one about Whitaker.


1. On Belmaker: I blanched at his casual affirmation that "research in schizophrenia and depression clearly presupposes multiple neurotransmitter abnormalities." The problem here is not with the assertion that the neurochemistry is complicated but that these disorders exist at all. There is no such entity as "depression." There are different kinds of mood disorders and to reduce neurasthenic depression, melancholic depression and atypical depression (all of which have little in common) to the simple notion of "depression" flies in the face of science. A massive pushback against DSM's "major depression" is currently underway and to see Belmaker assert that "depression" exists as a simple, undifferentiated entity is discouraging. Ditto for "schizophrenia." We have been unpacking Kraepelin's "dementia praecox" (Bleuler's "schizophrenia") for some time now. The term clearly encompasses several different and unrelated psychotic disorders and is as useless as "hysteria" in terms of a scientific construct. Catatonia is the most recent chunk to break off the "schizophrenia" mass and other chunks will doubtless follow, so that at the end what remains will likely be Hecker's homogeneous "hebephrenia."


2. On Whitaker: I am not a fan. There is a paranoid note that runs through a good deal of recent writing on industry's involvement in psychopharmacology. Having now seen a lot of internal industry correspondence, I am impressed by the dedication to science of industry's in-house researchers. This emerges quite strongly at Lilly, for example. Roy Vagelos's memoir,Medicine, Science and Merck (Vagelos and Galambos2004), is totally impressive as evidence of the commitment to science of a major drug house. It is true that many research departments have been overpowered by the firms' marketing arms, but this is not something that has happened in concert. The companies, desperate to stay afloat, are all cutting the same corners. It's deplorable, but well known and not evidence of industry's intrinsic wickedness.



Vagelos  PR, Galambos L. Medicine, Science and Merck. Cambridge: Cambridge University Press;2004.


February 14, 2019