October 1, 2003

Out of Whack

The question, "Are we overmedicating our kids with psychiatric drugs?" was once again brought to our attention by a recent cover story in Time Magazine. I'll answer with another question, "How much more evidence do we need to decide something is terribly awry with our society and culture -- and especially with the way we address the behavior and performance problems of children?"

Rates of psychiatric diagnosis and medication use continue to soar. An estimated five million children take Ritalin type stimulant drugs. A national survey revealed one in ten eleven year old white boys to be on Ritalin. Data on other psychiatric drugs are less available, but easily millions take Prozac type medications and hundreds of thousands are on similarly untested (for children) medications like the anti-seizure drug, Depakote or anti-psychotic, Risperdal. It's now not uncommon to find three year olds taking Ritalin and teens on four different psychiatric drugs simultaneously.

Leaders in American child psychiatry say this increase in the use of psychiatric medication comes because of greater public awareness and improved diagnosis of children's mental illness. They point to prevalence surveys indicating 10% of American children have a disorder. These studies confuse symptoms with impairment (how affected are these children really?) and wind up medicalizing what was once extremes of normal coping behavior. All this "pathology" out there that needs treatment is used to justify and defend the alarming rise in meds for kids. People forget that at one time in the 1960s, using the psychiatric standards of the day, sixty per cent of people living in Manhattan were judged to be possibly mentally ill.

American psychiatry is missing the big picture. We have a major public health problem in our country and our doctors continue to focus on the individual. Before the biological revolution in psychiatry, doctors addressed the individual child's interior world. Now it's his brain that needs treatment. But really nothing has changed in that the larger social and cultural factors involved in generating stress and mental illness in kids are ignored.

Let me clue you in ñ if you didn't know this already. We live in a very busy very materialistic society. We have come to expect more from our children developmentally and educationally in the last twenty years than ever before. Five year olds are expected to read and every kid is expected to go to college. Discipline of children which has been eroding for decades is completely in the toilet (parents are too afraid or guilty to say "no" and a physical intervention has you worried about Children's Protective Services).

We have a public that has been manipulated to believe their kid has a brain disorder by the TV commercials of a drug industry. Doctors stand to be paid three times more by insurance companies to see four "med checks" rather than one psychotherapy session. Everyone is under pressure (economic and emotional) so the "quick fix" becomes attractive to all involved.
So what's wrong with that. Don't some of these drugs "work" to relieve symptoms and the distress of children and their families? The answer is a qualified "yes" on the short term but no one knows the long term effects and safety of most of these medications. Doctors, in their desire to help, run a great risk here of violating their Hippocratic Oath of "First do no harm."

But we are missing the big picture. Every day I write another psychiatric medication to "ease the suffering" of a child. In the same way, if a child presented with dehydration from acute diarrhea I would treat that child immediately with fluids without waiting to discover the specific cause of the illness. But over time, as I saw more children with the same condition, and learned they were drinking river water possibly contaminated by a factory upstream, it would be unconscionable for me to simply treat the diarrhea without at least raising questions about the source of this contamination. American psychiatry, by ignoring the larger public health issues associated with the huge rise in psychiatric drugs for children, runs the risk of being complicitous with values and forces that are harmful to children and families. When will we have learned enough to address this bigger issue of what's good for our kids?


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