The Deputy Juvenile Officer, the representative of the court, diligently scribbled notes into the boy’s file while the child’s case manager, the person in charge of navigating the murky waters of the state’s foster-care system droned on about attention seeking misbehaviors and individualized education plans (IEPs). The drab décor of the courthouse room reflected the manner in which the nine people present to decide the future of this child conducted themselves. The overwhelming sense of routine and the overall lack of enthusiasm for the decisions being made were appalling. One voice spoke up. One voice dared ask a question of the team. One person was willing to wonder why it is that this child is being treated with nine different psychotropic medications to treat symptoms ranging from mild depression to severe anxiety. Why is this 7 year-old boy taking so many different medications to treat issues he didn’t have at the last foster-care home he was in? Does this boy have actual issues or is the foster-care system just too busy to deal with the real needs that a child in severe distress might have?
While there are certain situations where psychotropic drugs are necessary for the treatment of severe psychological disorders, many cases of misdiagnosis and improper application of the drugs exist. This misappropriation of these powerful drugs can lead to severe psychological damage to children. It is the responsibility of those in authority, parents or otherwise, to cut through the hype and pretense offered by the media, the marketing departments of the major manufacturers, and overzealous physicians pandering to the whims of distressed families and get to the core of the psychological issues at hand for the health and long-term well-being of our children.
Child psychology and the research done to support the presence of psychiatric disorders in children is fairly new. Most of the fifty or so years that research has been done have been spent working to convince the medical fraternity and the public at large that these conditions do exist; that children are not just a product of poor parenting or other environmental concerns (Elliott 15). To contrast that reality, the adult mind has been studied for nearly all of recorded history. As far back as Ancient Greece, scholars like Socrates, Aristotle and Plato asked questions and formulated hypotheses on the inner workings of the adult mind. Aristotle wrote the first book on psychology called Para Psyche around 300 B.C.E. In it are mentioned several of the ideas upon which modern psychology are based (Boeree 23). Throughout the next 2000 years, many would pose questions, and many would seek answers. Finally in 1808 Johann Christian Reil began using the term psychology to define the study of the mind (Wallace 291). Throughout this lengthy study of the adult human mind, childhood was generally regarded as a developmental period in which the parents and the environment were largely responsible for the behaviors and shortfalls of children (Eliott 15). Furthermore, it wasn’t until 1946 that Anna Freud published her book The Psychoanalytic Treatment of Children which, for the first time, explored the basic ideas of psychology in children (History of Psychology).
Given that research into the developing minds of children is so new, it is questionable whether the research regarding the treatment of newly labeled childhood psychological disorders is sufficient enough to warrant the heavy-duty psychotropic medications being prescribed to treat them. In his book, Straight Talk About Psychiatric Medications for Kids, Timothy Wilens, a medical doctor at Massachusetts General Hospital talks about the conflict that has arisen from the treatment of adolescent mental and emotional problems with powerful psychoactive substances. He states that, “Conflicting reports abound mainly because child psychopharmacology is still a relatively new science.” He goes on to state that, “Psychoactive substances have been a standard psychiatric treatment for adults for only about 50 years; for children, only about 20 (Wilens 21).” While 20 years is a long time, consider the research done on cigarette smoking. Consider the moral and philosophical debates, the political battles fought and won on both sides and the emotional undercurrents that have been sparked over that last twenty years let alone the last eight-thousand years.
Although it is suspected that tobacco was grown for human consumption as early as 6000 B.C.E., tobacco’s first recorded usage dates from the 1100s B.C.E. Mayan pottery depicts adults smoking what appear to be cigarettes. They even had a word for the pastime; they called it sik’ar. Throughout the exodus from Europe to the Americas, tobacco was seen as a remedy, a cure-all for such common maladies as bad breath, minor pain and even cancer. In 1571, a Spanish physician, Nicolas Monardes, even wrote a book touting the healing properties of the leaf. He claimed that the plant could cure more than 35 health problems (Borio).
As time wore on, more and more support for the substance grew. As is true of most ascents to popularity, tobacco had its detractors as well. As early as 1610, Sir Francis Bacon was recorded as noting the difficulty in quitting smoking. Later, as more and more research was done on the chemicals present in tobacco smoke, the public began to realize the dangers of smoking (Randall). Entering the modern era, the early 1900s saw tobacco as a blight on society. During this period, cigarettes were commonly referred to as, “coffin nails.” Funny thing though, as the marketing machine of the 1940s and 1950s moved into full capacity, smoking became the thing to do. Smoking was everywhere and was considered not only socially acceptable but even trendy and very chic. Finally, moving into the twenty-first century, cigarettes and their smoke has been determined to be a major public health issue and is even on the cusp of being outlawed (Tracy 1).
Many drugs, cocaine, heroin, morphine, even LSD were at one time considered to be useful and harmless drugs used to treat various symptoms and bring relief from common ailments (Tracy 1). This process of discovery, usage, testing, and ultimately disuse due to negative consequences, has taken humanity nearly 8000 years to develop. Can twenty, fifty, even one-hundred years of usage and testing really be enough to determine the safety and reliability of a lab-synthesized substance? The tenuous relationship the world has had with tobacco should lead to a strict, negative response.
The tobacco comparison may seem far-fetched but is it really? Consider the drug Thaliomide, a drug produced in the early 1950s with no real application. It was first marketed as an anti-convulsant, for those with epilepsy. Finding that the drug did not work and hoping their research dollars would not go to waste, the manufacturer began marketing the drug as a sedative, a completely safe sedative, which did not even require a prescription. As time wore on, the drug gained in widespread popularity and began to be prescribed for an increasingly long list of maladies including asthma, headaches and colds. Finally, the drug became best known as a treatment for morning sickness. This drug became the best-selling medication the manufacturer had ever had. It was sold all over the world. This continued for years until it was discovered that more than 10,000 children had been born with severe birth defects as a result of the drug. Many children were born with malformed limbs or even none at all. This was a drug that was considered safe for over 12 years. The bottom line is that we don’t really know what is safe and what isn’t (Scott 188-191).
Currently, psychiatric medications and the companies that manufacture them are enjoying a major boom period; counting record profits and reaching unheard of heights in the financial world. The marketing engine driving this success spends nearly 20 billion dollars a year for direct to consumer advertising (Scott 115). While it is fair to assume that advertising introduces consumers to medications that they may not have heard of otherwise, medications that could indeed create better living conditions for the patient, what are the chances that the advertising is correct? In 2007 the Department of Health and Human Services issued a direct warning to Robert Essner CEO of Wyeth Pharmaceuticals demanding that Wyeth remove an ad campaign for the wildly popular anti-depressant Effexor. The six page letter states:
“The journal ad is misleading because it overstates the efficacy of Effexor XR, makes unsubstantiated superiority claims, in addition to other unsubstantiated claims, and minimizes the risks associated with the use of Effexor XR. Therefore, the piece misbrands the drug in violation of the Federal Food, Drug, and Cosmetic Act (Act), 21 U.S.C. § 352(n) and FDA implementing regulations, 21 CFR 202.1(e)(6)(i) & (6)(ii); (e)(7)(i). These violations are concerning from a public health perspective because they suggest that Effexor XR is safer and more effective than has been demonstrated (Abrams).”
This misleading information is important because it works to paint an incomplete picture of the efficacy and safety of the drug. With these issues shrouded behind a cloak of safety and effectiveness, the average consumer is more likely to request the drug from their physician, which they can and do. In a 2005 study by the American Medical Association (AMA), it was found that more than half of those requesting a name-brand drug as treatment for self-diagnosed symptoms were granted. It was further recognized that 98% of those making a request received only, “minimally acceptable initial care, “according to AMA guidelines (Franks).
The real issue here is that pharmaceutical companies are making products that treat an increasingly diverse set of circumstances that are the product of everyday living. Children are especially prone to experiencing a new level of the intensity of living with both parents out of the house, and a vast array of social issues confronting their everyday. While clinical depression does indeed exist, the average American child does not suffer the symptoms of depression to the level that medication is necessary (Curtiss 186-189). In fact, “many psychotherapists wouldn’t dream of prescribing a drug for anything so obviously psychological and spiritual in origin” says Dr. Peter Breggin. He continues,
“The vast majority of people overcome depression without resort to any mental health services. They do so by virtue of their own inner strength, through reading and contemplation, friendship and love, work and play, religion, art, travel, beloved pets, and the passage of time – all of the infinite ways that people have to refresh their spirits and transcend their losses (Breggin 171).”
This comment begs the question: If depression and other psychiatric illnesses are easily treatable through love, compassion and understanding, why do we have these drugs at all?
The two-fold answer is simple. First, there is profit in providing a solution to anything. Build a better mouse trap and there will be people who will spend money on it. Second, the medical fraternity has portrayed, and the general public has perpetuated, the myth that they are the be all and end all in solutions to everyday living (Breggin 11). I have an ache, go to the doctor. I have a fever, go to the doctor. My child won’t behave the way I’d like her to, go to the doctor. This type of thinking provides a demand for solutions. The average physician cannot afford to send patients away and thus will typically cater to the wants and needs of her patients. The average American businessman has a desire to build a successful company that meets a demand at a reasonable level of profit. This is the reason these drugs exist in the first place, to meet the demand built out of a need for the average person to wrest control and satisfaction out of their live pursuant to a dream implanted in their consciousness by a media that never sleeps (Scott 111-122).
Children fall victim to their parents desire for the perfect reality every day. Parents wanting the best for their children seek out the advice of well-meaning physicians and are often times directed toward medications as the solution to the issue at hand. What if there was another way? Bruce St. Thomas thinks there is. He states:
“Change and the human capacity to transform and integrate trauma and misfortune is directly mediated by the human instinct to embrace humanity, to be creative and to see the possibility of hope and change.”
He goes on to state, “children have the ability to both comprehend and resolve life’s difficulties by playing out all parts of themselves. . . searching for personal and collective truth (St. Thomas 13-22).”
So, what of Bobby, the boy in state custody on nine different psychotropic drugs? If the thousands of those who have gone before him are any example, he will become another statistic. He will likely endure several more hospitalizations throughout his stay with the foster care system. He will most likely endure the intake of a bevy of medications to treat the myriad of symptoms brought on by the trauma of growing up in a difficult environment surrounded by indifferent adults. There is another way, it will mean the reversal of years of medicalized attitudes toward the application of mind altering chemicals and it will mean a new commitment to the well-being of our youth. It will mean more effort, more compassion and more faith that these children can and will come through this period if only we can support them in the ways they need.
Abrams, Thomas. Letter to Robert Essner. 10 Dec. 2007.
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