Friday, March 5, 2010

Medication - the low hanging fruit

There was a strange book review in the New York Times last week by Abigail Zuger. She managed to heap praise while smugly writing with a "didn't I tell you so" attitude on Judith Warner's new book, We've Got Issues; Children and Parents in the Age of Medication.

Strange because the reviewer took such obvious delight in Ms Warner's sadder but wiser girl perspective about how she naively thought that the overmedication of children was a fact, and gosh, six years later she couldn't find a parent out there who was thrilled about medicating her with drugs. This is news?

Dr. Zuger, an assistant medical professor at Columbia University, is entitled to her opinions, but she is unfortunately trying to present her opinions as medical truth. They are just opinions but will be construed as fact because she's a doctor. Treating troubled children is more than symptom management for a calmer classroom: the medications seem actually to change the structure of the brain, helping it develop in what all evidence indicates is the right direction. More children in treatment should spell the beginnings of a healthier adult world.

What? Dr. Zuger is equating treatment with drug taking, not with treating the underlying problem. The "changes the brain for the better" argument is dangerous thinking and has no scientific basis but it sure is promoted by pharmaceutical companies. They, together with medical professionals pushing the enhanced brain function, have turned college students on to the perceived benefits of self-medicating prescription drugs for the purposes of competitive advantage. (Mother's tip: Dr. Abram Hoffer's niacinimide remedy for schizophrenia gives you focus with side benefits, not side effects.)

More children in treatment will lead to even more children in unnecessary treatment as our college students have demonstrated. There is a "me, too" effect here, and who can blame them? Similarly, if I were a mother of a school age child and observed that all the other kids had this competitive advantage, I would be tempted to ask why should my child be denied this harmless drug that protects the brain and increases focus? That's discrimination, isn't it?

Dr. Zuger goes out of her way to paint a disparaging picture of naive but caring twits like me who think that young children's mental health should be managed in a different way. After all, almost nothing is known about the effects of antipsychotic medications on developing brains, reason enough to stay away from them. The effects on developed adult brains are pretty awful, the effectiveness of the medications are being widely questioned by science, and then there is the obesity problem. Why would we foist the same problems on children?

The answer to why we do this despite knowing the risks is found in the same article. There are only 7000 child psychiatrists in the United States. Lack of insurance and/or geographical access to psychiatrist means that most children will never see a psychiatrist, or else that one psychiatrist you do have access to is going be extremely overworked. Time, money and access being a problem, it's cheaper for psychiatry to go for the low hanging fruit. Medication is that low-hanging fruit.

I see it this way. Your child (or the child in you if you are an adult) is being sacrificed for the "easy" solution, which is always the cheap solution when society is looking for mass "fix-its." Mental health, unfortunately, does not lend itself well to one size fits all solutions. Increasing the number of child psychiatrists is a good idea if children and families are helped to find non-drug ways of dealing with their problems. (The job I naively thought psychiatrists were suppposed to be doing in the first place.) If it leads to a proportional increase in the number of children on psychiatric drugs, the potential benefit has been lost.

So, let's call medication what it is, which is a cheap intervention, but let's not pretend that it is something more noble than it is or that medication will somehow "protect the brain" when there are other therapies and ideas out there that work and which don't produce side-effects. The poorer you are, the better your chances that you'll be handed a drug and told to go away.


  1. Please, let's not promote that the world needs more psychiatrists. Their sole purpose in life is to write prescriptions.

    Peter Breggin (Medication Madness, Talking Back to Prozac, etc.) advocates that children do not have ADHD. They lack the time, nurturing, and compassion of their parents. Children today socialize through a computer screen, they don't play outside, and as a consequence are pent up and can't focus.

    I believe that not only are drugs harmful to developing brains but also that their brains have not developed the cognitive capability to process all of the data that they are exposed to via the internet, television, and other forms of media and that this has negative effects on their attitudes and behaviors. And, the content of all that subject matter is either violent, or sexual, in nature.

    The problem is not the child's brain function. It is quite simply the parents not using theirs'.

  2. Anonymous: "Please, let's not promote that the world needs more psychiatrists."

    Thank you! I'd even say, let's not promote that the world needs more professionals to identify, label, and "treat" the perceived problem-individual. Let's instead have more people, professionals and other, to look at the true causes of why more and more individuals end up with greater and greater problems. And to bring about (radical) social change.

  3. Not sure I agree. Do we want more people, including children, to be treated by dermatologists? Isn't Peter Breggin (who scares, me, frankly) a psychiatrist? My point, which I think was clear, is that psychiatrists aren't doing the job they were put here to do, which is to treat human suffering by through understanding and empathy, not by writing prescriptions. Call me an optimist, if you will.

  4. Rossa: Have a look at the history of psychiatry. Once throughout this entire history people in distress have been treated with respect, and through understanding, rather than through "interventions": during the first half of the 19th century, "moral treatment", the Quakers. The Quakers didn't allow medical doctors at their facilities. So, in fact, this period isn't even a part of the history of psychiatry, since psychiatry, which per se is a medical speciality, wasn't really practised at the time. Alternatives like Soteria, and also people like Breggin (who scares me too, btw), are heavily influenced by the Quakers non-medical approach.

    Psychiatry is by definition medical treatment of existential problems. The moment someone (like Breggin for instance) decides to treat someone else's existential problems other than with medical remedies (drugs, ect), they do not practise medicine, psychiatry, anymore. They do not rely on any medical/psychiatric training anymore, but on their experience as human beings, qualities like empathy, and non-medical knowledge (philosophy, sociology, psychology, spirituality, etc.).

    No medical training needed for that. Indeed, medical training can get in the way.


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