Wednesday, October 30, 2013

An Epidemic Out of Control: Poor Children and Psychiatric Drugs

An excellent, but in its own way truly horrifying presentation was given at the recent annual meeting of the American Society for Bioethics and Humanities in Atlanta by Dr. Melody J. Slashinski of the Center for Medical Ethics and Health Policy at Baylor College of Medicine up the road in Houston. Her account of some of the fallout from intensive marketing of psychotropic drugs suggests a serious public health threat to the well-being of children.

Dr. Slashinski presented the findings of a participant-observer study of African-American single moms trying to raise their kids in a public housing project in Houston. The material she reported was impressive in showing the extent to which she gained the trust of this community and got her informants to reveal things they would normally keep hidden from outsiders. In response to a question about this Dr. Slashinski said that the nickname given to her among this community was “the keeper of secrets.”

Dr. Slashinski reported an effective folk-knowledge network that linked these mothers and that conveyed information about the dangerous side effects of drugs commonly prescribed for kids today for ADHD, bipolar disorder, etc. I doubt these mothers had read Robert Whitaker’s Anatomy of an Epidemic:
--but they might well have for the accuracy and incisiveness of what they seemed to be aware of. The net result was that many felt they had a critical obligation as good mothers—save their children at all costs from these medications.

That might sound easy to do, but the data went on to show that it’s extremely difficult in this population especially. The mothers also feared, quite realistically, that any evidence of “medical noncompliance” on their part would end up with a report to Protective Services and eventually losing custody of their children. So the stories Dr. Slashinski told generally depicted a delicate balancing act—moms on the one hand certain that they would not give these medicines to their children, and on the other hand going through as many hoops as they could to appear compliant and submissive to the medical system so as not to set off alarms.

There was another group of mothers who were intent on protecting their children—but they elected to do so by giving the medications despite their fear of side effects. This strategy was based on a sort of pact with the devil—if they gave the children meds then the outer world might be compassionate and regard their children as sick, whereas if they withheld the medications, the world was almost sure to regard their children as bad. Being seen as bad was viewed by these moms as much more dangerous for the kids than being sick.

The other reason saving your kids from the harms of these drugs is difficult was illustrated by an account Dr. Slashinski gave of one pediatrician office check-up visit with a mom, a 9-year-old son, and 8-year-old daughter that she personally witnessed. The son had already been diagnosed with ADHD and the mom had not admitted to the pediatrician that she was not giving the son his meds (even though overall the mother liked and trusted this pediatrician a lot). As the doctor entered the exam room, she wheeled in a cart laden with equipment such as tongue depressors, and the son immediately went to the cart and started rummaging through it. The doctor used this as a launch for a lecture to the mom on how the son clearly had serious ADHD and really needed his medications.

The doctor then examined the daughter and said something at one point about her “boobies.” The daughter apparently became offended by this comment and stopped cooperating with the exam. The doctor immediately asked the mother how often the daughter had these “tantrums” and started talking about the possibility of bipolar disorder. The visit ended with a psychiatric referral to evaluate the daughter and a new prescription for the ADHD medication for the son. The mom told Dr. Slashinski that she would continue to withhold the son’s medicine, but felt she needed to take the daughter to see the psychiatrist for fear of the consequences of being “noncompliant” if she didn’t.

OK, that’s the data presented by Dr. Slashinski; here’s my comment. Whitaker and others have demonstrated that the sheer number of kids now being prescribed medicines for ADHD, bipolar disorder, and other psychiatric diagnoses is so massive that there can be no biological explanation for how such a huge percentage of the pediatric population of the U.S. suddenly became crazy. The only possible scientific explanation for this phenomenon is overdiagnosis and consequent overuse of medicines whose long-term safety in kids has never been shown, and whose short- and long-term adverse consequences are legion. It is not only psychiatrists but my fellow primary care physicians (as shown by the pediatrician in the case study) who have bought into this insane model of diagnosis and treatment—not the least because of how quick it is to slap on a diagnosis and write a prescription, and how hard (indeed, in cases like this, nearly impossible) to fully inquire into the child’s psychological and social environment and then identify helping interventions if needed. Are things truly so bad that the only way parents can protect their kids is by not taking them to the doctor?

Everything I just said applies to the American society at large. But now, back to Dr. Slashinski’s data, we see that when American society gets the sniffles, poor minority populations come down with pneumonia. It appears to be the new social campaign to get all kids to be as passive and submissive as possible, no matter how much we have to drug them. But this is especially true of black kids, especially black males, who as shown by the Trayvon Martin case can be thought to pose a threat to the lives and safety of the white community merely by existing—let alone by acting curious and assertive. So the call goes out even more shrilly to diagnose this group of children and medicate them, and the parents have even less social authority and credibility to question this.

In short, the epidemic of psychiatric overdiagnosis and overtreatment that Whitaker identified is truly out of control, if Dr. Slashinksi’s findings are in any way representative. And the medical and medical-scientific community bears major responsibility for this state of affairs.

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