View Full Version : The Med Scare


Andrew
02-22-08, 06:57 PM
http://warner.blogs.nytimes.com/2008/02/21/the-med-scare/

The Med Scare

By: Judith Warner (This appeared in the New York Times. Please see the link above to see some of the public's reaction to this blog)

At the end of my last column (http://warner.blogs.nytimes.com/2008/02/14/overselling-overmedication/), I wondered about the purpose served by the narrative of the disastrously overmedicated American. I’ve been pondering this question as it relates to children for the better part of the past four years.


Recently, in search of an answer, I was re-reading “Huck’s Raft: A History of American Childhood,” (http://www.hup.harvard.edu/catalog/MINHUC.html) by the Columbia University historian Steven Mintz. In the book, Mintz identifies a “pattern of recurrent moral panics over children’s well-being” that has emerged at varying points in our history, and dissects how these episodes mask other diffuse worries Americans have been either unable or unwilling to directly articulate.


“Children have long served as a lightning rod for America’s anxieties about society as a whole,” Mintz writes. “During the late 1940s and early 1950s, as anxiety about the Cold War deepened, many Americans doubted that the young had the moral fiber, intellectual acumen, and physical skills necessary to stand up to Communism. During the 1960s, as the nation underwent unsettling moral and cultural transformations, public worries again centered on the young, around such issues as permissive childrearing, youthful drug and sexual experimentation, and young people’s scraggly hair and unkempt clothing. It is not surprising that cultural anxieties are often displaced on the young; unable to control the world around them, adults shift their attention to that which they think they can control: the next generation.”
I asked Mintz this week what he believes are the underlying anxieties — conscious or not — that animate the stories of peril we tell about children in our time.


“Tremendous fears about downward mobility,” he quickly answered. “We believe we’re living in a new world where the avenues of success are harder to get into and there’s no guarantee that things will work out. There’s tremendous worry that our kids won’t be able to recreate our class status. This creates an adversarial relationship between our kids and other kids.” And, he added, “displaced guilt.”


I couldn’t agree more. And I believe it’s these fears, this worry, this adversarial attitude and this bad conscience that keep the narrative of the overdiagnosed and overmedicated child alive.


Let me make clear again why I keep referring to the overdiagnosis and overmedication of children today as a “narrative” – the sort of phenomenon that deserves to find its place among what Mintz calls “public panics” – and not as an established fact. It’s because I believe that, over the past decade or so, scattered reports of increased diagnoses of mental health ills and of increasing use of psychotropic medications by the young have been woven into a scary storyline that distorts the reality of what’s happening to kids in our country.


It is true that some populations of children appear to be overmedicated. Abuse of prescription drugs is a reality in upper middle class communities, where high school and college students use pilfered ADHD meds like so much No Doz to try to attain better academic results. Children in the foster care system appear to be particularly at risk of being prescribed mood stabilizers to dull the effects of their often wretched early lives; Last year, an administrator at the Nebraska orphanage Girls and Boys Town said that more than 50 percent of the children coming into the institution were on some kind of psychotropic drug. Studies in Tennessee and Florida found that 25 percent of foster children were taking prescription medications for psychiatric ills. (One advocate spoke of a “chemical sledgehammer that makes children easier to manage.”)


Similarly, I’ve been told that children in military families who are suffering from widespread and undiagnosed post traumatic stress disorder as a result of extended separation from parents, family deaths or extreme disabilities suffered by loved ones are disproportionately being treated chemically for behavior issues instead of having access to more expensive and appropriate therapy.


There have been indications that some middle class children, particularly boys, have been overmedicated: In the late 1990s, an article in the American Journal of Public Health showed the proportion of children in two school districts in southeastern Virginia receiving ADHD medication was “two to three times as high as the expected rate of ADHD.”


Yet more wide-ranging studies from that time and since then have shown little evidence that such gross overprescription is the norm nationwide. According to the American Academy of Pediatrics, approximately 70 percent of children and adolescents who are in need of mental health treatment do not receive any services. Only half of the 3 to 5 percent of children believed to have ADHD receive any kind of treatment (generally medication).


“Most kids are underdiagnosed and don’t get services. Access is poor and there’s a lack of providers,” Dr. Ronald Brown, a professor of public health, psychology and pediatrics at Temple University, who in 2006 headed an American Psychological Association committee that looked into the issue of the great rise in psychiatric drugs for children, told me last year. Indeed, a 2001 report from the National Institute of Mental Health found the “deficiencies” in mental health services for children “staggering.”


Why, then, the exaggerated belief that we’re raising a nation of pacified, high-performance zombies? I think it’s because we have real worries about the state of children – and childhood itself – in our time. We know that our current lifestyle of 24/7 work, constant competition, chronic stress and compensatory consumerism is toxic. But we also know – or feel – that there’s not much we can do about it. We feel guilty about the world we’ve created for our kids, one of lots of work and not much free play. But we’re also wedded to that world, invested in it, utterly complicit with its values and demands.


And so we shift the focus of our fears away from big forces we feel we can’t do anything about (globalization, an increasingly merciless marketplace, a growing gap between the wealthiest Americans and everyone else, the general indignities of life in the beleaguered middle class). Instead, we focus on decisions we can control (whether or not we will “drug” our kids). Our minds shift away from the myriad ways we collude in making life toxic for our children, and we obsess instead on condemning other people for allegedly poisoning their children’s bodies.


We jump at every story that shows other people’s kids (and it’s always other people’s kids whose maladies are “fashionable;” one’s own children’s problems are always “real” and unique) succumbing to any one of the “epidemic” mental ills said to be sweeping the nation’s youth. And we snap up the idea that other parents are drugging their kids to perform like racehorses; how could they not be, when our own kids are struggling so much to get by? In this age of personal trainers for tots and pre-K tutors, isn’t everyone always fighting to do whatever they can do to give their kids an advantage? Take away test jitters with Zoloft, super-prime their minds for cram sessions with Adderall, chemically lobotomize them into the kind of docile behavior that wins a spot in the very, very best private preschools?
The belief that overmedicated children are the canaries in the coal mine for our sick society ought to place the onus of blame upon society. Instead, I fear, to borrow a phrase from family therapists, it’s the kids who have emerged as the “designated patients” in our self-serving displacement systems.


It’s easy to panic about the state of The Child. It’s a whole lot harder to take action on behalf of real children.

Imnapl
02-22-08, 07:45 PM
Yet more wide-ranging studies from that time and since then have shown little evidence that such gross overprescription is the norm nationwide. According to the American Academy of Pediatrics, approximately 70 percent of children and adolescents who are in need of mental health treatment do not receive any services. Only half of the 3 to 5 percent of children believed to have ADHD receive any kind of treatment (generally medication).
Why, then, the exaggerated belief that we’re raising a nation of pacified, high-performance zombies? I think it’s because we have real worries about the state of children – and childhood itself – in our time. We know that our current lifestyle of 24/7 work, constant competition, chronic stress and compensatory consumerism is toxic. But we also know – or feel – that there’s not much we can do about it. We feel guilty about the world we’ve created for our kids, one of lots of work and not much free play. But we’re also wedded to that world, invested in it, utterly complicit with its values and demands.
Instead, we focus on decisions we can control (whether or not we will “drug” our kids). Our minds shift away from the myriad ways we collude in making life toxic for our children, and we obsess instead on condemning other people for allegedly poisoning their children’s bodies.


The belief that overmedicated children are the canaries in the coal mine for our sick society ought to place the onus of blame upon society. Instead, I fear, to borrow a phrase from family therapists, it’s the kids who have emerged as the “designated patients” in our self-serving displacement systems.
It’s easy to panic about the state of The Child. It’s a whole lot harder to take action on behalf of real children.A most excellent article and one of the best I've read on the topic. Thanks, Andrew.