Judith Warner has some insightful essays in the NYT column, pertaining
to the long-raging question about whether psychiatric patients are overmedicated or undermedicated.
One of the essays addresses the question directly:
February 14, 2008
…In the book, Barber
argues that Americans are being vastly
overmedicated for often relatively minor mental health concerns. This
over-reliance on quick-fix medication is numbing our nation and dulling
our awareness of real and pressing social issues and of
non-psychopharmacological therapies and treatments.
Barber is hardly alone these
days in this line of reasoning. The
notion that American children and adults are being over-diagnosed and
overmedicated for exaggerated or even fictitious mental disorders has
now become one of the defining tropes of our era.
despite the fact that government research has repeatedly
shown that most adults and children with mental health issues don’t
get the specialized help that they need…
…contrary to received wisdom, the United States is not
leader when it comes to the use of psychiatric medications. (The U.S.
is “’in the middle’ relative to other
countries, and is not an
outlier,” a study from M.I.T’s. Sloan School of
Management, cited by
Kramer, showed last year.)…
Her next essay examines the questions of how and why we developed a
national myth, that people — particularly children — are
February 21, 2008
At the end of my last column, 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,” 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,”
…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
Ms. Warner makes some very good points. I won’t
elaborate on her arguments here, because she does a perfectly good job
of presenting her case.
What I would add is a subtle point that, it seems, is overlooked in
discussions on this topic. This is something that frequently
causes confusion when it comes to interpreting information about
medication (all medications, not just those used in psychiatry.)
The information we have comes from studies. Mostly, those
studies are done on populations. But populations do not come
in for treatment; individuals do. Doctors generally do not
treat populations; they treat individuals. Populations do not
ask their doctors about medication; individuals ask those questions.
But when individuals ask those questions, the answers they get do not
pertain to the individual. Rather, the answers pertain to the
average in a population of individuals who have been the subjects of
So, when we ask if “people” are overmedicated, what we learn is that
there is no evidence that the percentage of the population receiving
medication is not suspicious. The absolute numbers are large,
and they are increasing. To some, the absolute numbers are
alarming. But the absolute numbers do not tell us anything
Granted, there are people who do look at the proportions, and still
find them alarming. It is hard to know what to make of that.
I have some speculations. For one, it may seem contrary to
one’s experience, to hear that 10 to 15% of the population has a
problem with serious depression. If true, that would mean
that during your typical trip to Wal-Mart, you would see several people
with depression. But the last time you went, you did not see any.
Therefore the statistics must be wrong. Something
Another thing is this: most people experience their brain as a pretty
reliable organ. It does not seem to make sense that so many
people would have problems with it. But consider this: the
human brain is the most complex organ in the body. Indeed, it
is the most complex entity in the known Universe. Is is any
wonder that a high proportion of people have problems with it?
Anyway, back to the point. Studies show that the population
is not overmedicated. Does that not contradict some people’s
experiences, seeing themselves or their loved ones taking multiple
medications, high doses of medications, suffering ill effects from all
those pills? Ah. That is a different question.
That is a problem experienced by individuals. If
you merely look at what percentage of the population is taking some medication,
you will not find out how many people are taking too much
Plus, there is another issue. Some people will be
overmedicated temporarily, when they are started at a dose that is too
high for them, or the dose is increased too rapidly, or when
incompatible medications are mixed. But, that should not go
on for long. Sometimes it does, granted, but the temporary
situations sometimes are a necessary part of an ongoing process.
Or they are not necessary, but are identified and corrected.
The main point is this: just because studies show that the population
as a whole is not overmedicated, that does not mean that there are not
individuals who are. How common is it? I don’t
know. My suspicion is that it is all too common.
Some instances are transitory, or unavoidable, but it still
is a problem.