I was glancing at the Huffington Post today when I ran into yet another piece of what I wish was absurdist health reporting. Unfortunately, it's meant to be taken seriously.
What's even worse is that there is a real problem hidden in the hyperbole, but the author's over-the-top rant does more to obscure than expose the issue.
In this country, we've never known how to deal with psychiatric disease. From the mass institutionalization present for much of our history, to the massive de-institutionalization of the mid-1960's, from forced lobotomies and sterilizations, to the development of helpful medications and their use, and perhaps overuse, we have lived with a chaotic mental health care system. This system is somehow divorced from the rest of the health care system, despite the fact that the brains is an organ like any other. Mental health care is expensive and spotty, and compared to health care involving every other organ, is nearly completely uncovered by insurance.
All that being said, we've made huge strides in treating disorders of the mind. Lobotomy, a crude, but occasionally effective technique was replaced by anti-psychotic drugs in the 1950's and 1960's. Forced sterilizations were finally abandoned by the early 70's. Advances in psychotherapy and psychopharmacology continued, and the last 20 years have seen the introduction of very effective anti-depressants, and of anti-psychotics that largely lack the devastating side-effects of the earlier drugs. In addition, newer forms of electroconvulsive therapy have been studied that, while still largely a last resort, are much more effective and much safer.
One of the controversies in modern child psychiatry is the role of diagnosis and of medication in children, especially regarding attention deficit/hyperactivity disorder (ADHD). There are a number of legitimate controversies regarding possible overdiagnosis and overmedication, and these issues are subjects of active study.
For example, Breggin starts his essay with a seductive statement that is based on a questionable premise:
In this highly politicized season, is there something we can all agree upon? I think so. From the political left or right, we should be able to come together around the idea that it's bad to use psychiatric drugs to control children.
Well, duh! But is there really a widespread problem such as the one he assumes? Certainly he gives no evidence other than emotional appeals and hyperbolic language.
The same issues arise in regard to the massive drugging of millions of American children. The threat of social control is now an actuality. In almost every classroom in the nation, at least a few children are being subdued by psychiatric drugs to make it easier to manage their behavior. In many public schools, 10%-15% or more of children are being drugged with stimulants, mood stabilizers, antidepressants and antipsychotic drugs. Meanwhile, in special education, foster care and public institutions, nearly all the children will be drugged, often with multiple chemical agents at once.
We are literally subduing our children instead of reforming our schools and family life. And since every child knows that many children are being drugged, every child, for better or worse, knows that certain kinds of behavior will lead to being medicated.
He apparently believes that there is an active conspiracy to subdue and control most children pharmacologically, and terrorize the rest.
Who is this guy?
Breggin has been around for a while. In the early 70s he was associated with the Scientology cult's anti-psychiatry CCHR. He reportedly left the organization because the Scientologists creeped him out, although he does admit to sharing some of their goals.
At his website, Breggin takes aim at the entire psychiatric profession, attacking every tool available to modern psychiatry. From reading his website, it's not clear what alternative he proposes, other than "compassion and empathy", which certainly is a requirement, but hardly sufficient.
When Jack Kennedy initiated the mass deinstitutionalization of psychiatric patients, he had very good intentions. Unfortunately, there was no societal mechanism available to help the now-homeless patients.
Similarly, Breggin would appear to toss out any beneficial treatments that involve pharmacology on principle, without a clear, evidence-based alternative. This not only does a disservice to those suffering from illnesses of the mind, but it detracts from real criticisms of over-medication and medicalization.
This guy is a classic crank, so it's no surprise to seem him being hosted by HuffPo. It's too bad they can't use their influence to help inspire actual change in our broken system. If Breggin and Huffington actually care about the mentally ill, perhaps they could lobby for increased access to care, increased research funding, and a social support system. Perhaps they could provide solutions rather than conspiracy theories. Or maybe that's too much to hope for.
Nevertheless, I think that we dodged a bullet with the ADHD meds. At the time this treatment approach began, nobody really had any idea what would be the consequences of chronically treating the developing brain of a child with stimulant medications. Considering that some stimulants are now know to be neurotoxic, it wouldn't be at all surprising if these kids were to suddenly start coming down with Parkinson's Disease or dementia. I find it remarkable that we would engage in such a massive human experimentation with so little thought of the potential risks. However, the first generation of kids to be widely treated with these agents is now entering middle age, and so far I haven't seen any indication of a spike in neurological illnesses. So I think that we probably lucked out.
help inspire actual change in our broken system... lobby for increased access to care, increased research funding, and a social support system. Perhaps. In the current political system of the past quarter century, that is too much to ask for.
I was a childcare worker (children three to twelve, outside school, large centre) in Canada between 1972 and 2005. While your crank is certainly a crank, and there certainly are times when medication is warranted and may be helpful, I witnessed an upsurge, in the 1980s, in medicating children for behaviour problems which may or may not have been caused by various mental disorders. Sometimes the complaint of a school and the collusion of a GP was all it took to get a child on long term Ritalin.
Quite a few of those children were not considered by childcare staff to be unusually active or disruptive, but as soon as they entered the school system, they were judged to be severely disruptive. Most were taken off medication entirely, by their parents, for the summer holidays, "They didn't need it when they weren't in school".
I worked with a few children who seemed to benefit greatly from such medication. I worked with a larger number of children who seemed not to benefit at all, they were medicated into a stupor. The percentage of children medicated rose until around the early nineties, when quite a bit of protest about the practice had been made, after which the numbers dropped very noticeably.
At least in this part of Canada, I don't think children are being over-medicated to that extent any longer - at least I haven't seen evidence of it. But there's little doubt in my mind that in the eighties there were a significant number of children given un-necessary meds to no good end, just because they were vocal, or active, or a little stubborn.
It is unfortunate that people like this detract from examining the real potential problems of overmedication and medicalization.
"we've made huge strides in treating disorders of the mind"
In your fantasy world, maybe. In reality, there has been almost no progress in understanding or treating most mental illness. The drugs may dull symptoms in some cases but they don't cure anything.
I am not at all surprised that PalMD would support the mass drugging of children.
Breggin is in argeement with the Seriously Mentally Ill, who often believe that: " There's Nothing Wrong,No Help is Needed"( my paraphrase of X. Amador's book title).Hmmmm.
Pec, have they diagnosed your problem yet?
Thanks, pec! I guess in all those words, I sorta lost track of my real message.
Also, I've come for your brains.
I'm still hungry.
There has been no progress in understanding or treating mental illness???
My boyfriend's grandmother became ill with schizophrenia in the early sixties. Now, having schizophrenia in that time, in communist Romania, was not a good place to be. Electroshock therapy, lobotomy, institutionalization. She died young.
A few years ago, my boyfriend became ill as well. As I was living with him, we caught it early (during his first psychotic episode). He was immediately placed on Risperidol, and after a week stay in the psych ward to ensure he was stable, placed on cognitive-behavioural therapy on an out-patient basis.
Today, he is finishing a master's degree in chemistry. He still takes Risperidol, although at a very low dose (about a quarter of what he started on). He hasn't had an episode in years.
Now, of course this is all anecdotal... but...
In many cases, I think ADHD medication is warranted, but I do feel that some parents, especially those who are obsessed with their child's academic performance, are far too quick to beg for a cure-all pill that can make their children sit still.
And the problem is that we still don't know what these long term stimulants can do. We're giving them at younger and younger ages, and for longer periods of time. Some evidence in animal work indicates that ADHD medications in particular, when given in certain periods of development, can cause changes in the brains response to stimulants in adulthood (such as Brandon et al 2001, Schenk and Izenwasser 2002, Yang 2007, etc. Though for the other side of the coin, there's Yang and Dafny 2006, Carlezon 2003, and Andersen 2001). So there may be no overt changes regarding psychological issues, but other changes may still be present.
Still, active conspiracy to medicate our children? I don't think so. And modern psychiatry has changed the lives of many people. The trick is to just make the the drugs do only what we want them to.
I know at least one excellently medically-controlled schizophrenic. He has maybe one mild episode every few years, mostly when he gets overstressed.
I wonder what people like pec think is the difference between treating a condition and lessening the symptoms and/or making them go away? It's "cure or nothing"? Do people like pec think that physically ill people shouldn't use wheelchairs or assistive devices either?
Frankly, speaking as someone with several chronic conditions, being able to manage them and "dull the symptoms," as it were, is a tremendous improvement over what I would have been stuck with even thirty or forty years ago. And none of my problems are mental illnesses.
Has anyone looked at the correlation between the decline of recess and PE in schools and the rate of ADHD medication? As a parent, I can tell you firts hand that kids need to burn off their energy, which they have a lot of. But we don't let them do that in elementary school anymore. Instead we stuff htem into class rooms all day long, taking away their other creative outlets so they can be forced to learn materials that will get hihg standardized test scores. UGH!
There has been no progress in treating Diabetes! We can dull the symptoms but we cannot cure anything!
Ah schizophrenia. Unfortunately I know a thing or two there. There are several cases in my family and I had the "priviledge" to experience both, untreated and treated schizophrenia. Altough I am quite aware that the medication does not really cure the illness, medication is by far to be preferred even if the side effects can be quite severe.
What would you prefer? Somebody who threatens to kill herself and her little children oder somebody who is sometimes tired but otherwhise is able to live quite normal?
Katie: Hmm, just by chance my own grandmother was diagnosed with schizophrenia in the late 50s in communist Romania and was not treated in such a way.
But this difference in treatment could simply come from the fact that my grandparents are considered to be middle class, are very highly educated and they live in the capital. Plus my grandfather is a very kind and loving husband and would have not accepted neither lobotomy nor institutionalization. Both are alive even today. Thanks to medication available in Romania even in the late 50s.
From what I understand, she was quite poor L. Carone. There may have also been differences since she was ethnic Hungarian, which I understand is a bit of a sticking point?
But, again, that story may have been embellished since I heard it from my boyfriend, who heard it from his parents!
I personally have inattentive type ADD, and problems with depression. I take medication for both. Depression is an unimagineable nightmare. If you've never experienced it, be very happy.
With ADD, imagine being unable to do things you know you must do. There's no reason that you can explain. People think you are lazy. You let them down constantly and can't control it. You become boxed in by the terror of failing. It's virtually impossible to gather the motivation to do anything.
You didn't have to live in the USSR in the fifties to be lobotomized as treatment for mental disorder. In Canada in 1953 my 22 year old aunt was treated by lobotomy after extensive (and experimental) drug therapy and extensive electrotherapy failed to control her outbursts.
I may have ADD, but have never been--HEY LOOK! Raymond's on.
wackyvorlon got it right. I suffer from ADHD-I, and it's insane how your brain works when you have work to do. After suffering throughout college, I finally got help afterward. The medicine makes a world of difference. I can do work and be productive. I don't want to take medication for the rest of my life, but I haven't figured out how to overcome the problem otherwise. If I forget to take the meds, the old work avoidance behaviors come right back, and I spend more time worrying about work than I do actually working.
But no, medication doesn't do anything for psychiatric disorders.
I suffer from chronic severe melancholia... basically biologically based depression (http://en.wikipedia.org/wiki/Melancholic_depression).
It's theorised that my brain is unable to produce enough neurotransmitters (such as serotonin and nonadrenalin) to effectively control my moods.
Regardless of whether or not the medication that I'm on "cures" or "treats the symptoms" of my illness, I'm a million times better after taking the anti-depressants. Indeed, using the drugs enabled me to control my depression for long enough that I could take positive steps to manage my illness, such as exercising and eating correctly... which were very difficult to manage during a depressive episode.
So pec... it would probably be a great idea if you would refrain from commenting until you get a clue.
Good work. I've read a lot of this nonsense from Breggin before. He's got REALLY spotty use of science mixed with wholly stolen sections of Thomas Szasz's thoughts about issues. He's been beat around in court rooms for his antics for years. It's high time that another doctor called him out in the blogosphere.
I've never been all that worried about his ilk though. As long as people wake up feeling out of it every now and then and overly tired and notice how that affects the rest of their day, there will be an inherent ability of most people to understand the underlying biological interplay in all mental health.