Friday, June 4, 2010

Sue Scheff: We've Got Issues - Children and Parents in the Age of Medication

What a fascinating new book by Judith Warner.  Here are some highlights:
  • Extraordinary stories from parents that reveal, in a very visceral way, the lived reality of having children who struggle with bipolar disorder, obsessive-compulsive disorder, autism, Asperger’s, ADHD, and other disorders.
  • Why there is such a widespread perception that many of the treatments and services related to children’s mental health—whether medication, therapy, special education, or school accommodations—are basically a sham, a way for some parents to help their kids get a leg up on everyone else.  Warner also explores a much larger and darker reality behind this perception: Only parents with considerable means (and the time and the savvy that usually accompany such means) are able to navigate our school systems to get the services and accommodation to which kids with issues are entitled.  The startling truth is that for most kids in America, mental health care is nonexistent.
  • Since the early 1990s the number of children receiving diagnoses of mental health disorders has tripled.  This vast increase has fed enormous skepticism, prompted talk of “epidemics,” and serves as a mainstay of the so-called naysayer position—namely that there were virtually no kids with mental health issues in the past, but somehow, suddenly, they’ve sprung up from nowhere.  Warner looks at key factors driving this widespread perception, including increased visibility and profound changes in how parents, teachers, and doctors look at and label kids who have problems.
  • A look at what the author considers the true epidemic in this country when it comes to children’s mental health: the lack of quality care.  Says Warner, “At a time when we have treatments that actually work, when there’s more research than ever before, more knowledge, better understanding, more support in the schools, and more public awareness of the dangers of untreated mental illness, the actual caretaking that kids with mental health needs receive, is for the most part, really poor.”
  • A look at what Warner calls “the new face of mental health stigma in our time”—a web of belief that combines doubts that mental health problems are real and aspersions cast on parents of children with problems with a tendency to conflate children’s disorders with bad behavior. The net result is that children are viewed symbolically—as canaries in the coal mine, showing the frontline symptoms of the toxicity of our pathological age—instead of as real people.  This so-called “naysayer” position, says Warner, “is voiced as concern, as a desire to save children, and as a wish to give childhood back to kids, but what it really is, most of the time, is prejudice.  And it’s a poison.”
  • Why people have a hard time acknowledging that children’s disorders are common, impairing, at least in part genetic, and very real.  Warner also looks at what the latest scientific research has to say about the interplay between genes and environment in causing the kinds of disorders we’re seeing in kids. And she shows how this complex and nuanced way of thinking opens up avenues for understanding that are very different from those dictated by the more black-and-white terms in which children’s mental health issues are typically painted in the public debate.
  • A look at the irresponsible marketing practices of Big Pharma; its control of published research; and its co-opting of government regulators and institutions, including the Food and Drug Administration and the National Institutes of Health.  Warner also looks at the damage done to the psychiatric profession by individual psychiatrists who have enriched themselves by becoming what amounts to shadow employees of the drug companies.  “For many people, the revelation of psychiatry’s extensive ties to the pharmaceutical industry are just proof of the inner corruption of the whole psychiatric enterprise in the age of biological psychiatry.”
  • A debunking of the commonly held belief—fostered by a dizzying array of damning numbers that have made headlines over the past ten years—that kids are being given meds virtually like candy, by parents and doctors.   Warner shows that the total number of kids taking antidepressants and psychotropic drugs is far smaller than most people think.  Even after decades of rapid increase, the percentage of American kids taking medications—5 percent—is still just a fraction of the number of kids with diagnosable “issues.”
  • The romanticization of mental illness.  Warner reflects on the harm done when depression, anxiety, obsessive-compulsive disorder, autism, and other disorders are treated as quirks of personality to be cultivated and preserved, even celebrated as expressions of individuality and a highly refined sensitibility.  She also explores the widespread, unthinking trivialization of mental health disorders in our public discourse and shows how it can lead parents to minimize their children’s problems and not seek help for them.
  • A look at the seductive belief that our toxic world is either producing symptoms in children or classifying children as abnormal when they don’t conform.  Warner argues that the pathologies of our out-of-whack society just can’t provide a sufficient explanation for why some children develop disorders like autism, ADHD, Asperger’s, bipolar disorder, and so on, while the overwhelming majority does not.
  • How the bottom line—cost control measures decided upon by health insurance companies—is driving the mental health care of kids today.  Says Warner, “There should be gatekeepers within our health care system shepherding parents toward getting the best treatments.  There should be protocols for what these best treatments consist of.  There should be safeguards against profiteering and quackery.  There should be affordable access.  There should be guidance, and protections in place to make parents feel that they can trust whatever care their children receive is safe, necessary, and of proven efficacy.  None of this is happening.”
WE’VE GOT ISSUES concludes with a look at how we, as a society, can bring an essential and much-needed humanity to the treatment of kids with special needs.  The way to start, according to Warner, is by advocating for better care.  Among other things, she argues for health care reform that will allow annual or semiannual extended visits with pediatricians to talk about children’s lives and screen for mental health issues; the passage of long-stalled legislation to address the appalling shortage of doctors who specialize in child and adolescent psychiatry; better incentives to get more child psychiatrists and psychologists to participate in health insurance; and a legislative mandate that requires insurers to provide mental health services.  Warner also looks at the ways in which medical schools and academic research institutions, to greatly varying degrees, have started taking steps to reduce the influence of the drug companies, or at least avoid the appearance of conflict of interest.  She reflects on various efforts to change the way drug research is conducted and funded.  And she advocates for putting a stop to, or at least tightly regulating, the pharmaceutical industry’s direct-to-consumer advertising.        

Above all, Warner insists, it’s time not only to rethink our commonly held beliefs about “labeling” and “drugging” children but also to become more aware of what the lived reality of having children, or being a child, with special needs is.  Says Warner, “Those parents you see, going from doctor to doctor and trying pill after pill?  They’re scared.  They need help.  And so do their kids.”

Order on Amazon today.

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