Archive for September 3rd, 2010

Poisoning our Children?

In the middle of the 20th century psychiatrists thought they may have found a solution to deviant and psychotic behavior: the lobotomy.   Easy to perform, patients often went from being violently insane into becoming docile and quiet.   However, the procedure left people a shell of what they used to be, or as the Soviet Union put it in abandoning the procedure in 1950 “people go from being insane to being idiots.”

Even more people are affected by a new psychiatric effort to take the anti-psychotic drugs that replaced the lobotomy and prescribe them to children who have behavioral problems.   Children often end up on a mix of medications, all designed to alter behavior in some way, usually to counter act side effects of other drugs being taken.  The result can be seen by considering this story in the New York Times, or watching this episode of Frontline.   Quite literally children are being treated with drugs whose efficacy has not been tested, and which can alter the children so much that they cannot live normal lives.   Since they were diagnosed as mentally ill in the first place, parents (and Doctors) often see mental illness as the reason for their difficulties, when in many  (perhaps most?)  severe cases it’s the “medications” that cause the problem

In some ways, this is a result of the inhumane way health care has been provided in the US.   Insurance companies, loathe to pay more than have to, have determined that a child psychiatrist usually needs at most 15 minutes to evaluate and assess a child.  That’s all they’ll pay.   Hospitals and clinics push doctors to see as many patients as possible so that they can pay their costs (including, of course, doctors’ salaries).   This is also a result of our culture.  We’ve been conditioned to think that medicines can cure anything.  Any ache, pain, or abnormality needs to be treated — and the pharmaceutical companies promise they can give us a “better life.”

Doctors, of course, complain that parents come in at wits end about their child’s behavior, often demanding something be given to make the child ‘normal.’   Therapy takes too long to work, after all.  Moreover, children develop at such different rates and in different ways that behaviors exhibited can be interpreted as being mental illness.   A hyperactive child or one with attention deficit disorder — conditions that often need no treatment or can be treated with non-psychotic drugs — can show behaviors that might be labeled bipolar disorder, autism, or some other malady thought to benefit from anti-psychotic medication.

So doctors under pressure from parents and insurance companies dash off a prescription, and the parent leaves hoping they now have the magic potion to make their child “normal.”   If it works, but the child has trouble sleeping, then the doctor prescribes something for that.   Soon there is weight gain, so medications are changed again.  The child then may seem anxious, so a new medication might be added.    Children might be on a regimen of ten drugs or so for their entire childhood, usually making them different from the rest, often thinking they have some deep down problem that would consume them should they go off their medication.  And, of course such powerful drugs can’t be dropped cold turkey, children need to be weaned off of them, and as they are the side effects of ending a medication may make it seem like it actually was needed.   For some, a diagnosis at 2 years old may mean a lifetime of possibly dangerous and unnecessary drugs.

Because studies are so rare and vague, we have no way of knowing how many children have their lives altered or even destroyed by such practices, nor do we know in how many cases the medications do some good.   We’re experimenting on our children, and we don’t know the impact of these powerful drugs on the long term psychological and physical development of the child.   But because smart doctors prescribe, and our culture sees medication as the cure to any problem, people go along with it.

Two things need to be accepted:  first, children need to learn to live with themselves as themselves.   If a child has a temper, is wired to react quickly and perhaps be anxious, that might just be who he or she is.    Young and unable to really understand or control behaviors, a child of this sort might violently misbehave, or have times of uncontrollable rage.   Now, in some cases mild medications may be necessary to help the child through this, but ultimately the child has to learn to control his or her temper, and deal with the fact that he or she has this kind of personality.  If a child is overly medicated so that his or her true self isn’t experienced, then medications may continue for life — the person will never discover who he or she really is.  Or, if the medications end when the child becomes an adult it’ll be much harder for the individual to handle his or her own personality — the lessons weren’t learned gradually while growing up, but would need to be learned all at once, with expectations higher.

Second, it takes all kinds to make up a world.   Normalcy is simply an average.    Each person brings a unique perspective to life, and contributes in his or her own way to a community.  Most importantly, though, children need to be shown patience.   The uncertainties of human and psychological development make it dangerous to see ‘abnormal’ behavior as an illness so early in life.   It could just be a quirk of that person’s development.

Yet, there are children who have serious chemical imbalances and really benefit from even strong anti-psychotic drugs.  How do you know when to make that call?   Well, last year my son, then age 6, had a series of difficult episodes at school.   We took him to a doctor to assess what the problem is.    She came in on a day she’d otherwise have partially off, and spent almost two hours talking with us and our son.   She listened.   She made a diagnosis (Tourettes, with ADHD symptoms), and recognized that we were very skeptical of medications.   She not only respected that, but praised our concern.   Ultimately we did choose a mild medication – Intuniv (guanfacine), which is usually used to fight high blood pressure.

We researched this decision intently (I check now and then for anything new — it seems a very safe drug, with few side effects and is neither an anti-psychotic nor a stimulant), have kept the dosage low.    He did show improvement, and most importantly our son’s personality has not changed.  He’ll still get angry, he’ll still be intense — he is definitely himself.  But problem behavior has become rare, he’s learned to control his actions most of the time, and he remains active, creative, inquisitive and academically well ahead of the second grade average.

So I’m not completely anti-medication, I don’t mean this as an extremist tirade.  But with children it’s really important parents and doctors take TIME to assess, and do what we can to cope with behaviors that are difficult.  Children do grow and learn, and sometimes maturity is what it takes for an especially intense child to learn how to operate effectively with his or her personality.  Also, from what I’ve read, I think parents should be VERY skeptical of anti-psychotics for children, or a regimen of any more than one drug at a time.     Children should be given every opportunity to be themselves, even if it’s sometimes hard on the adults.