The Medication Question Again
Neither today’s children, nor today’s adults, are overmedicated, writes Judith Warner in today’s New York Times. Nonetheless, she writes, the belief persists that “American children and adults are being over-diagnosed and overmedicated for exaggerated or even fictitious mental disorders”; such a notion “has now become one of the defining tropes of our era.” Warner notes that there’s an image out there in the public mind that people seek out prescriptions to pop pills for minor ailments and issues, and put more medication into the mouths of babes (their children) because Johnny can’t sit still after lunch.
Far from it, Warner writes. People and parents (myself among them) only decide to give medication after serious, serious consideration and (in my case) self-scrutiny:
……. search your minds and memories: Have you, or people close to you, ever taken medication in a lazy or thoughtless way? Eagerly? As a lark? Ask around a bit; find out what kind of desperation led others to the point where they had to accept psychopharmacological help……..
The psychiatrists I’ve interviewed over the course of the past four years say that they have yet to be swamped by frivolous patients showing up in their offices looking for pills to help them tweak troublesome little aspects of their personalities. “Not only have I not encountered many [such patients], I haven’t encountered any in my office or even in detailed phone calls,” [psychiatrist Peter] Kramer, most recently, told me.
As I’ve noted before, my son has been taking Risperdal and Zoloft—to help him manage his self-injurious and aggressive behavior and anxiety—-for a few years. I’m not alone among parents who has found herself defending the decision to give a child medication. My son’s neurologist is quite aware of what medication can do and of its limitations; giving a child medication has proven to be one more tool to him get through school days with minimal disruptions and we work hard to keep the dosages of Charlie’s medications low. We watch very carefully to see what effect the medications might have on everything from Charlie’s stomach to his behavior, depending on the quantities the time of day he takes them. We mostly work on teaching Charlie and making sure that he learns to handle his own anxiety and to communicate.
Noting that we don’t know how many people suffered from depression in the past “because no one ever asked,” Warner also writes:
Just because it feels like, just because it sounds like, just because soaring drug company profits and obnoxious direct to consumer advertising seem to indicate that everyone around us is popping pills like mad doesn’t mean that they are doing so. Nor does it mean that we’re in the grip of some new, previously unheard-of, and uniquely epoch-defining social phenomenon.
People have been unofficially drugging themselves for as long as they’ve had the capability to do so. They smoked cigarettes to boost their concentration. They drank cocktails with lunch and dinner — and more — to deal with anxiety and despair. Prior to the modern era of F.D.A.-regulated prescribing practices, they slugged down untold quantities of tonics and bromides.
All of which suggests that what social critics now identify as the signature event of our time (the urge to manage psychic pain through substance use) may, in fact, almost always have been a facet of the human condition. It may just be that we’re better at it than ever before – with cleaner, safer, less addictive and debilitating tools at our disposal.
And plenty of people are still slugging down those “untold quantities of tonics and bromides,” like those given to some autistic children, with some debilitating results under various biomedical protocols. I know that parents who seek out and administer any and many kinds of treatments in the name of their children’s health are not “lazy” or “thoughtless” in their decisions. But there is a tendency among some who seek biomedical treatments and who believe that a substance in a vaccine or a vaccine itself is the reason that a child “became” autistic—that some who utilize such treatments tend to think “Big Pharma” is the enemy, and that parents who give them to their children may as well being feeding them mind-altering toxins.
And that’s an unfounded notion—-a serious misunderstanding—of the very real, very careful thinking that parents who have chosen to use medication for a child have put themselves through. As Warner asks,
Tags: asd, asperger, autism, autism spectrum disorder, children, drugs, medication, pdd-nos, Psychiatry, Psychology“what if, examined in the light of basic facts, and with a perturbing bit of common sense thrown into the mix, the popular storyline of our fatal corruption by Big Pharma turns out to be, if not utterly baseless, then at least greatly exaggerated?”
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POSTED IN: Medicine, Parenting, Psychiatry
16 opinions for The Medication Question Again
Regan
Feb 15, 2008 at 4:42 pm
I don’t have to be anti-Big Pharma to think that it’s possible for psychiatric labels to be overextended and medication to be overprescribed, and that’s even agreeing one part of J. Warner’s points–that as a species we do seem to seek the magic bullet, potion or soma that’s going to make the difference. I don’t think agreeing with one necessarily validates the other. Each thing needs to be judged on its own merit to the particular situation.
Some folks take something, it does the job and equilibrates, some folks take something and it doesn’t work or makes things worse, some folks overdo it and overdose. Some things we are not quite sure of how they work and study finds that they don’t work better than a placebo.
So it depends.
Kristina Chew, PhD
Feb 15, 2008 at 5:46 pm
I’m always puzzled that people think there is something, like a pill, that might “do it all”—be the cure-all—-or the opposite, that a medication might be the sole reason for someone doing something.
In deciding to use medication for Charlie was difficult and also made me really scrutinize myself—–and reminded us yet again, we have always to work on teaching, teaching, teaching. Medication is just a start.
daedalus2u
Feb 15, 2008 at 6:32 pm
I went to a talk by Heidi Feldman
http://web.mit.edu/autism/feldman.htm
She is in the process of doing a comprehensive literature review on medication in autism. What was somewhat surprising to her was just how little there was in the literature about any kind of medications and their effects on core symptoms of autism.
She showed two video clips of a boy on the same day, once with a female psychologist, and once with his dad, and they were worlds apart. With his dad he was focused, with the psychologist he couldn’t sit still. Dr Feldman remarked that this difference was with no treatment, just a few hours of time. If this difference had been seen between office visits where a new drug had been used, the change would have been attributed to the drug.
The only medications that had been tested seemed to be a couple of atypical antipsychotics, Risperdal and olanzapine, and the results on them were mixed. There seemed to be very little in the way of something that “worked”. Certainly there was nothing that was a “magic bullet”.
She brought up the used of stimulents for ADHD and said that you could see the difference in minutes and it was a clear and obvious difference. Impossible to miss. There is nothing like that for autism.
Autismville
Feb 15, 2008 at 6:42 pm
I’m one of those people who considers medication of any sort a last resort. My anti-depressant is running. My stomach can’t handle pain killers. That said, meds are extremely important for so many. I am not ruling them out for Jack if he ever requires them. Like you, I will consider them carefully. His well-being is the most important thing.
madam ovary
Feb 15, 2008 at 6:50 pm
Our child psychiatrist actually gave us homework before he would prescribe a medication for our son’s anxiety problems. We had to use the internet and find the five most commonly prescribed mdeications for the problem and write a paragraph about which one we thought would be best for our son. No kidding. It did make us do alot of research, and we came up with the same choice he had in mind.
Eleanor
Feb 15, 2008 at 6:51 pm
I was pretty much of the view that ADHA meds were over-prescribed and likely harmful, but eventually was persuaded to try them for my very bright but very distractible son. They have really made the difference: He literally could not get through a day at school successfully until we tried started him on the daytrana patch. I’m hoping that he grows out of the need for them, but meanwhile, I’m very happy that such medications exist!
dkmnow
Feb 15, 2008 at 7:10 pm
“There are good reasons to harbor considerable distrust about whether some psychiatrists’ prescribing practices really have patients’ best interests in mind. The Times has repeatedly and extensively covered the pernicious gravy train of payments from the pharmaceutical industry to psychiatrists who help promote their latest products; studies have indicated that receiving drug company money does influence doctors’ prescribing habits … This is a disturbing, even disgusting, state of affairs.”
Uh-huh. And this one passing acknowledgment notwithstanding, the entire article is meticulously calculated to trivialize that very concern — which is itself at the very core of the anti-Big-Pharma argument. Judith’s high school debate team must be very proud.
But as Regan suggests, There’s A Lot More To It.
While I freely acknowledge that many people are greatly helped by some psych-meds, and that many who could be helped instead go untreated, it is hardly approp—
[system: message truncated per requirements of soundbyte duration limitations and entrenched rhetorical convenience /system]
Katherine
Feb 15, 2008 at 7:44 pm
I think your point is well taken, that people do not make the decision lightly to give their children medication. We are in the process of weighing this question ourselves. Furthermore, I am not against using medication by any means.
However, I do take issue with your implication that parents who choose to use biomedical treatments, do not enter into it with the same level of concern as those who chose pharmaceutical measures. Or that anyone who makes the choice to explore special diets, supplements, etc. is automatically anti “big pharma” and is allowing their desire for “a cure” to outweigh logic and reason.
Dietary changes and a few supplements have helped my son feel better. Did they cure him? No. Did I expect them to cure him? No. But he feels physically better. That’s all that matters to me. When he feels better, he does better overall. Like any of us. We may find that meds are necessary to help him with different issues, and that is ok. Do I think the meds will “cure” him. No. They may or may not help him. It is the exact same principle. You research, you consult specialists, you talk to other parents. You weigh your options.
I fail to understand why the so-called “curebies” and so-called “ND’s” are in such separate camps. I am not either. I consider myself a little bit of both. I embrace the gifts that autism has given my son. I wouldn’t change those for the world. I actually love the way he looks at the world, though it is different from me.
However, did my son enjoy his constant diarrhea prior to exploring GFCF? No. And he has told us so. For us, and I am by no means suggesting this is for everyone, GFCF eased that one particular problem. That’s all.
I am sorry if it seems I am taking this out on you. I love your writing. I read you every day. But just because someone chooses to use “alternative” medicine does not mean they are not thoughtful people or that they shun all logic and modern medicine.
I really wish these “parent wars” would stop. I do not see how it is helping anyone.
Katherine
Kristina Chew, PhD
Feb 15, 2008 at 10:58 pm
@Katherine,
Thanks for your kind words about my writing—–we’re still kind of gluten-free casein-free with Charlie, with planned “infractions.” Did a lot of biomedical remedies and have a lot of reservations about the claims made and the practitioners and have watched the son of a friend—who has done a laundry list of treatments, still chelates regularly, etc.—seem to have some changes in his health, not for the better.
I know and tried to state that of course all parents weigh these decisions with excruciating car—-I figured I would not strike the right note! I do think that Warner touches on an important point, about a sort of undercurrent of reserve about medications.
My mother-in-law was in a psychiatric institution the summer before last (not the first time this had occurred). She was catatonic and hallucinating. She has had depression, bipolar, throughout her life; one relative “blamed” the medication for causing her to have the hallucations—-but she has had mental illness for much of her life. It seemed inaccurate to me that some chose to “blame the medicine,” rather than to consider the facts of her life and try to address those.
Always too much to consider.
Thanks for your writing too——
Daisy
Feb 16, 2008 at 12:18 am
And now with the latest “school shooting,” the attention is on the shooter and how his behavior becamse erratic after he stopped taking his medications. No one knows yet (or is able to discuss) what they were, what they were for, and why he might have stopped taking them.
Kristina Chew, PhD
Feb 16, 2008 at 1:52 am
Jim and I were just talking about that—I don’t think this is the last post I’m writing on the topic.
Mrs. C
Feb 16, 2008 at 5:46 am
It scares me that they’re even TALKING about the shooter taking the medications… I sure wouldn’t go get meds or even talk to a doctor if I knew that anything I did wrong would get my diagnoses/ medications publicized on the news. This is NOT going to help people seek help for mental illness.
I am all for parents doing whatever they feel is best for their children on this issue. I’ll add, though, that “school problems” are usually just that in my opinion. Though we live in a district that is particularly unfriendly to children with special needs in the elementary school, so perhaps my comment should be taken with a saltshaker and a little sympathy LOL!
Kristina Chew, PhD
Feb 16, 2008 at 9:59 am
I guess I should shake some grains of salt over my own thoughts!
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Feb 17, 2008 at 2:04 am
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Rachel
Feb 21, 2008 at 3:25 am
I’m a long term reader, first time commenter. This time I just really wanted to jump in. And I’m not quite agreeing or disagreeing with the sentiments in the post.
Personally I was on antidepressants for two years, and found them beneficial. I have also worked with autistic children for 7 years (I’m an ABA consultant/therapist). I have seen children benefit from medication, and I’ve seen medication not make a bit of difference.
My problem is this, after coming off of my antidepressants (I was feeling better and tired of the side effects) I discovered that my diet and thought processes were the major contributing factors in my depression. I had worked on more positive thoughts before coming off the medication, but figuring out the food part was key in my improvement. I am now better than I ever was, including the time while taking my medication.
There are studies coming out of Europe regularly showing problems with attention and behavior in young children related to preservatives and additives in food. And Kristina and other parents here have had great benefit with GFCF.
So, to get to the point, my problem is not with people taking medication, but with the lack of alternatives presented. I had suffered stomach problems for much of my life, and neither my physician nor psychiatrists ever asked about my nutrition. Changing my diet was what really helped me get better.
What bothers me is that for many families I’ve worked with, and in my own experience, the options are a) continue doing what you’re doing b) try a medication. Whereas there should be c) exercise and d) change what you eat (along with many other possible, healthy options). Do the alternatives always work? No. Medication can be life saving, and often is. But I want alternatives presented in more forums, not just from some doctors and therapists, but all of them!
Ok, my rant is over. Thank you for listening. And thank you Kristina for your wonderful blog!
Namaste.
Kristina Chew, PhD
Feb 23, 2008 at 11:57 am
@Rachel,
Thank you so much for writing this and sorry it’s taken me a bit to respond. We have been to doctors who have taken one half-look at Charlie (it seems) and said that they want him on meds; we have not gone back to see those doctors. The meds are one piece in a whole lot of options and certainly exercise plays a big part, and healthy eating. While I might question the claims of recovery or cure etc. from diets, Charlie’s lunchbox has some very nutritionally sound contents: Rice, homemade chicken, fruits and vegetables, brown rice bread, the occasional pack of frozen French fries, edamame. And some fast food on the weekends — it’s all a balancing act, no?
Yes, namaste.
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