I have been mulling over this whole thing about pediatric bipolar disorder, medicating kids, contaminating influences thing this week. I am trying really hard to see meaning in the rush to diagnose and then medicate so many children and I confess I am baffled. I think about my son, getting ready now to start graduate school to become a therapist himself, and what he was like as a young child -- intense, rarely sleeping, challenging. He gave his father and me a run for our money but not for a minute did we think of him as a problem. He was challenging because it took us time to learn how best to deal with him, how to deal with his relentless drive to take things in, to see and learn and his apparent lack of interest in sleep. But learn we did and he did also. We used to joke that anyone could be a good parent to his sister but the challenge he presented us made us into really good parents. I shudder to think what might have happened to him or us had we been less confident in our abilities to figure it all out or less knowledgeable about mental health (we are both psychologists) because he might have becomes one of those kids placed first on this drug and then on another. Instead he remained bright, alert, active, intense and delightful -- a challenge yes, and an engaging and loving child now grown into a mature and considerate man.
So as I read all of these reports of off-label uses of atypical anti-psychotics with kids, of the FDA chief deciding that pediatric bipolar disorder exists despite conflicting expert opinion, the revelation of his, and many other so-called leaders in psychiatry, conflicts of interest, and I feel slightly ill. (If you have not been following all of this on Furious Seasons, you certainly should do so). Why on earth are these people so eager to stigmatize so many children with diagnoses of major mental illness -- and there is no way to get around the reality that such a diagnosis is stigmatizing -- and then place them on major psychotropic drugs whose long term effects in children are unknown? How on earth did we get here?
The story last week that so few psychiatrists are practicing therapy certainly points to one piece of this puzzle. Whether those of us who are psychologists and social workers like it or not, the lay public sees psychiatrists as THE experts in mental health. The subtle nuances of the various disciplines in mental health are unknown and meaningless to the average person. So if psychiatrists are more and more inclined to psychopharmacology and less involved in therapy, then to the average person that must mean that this is the best approach. Of course other influences come into play -- relentless advertising by the drug companies, insurance companies which prefer the control they have over prescription drugs to the harder to control treatment by psychotherapy, and of course, turf wars among mental health professionals. I want to believe that many of these psychiatrists, untrained in and not practicing psychotherapy, have reached the place where because all they have is hammers (psych meds), everything they see is a nail. I want to believe this because that almost makes it understandable.
Today I ran across this excellent piece in the Dallas Morning News, reporting
" A state mental health plan naming the preferred psychiatric drugs for children has been quietly put on hold over fears drug companies may have given researchers consulting contracts, speakers fees or other perks to help get their products on the list.
The Children's Medication Algorithm Project, or CMAP, was supposed to determine which psychiatric drugs were most effective for children and in what order they should be tried at state-funded mental health centers. In April, high-ranking state health officials gave researchers the go-ahead to roll out the guidelines."
Never mind how mind boggling it is that there is a need for such a list. The existence of the project tells us already that there is a heavy bias in favor of medicating children. The protocol will govern particularly those children in foster care and on Medicaid, because of course, such children are simply rife with mental illness -- or maybe they have less well-educated parents or have caretakers more interested in ease of management than they are in longer term interventions?
The report goes on:
"Drug protocols are designed to ensure all patients with a particular diagnosis receive the most effective, proven treatment available. They're created by bringing together academics, researchers and public health experts, who run trials, compare best practices and recommend a road map, or algorithm, for which drugs should be used.
While the protocols are generally created with the best intentions, they can be controversial, particularly when drug companies have a hand in designing them.
Some lawmakers and activists say it's time the state took a close look at the financial motivations of experts making drug decisions for hundreds of thousands of Texans. The adult protocol determines treatment decisions in state mental health facilities, despite the lawsuit and studies that have played down the benefits of some of the drugs chosen for it.
"In our country, there's been a switch from taking care of people to focusing on big corporate money," said Rep. Juan Escobar, D-Kingsville, who unsuccessfully offered legislation last year that would have banned researchers or government employees funded by the pharmaceutical industry from designing state psychiatric drug protocols. "There need to be restrictions on how these things are done, because the victims are our children."
But it was this that really grabbed me:
"At least four of CMAP's key developers – all affiliated with the University of Texas system, and all of them published child psychiatry experts – have received research funding from drug companies, or have been consultants and speakers for several different pharmaceutical firms, according to their own published papers and financial disclosure forms filed with the university. Drugs made by some of these manufacturers appear in the children's drug protocol.
The doctors say there's no room for improper influence when their reputations are at stake. If the drugs weren't effective, they wouldn't endorse them – and the research they conducted to craft CMAP wouldn't have been published in prestigious medical journals."
Reputations trump all?? Mightn't the well being of children, who have no say in treatments they receive, mightn't that be more important than the professional reputations of those seeking to prescribe for them?
So, I believe it is good news that the CMAP is on hold. I only wish it were because the whole premise for it were under question.
And the question remains, what does it mean that we have become so willing to medicate ourselves and our children? And what price will we be paying for it in the future?