Judith Warner - Weve Got Issues: Children and Parents in the Age of Medication

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Table of Contents

Also by Judith Warner

Hillary Clinton: The Inside Story

Newt Gingrich: Speaker to America

(BY JUDITH WARNER AND MAX BERLEY)

In and Out of Vogue

(BY GRACE MIRABELLA WITH JUDITH WARNER)

You Have the Power: How to Take Back Our Country and Restore Democracy in America

(BY HOWARD DEAN WITH JUDITH WARNER)

Perfect Madness:

Motherhood in the Age of Anxiety

For Max, who makes everything possible
And, as always, for Julia and Emilie, with love

Brave New World

NOUN: A world or realm of radically transformed existence, especially one in which technological progress has both positive and negative results

The American Heritage Dictionary of the English

Language: Fourth Edition, 2000

Preface

As I write these pages, Sex and the City superstar Cynthia Nixon is starring off-Broadway in Distracted, a play about a mothers attempt to determine whether her son has attention-deficit/ hyperactivity disorder and should be medicated. A few blocks away, the musical Next to Normal is putting into song a familys struggles with bipolar disorder.

In the news, a psychologist who has developed a highly regarded summer treatment program for kids with ADHD is taking on the psychiatric establishment on the safety and efficacy of stimulant medications. Federal investigators have issued a subpoena seeking detailed information about the activities of three Harvard child psychiatrists reported to have made considerable sums of money consulting for drugmakers and to have hidden much of that money from university authorities.

Meanwhile, the National Institute of Mental Health has committed $60 million in federal Recovery Act funds to autism researchthe largest sum ever granted to the study of the disorder. Some mental health experts believe that in the coming decades, thanks to such research, scientists will not only be able to figure out the causes of disorders like autism, but also actually develop a possible cure.

This is a pivotal moment for mental health in America. An explosive moment. A moment pregnant with potentialfor good and for ill. On the one hand, we are at the brink of never-before-seen opportunities for scientific progress. On the other hand, with these new opportunities have come terrible abuses and betrayals of the public trust. At the very least, for millions of families, there are new and difficult sorts of personal dilemmas to confront: complicated decisions, levels of confusion and pain that havent been eased or soothed or helped or even better informed by the way we tend to talk about them in our culture at large.

Public opinion and most media treatment of this complex and confusing phenomenon have tended toward simplification. Instead of untangling the mysteries of new and confusing areas of science, teasing out whats true and untrue, good or bad about the present moment in the history of psychiatry, our culture has turned complex reality into a simple-minded morality play. In this play, the actors are defined by stereotypes, good and evil are neatly demarcated, and the truththe gray, ambiguous truthis deeply hidden beneath prejudice, fear, and bombast.

Nowhere is this morality play staged with greater stupidityand crueltythan in media depictions of how parents and doctors are caring for children with mental health issues, or, as its generally put, drugging and pathologizing kids. In newspaper reports, TV documentaries, in the shadow world of the blogosphere, the dominant story today is one of profit-mad scientists and quick fix-seeking parents. Children, in our real and virtual watercooler chatter, are no more than misunderstood lab rats, free-spirited misfits who have to be drugged into submission because they dont conform to the demands of our competitive, hyperperformancedriven society.

When I first began this book in February 2004, I bought into that story. I was one of the many people who regarded ADHD, bipolar disorder, and the milder variants of the autistic spectrum disorders as fashionable maladies of questionable reality. I would, perhaps, not have been quite as blunt as Rush Limbaugh, when he described ADHD as the perfect way to explain the inattention, incompetence, and inability of adults to control their kids, but my opinions werent really all that far off from his views.

I am embarrassed to admit to that commonality of belief today. I cringe, thinking back on the company that I was prepared to keep, out of ignorance and a whole host of unrecognized preconceived notions about psychiatry, psychiatrists, and other parents. I really believed then that psychiatry was a sinister profession. That psychiatrists medicated kids for expediency and with a callous disregard for their unique personalities and individual life circumstances. That parents turned to psychiatry to avoid dealing with problems in their family lives that were inconvenient, or overcomplicated or, simply, embarrassing.

Writing this book changed all that.

Research, observation, scores of interviews with mental health experts, critical thinking, and, above all, the compassion Ive gained from talking to dozens and dozens of the parents who stare the whole issue of childrens mental health in the face every single day, have now made holding on to such beliefs impossible for me.

Listening to these parents, letting their voices ring out louder than the cultural noise surrounding them, a couple of simple truths have become clear.

They are: That the suffering of children with mental health issues (and their parents) is very real. That almost no parent takes the issue of psychiatric diagnosis lightly or rushes to drug his or her child; and that responsible child psychiatrists dont, either. And that many childrens lives are essentially saved by medication, particularly when its combined with evidence-based forms of therapy.

Saying this does not mean that I now accept absolutely everything thats done today by child psychiatrists. There is much to excoriate about the current state of psychiatric care in our country and the outsized, insufficiently regulated, sometimes criminally irresponsible role of the pharmaceutical industry.

For that matter, there is much about our current culture of childhood and the climate of contemporary family life generally that should raise alarms. These alarms have been raised many times, by many others, in the nearly endless parade of books, articles, and interviews that have been published or aired over the past few years, detailing the ways that our culture is poisoning the lives of todays kids.

I will explore all this, but, at heart, this book aims to do something different. Its an attempt to set the record straight on what life really is like for parents and children confronting mental health issues. Its an attempt to lay out what the current scientific understandings are of mental disorders. Its an attempt to get beyond hyped-up headlines and all the hand-wringing, finger-pointing, moralizing, and catastrophizing that too often dominate our discussions of childrens mental health issues, and to instead start to articulate a new way to more realistically, compassionately, and productively think about and help a very vulnerable population of kids.

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