As I wrote in my previous post, I was quite disturbed at the implications of Judith Warner’s recent New York Magazine article, where she suggests that to deny medication to children is to let them suffer. Therefore, I was much relieved when I read an interview with her where she discusses her book that is coming out this week.
I fully agree with her main argument that children with mental health problems suffer, and that there is a severe shortage of quality mental health care services for children in this country. Her premise before she did her research, a premise which likely grew out of spending time immersed in the culture of wealthy, high achieving families, was that mental illness is a “mirage”, a sign of “cultural malaise.” After speaking with many parents and psychiatrists, she changed her mind.
But her original premise, in my opinion, was, so far off the mark that her ”soul-searching” journey, as it is referred to by her interviewer, still leaves her miles from a full understanding of the problem of over-reliance on medication for our nation’s children. As a pediatrician working on the front lines with children and families, and scholar of contemporary developmental theory and research, I offer a different view.
The combined forces of the pharmaceutical industry and health insurance industry prevent our culture from exploring meaningful alternative interventions. Had Warner spoken to researchers and clinicians in behavioral genetics, developmental psychology and psychoanalysis, she might have gotten a different view.
Emotional problems in children result from a complex interplay of biology and environment. Children may be born with a genetic vulnerability to a particular mental health problem, but the environment, and in particular the degree to which the parents can reflect and contain the child’s experience, have a significant role to play in how those genes are expressed. In other words, parents have the ability to positively influence their children’s development.
Like Warner, I believe there is a lack of empathy for parents whose children are suffering from a range of mental health problems. But empathizing with these parents, in my opinion, does not mean we should promote use of medication. True empathy for parents involves listening to them, giving them time and space to have their experience heard. Addressing children’s emotional problems in their full complexity is very hard work. It may involve exploring painful issues, in parents' relationship with each other and from parent’s own history. There are insufficient resources to help parents with this task.
The influences of the pharmaceutical industry, in promoting the idea of the quick fix, and insurance companies, favoring short, medication based interventions over more time consuming, relationship based ones converge to move parents away from exploring difficult but important issues. I would argue that over-reliance on medication for children allows our culture to shirk responsibility for truly listening to parents and children.
There are circumstances where use of medication for children is indicated. In fact, in my practice I have many children on medication for ADHD. But there is both an over-use of medication and an over-reliance on medication to treat complex problems.
We cannot, though Warner says we can, separate out discussions of treatment of mental illness from discussion of medication. The road to improved treatment for children’s mental health care involves health care reform, specifically loosening the grip of the health insurance industry and the pharmaceutical industry. We need to work towards creating a system that values early intervention, primary care and quality mental health care.