If the public knew these things, there would be more focus on how to use these drugs judiciously and there would be more focus on alternative therapies that don’t rely on meds, or that minimize use.

The author spends some time visiting psychiatric facilities in Western Lapland. Here, patients are treated to something called “open-dialogue” therapy. The nurses, psychologists, social workers, and psychiatrists have, for the most part, completed a three-year, 900-hour course in family therapy. According to psychologist Tapio Salo, “Psychosis does not live in the head. It lives in the in-between of family members, and of people. It is in the relationship, and the one who is psychotic makes the bad connection visible. He or she ‘wears the symptoms’ and has the burden to carry them.”

Wow. And, even though this practitioner is referring specifically to psychosis, I felt when I read those words that they potentially have much wider application. What if all the folks who bought into the myth of “chemical imbalance in the brain” were to switch over to an understanding that mental illness resides in the spaces between people… between family members, certainly… and friends, but also members of one’s church, classmates, co-workers, between a government and a people, and between other species and ourselves? What if we all took that seriously and began to put the focus on treating those relationships as if our sanity depended on it?

But let’s go back to this “open dialogue” in Western Lapland. Everyone goes to the first meeting with family and patient with the awareness that they “know nothing.” Wow. Really? Yes, really. Those 900 hours have trained them all to be “specialists in saying that we are not specialists.”  In fact, the therapists consider themselves guests in the patient’s home. If the patient runs off, they just ask them to leave the door open so they can hear the conversation.

There is no mention of antipsychotics in the first few meetings. If the patient begins to sleep better and bath regularly, and in other ways reestablish societal connections, the therapists see that the “grip on life” is strengthening and meds will not be needed. Sometimes benzodiazepenes are given short-term for anxiety or sleep problems, but when the problem goes away, the meds are stopped.

Yes, this process takes time. Sometimes up to five years. Teachers and prospective employers are asked to join the dialogue. The focus is on restoring social connections.

 Results? Since 1992 not a single first-episode psychotic patient has ended up chronically hospitalized. The spending is less than any other district in Lapland. Eighty-four percent of the patients had returned to work or to school, and only 20% were on antipsychotics. Families have come to trust the system and call for help at the first sign of psychosis… and, consequently, very few go on to develop schizophrenia.  They have had a 90% drop in new cases of schizophrenia since the early 1980’s.

 
What about alternative therapies for depression? 70% of depressed patients respond to an exercise program. In fact, general practitioners in the UK are writing prescriptions for exercise. And the side effects are fantastic: more strength, better cardiovascular function, lower blood pressure, better sleep, better sex, improved cognitive functioning. Oh, and studies have shown it is not wise to combine exercise with drug therapy.

Then there is the Seneca Center in California, a last-stop for severely disturbed kids. When a child enters the residential program, the question is not “What’s wrong with the kid?” but “What happened to them?” The Seneca Center also does something else interesting. As they chart the life history of the kids, they also chart the medication history… looking for how behavior may have changed after medication. Not surprisingly, these histories regularly tell of psychiatric care that has worsened behavior.  If they can see that a drug did not help, they don't prescribe it.They frequently detox the kids and institute behavior modification techniques to help the kids control their own behavior.

According to the program director, “… feeling in charge of yourself and being responsible for yourself is [sic] the central issue of their lives.” It’s about power. And power in relationships. They provide “mentors” for the kids, and the kids learn that it’s safe to form attachments.

The Seneca Center highlights a major issue in mental health today: The need for social and medical support for detoxing from prescription medications.

Whitaker ends his book talking about an organization in Alaska called PsychRights that mounted a public information campaign in 2002 with judges, lawyers, psychiatrists, and the general public about the outcomes for antipsychotics. The founder of this organization, Jim Gottstein, filed a lawsuit against the state in a forced-drugging case, and won a stunning legal victory in 2006. The Alaska Supreme Court ruled, “Psychotropic medication can have profound and lasting negative effects on a patient’s mind and body. These drugs are known to casue a number of potentially devastating side effects.”

Gottstein has moved on to filing lawsuits on behalf of foster children and children living in poverty. He likens these suits to Brown vs. Board of Education, hoping they will have a similar effect to that watershed lawsuit that ended segregation—in this case changing national attitudes about the drugging of children.

There’s no neat way to sum up these ten blogs. Obviously, I consider it an important book. As an activist, I have seen a country and a generation of activists become progressively more numb and more complacent. I have seen friends change personalities, stop moving forward. I have experienced the suicides and attempted suicides of friends and colleagues—four in this last year. As global warming advances, as resources become more scarce and economies more fragile, as social services are increasingly cut, and as the environment becomes more and more toxic, there has never been so great a need for awareness, for clarity, and—yes—alarm. It is a time for radical honesty, for confrontation of the conflict-of-interest when drug companies have so many financial ties to Congress, to doctors, and to medical schools. It is time for honest studies, for “open dialogue” on a national level.

What I take away from the book, and take most seriously, is a new understanding that mental illness resides in the spaces between people. I want to take responsibility for my part in the healing of that space.

Click here to go back to Part 1.

This is the ninth part of my very long blog on Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America by Robert Whitaker.

Today's blog is on childen… specifically the so-called rise of mental illness among children and young people. What appears to be on the rise is an ideology.

The first thing to understand is that  the prescribing of psychiatric drugs to children is fairly recent. Prior to 1980, very few young people were medicated for mental conditions.

As Whitaker’s book makes clear, it’s all about the story. In fact, no research has ever shown a chemical imbalance in the brain to be the cause of depression or schizophrenia. Research does show that long-term use of psychotropic drugs creates a chemical imbalance in the brain that can be permanent, leading to permanent dependence and disability. Okay.. but the story is this: "Wow!  Good thing you’re on meds, because look how ill you get when you try to get off them! That just PROVES what a terrible imbalance you had before you were diagnosed."  I suppose alcoholics and heroine addicts could try to spin their withdrawals the same way…

Anyway, same thing going on with the drugging of kids:  Spin. Story. Apparently millions and millions of kids who, in the benighted past, were considered bored, rambunctious, temporarily sad, introspective, or angry were (according to “the story”) actually suffering from mental illness that was biological in nature (the elusive “chemical imbalance of the brain” story puts in a pediatric appearance), and FORTUNATELY these kids are now being diagnosed and medicated, and the fact that their mental health is becoming worse and worse just shows what a great thing it is that they are now getting help!

Turns out, depression and mania have always been common among children.  At least, that's the story.

And, here, let me put in a word for my own reasoning capacities. I think there are many and excellent reasons for a decline in the mental health of children. For starts: nutrition. There’s a B-vitamin deficiency in the global food supply (result of depleted soil). Kids eat crap. We all know that. It’s pushed on them. And low-income families have little choice but to load up on high-carb, low-nutrient foods. If we treated our cars the way we treat our bodies, the engines would have seized up long ago. 

Then there is what some have begun to call Nature Deficiency Syndrome. It’s a pretty recent thing that a child can spend months, even years at a time in man-made environments without a day in nature. I think this has a severe impact on perspective, perceptions of reality, being right-sized, etc.  I think that being in nature has many effects on us that are still poorly understood.

And then there is the electronic media thing… staring at screens: TV, DVD’s, WII sports, Nintendo games, texting. We are learning reality from unreality. Not to mention that radiation thing.

And, seriously, WHAT are they watching for 5-8 hours a day? Porn and violence. There have been some hugely ignored studies documenting that children before the age of four register traumatic events they see on film as if these events were real. In other words, they actually develop PTSD from watching people get burned alive, blown up, eviscerated, raped, tortured, and murdered. I remember back in the 1950's, my brother developed a bunch of fear behaviors after seeing the movie "House on Haunted Hill." Which would be considered light-weight today.  Anyway, the research about pornography is equally conclusive and equally ignored: exposure to pornography desensitizes the viewer, impairing their capacity for intimacy, fostering an objectification of (usually) women. Oh, and it teaches rape.

Are children more restless, depressed, aggressive? I wouldn’t doubt it. Is it about chemical imbalance in the brain? Until there is one shred of research to support that theory, I’m going to go with “no.” Is it about how far we have removed ourselves from being an animal species among animal species?  Well, those folks who are actually creating environments to bring us back to that are getting good results.

But let’s get back to “the story.”  Children have been massively mentally ill all along… who knew? 

Let’s look at Attention Deficit Disorder (ADD).  At the turn of the century, a doctor did identify hospitalized children with “violent outbursts… destructiveness, and a lack of responsiveness to punishment.” This was found to be associated with known brain injuries (meningitis, brain tumors, etc.) It was a rare condition.

In 1956 Ritalin went on the market as an alternative to amphetamines for treatment of narcolepsy. It was found helpful for treating these hyperactive kids who were hospitalized for brain injuries. But things didn’t really change until 1980, when ADD made it into the DSM for the first time (Diagnostic Statistical Manual), which, in cynical terms, determines what insurance will and won’t pay for. In 1987, ADD became ADHD (Attention Deficit Hyperactivity Disorder). In 1991, ADHD became covered by an act of Congress, so that now children with the diagnosis were eligible for a range of special services.

What happened? Suddenly there were children in every classroom with this formerly rare, brain-disease side effect. Who was diagnosing? Mostly teachers, not doctors.  A study in 2009 showed that “only a minority of children with this disorder exhibit symptoms during a physician visit.” By 2007, one out of twenty-three children (4-17 years old) were being medicated for ADHD.  It’s called a brain disease, but, again, no research supports this finding. The neuroanatomy appears to be normal. The “chemical imbalance” thing is a drug-marketing claim, not science. Who needs facts when the story is so good?

Do the drugs “work?” Well, the children definitely become subdued, or, in clinical terms, there is a “reduction in movement and engagement with others.” In teacher language that would mean “stops fidgeting and talking to students during class.” In research language, other phrases have been used: “emotionally flat,” “reduced curiosity about the environment,” “socially withdrawn,” “little or no initiative,” “devoid of humor.”

What about the children?  Researchers have found a pervasive dislike for taking the pills among hyperactive kids. Seems that it’s not great for self-esteem. But what about academic performance? If the pills enhance the student’s ability to focus, then wouldn’t that enhance self-esteem?

Ritalin helps with focus on  routine, repetitive tasks, but it does not lend itself to creative problem solving or divergent thinking—both of which are necessary for critical thinking. Ritalin appears to be taking on a sinister tinge: The improvement is in classroom manageability, not academic performance.

And the long term?  Seems to be a growth suppressant (shorter, less weight). Symptoms worsen over time. Greater overall functional impairment.  Oh, gosh… Okay (deep breath): drowsiness, appetite loss, lethargy, facial and vocal tics, insomnia, headaches, abdominal pain, motor abnormalities, skin problems, liver disorders, sudden cardiac death, depression, apathy, anxiety, irritability, obsessive-compulsive disorder, mania, paranoia, hallucination…  reduced ability to experience pleasure. Yeah. Ritalin.

Moving on. By 2002, one in forty children were on anti-depressants. In 2004, the number of children killing themselves on these drugs was so alarming, the FDA started requiring the drug companies to include a warning label that describes the "increased risk of suicide and suicidal thoughts and behavior in children and adolescents given antidepressant medications." A warning. The drugs are still available, still prescribed, and young people are still killing themselves. Read my earlier blog on the failure of antidepressants… Or, if you have a strong stomach, go to the SSRI stories website.

In 1960, researchers were unable to find any cases of manic-depressive syndrome in children. By the late 1960’s, Ritalin began to be prescribed. Some children taking Ritalin began to exhibit manic behavior.  No surprise there. Any parent with a kid on Ritalin can tell you about the daily “crash.” The drug produces arousal followed by dysphoric symptoms. Daily. But this is the very cycle that doctors describe as bipolar!  Every child on a stimulant is a bit bipolar, and the risk of moving on to a full diagnosis is ever-present. Voila! Pediatric bipolar disorder was “discovered.”

As antidepressants began to be prescribed, the numbers rose even higher.  And here was the story: The antidepressants were not causing bipolar.. no, no, no!  They were simply unmasking the bipolar illness that was already there! In fact, by 1995, studies showed that one quarter of children and adolescents diagnosed and medicated for depression would convert to bipolar within two-to-four years.

To sum up: 400,000 children have arrived at bipolar via the ADHD doorway, with at least another half-million on the way through the antidepressant doorway. This is an iatrogenic epidemic, people. Iatrogenic. Look it up. And how bad off are these kids?  In 1987, there were about 16,000 psychiatrically disabled youth on SSI.  Twenty years later? 560,000.

And what about really young kids? About ten years ago, doctors began to prescribe psychotropic drugs to toddlers. In those ten years, the number of children under the age of six who are on SSI has tripled.

Whitaker goes on to interview some of the children who are on these medications. The stories are heartbreaking and also infuriating. What is most upsetting is that the doctors who are attempting to explore other treatment modalities in lieu of medication are finding they can’t get funding, and their work is not being published. 

The next blog will probably be the last… talking about these alternative methods for dealing with mental illness.

Click here to go back to Part 1.
Click here to go on to Part 10.