The Wholesale Sedation of America's Youth

By Andrew M. Weiss, Skeptical Inquirer. Posted May 5, 2009.

In a larger sense, the whole undertaking has had the disturbing effect of making drug use an accepted part of childhood. Few cultures anywhere on earth and anytime in the past have been so willing to provide stimulants and sedative-hypnotics to their offspring, especially at such tender ages. An entire generation of young people has been brought up to believe that drug-seeking behavior is both rational and respectable and that most psychological problems have a pharmacological solution. With the ubiquity of psychotropics, children now have the means, opportunity, example, and encouragement to develop a lifelong habit of self-medicating.

Common population estimates include at least eight million children, ages two to eighteen, receiving prescriptions for ADD, ADHD, bipolar disorder, autism, simple depression, schizophrenia, and the dozens of other disorders now included in psychiatric classification manuals. Yet sixty years ago, it was virtually impossible for a child to be considered mentally ill. The first diagnostic manual published by American psychiatrists in 1952, DSM-I, included among its 106 diagnoses only one for a child: Adjustment Reaction of Childhood/Adolescence. The other 105 diagnoses were specifically for adults. The number of children actually diagnosed with a mental disorder in the early 1950s would hardly move today's needle. There were, at most, 7,500 children in various settings who were believed to be mentally ill at that time, and most of these had explicit neurological symptoms.

Of course, if there really are one thousand times as many kids with authentic mental disorders now as there were fifty years ago, then the explosion in drug prescriptions in the years since only indicates an appropriate medical response to a newly recognized pandemic, but there are other possible explanations for this meteoric rise. The last fifty years has seen significant social changes, many with a profound effect on children. Burgeoning birth rates, the decline of the extended family, widespread divorce, changing sexual and social mores, households with two working parents -- it is fair to say that the whole fabric of life took on new dimensions in the last half century. The legal drug culture, too, became an omnipresent adjunct to daily existence. Stimulants, analgesics, sedatives, decongestants, penicillins, statins, diuretics, antibiotics, and a host of others soon found their way into every bathroom cabinet, while children became frequent visitors to the family physician for drugs and vaccines that we now believe are vital to our health and happiness. There is also the looming motive of money. The New York Times reported in 2005 that physicians who had received substantial payments from pharmaceutical companies were five times more likely to prescribe a drug regimen to a child than those who had refused such payments.

So other factors may well have contributed to the upsurge in psychiatric diagnoses over the past fifty years. But even if the increase reflects an authentic epidemic of mental health problems in our children, it is not certain that medication has ever been the right way to handle it. The medical "disease" model is one approach to understanding these behaviors, but there are others, including a hastily discarded psychodynamic model that had a good record of effective symptom relief. Alternative, less invasive treatments, too, like nutritional treatments, early intervention, and teacher and parent training programs were found to be at least as effective as medication in long-term reduction of a variety of symptoms (of ADHD, The MTA Cooperative Group 1999).

Nevertheless, the medical-pharmaceutical alliance has largely shrugged off other approaches and scoffed at the potential for conflicts of interest and continues to medicate children in ever-increasing numbers. With the proportion of diagnosed kids growing every month, it may be time to take another look at the practice and soberly reflect on whether we want to continue down this path. In that spirit, it is not unreasonable to ask whether this exponential expansion in medicating children has another explanation altogether. What if children are the same as they always were? After all, virtually every symptom now thought of as diagnostic was once an aspect of temperament or character. We may not have liked it when a child was sluggish, hyperactive, moody, fragile, or pestering, but we didn't ask his parents to medicate him with powerful chemicals either. What if there is no such thing as mental illness in children (except the small, chronic, often neurological minority we once recognized)? What if it is only our perception of childhood that has changed? To answer this, we must look at our history and at our nature.

The human inclination to use psychoactive substances predates civilization. Alcohol has been found in late Stone Age jugs; beer may have been fermented before the invention of bread. Nicotine metabolites have been found in ancient human remains and in pipes in the Near East and Africa. Knowledge of Hul Gil, the "joy plant," was passed from the Sumerians, in the fifth millennium b.c.e., to the Assyrians, then in serial order to the Babylonians, Egyptians, Greeks, Persians, Indians, then to the Portuguese who would introduce it to the Chinese, who grew it and traded it back to the Europeans. Hul Gil was the Sumerian name for the opium poppy. Before the Middle Ages, economies were established around opium, and wars were fought to protect avenues of supply.

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