The Wholesale Sedation of America's Youth

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

People seeking treatment were no longer clients, they were patients. Their complaints were no longer suggestive of a complex mental organization, they were symptoms of a disease. Patients were not active participants in a collaborative treatment, they were passive recipients of symptom-reducing substances. Mental disturbances were no longer caused by unique combinations of personality, character, disposition, and upbringing, they were attributed to pre-birth anomalies that caused vague chemical imbalances. Cures were no longer anticipated or sought; mental disorders were inherited illnesses, like birth defects, that could not be cured except by some future magic, genetic bullet. All that could be done was to treat symptoms chemically, and this was being done with astonishing ease and regularity.

In many ways, children are the ideal patients for drugs. By nature, they are often passive and compliant when told by a parent to take a pill. Children are also generally optimistic and less likely to balk at treatment than adults. Even if they are inclined to complain, the parent is a ready intermediary between the physician and the patient. Parents are willing to participate in the enforcement of treatments once they have justified them in their own minds and, unlike adults, many kids do not have the luxury of discontinuing an unpleasant medication. Children are additionally not aware of how they ought to feel. They adjust to the drugs' effects as if they are natural and are more tolerant of side effects than adults. Pharmaceutical companies recognized these assets and soon were targeting new drugs specifically at children.

But third-party insurance providers balked at the surge in costs for treatment of previously unknown, psychological syndromes, especially since unwanted drug effects were making some cases complicated and expensive. Medicine's growing prosperity as the purveyor of treatments for mental disorders was threatened, and the industry's response was predictable. Psychiatry found that it could meet insurance company requirements by simplifying diagnoses, reducing identification to the mere appearance of certain symptoms. By 1980, they had published all new standards.

Lost in the process was the fact that the redefined diagnoses (and a host of new additions) failed to meet minimal standards of falsifiability and differentiability. This meant that the diagnoses could never be disproved and that they could not be indisputably distinguished from one another. The new disorders were also defined as lists of symptoms from which a physician could check off a certain number of hits like a Chinese menu, which led to reification, an egregious scientific impropriety. Insurers, however, with their exceptions undermined and under pressure from parents and physicians, eventually withdrew their objections. From that moment on, the treatment of children with powerful psychotropic medications grew unchecked.

As new psychotropics became available, their uses were quickly extended to children despite, in many cases, indications that the drugs were intended for use with adults only. New antipsychotics, the atypicals, were synthesized and marketed beginning in the 1970s. Subsequently, a new class of antidepressants like Prozac and Zoloft was introduced. These drugs were added to the catalogue of childhood drug treatments with an astonishing casualness even as stimulant treatment for hyperactivity continued to burgeon.

In 1980, hyperactivity, which had been imprudently named "minimal brain dysfunction" in the 1960s, was renamed Attention Deficit Disorder in order to be more politic, but there was an unintended consequence of the move. Parents and teachers, familiar with the name but not always with the symptoms, frequently misidentified children who were shy, slow, or sad (introverted rather than inattentive) as suffering from ADD. Rather than correct the mistake, though, some enterprising physicians responded by prescribing the same drug for the opposite symptoms. This was justified on the grounds that stimulants, which were being offered because they slowed down hyperactive children, might very well have the predicted effect of speeding up under-active kids. In this way, a whole new population of children became eligible for medication. Later, the authors of DSM-III memorialized this practice by renaming ADD again, this time as ADHD, and redefining ADD as inattention. Psychiatry had reached a new level: they were now willing to invent an illness to justify a treatment. It would not be the last time this was done.

In the last twenty years, a new, more disturbing trend has become popular: the re-branding of legacy forms of mental disturbance as broad categories of childhood illness. Manic depressive illness and infantile autism, two previously rare disorders, were redefined through this process as "spectrum" illnesses with loosened criteria and symptom lists that cover a wide range of previously normal behavior. With this slim justification in place, more than a million children have been treated with psychotropics for bipolar disorder and another 200,000 for autism. A recent article in this magazine "The Bipolar Bamboozle" (Flora and Bobby 2008) illuminates how and why an illness that once occurred twice in every 100,000 Americans, has been recast as an epidemic affecting millions.

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