This is my — an interested parent’s — response to a post I read. I follow the website, ‘Mad in America’, which publishes writing that is critical of psychiatry. It’s a wonderful website and a calm in the storm of a world taken over by psychiatry and its drugs.
This post popped up and is on a topic so close to my interests in this blog that to have merely commented below it would have not done justice to my own feelings on the subject (if I had been brief); or would have been removed by the site’s moderator (if I had gone on and on).
So I decided to have my own imaginary conversation with the post, and to post it in my own blog. Dave Traxon’s writing as published on ‘Mad in America’ is in italics; my reponses are in bold script. It appears argumentative, but my arguments aren’t with its author, who appears genuine and seems to have great intentions. I applaud him for that. My arguments are with a world gone pharma-bonkers.
This is the URL to the original post:
My imaginary conversation starts here:
A Reflective Checklist to Reduce Psychotropic Drugs for Vulnerable Children by Dave Traxson (October 2015)
Vulnerable? But what child is NOT ‘vulnerable’ in an overdiagnosed, overpathologized, overmedicated, unhealthy world where massive power rests in the hands of pharma giants and doctors, and where no parent is capable of making informed opinions or of giving informed consent because of a lack of information?
Let’s be clear: NO child is safe where profit-seeking pharmaceutical giants stand directly behind mass media, government policy, medical education, and medical bodies.
We exist in a climate where pharmaceutical producers omit data; lie about data; do no control-group studies; do no long-term studies; manipulate doctors to prescribe off-label; and where the DSM grows its list of pathological behaviours with each new edition.
We live in a climate where teachers learn, through their complaints, that they can manipulate parents into having unruly children medicated and therefore easier to deal with. In this climate no parent can make informed choice on medications (because real information does not exist); and no parent is presented with workable options for raising difficult children because society has not evolved to that point. Drugging healthy children has become an accepted default. Shame.
A question that has recently exercised my mind since reading a bestselling and much applauded book by Atul Gawande, ‘The Checklist manifesto – How to Get Things Right (2011), is “Could the use of some carefully formulated questions in a short checklist by themselves actually change practice, in terms of the increasingly common practice of prescribing of psychotropic drugs for children, following a clinical assessment, by child mental health practitioners?
There is indeed some (at present anecdotal) evidence that the use of such checklists to promote good practice and mindful responses in doctors could also work in this field. This approach of a team following a simple checklist has had a huge positive impact on many areas starting with the aircraft safety exemplar that Gawande first drew on before he developed one for his own field of surgery. Few predicted that following simple protocols and having simple clarifying conversations, as a team, before a scalpel is used would boost the survival rates in operating theatres so dramatically.
He believes that one of the key concepts underpinning such approaches is that ”Under conditions of complexity, people need room to act and adapt. They require a seemingly contradictory mix of freedom and expectations. This process requires balancing of several virtues – freedom and discipline, craft and protocol, specialized ability and group collaborations.”
Gobbedlygook. We’re dealing with fundamentally healthy children and we’re drugging them in order to control them, not heal them. These drugs heal nothing. We’re drugging them at their future peril. But, please, be my guest: Go ahead and talk gibberish and jargon while kids’ heads are swimming in uppers and downers.
So doctors prescribing psychotropic drugs to children and adults need the freedom to act according to their considered professional opinion whilst operating within the clear expectations of ‘at least no harm’ or the paramount principle of safeguarding children.
Doctors need freedom? Now my head is swimming. Conventional doctors receive a particular type of education where they are trained to view the body as a series of compartments. The information they’re learning at any given moment is about 17 years old (google it). They are not taught to think critically. They have no basis for understanding about society, politics, and economics, which are the elements driving the drugging of healthy children. And, worse, doctors are soaked in pharmaceutical advertising regularly, making them the worst-placed to make sound judgments once they know that the world around them finds this practice (drugging healthy kids with psychotropics) acceptable.
Conventional medicine doesn’t teach root-cause resolution, so it relies on pharmaceuticals to address symptoms. There’s no louder and more obnoxious “symptom” than a difficult child. Conventional medicine’s logical response is to prescribe behaviour-altering drugs. That’s what doctors do with “freedom”.
The idea behind the checklist that I have developed is to promote ‘ethical mindfulness’
Except an environment without real/true/actual informed consent is unethical by design. No way around that.
and therefore more responsible prescribing to meet these above requirements. It should also provide a reflective structure that does not censure action. It rather encourages a child mental health professional to pause, reflect, and review some of the complex interacting variables that might be impacting on a child to create their current pattern of presenting behaviours, before they take the significant step of prescribing psycho-active drugs to a child whose brain is still in the process of development.
The entire notion of prescribing psychotropics to developing brains is criminal. Only the very tiniest percentage of children require psychotropic medication on balance for the possible, known, and unknown, harms they cause now, or will cause in the future. And the most glaring issue — largely ignored — is that these drugs do not address or treat root causes but act solely on symptoms! That we now blithely accept the doping of our children, and that it is normalized everywhere, is an excellent indicator of how sick the planet has become, and how profit-hungry are our corporations.
If they feel, having considered the questions posed, that issuing a drug is the right way ahead then that process may indeed have enhanced the appropriateness of that course of action. On the other hand, it may also reduce erroneous and ‘overzealous prescribing by some colleagues,’ as raised by Sir Simon Wesseley, the President of the Royal College of Psychiatrists, when interviewed for a Times editorial in the summer of 2014. He shared his concerns and said the current position represented ‘a perfect storm’ of the over-diagnosis of children with normal behavioural patterns, and an under-diagnosis of children with genuine mental health conditions.
What is a genuine mental health condition, exactly and precisely? And if the DSM is our arbiter of all things mental, and its members are tainted by corporate conflicts-of-interest, and if psychiatry doesn’t actually study, research, or understand the brain (that’s the domain of neurology, and it’s moving ahead at lightning speed) then where are we exactly…?
In a world where troublesome children are drugged in order to be made easier to deal with, and pharma producers are making billions of dollars in the wake of those kids, of course the quiet, well-behaved 13-year-old girl with bulemia goes unnoticed!
Another related issue is the growing number of diagnostic categories that have been included in the most recent ‘Diagnostic Bible,’ as practitioners refer to it, DSM-5 which was published in 2013. Many child mental health feel that there is an increasing tendency to pathologise normality. Professor Peter Kinderman, head of the Institute of Psychology at the University of Liverpool and President elect of the British Psychological Society stated, ‘It will pathologise a range of problems which should never be thought of as mental illnesses. Many who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as ‘mentally ill.’
That ship has sailed! Ahoy, matey!
An internationally renowned psychiatrist Professor Allen Frances (Duke University) who was Editor in Chief of DSM-IV the American Psychiatric Association’s previous international diagnostic manual, in a recent article on the PsychiatricTimes website, on July 31 2015, endorsed such a checklist approach and also used the ‘perfect storm’ theme saying,
” A perfect storm of interacting detrimental factors has resulted in the recent massive overuse of psychotropic medication in children. Drug companies started to focus their marketing campaigns on kids when the adult market was saturated. “
You said it! Statements like that have an opiate-like effect on me, like chocolate ice cream or a great glass of wine. I feel all fuzzy, happy, and validated. I wish the author had quoted Robert Whitaker, who has done great work in ADHD drug criticism.
He then went on to say in the same article that I “had come up with a terrific suggestion to help contain the epidemic of careless medication in kids.” He also kindly stated,” We simply don’t know what will be the long-term impact of bathing a child’s immature brain with powerful chemicals. We are now conducting an uncontrolled experiment without informed consent with unknown consequences for millions of our kids.
And of course that’s exactly what’s happening, because there is no control group for unmedicated, behaviourally challenged kids. Parents like me, and children like mine, fly under all radar for decades. A parent can’t possibly ask a doctor or psychiatrist, “What if I don’t medicate my son/daughter?” and get any truthful answer except, if the MD has a brain and is truthful, “We don’t know.”
Usually, though, the MD will fudge the issue and give a fuzzy, equivocal answer to a fearful, nervous parent faced with a white-coated authority figure. How can a parent win here? Have you ever presented a doctor with information they were ignorant of, or that contradicted their practice?
No MD can point the parent to me and say, “Ask Liz. She’s a parent who had no trust in conventional medicine or in psychiatry and deliberately avoided all the current conventions in order to avoid being manipulated into medicating her son. And ask her again in 20 years, because we need to know how her son turned out.” There is no control group to compare against the millions of unnecessarily medicated children. It should be a crime.
There are childhood problems that certainly do require medication,
There’s a phrase to drive a truck through…
but this should only be a last resort after careful consideration of less invasive interventions. Medication should never be, as it now too often is, a first and careless reflex. Dave Traxson’s checklist is an excellent guide to more responsible practice.”
The trouble with this fix-it starts here. The default mode has now become prescribing psychotropic medication for unruly, or difficult, or challenging kids. Parents find dulled kids easier to raise in a world where everything is more stressful and difficult than even a generation ago; schools LOVE easily controlled kids; MDs enjoy quick, no-hassle visits; pharma loves to sell products. That’s a lot of pressure once the barn door of EZ-pop-a-pill-pharma has been opened; let’s see you close it.
Without drugs, what will you place in this vacuum? What are you going to tell parents and schools to do, and can I be there to watch the conversation? It seems to me, from my experience with my difficult child, from seeing other difficult children, from following the flow of new information from Integrative medical research, that autoimmune disease and neurological issues are exploding on our planet that is now soaked in environmental toxins. It seems that one of the many canaries of this coal mine is a couple of generations of children with more developmental problems than ever in history.
If you disagree, do you have a better explanation for a veritable tsunami of kids with assorted developmental issues, neurological problems, and other dysfunction?
[Not to mention that childhood cancer is so normalized that we barely blink when seeing photos of bald, radiated/chemo’d kids that would have shocked anyone a few decades ago. A gleaming, new childhood cancer wing in your local hospital? Wheeeeee! Why bother asking why so many children are now diagnosed with cancers? A new wing: How wonderful! Funny that a pharma giant is giving a million dollars, isn’t it? No! That’s an ethical, caring, community-building corporation!…that also just happens to make and sell chemo agents and radiation machines…]
So let’s just say this might be the case, that all these kids’ issues are linked to their environments:
Then you need to inform the parent that INSTEAD OF POPPING ONE LITTLE PILL they must: reduce exposure to toxins, to radically change the family diet, to add brain-healthy supplements, to increase a child’s amount of exercise (brain- and body-healing), and make the school alter its teaching methods and environment to better fit the needs of all these neurologically struggling kids, and to discipline differently.
And maybe — hold onto your chair — you’ll need to secretly look at some of the peer-reviewed, credible science
that is critical of contemporary vaccine orthodoxy, and consider that vaccines being given to babies and throughout childhood are not as safe as suggested by their producers (who are conveniently free of liability in the case of harm, injury and death); and that the beliefs we were all taught about vaccines are possibly not concrete but in fact crumbling? But that would require an openmindedness that psychiatrist (!) and political philosopher Frantz Fanon warned about decades ago:
“Sometimes people hold a core belief that is very strong. When they are
presented with evidence that works against that belief, the new
evidence cannot be accepted. It would create a feeling that is
extremely uncomfortable, called cognitive dissonance. And because it
is so important to protect the core belief, they will rationalize,
ignore and even deny anything that doesn’t fit in with the core belief.”
This is indeed my main hope that a reduction of prescribing will be a measurable outcome once the checklist is introduced to prescribers. More research will need to be undertaken to determine which the most discriminating questions are in terms of a doctor re-evaluating what a child needs and then influencing their decision so as not to prescribe a psychotropic drug.
The Reflective Checklist is to help clinicians think through the necessary steps that should be part of every careful prescription of medication for children.
- Does the child have a classic presentation that closely conforms to an approved indication for this particular medication?
- An approved indication that follows overzealous, pharma-happy DSM diagnostics? Really? And a medication with no long term data for children, prescribed off-label, etc…?
- Is there well documented research on efficacy and safety with children of the same age, gender, and social grouping?
- Which there is not, period because there are no control groups and long-term studies…
- Are the child’s problems pervasive, occurring in a wide range of social settings and observed by many different individuals?
- Are the child’s problems severe, enduring, and impairing?
- Do the child’s parents and involved professionals see the problems as significant enough to require medication?
- Adults will reply to that question according to their needs, not the child’s.
- Are there stresses in the child’s relationships, social context, and recent history which might explain this pattern of behaviors?
- Has a psychological or social intervention been tried prior to prescribing medication?
- Have there been any significant adverse side effects from any medications in the past which may influence your decision and have children with a similar profile had adverse reactions to the proposed class of drugs?
- How many five- or 10-year-olds have experience with similar drugs…?
- Have you carefully weighed short- and long-term risks and balanced them against possible benefits?
- Impossible to weigh risks that aren’t researched and documented. And most parents don’t realize that these drugs act on symptoms and do not treat any abnormalities.
- Have you received informed consent from the parent and (where appropriate) the child?
- As I mentioned previously, there is no informed consent with psychotropics and children. It’s a fable.
And, perhaps the most telling question
- If a child in your immediate family or circle of friends had the same presenting problems as the child you are considering psychotropic drugs for, would you be prescribing medicine now?
- I don’t see how that is a telling question. Its answer only speaks to the degree to which a parent or MD is in denial over the possible effects of psychotropics on the developing brain and/or behaviour of their child, or the degree to which they are lacking information about the drugs and what they do. What would be more telling is a list of the parents’ own current and past prescriptions and the degree to which they believe in the conventional medical and psychiatric model; and knowledge of the MD’s prescribing history.
- A more ‘telling question’ would be to ask the parents how badly they need the child’s behaviour dulled so that they can get the school off their back, and have to do less work with the child at home. Everyone is busy and preoccupied; an unruly child is a stress and a headache for everyone. Ergo: drugs.
Since this article was published I have received many positive comments from practicing mental health professionals around the world highlighting the following points:
- That applying such a reflective approach would improve the Safeguarding of vulnerable children who may possibly be harmed by overzealous prescribing.
- All children are vulnerable in a world where we find it acceptable to drug them in order to control them, since the drugs do not treat or heal.
- That they would expect the prescription rates to fall considerably due to the reflective process involved reducing the likelihood of the doctor going on to sign the prescription.
- Really? When the school and teacher, who were expecting a prescription that would dull the child into sitting quietly, see that none was given…?
- That valuable resources within their health services may be released for higher priority interventions, with more needy clients, especially in poorer developing countries.
- Forgive my cynicism. Developing nations just represent new markets for pharma.
- That young people have the chance to mature and pass through transient problems without them being pathologised as having mental health disorders.
- Another sailed ship. This piece shows how pervasive and acceptable it’s become to drug children into control. Instead of slamming 90% of behaviour-control-through-pharma, the piece just advocates dialing it back a wee bit.
- That psychological and social interventions would be more likely to be tried first which complies with the guideline issued by such regulatory bodies as the National Institute of Health and Clinical Excellence (NICE) in the U.K.
- I’m not in UK and don’t know this organization, but in my experience public policy sells out everywhere to the pharma coporations to some degree or another. How else would the drugging of millions of healthy children even be allowed in the first place?
- That younger children in a year group are not singled out as having behavioural difficulties just for being what they are, the youngest and therefore less mature children in that year. One Canadian study recently showed this was a legitimate concern.
- Nice, but too little and too late. My son is born halfway through the year; so by those guidelines he might’ve been drugged.
The study author, Dr Richard Morrow, a research analyst at University of British Columbia, said in a written statement: “Our study suggests younger, less mature children are inappropriately being labelled and treated. It is important not to expose children to potential harms from unnecessary diagnosis and use of medications.”
For the study, published in the March 5 issue of the Canadian Medical Association Journal, researchers examined data on nearly 938,000 children from British Columbia. The researchers found children born in December were 39 percent more likely to be diagnosed with ADHD, and 48 percent more likely to be treated with a medication for ADHD than their counterparts. This demonstrates clearly the systemic madness that is potentially harming our children due to the rising trend to pathologies normality.
Professor Peter Kinderman, the current President-elect of the British Psychological Society supported the existing NICE guideline for using psychological interventions first, in a press release at the time of DSM-5 publication in 2013, which was published contemporaneously in The Psychologist (BPS Magazine):
“Clearly, it is important to evaluate and assess behavioural and psychological problems fully, and to invest in proper, expert, therapeutic approaches. We would be very concerned if children were being prescribed medication as a ‘quick fix’ rather than accessing the full psychological therapies which may take longer and cost more but ultimately are likely to be better value in the long run.”
“Would be”? “If”? I’m not sure that the professor and I live on the same planet. It IS the QUICK FIX of our epoch. Period.
Other NICE Guidelines which are regularly breached but are being challenged by many Educational and Clinical Psychologists are :
- To utilise a ‘drug holiday’ if the child has been on a psychotropic drug for longer than two years. Some psychiatrists say they haven’t got enough manpower to operate this but one leading psychiatrist told me that if they haven’t got enough doctors to do this then they should not be prescribing so many drugs.
- TWO years? Two years in the brain of a child whose brain has just begun to develop?
- Not to prescribe drugs to children under the age of 5 years old. This is regularly being ignored and my ‘worst case scenario’ was a senior psychiatrist who got one of his team to prescribe a psychostimulant to his own child.
- Appalling, appalling, appalling.
- Not to use a psychostimulant if a child is presenting as having high levels of anxiety. This too is breached regularly but again psychologists are professionally challenging psychiatrists about it to good effect.
- Hair splitting in a world where kids are drugged-by-default.
The reality is that these NICE Guidelines, as we are often told by psychiatrist colleagues, are only guidelines and as a Society we are reliant on the self-monitoring and self-regulation of the rate of prescribing psychotropic drugs to children by the doctors themselves. My two professional bodies the Association of Educational Psychologists and the Division of Educational and Child Psychologists (BPS) are both keen to urge the government to trigger a review of all prescribing of psychotropic drugs issued to young children within the U.K. and to encourage Reflective Thinking before prescribing. There are a variety of reasons for this ranging from a prime concern of many that we do not know what the long term harm is of putting toxic compounds, at varying concentrations, into the developing brains of younger and younger children. We are also aware of a scary new development across ‘the pond’ that the abuse of legally prescribed psychotropic drugs has for the first time in history exceeded the abuse of illegally obtained drugs. We do not want to import this trend to the U.K.
If these authors and bodies were all using Reflective Thinking themselves, they would ask and answer this question:
Is it OK to drug healthy children in order to control their behaviour?
And if the role of psychology, psychiatry, and general medicine is OK with that, then can we simply admit we now live in a novel by Orwell and be done with it?
The troubling thing here in all this hand-wringing is that nowhere do these bodies say, unequivocally, that it’s unethical by any standard to drug healthy children with compounds that may do long-term damage for the sake of controlling their behaviour — and NOT healing any illness.
Reading this long rationale for feeding children psychotropics unnecessarily makes me feel as if I’m in a real life ‘Invasion of the Body Snatchers’.
Let’s send a more positive message forward to future generations about how we can better Safeguard our children and our childrens’ children.
“…a positive message… to future generations…”? So we’re OK with drugging healthy children unnecessarily, but only a few less under some new guidelines? So that’s the message?
For as Nelson Mandella rightly stated, “There can be no keener examination of a society’s soul than the way it chooses to treat their children.”
Yes, well, it chooses to drug healthy children and their brains so that they sit in their chairs at school.
Or as Professor Sami Timimi, a practicing child and adolescent psychiatrist in the U.K., said in a recent article in the Independent newspaper, “ADHD is a cultural barometer of how we treat our children.”
Hmmm…that’s IF “ADHD” exists, after all, Professor.
I’m using some sarcasm here but in the current climate I do sincerely applaud the efforts of professionals like Mr Traxson and like-minded individuals for realizing that the mania to drug children needs attention. If I had my way, of course, a micro-miniscule percentage of children would be drugged but, alas, it’s pharma corporations that have their way with this world, not me.