Another case is the creating an illness is Attention Disorder, then selling it to
physicians, parents, teachers, and school administrators, and then giving the children stimulant drugs which modifies
the level of neurotransmitters. This in turn causes a response by the brain to counter the abnormal condition created
by the stimulants. The modification creates a dependence for which over half of the children who have been left on the
drug while going through public school will be taking neuroleptic drugs for the remainder of their life. The damage
to the brain, and the long-term consequences are buried under a very broken reporting requirement. And certainly are
corporate friendly government doesn't care.
The article below is about the creating
out of normal behavior a condition, and then instead of making school classes less boring and suitable for active children,
the system following pharma's lead drugs those children. I was one of those active children but fortunately I just missed
the Ritalin craze.
Found in the December 2008 issue of Skeptical
32, No. 6 and on the web at
The Wholesale Sedation of America’s Youth
In 1950, approximately 7,500 children
in the United States were diagnosed with mental disorders. That number is at
least eight million today, and most receive some form of medication.
Is this progress or child abuse?
ANDREW M. WEISS
In 1950, approximately 7,500 children
in the United States were diagnosed with mental disorders. That number is at
least eight million today, and most receive some form of medication.
Is this progress or child abuse?
ANDREW M. WEISS
Andrew Weiss holds a PhD in
school-clinical psychology from Hofstra University. He served on the faculty of
Iona College and has been a senior school administrator in Chappaqua, New York.
He has published a number of articles on technology in education. E-mail:
anweiss [at] optonline.net.
In the winter of 2000, the Journal
of the American Medical Association published the results of a
study indicating that 200,000 two- to four-year-olds had been prescribed
Ritalin for an “attention disorder” from 1991 to 1995. Judging by the response,
the image of hundreds of thousands of mothers grinding up stimulants to put
into the sippy cups of their preschoolers was apparently not a pretty one. Most
national magazines and newspapers covered the story; some even expressed dismay
or outrage at this exacerbation of what already seemed like a juggernaut of
hyper-medicalizing childhood. The public reaction, however, was tame; the
medical community, after a moment’s pause, continued unfazed. Today, the total
toddler count is well past one million, and influential psychiatrists have
insisted that mental health prescriptions are appropriate for children as young
as twelve months. For the pharmaceutical companies, this is progress.
In 1995, 2,357,833 children were
diagnosed with ADHD (Woodwell 1997)—twice the number diagnosed in 1990. By
1999, 3.4 percent of all American children had received a stimulant
prescription for an attention disorder. Today, that number is closer to ten
percent. Stimulants aren’t the only drugs being given out like candy to our
children. A variety of other psychotropics like antidepressants,
antipsychotics, and sedatives are finding their way into babies’ medicine
cabinets in large numbers. In fact, the worldwide market for these drugs is
growing at a rate of ten percent a year, $20.7 billion in sales of
antipsychotics alone (for 2007, IMSHealth 2008).
While the sheer volume of psychotropics
being prescribed for children might, in and of itself, produce alarm, there has
not been a substantial backlash against drug use in large part because of the
widespread perception that “medically authorized” drugs must be safe. Yet,
there is considerable evidence that psychoactive drugs do not take second place
to other controlled pharmaceuticals in carrying grave and substantial risks.
All classes of psychoactive drugs are associated with patient deaths, and each
produces serious side effects, some of which are life-threatening.
In 2005, researchers analyzed data from
250,000 patients in the Netherlands and concluded that “we can be reasonably
sure that antipsychotics
are associated in something like
a threefold increase in sudden cardiac death, and perhaps that older
antipsychotics may be worse” (Straus et al. 2004). In 2007, the FDA chose to
beef up its black box warning (reserved for substances that represent the most
serious danger to the public) against antidepressants concluding,
“the trend across age groups toward an association between antidepressants and
suicidality . . . was convincing, particularly when superimposed on earlier
analyses of data on adolescents from randomized, controlled trials” (Friedman
and Leon 2007). Antidepressants have been banned for use with children in the
UK since 2003. According to a confidential FDA report, prolonged administration
(the standard treatment for ADD and
ADHD) “may lead to drug dependence and must be avoided.” They further reported
that “misuse of amphetamine may cause sudden death and serious cardiovascular
adverse events” (Food and Drug Administration 2005). The risk of fatal toxicity
from lithium carbonate, a not uncommon treatment for bipolar disorder, has been
well documented since the 1950s. Incidents of fatal seizures from
sedative-hypnotics, especially when mixed with alcohol, have been recorded
since the 1920s.
Psychotropics carry nonfatal risks as
well. Physical dependence and severe withdrawal symptoms are associated with
virtually all psychoactive drugs. Psychological addiction is axiomatic.
Concomitant side effects range from unpleasant to devastating, including:
insulin resistance, narcolepsy, tardive dyskenisia (a movement disorder
affecting 15–20 percent of antipsychotic patients where there are uncontrolled
facial movements and sometimes jerking or twisting movements of other body
parts), agranulocytosis (a reduction in white blood cells, which is life
threatening), accelerated appetite, vomiting, allergic reactions, uncontrolled
blinking, slurred speech, diabetes, balance irregularities, irregular
heartbeat, chest pain, sleep disorders, fever, and severe headaches. The
attempt to control these side effects has resulted in many children taking as
many as eight additional drugs every day, but in many cases, this has only
compounded the problem. Each “helper” drug produces unwanted side effects of
The child drug market has also spawned
a vigorous black market in high schools and colleges, particularly for
stimulants. Students have learned to fake the symptoms of ADD in order to
obtain amphetamine prescriptions that are subsequently sold to fellow students.
Such “shopping” for prescription drugs has even spawned a new verb. The
practice is commonly called “pharming.” A 2005 report from the Partnership for
a Drug Free America, based on a survey of more than 7,300 teenagers, found one
in ten teenagers, or 2.3 million young people, had tried prescription
stimulants without a doctor’s order, and 29 percent of those surveyed said they
had close friends who have abused prescription stimulants.
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
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
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).
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.
With the modern science of chemistry in
the nineteenth century, new synthetic substances were developed that shared
many of the same desirable qualities as the more traditional sedatives and
stimulants. The first modern drugs were barbiturates—a class of 2,500
sedative/hypnotics that were first synthesized in 1864. Barbiturates became
very popular in the U.S. for depression and insomnia, especially after the
temperance movement resulted in draconian anti-drug legislation (most
notoriously Prohibition) just after World War I. But variety was limited and
fears of death by convulsion and the Winthrop drug-scare kept barbiturates from
more general distribution.
Stimulants, typically caffeine and
nicotine, were already ubiquitous in the first half of the twentieth century,
but more potent varieties would have to wait until amphetamines came into
widespread use in the 1930s. Amphetamines were not widely known until the 1920s
and 1930s when they were first used to treat asthma, hay fever, and the common
cold. In 1932, the Benzedrine Inhaler was introduced to the market and was a
huge over-the-counter success. With the introduction of Dexedrine in the form
of small, cheap pills, amphetamines were prescribed for depression, Parkinson’s
disease, epilepsy, motion sickness, night-blindness, obesity, narcolepsy,
impotence, apathy, and, of course, hyperactivity in children.
Amphetamines came into still wider use
during World War II, when they were given out freely to GIs for fatigue. When
the GIs returned home, they brought their appetite for stimulants to their
family physicians. By 1962, Americans were ingesting the equivalent of
forty-three ten-milligram doses of amphetamine per person annually (according
to FDA manufacturer surveys).
Still, in the 1950s, the family
physician’s involvement in furnishing psychoactive medications for the
treatment of primarily psychological complaints was largely sub rosa. It became
far more widespread and notorious in the 1960s. There were two reasons for
this. First, a new, safer class of sedative hypnotics, the benzodiazepines,
including Librium and Valium, were an instant sensation, especially among
housewives who called them “mothers’ helpers.” Second, amphetamines had finally
been approved for use with children (their use up to that point had been
“off-label,” meaning that they were prescribed despite the lack of FDA
coincidentally, became more aggressive in marketing their products with the tremendous
success of amphetamines. Valium was marketed directly to physicians and
indirectly through a public relations campaign that implied that
benzodiazepines offered sedative/hypnotic benefits without the risk of
addiction or death from drug interactions or suicide. Within fifteen years of
its introduction, 2.3 billion Valium pills were being sold annually in the U.S.
So, family physicians became society’s
instruments: the suppliers of choice for legal mood-altering drugs. But medical
practitioners required scientific authority to protect their reputations, and
the public required a justification for its drug-seeking behavior. The
pharmaceutical companies were quick to offer a pseudoscientific conjecture that
satisfied both. They argued that neurochemical transmitters, only recently
identified, were in fact the long sought after mediators of mood and activity.
Psychological complaints, consequently, were a function of an imbalance of
these neural chemicals that could be corrected with stimulants and sedatives
(and later antidepressants and antipsychotics). While the assertion was pure
fantasy without a shred of evidence, so little was known about the brain’s true
actions that the artifice was tamely accepted. This would later prove devastating
when children became the targets of pharmaceutical expansion.
With Ritalin’s FDA approval for the
treatment of hyperactivity in children, the same marketing techniques that had
been so successful with other drugs were applied to the new amphetamine. Pharmaceutical
companies had a vested interest in the increase in sales; they spared no
expense in convincing physicians to prescribe them. Cash payments, stock
options, paid junkets, no-work consultancies, and other inducements encouraged
physicians to relax their natural caution about medicating children. Parents
also were targeted. For example, CIBA, the maker of Ritalin, made large direct
payments to parents’ support groups like CHADD (Children and Adults with
Attention Deficit/Hyperactivity Disorder) (The Merrow Report 1995). To increase
the acceptance of stimulants, drug companies paid researchers to publish
favorable articles on the effectiveness of stimulant treatments. They also
endowed chairs and paid for the establishment of clinics in influential medical
schools, particularly ones associated with universities of international
reputation. By the mid 1970s, more than half a million children had already
been medicated primarily for hyperactivity.
The brand of psychiatry that became
increasingly popular in the 1980s and 1990s did not have its roots in notions
of normal behavior or personality theory; it grew out of the concrete,
atheoretical treatment style used in clinics and institutions for the
profoundly disturbed. German psychiatrist Emil Kraepelin, not Freud, was the
God of mental hospitals, and pharmaceuticals were the panacea. So the whole
underlying notion of psychiatric treatment, diagnosis, and disease changed.
Psychiatry, which had straddled psychology and medicine for a hundred years,
abruptly abandoned psychology for a comfortable sinecure within its traditional
parent discipline. The change was profound.
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
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,
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.
To overwhelmed parents, drugs solve a
whole host of ancillary problems. The relatively low cost (at least in
out-of-pocket dollars) and the small commitment of time for drug treatments
make them attractive to parents who are already stretched thin by work and home
life. Those whose confidence is shaken by indications that their children are
“out of control” or “unruly” or “disturbed” are soothed by the seeming
inevitability of an inherited disease that is shared by so many others. Rather
than blaming themselves for being poor home managers, guardians with
insufficient skills, or neglectful caretakers, parents can find comfort in the
thought that their child, through no fault of theirs, has succumbed to a modern
and widely accepted scourge. A psychiatric diagnosis also works well as an
authoritative response to demands made by teachers and school administrators to
address their child’s “problems.”
Once a medical illness has been
identified, all unwanted behavior becomes fruit of the same tree. Even the
children themselves are often at first relieved that their asocial or
antisocial impulses reflect an underlying disease and not some flaw in their
characters or personalities.
In the last analysis, childhood has
been thoroughly and effectively redefined. Character and temperament have been
largely removed from the vocabulary of human personality. Virtually every
single undesirable impulse of children has taken on pathological proportions
and diagnostic significance. Yet, if the psychiatric community is wrong in
their theories and hypotheses, then a generation of parents has been deluded
while millions of children have been sentenced to a lifetime of ingesting
powerful and dangerous drugs.
Considering the enormous benefits
reaped by the medical community, it is no surprise that critics have argued
that the whole enterprise is a cynical, reckless artifice crafted to unfairly
enrich them. Even though this is undoubtedly not true, physicians and
pharmaceutical companies must answer for the rush to medicate our most
vulnerable citizens based on little evidence, a weak theoretical model, and an
antiquated and repudiated philosophy. For its part, the scientific community
must answer for its timidity in challenging treatments made in the absence of
clinical observation and justified by research of insufficient rigor performed
by professionals and institutions whose objectivity is clearly in question, because
their own interests are materially entwined in their findings.
It should hardly be necessary to remind
physicians that even if their diagnoses are real, they are still admonished by
Galen’s dictum Primum
non nocere, or “first, do no harm.” If
with no other population, this ought to be our standard when dealing with
children. Yet we have chosen the most invasive, destructive, and potentially
lethal treatment imaginable while rejecting other options that show great
promise of being at least as effective and far safer. But these other methods
are more expensive, more complicated, and more time-consuming, and thus far, we
have not proved willing to bear the cost. Instead, we have jumped at a
discounted treatment, a soft-drink-machine cure: easy, cheap, fast, and
putatively scientific. Sadly, the difference in price is now being paid by
eight million children.
Mental illness is a fact of life, and
it is na´ve to imagine that there are not seriously disturbed children in every
neighborhood and school. What is more, in the straitened economy of child
rearing and education, medication may be the most efficient and cost effective
treatment for some of these children. Nevertheless, to medicate not just the
neediest, most complicated cases but one child in every ten, despite the
availability of less destructive treatments and regardless of doubtful science,
is a tragedy of epic proportions.
What we all have to fear, at long last,
is not having been wrong but having done wrong. That will be judged in a court
of a different sort. Instead of humility, we continue to feed drugs to our
children with blithe indifference. Even when a child’s mind is truly disturbed
(and our standards need to be revised drastically on this score), a treatment
model that intends to chemically palliate and manage ought to be our last
resort, not our first option. How many more children need to be sacrificed for
us to see the harm in expediency, greed, and plain ignorance?
- Flora, S.R., and S.E. Bobby,
2008. The Bipolar Bamboozle. Skeptical Inquirer 32(5): 41–45
- Food and Drug Administration.
2005. FDA Confidential NDA 11-522. Available online at www.fda.gov/MEDwatch/safety/2005/aug_PI/Adderall_PI.pdf.
- Friedman, R.A., and A.C.
Leon. 2007. Expanding the black box—Depression, antidepressants, and the
risk of suicide. New England
Journal of Medicine, 356(23): 2343–2346.
- IMSHealth. 2007. Available
online at http://imshealth.com/vgn/images/portal/CIT_40000873/56/43/83743772Top%2010%20Global%20Therapeutic%20Classes%202007.pdf.
- The Merrow Report. 1995.
A.D.D.—A Dubious Diagnosis? PBS.
- The MTA
Cooperative Group. 1999. A 14-month randomized clinical trial of treatment
strategies for attention-deficit/hyperactivity disorder. Archives of General
Psychiatry, 56, 1073–1086.
- Sample, Ian. 2005. Leo Sternbach’s
Obituary. The Guardian (Guardian Unlimited) Oct. 3.
- Straus, S.M., et al. 2004.
Antipsychotics and the risk of sudden cardiac death. Archives of
Internal Medicine, 164(12): 1293–1297.
- Woodwell, DA. 1997. 1995
Medical Care Survey. May 8; 286, 1–25.