Buy now, pay later

One thing that drives me crazy is when people use a narrowly-defined short-term “gain” to justify intervening in kids’ lives, without regard to the long-term consequences. Using elaborate reward systems means fewer referrals to the principal’s office! Piling on homework will raise third-grade standardized test scores! Even if there were evidence to support these assertions, who would define success so narrowly? I’d much rather raise a kid who enjoys reading than one whose third-grade test scores are higher but who thinks of reading as a chore.

I’ve been meaning for some time to link to this article by Marcia Angell in the New York Review of Books. It reviews three books that discuss the increasing diagnosis of mental illness and the corresponding increase in the use of psychiatric drugs. If what the authors say is true, the story is basically one long parade of short-term thinking at the expense of long-term well-being, with a big dose of corporate avarice and bad government policy driving it all:

For obvious reasons, drug companies make very sure that their positive studies are published in medical journals and doctors know about them, while the negative ones often languish unseen within the FDA, which regards them as proprietary and therefore confidential. This practice greatly biases the medical literature, medical education, and treatment decisions.

. . .

Whereas [Irving] Kirsch concludes that antidepressants are probably no more effective than placebos, [Robert] Whitaker concludes that they and most of the other psychoactive drugs are not only ineffective but harmful.

. . .

Moreover, Whitaker contends, the natural history of mental illness has changed. Whereas conditions such as schizophrenia and depression were once mainly self-limited or episodic, with each episode usually lasting no more than six months and interspersed with long periods of normalcy, the conditions are now chronic and lifelong. Whitaker believes that this might be because drugs, even those that relieve symptoms in the short term, cause long-term mental harms that continue after the underlying illness would have naturally resolved.

The review then specifically focuses on the increasing use of psychiatric drugs on children:

What should be of greatest concern for Americans is the astonishing rise in the diagnosis and treatment of mental illness in children, sometimes as young as two years old.

. . .

The apparent prevalence of “juvenile bipolar disorder” jumped forty-fold between 1993 and 2004, and that of “autism” increased from one in five hundred children to one in ninety over the same decade. Ten percent of ten-year-old boys now take daily stimulants for ADHD—“attention deficit/hyperactivity disorder”—and 500,000 children take antipsychotic drugs.

. . .

One would be hard pressed to find a two-year-old who is not sometimes irritable, a boy in fifth grade who is not sometimes inattentive, or a girl in middle school who is not anxious. (Imagine what taking a drug that causes obesity would do to such a girl.) Whether such children are labeled as having a mental disorder and treated with prescription drugs depends a lot on who they are and the pressures their parents face. As low-income families experience growing economic hardship, many are finding that applying for Supplemental Security Income (SSI) payments on the basis of mental disability is the only way to survive.

. . .

In December 2006 a four-year-old child named Rebecca Riley died in a small town near Boston from a combination of Clonidine and Depakote, which she had been prescribed, along with Seroquel, to treat “ADHD” and “bipolar disorder”—diagnoses she received when she was two years old.

. . .

Rebecca’s two older siblings had been given the same diagnoses and were each taking three psychoactive drugs. The parents had obtained SSI benefits for the siblings and for themselves, and were applying for benefits for Rebecca when she died. The family’s total income from SSI was about $30,000 per year.

The whole thing is really a must-read. Part 1 is here; part 2 is here.
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