The Use of Prescription Drugs to Treat Children and Adolescents with Mental Disorders - Essay Example

Demons and Drugs As long as humans have existed on this earth, there have been people who did not behave normally according to society’s rules (Arieti 1974). Prehistoric mental disorders were treated in a variety of ways. Archaeological evidence has been found dating back to the Neolithic era that shows how prehistoric peoples practiced trepananation1 and cicatrization2 (Arieti 1974). In modern times, trepanning is still done in some primitive cultures to relieve psychological and neurological ailments (Arieti 1974). Prehistoric healers also used magic to heal the mentally ill, as some cave paintings show (Arieti 1974). It is important to note that only a very fortunate few were treated at this time. Many prehistoric sufferers of mental disorders were either killed as infants or left alone to die in the wilderness (Arieti 1974). This cruel and heartless treatment continued for several millennia. As people gained a wider understanding of the body and how it worked, they also gained greater knowledge of the brain and its possible abnormalities. The advent of Christianity and Islam led to more humane treatment of the mentally ill. The first psychiatric hospital appeared in the Byzantine Empire during the 6th Century A.D. (Arieti 1974). Over the next several hundred years, an enormous evolution of thought took place. Psychiatric patients were no longer seen as monsters to be gotten rid of in any way possible; they were seen as humans who needed medical help. Most of the responsibility for the care of the mentally ill fell on the shoulders of religious organizations, and this would cause more problems for mental patients during the European Reformation and Renaissance periods. They were often left to fend for themselves when the monasteries were dissolved (Arieti 1974). The European obsession with witch hunts during the 16th and 17th Centuries led to even more deplorable treatment of the mentally ill, who were incorrectly thought to be possessed by the devil, and were tortured or executed because of this (Arieti 1974). For a time, it appeared as if the treatment of mental patients was going to revert back to prehistoric cruelty. Then, in the 18th Century, the cultural period of Enlightenment began, and many psychiatric hospitals were reinstated (Arieti 1974). Some were formed out of the prison system, while others sprang once again from religious organizations (Arieti 1974). The 19th Century ushered in a new era of psychiatry. Psychiatry had now become its own autonomous specialty, recognized as being independent from the field of medicine (Arieti 1974). Even thought the actual science of psychiatry has only been around for about two hundred years, it has made great strides in this brief period of time. New medications have been discovered, more humane treatment practices have been instituted, and more research has been done to help mental health professionals better understand how to treat their patients. Also, in the 1920s, child psychiatry began to be treated as a separate discipline (Arieti 1974). Up until this time, children with mental problems were either ignored, treated as adults, or worse. The children who were, in Ancient times, murdered or left to die were now beginning to receive the treatments they so desperately needed. Children and adolescents suffer from many of the same mental conditions adults do. In fact, most adult psychiatric disorders will evidence themselves during childhood (NIMH 2005). The most common disorders from which children suffer include: pervasive developmental disorders1, bipolar disorder2, borderline personality disorder3, depression4, schizophrenia5, and eating disorders6 (NIMH 2005). One psychological disorder that has gotten a lot of attention in the media because of its effect on children’s behavior and school performance is attention deficit hyperactivity disorder. Approximately 2 million children in the United States have been diagnosed with this disorder, making it one of the most common childhood mental disorders (NIMH 2005). ADHD was first diagnosed in 1845 by psychiatrist Heinrich Hoffman (NIMH 2003). Its main distinctive characteristics are inattention, hyperactivity, and impulsivity (NIMH 2003). The latter two symptoms often show up before the former, and all three of them will appear gradually, over many months (NIMH 2003). Three types of ADHD have been identified: predominantly inattentive (where there is a consistent pattern of inattentiveness); predominantly hyperactive-impulsive (a pattern of more hyperactivity and impulsivity when compared with peers); and the combined type (a combination of the three key behaviors) (NIMH 2003). It is not an easy disorder to diagnose. All children are hyperactive, inattentive, or impulsive at times. But when these behaviors persist for long periods of time (over six months) and negatively affect a child’s interpersonal relationships and academic performance, it is likely that the child has crossed the line from normal childhood behavior to ADHD (NIMH 2003). The exact causes of ADHD are not well-known, but there are many things that are suspected to play a part in its development: genetics; maternal use of cigarettes or alcohol during pregnancy; lead poisoning; and brain injury, or unusually small frontal lobes 1 or the connective tissue surrounding the frontal lobes (NIMH 2003). Contrary to popular opinion, no scientific studies have reported that excessive sugar intake contributes to ADHD (NIMH 2003). Despite the lack of information concerning the causes of ADHD, a great deal is known about the various mental disorders that may co-exist with ADHD. These include: learning disabilities; Tourette syndrome2; oppositional defiant disorder3; conduct disorder; anxiety and depression4; and bipolar disorder (NIMH 2003). The co-morbidity of ADHD with so many other disorders makes treatment difficult. Historically, the only treatment that has consistently proven to be effective is medication5, although recent research has shown that a combination therapy of behavior modification and medication is almost, if not more effective in treating ADHD (NIMH 2003). Behavior therapy alone does not seem to help to reduce the problematic behaviors of children with ADHD (NIMH 2003). This dependence on drug treatment for ADHD is troublesome for many reasons. First, the medications that are used to treat ADHD have many harmful possible side effects (NIMH 2003). Second, medications don’t cure ADHD, they merely help the child pay better attention in school and behave better at home (NIMH 2003). Once medication is stopped, the problematic behaviors will return. In fact, about 80 percent of children with ADHD who need medication also need it as adolescents (NIMH 2003). What is even more disturbing is the fact that more than 50 percent of these children still need their medication when they are adults (NIMH 2003). Despite this surprising fact, most experts insist that ADHD medications are non-habit-forming (NIMH 2003), but perhaps this claim has more to do with supporting the current trend of over-diagnosing ADHD and over-prescribing ADHD medical treatments than it does with reporting an actual fact. A study published in the Journal of the American Medical Association (JAMA) in 2000 described this growing problem with over-diagnosis and over-prescribing (Vatz and Weinberg 2001). Among the most worrisome of the findings of this study was the fact the number of preschoolers on antidepressants rose 200 percent between 1991 and 1995, and the number of children ages two to four who were given a generic form of Ritalin had increased by two to three times (Vatz and Weinberg 2001). This finding was especially troubling because the warning label for Ritalin cautions against giving it to children under the age of six (Vatz and Weinberg 2001). It is suggested that some credit the increased use of Ritalin as a result of the "pressure to conform to school standards," but this claim in not believable (Vatz and Weinberg 2001). Nor is the: suggested explanation for such an increase, including the drugs universal effect on every recipients ability to focus, [which] had been articulated by us and others, but had not been taken seriously (Vatz and Weinberg 2001). Whatever the reason for the increase in diagnosis and prescription, it is obvious that this is a major problem. Use of Ritalin as a child has been linked to use of illegal recreational drugs later in life, and Ritalin itself is being used illegally on college campuses across the country, as the “poor man’s cocaine” (Vatz and Weinberg 2001). Not only can ADHD medications be addicting, but they can also be dangerous in other ways, as well. The non-stimulant medication Strattera, which was approved by the Food and Drug Administration (FDA) in 2002, is known to have a variety of dangerous side effects. These include “agitation, irritability, changes in behavior, or suicidal thinking or behaviors, especially during the first few months of treatment or when doses are changed” (Child Health Alert 2005). Among 1,350 children treated with the drug, one attempted to commit suicide (Child Health Alert 2005). This may not seem like a very large number, but the important fact remains that at least one child attempted to take his/her own life while on the drug, and this is a very serious matter. It would be of interest to see whether this same effect could be seen with the other ADHD treatments, but this is highly unlikely because the others are stimulants. Strattera, being a non-stimulant, would be much more likely to produce depressive, suicidal symptoms. With all the dangers of ADHD drugs, it is no wonder that great concerns have arisen in the minds of the public, and it is also not surprising that the apparent overuse of prescription drugs has led to a number of legal battles. One article in the U.S. News & World Report described one lawyer’s crusade against the “American psychiatric establishment” (Shute 2000). Dickie Scruggs has already proven himself a worthy legal adversary against the asbestos industry, tobacco companies, HMOs, and gun manufacturers (Shute 2000). Scruggs and a group of other high-profile attorneys decided to take on the American Psychiatric Association and Novartis, charging them with conspiring to “promote the use of Ritalin for millions of children to treat attention deficit hyperactivity disorder” (Shute 2000). Scruggs claims that at least 90 percent of the children in the U.S. who are taking Ritalin are being incorrectly medicated (Shute 2000). He also asserts that the diagnostic criteria for the disorder are now so broad and vague as to make it possible for a diagnosis of ADHD to fit every American child (Shute 2000). Scruggs’s statements echo the sentiments of many critics over the years, who have argued “that the DSM’s ever growing list of disorders medicalizes behavioral problems that are a normal part of life” (Shute 2000). ADHD is simply the newest term on this list. The inadequacies of the APA to describe ADHD, and the overzealousness of psychiatrists to administer mind-altering drugs for what could be nothing more than a normal, healthy, active child has gained attention in the political realm. In 2000, then Surgeon General David Satcher held a meeting with hundreds of physicians, parents, and teacher’s in order to evaluate the effectiveness of children’s mental health treatment (Shute 2000). The conclusions drawn at this meeting were interesting, but certainly not earth-shattering: Some children get the medication they need, many others don’t get the medications they need, and still others are given unnecessary prescriptions (Shute 2000). According to Scruggs’s lawsuit, the drug company gave money to the APA and the organization Children and Adults with Attention-Deficit/Hyperactivity Disorder in return for their promotion of the use of Ritalin (Shute 2000). The APA flatly denied these allegations (Shute 2000). In addition to tackling the APA and makers of ADHD treatments, Scruggs says he also plans to bring a lawsuit against the makers of a schizophrenia treatment for children (Shute 2000). Obviously, if the Surgeon General thinks it is necessary to hold a conference about the issue of over-prescription of Ritalin and other ADHD drugs, and if high-profile attorneys are willing to go after psychiatric organizations and major pharmaceutical companies, this is a very serious matter indeed. Children have tried to kill themselves after taking Straterra, and still others are being prescribed strong medicines at alarmingly high rates, even when it is not certain that they have a disorder at all. This issue speaks to the general malady from which our society is currently suffering. Everyone is looking for a quick fix. It is much easier to pop a pill down a child’s throat than it is to teach him/her to behave or study or pay attention, or even change his/her behavior in miniscule ways to make steps in the right direction. Perhaps psychiatrists, teachers, and parents do not need any more medications. Maybe all they need is to learn how to be more patient in teaching their children. Since its creation as a scientific discipline 200 years ago, psychiatry has certainly made great progress, or has it? Several hundred years ago, people who were mentally ill were thought to be victims of demon possession. Aren’t we, as a society, demonizing children when we subject them to potentially harmful medications in order to fix a problem that may or may not be there? If a child is overactive, give him/her a pill. If a child falls asleep or daydreams in class, give him/her a pill. If we are not careful, our society may end up regressing, just as people in the Reformation/Renaissance period did. America’s children will fall victim to a new witch hunt mentality – the obsession with the quick fix prescription drug. References Arieti, S. (Ed.). (1974). The Foundations of Psychiatry. New York: Basic Books. Child Health Alert (2005). “And a New Warning About One Treatment,” 23, 3. Cicatrization (2005, September 26). Wikipedia, The Free Encyclopedia. Retrieved December 17, 2005 from http://en.wikipedia.org/wiki/Cicatrization. NIMH (2003). “Attention deficit hyperactivity disorder.” Retrieved December 17, 2005 from http://www.nimh.nih.gov/publicat/adhd.cfm NIMH (2003). “Borderline personality disorder: Raising questions, finding answers.” Retrieved December 17, 2005 from http://www.nimh.nih.gov/publicat/bpd.cfm NIMH (2005). “Child and adolescent mental health.” Retrieved December 17, 2005 from http://www.nimh.nih.gov/healthinformation/childmenu.cfm NIMH (2005). “Childhood-onset schizophrenia: An update from the National Institute of Mental Health.” Retrieved December 17, 2005 from http://www.nimh.nih.gov/publicat/schizkids.cfm NIMH (2005). “Eating disorders: Facts about eating disorders and the search for solutions.” Retrieved December 17, 2005 from http://www.nimh.nih.gov/publicat/eatingdisorders.cfm Shute, N. (2000). “Pushing Pills on Kids?” U.S. News & World Report, 129(13). Trepanation (2005, November 9). Wikipedia, The Free Encyclopedia. Retrieved December 17, 2005 from http://en.wikipedia.org/wiki/Trepanning. Vatz, R. E., & Weinberg, L. S. (2001, March). Problems in Diagnosing and Treating ADD/ADHD. USA Today (Society for the Advancement of Education), 129, 64. Read More