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Kamis, 15 Juni 2017

Practice of Doping up Children to Treat Parental Anxiety Continues to Grow


I have already written several posts about the inappropriate "diagnosing" of bipolar disorder in children and the even more inappropriate use of antipsychotic medications in children.  My main point has been that, rather than having a psychiatric disorder, the vast majority of these children are just acting out.  (For those readers who have difficulty making distinctions - especially those who automatically assume that things that look vaguely alike must be identical - this opinion does NOT apply to those uncommon children who are actually psychotic or to older adolescents who are clearly and obviously manic).


So what proof can I offer?  Well, at the American Psychiatric Association Annual Meeting, John Goethe, MD (director of the Burlingame Center for Psychiatric Research and Education at Hartford Hospital’s Institute of Living), presented the results of a decade-long study of antipsychotic prescribing for children and adolescents in psychiatric hospitals.

The results? Forty-five percent of patients with such behavioral disorders as ADHD or conduct disorder were given antipsychotics and 44% of patients with post-traumatic stress disorder (PTSD) received them. The percentage for other anxiety disorders was 31%!

Forgetting for the moment that an ADHD diagnosis may just be yet another case of acting out, antipsychotic medication is not indicated for ADHD.  In adults, antipsychotic medications are not indicated nor FDA-approved for any anxiety disorder or PTSD.  Not only that, but there is not the slightest evidence from any neurobiological study that the purported mechanism of action of antipsychotic medication has anything to do with anxiety disorders or ADHD. 

And conduct disorder?  This "disorder" was formerly called juvenille delinquincy.  Acting out by any other name. Don't even get me started.

One of the predominant side effects of these medications, is however, sedation.  So one might conclude that the reason the meds seem to both the parents and incompetent doctors to "work" is that the kids quiet down because they are being doped up. (This prescribing practice does not just apply to some psychiatrists but also to many other primary care doctors as well -as to pediatricians, read Claudia Gold's blogpost, Pediatricians Prescribing Psychiatric Medication: A Dose of Reality),

But who's anxiety is really being treated here? 

I submit that it is the anxiety of the parents. Parents who have out-of-control, acting-out children are the real objects of these "treatments."  These parents covertly feel guilty when they are unable to control their children due to inconsistent, neglectful, or abusive parenting practices.  Yet they have great difficulty changing these practices for a variety of reasons - sometimes very understandable reasons.  (One of which is that their doctors make no effort to understand what is really going on in their homes, and take advantage of their insecurities). 

Nonetheless, when the kids are doped up and are therefore less trouble, the parents feel better. And they have the doctors stamp of approval that the problem resides entirely within the child, not with them.

An unsolicited plug

The use of these drugs in kids diagnosed with PTSD is particularly instructive.  Unless you are treating victims of such disasters as the recent outbreak of tornadoes in the South and Midwest, or working with victims of crime like Jaycee Dugard, the most common trauma leading to PTSD in children is child abuse.

Of course, this whole process of sedating acting-out children usually does not end with the first prescription.  For most drugs that have sedation as a side effect, the sedation gradually subsides after  a few weeks on the medication.  Then, of course, the kid starts doing what kids always do - start reverting back to their previous behavior.

The parents then drag him or her back to the incompetent doctor, who starts to take one of the following steps and then another, in no particular order:
  1. Increase the dose of the medication.
  2. Change to a different medication which also is not indicated for anxiety and conduct disorders.
  3. Add a prescription for a second one of those medications, and then perhaps a third or a fourth.
  4. Change the diagnosis to something else other than acting out, and begin the whole process all over again.
Since the kid still is not controlled after the sedative side effect subsides, another step the parents can take is to apply for social security disability for the child.  This gives the child the message that the parents think he or she is both sick and incompetent.

Readers of the blog know what I believe happens next.  The child develops a false self that only seems to be sick and incompetent.  Such children hide their abilities as they grow into adults, continue to act in ways that preclude employment, and continue on social security disability. 

When you take the time to actually get to know them, however, it seems that the only thing they can not seem to do that most people can is maintain employment.

And then Robert Whitaker thinks that the medications were the cause of the disability, just like the less-than-thorough doctors thought that the medications caused the initial improvement of the child's "mental illness" when it was just a side effect that temporarily muted acting out behavior. 

It always amazes me how much people who seem to be on opposite sides of a debate think alike.  Basing their conclusions on totally incomplete information seems to be a favorite blind spot of theirs.

Selasa, 14 Maret 2017

The Culture Wars Parental Guilt and Out of Control Children Introduction





The popular parenting advice columnist John Rosemond writes about an epidemic of poor parenting practices that has been accompanied by an epidemic of out-of-control children. For instance, he notes that behavior such as children biting their parents has become increasingly common. 

In a recent column in the Memphis newspaper (8/31/14), he noted that in cases of parents whose children are disrespectful and refuse to do what they are told, the parents often are not actually telling their child what to do. Instead, they are “…pleading and bribing and bargaining and cajoling and encouraging and then, when all that fails, demanding and threatening and screaming.” 

He points out that there is a huge difference between saying “You could really help mommy out by picking up these toys” versus “I want you to pick up these toys right now.” If the child asks "Why?" he recommends the old standby, "Because I said so!" He correctly points out that children will usually, although of course not always, do what they are firmly and unambiguously told to do.

It seems that whenever anyone dares to point out that that maybe the problem in cases of out-of control, temper-tantrum-throwing children is not the child but the parents, they are often met with rage and accusations of “parent bashing.” This is accompanied by protestations that their child is in some way a problem child who was, I guess, just born that way. 

Such parents will react this way even when their children are running wild in a restaurant or in a store or even in church, and it is blatantly obvious to anyone who has eyes and actually looks that they are doing absolutely nothing to control the kids' behavior.

A good example of such an angry response was seen in a recent column by advice columnist Amy Dickinson. In an earlier column (6/30/14), Ms. Dickinson had responded to someone who asked about the best way to advise a parent with an out-of-control child with the following:

 “Talk to them about it and be supportive and uncritical. This is not a mutually exclusive concept. Tell them, "You can turn this around. Do you want to hear some of the things that have worked for us?" At the risk of providing yet another resource your sister-in-law will ignore, I highly recommend the work of Jo Frost, the ‘Supernanny.’ She enters households like your sister-in-law's, diagnoses the family dynamic and then offers sound and practical fixes.”

After she published that letter, another letter writer responded (7/15/14):

Dear Amy: "Perplexed" sounded like a sanctimonious parent with two "perfect" children, complaining about a family member with a typical tantrum-throwing 3-year-old. I can't believe you didn't call him on this. — Not Perplexed Parent

While toddlers of course do sometimes throw tantrums, parents routinely letting them run wild and doing absolutely nothing at all about it is something else entirely. Ms. Dickinson wisely responded that she “…felt sorry for the tantrum-throwing little boy whose parents let him rule the household and then worried about his behavior. Calm and confident parenting would benefit this child, and I hope the parents get a clue.”

When out-of-control children escalate their behavior, in some cases things can get really out of hand due to a variety of factors that differ somewhat with each particular family. Parents may in frustration start to become abusive verbally and/or physically, or they may just abdicate their role as parents completely – something known in the literature as biparental failure. Or do all of the above at different times.This latter pattern can be the beginning of a process by which a child starts to develop borderline personality disorder.

These problematic parental practices seem to be becoming more and more common. What is behind this? The explanation I have proposed, as I have discussed briefly in previous posts, is that there has been a relatively sudden - on the adapting to cultural changes time scale - and all-encompassing cultural shift that has led to a dramatic increase in the level of guilt among parents. The guilt has in turn led an increasing number of parents to become over-solicitous of and afraid to discipline their children. The kids act out in response, which then causes the parents to get angry with them.

What is this shift? Well, it’s the all of the elements of the cultural upheaval that happened during the infamous 1960's. In particular, it was the emancipation of women combined with economic changes that made surviving on only one income increasingly difficult for families. 

Now don’t get me wrong. The emancipation of women is of course one of the greatest things to have ever happened, as are most of the other changes that occurred during the sixties: civil rights for minorities, the revolt against mindless conformity, and the sexual revolution.

So it is not the new freedoms themselves that are the problem, but the reactions of people to the changes, and the difficulties some families have in adjusting to the new cultural contingencies. As many pundits have pointed out, we are still even now fighting over the sixties. Almost constantly. It is referred to as the “Culture Wars.” It’s part of the reason we have “red” states and “blue” states on the election maps of the United States.

For example, many people still have not got the message that the sexual revolution was won by the revolutionaries. Surveys show that around 90% of both men and women today are not virgins when they get married. And that’s just the people who will admit that. However, you would never know that from listening to the abstinence preachers. 

And of course we have those people who give lip service to encouraging abstinence while somehow still recommending that we should be more “realistic” about the fact that teenagers are going to have sex and therefore we should teach them birth control. They cannot bring themselves to say that having sex responsibly is really just an OK thing to do.

A lot of people continue to feel the need to lie about sex. Anyone really think the Jonas Brothers pop group kept those promises with the “promise rings” they wore, when they were constantly being besieged by legions of groupies? And some promise ring wearers admit that they do not consider oral sex to be “sex.” How bizarre is that?

In fact, there are still many casualties being generated from the sexual revolution of the sixties, even though it’s been over fifty years. One wonders if all the people having unprotected sex do so as a way of punishing themselves for having sex because they feel guilty about it. 

They like to make excuses for being careless, such as saying that condoms interfere with their “spontaneity.” Well perhaps, but so does an unplanned pregnancy or an STD. The real issue is that these people still cannot tell themselves and others that they believe deep inside that they are not doing anything wrong.

I recall a middle aged divorcee I saw for therapy, the son of a minister, who was trying to justify the fact that he had sexual relations with a woman he went out with. I asked him, “So are you saying you don’t really agree with the teachings of your church on this issue?” He replied that the teachings were absolutely correct, but then added, “It’s just that I have these needs…” (Therapists should definitely not face palm during sessions. I didn't but I sure felt like it).

I mentioned the time scale by which individuals and families adapt to cultural changes. The process moves a lot more slowly than most people realize (cultural lag). After all, people are raised by parents who grew up in a somewhat different time. The parents, in turn, were raised by grandparents who grew up in yet another different time. And so on and so forth. Old rules get passed down from one generation to the next, even when they have become obsolete and counterproductive due to cultural shifts.

The rapid cultural changes in gender roles during the last few decades is what I believe to be behind all the parental guilt that we are seeing today, and which have led to the problematic parenting patterns which seem to be increasing in prevalence.

It is hard to believe that just four or five generations ago, even in advanced industrial countries like the United States and England, women were treated in ways that are not all that much different from the way they are treated today in highly traditional Muslim societies like Saudi Arabia. Just the other night, on the Ancestry.com plugfest television show, Who Do You Think You Are (on TLC, formerly on NBC), actress Cynthia Nixon discovered that her 3X great grandmother, Martha Curnutt, killed her abusive husband, Noah Casto, with an ax in 1840s Missouri.

Actress Cynthia Nixon on Who Do You Think You Are?

The show’s narrator explained that she did not really have much choice. The law would not protect her, and her husband apparently told her in no uncertain terms that he was going to kill her. It was not just that women did not obtain the right to vote for another 80 years (in 1920 in the US – less than three generations ago). They were completely at the mercy of their husbands. The narrator explained that in United States until the late 1800's wives were ruled by a legal doctrine called coverture. 

Coverture stripped women of almost all civil rights upon marriage, and they were considered legally indistinct from their husbands. Women could not keep any money they earned, own property, sign legal documents, serve on juries, get educated without their husband's consent, or retain custody of their children in the event of divorce. Men were legally allowed to physically punish (although not kill) their wives, and wives had no legal right to refuse sexual relations.

Some aspects of coverture lasted until the 1960's in some states. In fact, it was not until 1973 that women could serve on juries in all 50 States.

Flash forward to the 1950’s - in my lifetime. When I was a child very few married middle-class women had careers. Children could play outside freely without fear of strangers coming into the neighborhoods because their mothers were almost all home, and were all looking out for all the kids behind the scenes. These mothers were the granddaughters of the women that were ruled by coverture! 

Despite the mothers mostly all being at home, kids were seldom actually actually spending a lot of time with their parents. They kept busy playing with each other. Since I grew up in sunny Southern California, it was almost always nice enough to play outside, and that is where we all were sent. And a lot of it was free play, not organized activities - although there was Little League if you liked that sort of thing.

These mothers, who came of age in the thirties and forties, had no idea what was about to hit them when their daughters became college aged and joined the "women's lib" movement en masse.

In my post about the family dynamics of borderline personality disorder from 9/21/11, I discussed the peculiar situation of these women, who as Rosie the Riveter types got a taste of what it was like to have a career, only to sent back to the kitchen with advice from the government to get barefoot and pregnant again at the end of World War II.  



As mentioned, their daughters came of age during the Women’s Lib movement, which set up a real “generation gap.” I discussed how those developments led to tensions which spilled over into the future parenting practices of the younger of the two generations. I would refer the reader to that post, as a prelude to part 2 of this one, which will discuss the details of the individual and family dynamics that have been creating today’s dysfunctional parenting styles.