The second part of an article we referred to earlier is online (see link below): Marcia Angell’s multi-book review of the psychiatric industry and its medicating ways. This long review goes over the standardized (note standardized, not necessarily valid or correct) practices that have come into place over the last three decades. I am only going to focus on the small portion that is relevant to some of our past discussions of medicating in the schools, and the problems with the Federal Disabilities programs.
It notes that the pharmaceutical industry has continued the practice of pushing medical uses of drugs for which they were never tested for. It notes that 10% of boys take stimulants to correct their ADHD , and that one-half million children are prescribed antipsychotic drugs.
Arguably this could be put toward increases in diagnostic capability (we did not know we were crazy before) , except that there appears to be trends and styles that go in and out of fashion within the industry. Once everyone had signed up all the boys for ADHS treatment, they changed their minds and decided that many of them actually had “juvenile bipolar disorder.” When questions came about all these new little bipolar monsters, a new disorder was created “temper dysregulation disorder (TDD)with dysphoria.” Based on the footnotes, this later trend was first noted in Science in 2010, so we will have to see how it plays out.
Marcia Angell, New York Review of Books, 14 July 2011 (hat tip NC).
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. It is more generous than welfare, and it virtually ensures that the family will also qualify for Medicaid. According to MIT economics professor David Autor, “This has become the new welfare.” Hospitals and state welfare agencies also have incentives to encourage uninsured families to apply for SSI payments, since hospitals will get paid and states will save money by shifting welfare costs to the federal government.
Growing numbers of for-profit firms specialize in helping poor families apply for SSI benefits. But to qualify nearly always requires that applicants, including children, be taking psychoactive drugs. According to a New York Times story, a Rutgers University study found that children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines.
The combination of money with expert opinion as to its necessity is a very persuasive force. The fact that the earlier article in the series noted that the effects of these drugs are difficult to reverse, that they often not tested for the usage to which they are being put, and that the limited evidence (for those which are tested) that they actually do anything beyond a placebo and/or side effect (the confusion of side effects with medical effect) response is somewhat beside the point: there is money to be made and a (self defining) industry that needs to keep afloat.