Wednesday, June 15, 2011

Psychiatrists, ADHD, Teachers, and Ritalin: The Path to Mental Illness

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Mental illness was once a mostly self-correcting abnormality in behavior that sufferers usually learned to cope with if provided some social assistance and some time. Over the past few decades the incidence of what we think of as mental illness has increased dramatically in adults. Mental illness in children was once unheard of, now it has become a raging epidemic. Robert Whitaker has tried to provide an answer for these developments in his book Anatomy of an Epidemic: Magic bullets, Psychiatric Drugs, and the Astonishing rise of Mental Illness in America. I find the sections in which he deals with the treatment of children particularly affecting. That will be the focus of this essay.

One cannot understand the state of society without learning a bit of the history of psychiatry. The term brings to mind giants like Freud and images of bearded men listening patiently to patients sprawled out on a couch. Well, one can forget all that. Freud and psychoanalysis no longer exist as part of modern psychiatry. Psychiatrists were medical doctors by training, but their traditional methods did not provide them the success rate, the prestige, or the income that other doctors had attained. When psychoactive drugs began to become available in the 1960s, they jumped on them as their pathway to respectability, and profitability. They would be able to provide a cure by simply scribbling some things on a sheet of paper, just like a “real” doctor.

Unfortunately, things did not work out. Whitaker’s narrative points out that by about 1980, psychiatry was in a “crisis.” The investment in drug usage had not been successful. They had tried to use drugs to cure things for which there was no defined cause. They had spent twenty years experimenting on patients only to discover that the drugs they had counted on turned out to be ineffective at best, and life-threatening at worst. The notion that mental illness was caused by a chemical imbalance in the brain that could be corrected by drugs had never been proven (and it still hasn’t). There was no scientific justification for continuing along the drug-directed path they had been following. Meanwhile, hordes of psychologists and counselors were taking their original psychoanalysis work away from them.

At this point one might consider declaring defeat after a hard battle and withdrawing with dignity intact. They did not choose that path. They decided to double down their bet on drugs. What followed was a highly successful public relations campaign that convinced public, press, and legislators that down was up, and left was really right. They created a new image for themselves and burned into the public consciousness the notion of a “revolution in psychiatry.” Public relations campaigns are expensive and require some expertise to be done right. Who do you turn to when you want to mislead the public? Who has the most experience in that area? Yes, you are correct—they sold their souls to the drug companies.

As part of the campaign the American Psychiatric Association produced a document called the Diagnostic and Statistical Manual (version III) that would provide the basis for proceeding along the drug-driven path. This tome identified (created?) 256 mental disorders. It listed symptoms and provided guidance on making diagnoses. This gave psychiatrists and drug companies multiple new opportunities for drugs and drug prescribing. Note that there was still no scientific basis for what they were planning. There were no new discoveries made that would justify anything. They had merely sold the idea that drugs could fix a “broken” brain.

One of the mental “diseases” that was created was “attention deficit disorder.” The symptoms of this illness were: “hyperactivity,” inattention,” and “impulsivity.” Eventually, the term “hyperactivity” was added and the condition became known as ADHD.

Those of us who can still remember our childhood can probably conjure up the names and faces of several classmates who would have exhibited those three symptoms. Fortunately, they were allowed to grow up and mostly learn how to control their urges and live normal lives. It is not so easy anymore. What we might have called the “class clown,” today would run the risk of being declared mentally ill with ADHD, and could end up with a short and unpleasant life of drug dependency.

Not surprisingly, it was decided that this disturbing condition should be treated with a drug. Whitaker provides a depressing description of the campaigns that have become standard practice when psychiatrists and drug companies want to create and market a new illness.

Needless to say, ADHD began to be discovered in classrooms across the nation. And it was in the classroom that this life-altering diagnosis was made.

“As the Harvard Review of Psychiatry noted in 2009, even today the diagnosis of ADHD arises primarily from teacher complaints, as ‘only a minority of children with the disorder exhibit symptoms during a physician’s office visit’.”

So the diagnosis of ADHD is generally made by teachers? Why not? The psychiatrists and drug companies have convinced the teacher that what they are about to do to the poor child is perfectly safe and will be beneficial. How tempting is it to a teacher to think ”If only I could get little Joey to take a pill and behave better, my life would be so much simpler.” Apparently, quite a few teachers opted for a pill. Whitaker claims there are now 3.5 million children being prescribed stimulants to control their behavior.

Stimulants are being prescribed in order to calm children down? It doesn’t have to make sense, it just has to work—or at least appear to work. It was discovered long ago that amphetamines could “subdue” a hyperactive child. Ritalin (methylphenidate) was brought on the market in 1956 as a “safe” alternative to amphetamines.

“Ritalin could best be described as a dopamine reuptake inhibitor. At a therapeutic dose it blocks 70 percent of the ‘transporters’ that remove dopamine from the synaptic cleft and bring it back to the presynaptic neuron. Cocaine acts on the brain in the same way. However, methylphenidate clears much more slowly from the brain than cocaine does, and thus it blocks dopamine reuptake for hours, as opposed to cocaine’s relatively brief disruption of this function.”

Whitaker explains the chemistry and neurological details at a level sufficient to explain the effects these drugs have on brain function without snowing the non-specialist. Suffice it to say, psychiatrists have tried to convince people that they are helping patients by adjusting chemical levels in the brain to bring them back to normal levels. In reality, mentally ill people are observed to have normal brain chemistry. It is the incursion of the psychiatrists’ drugs that create an abnormality. Creating a situation in which the brain has an excess of dopamine, which is what Ritalin does, forces the brain to compensate by changing the manner in which it produces and reabsorbs dopamine. If this process continues, the alterations in brain function become more and more irreversible. In other words, continued use of Ritalin causes brain damage.

Teachers were thrilled with Ritalin. The problem child was no longer a problem. But what about the student? Psychiatrists are supposed to be administering drugs to help the children, not the teachers. Here is a description Whitaker provided from a report by a psychologist who studied children under the influence of Ritalin.

“...[children] appeared....distinctly more bland or ‘flat’ emotionally, lacking both the age-typical variety and frequency of emotional expression. They responded less, exhibited little or no initiative or spontaneity, offered little indication of either interest or aversion, showed virtually no curiosity, surprise, or pleasure, and seemed devoid of humor. Jocular comments and humorous situations passed unnoticed. In short, while on active drug treatment, the children were relatively but unmistakably affectless, humorless, and apathetic.”

That response is probably not quite what the teacher had hoped for. One might ask if this changed behavior produced better academic results. There did seem to be some benefit in dealing with simple tasks that required concentration, but the evidence suggested diminished capability for more complex tasks. One investigator summed it up this way.

“....Ritalin did not produce any benefit on the students’ ‘vocabulary, reading, spelling, or math,’ and hindered their ability to solve problems.”

One might then hope that the medication would have ameliorated permanently the behavior that got him/her into this situation. The first lesson learned was that stopping taking Ritalin led to a return of the original symptoms, but now they were worse than before. A reasonable person might at this point conclude that it was not a good idea to medicate children this way. Such logic is lost on a dedicated psychiatrist. The conclusion reached was that Ritalin worked just fine, but now ADHD had to be defined as a chronic condition and the children would have to continue taking medication indefinitely.

So we have escalated to the point of administering brain damaging drugs to children for years on end because they misbehaved in a classroom. This was not destined to end well.

“At the end of three years....discovered that ‘medication use was a significant marker not of beneficial outcome, but of deterioration. That is, participants using medication in the 24-36 month period actually showed increased symptomology during the interval relative to those not taking medication.”

So, if you stop taking the drug you get worse, and if you keep on taking the drug you get worse also. This is a drug dealer/maker’s dream. The “getting worse” was also becoming serious.

“....those on meds had higher ‘delinquency scores’ at the end of three years, which meant that they were more likely to get in trouble in school and with the police. They were also now shorter and weighed less than their off-med counterparts, evidence that the drugs suppressed growth.”

Whitaker provides a long list of physical, emotional, and psychiatric effects that have been observed in stimulant takers. It is too long and depressing to reproduce here. You really should read the book.

All of this has been preamble to the really scary part of the story.

It was known that amphetamines could cause psychotic and manic mood swings. One experimenter provided his schizophrenic patients with Ritalin. It ended up doubling the severity of their symptoms. Whitaker asks the reasonable question: “Wouldn’t you expect people on Ritalin to experience manic or psychotic episodes.” In fact, the inevitable action of the drug is to daily cycle the child between highly aroused and highly lethargic states. These are the kind of mood swings psychiatrists search for in order to elevate the subject to a higher level of mental illness—and a higher level of medication.

The FDA estimated that 100,000 incidents of stimulant-induced psychoses or mania occurred in children and adolescents between 2000-2005. Once psychotic or manic behavior is observed, the children are then generally assigned to another recently created mental illness called bipolar disorder.

“In short, every child on a stimulant turns a bit bipolar, and the risk that a child diagnosed with ADHD will move on to a bipolar diagnosis after being treated with a stimulant has even been quantified. Joseph Biederman and his colleagues at Massachusetts General Hospital reported in 1996 that 15 of 140 children (11 percent) diagnosed with ADHD developed bipolar symptoms—which were not present in the initial diagnosis—within four years.”

With 3.5 million on stimulants that means ADHD and its treatment is the pathway for about 400,000 children to serious mental illness. Those suffering from bipolar disorder are generally prescribed a cocktail of drugs in an attempt to control their mood swings. This approach has been deemed ineffective and dangerous for children. There is little long-term data on the outcomes for children, but for adults, only about a third who are drugged ever attain the ability to function outside of a controlled environment. The rest end up on disability for the remainder of their lives. And their lives are not long. There is no reason to expect children to fare any better.

As a footnote to this sorry tale, Whitaker points out that about 10 years ago it became common to begin treating children at the age of two with psychoactive drugs. As a result, the number of children under the age of six who are on permanent disability has tripled in that period.

Catering to the illusions of psychiatrists and the greed of drug companies levies a terrible toll, not only on the unfortunate individuals who get ensnared in their schemes, but for the country as a whole.

Parents—keep you children away from drugs if at all possible. Beware of all drug pushers, even the ones with the white coats. Do your own research before you make a decision.

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