An Op-Ed

I want to say something here.  I don’t know who even reads this tiny patch of writing in the blogosphere, but I still want to say it.  It was recently brought to my attention that there is a different paradigm “out there” regarding mental illness in children.  That point of view goes something like this:

Children should not be medicated for mental illness regardless of their condition.  If they are depressed, anxious, violent, or even psychotic, then they should be sent to therapy and taught to live with their condition no matter how debilitated they are.  If they hallucinate and hear voices, then they should be taught to make friends with their hallucinations.  Their brain is trying to tell them something.  If they are violent, then they should be taken to therapy and given cognitive behavioral therapy until they stop acting out.  Bipolar Disorder doesn’t exist in children anyway so a child couldn’t possibly suffer with mania.  He really has anxiety, depression, or he is acting out from past or present abuse.  He’s trying to tell you that he’s traumatized.  If the child has Oppositional Defiant Disorder, then he must be taught how to obey.  If he is homicidal or killing animals, then he has been abused.  His parents have obviously hurt him.  Call Child Protection Services immediately, but all pharmaceutical supports of any kind are always wrong.  Always.

There is a tiny kernel of truth here.  We all know that child abuse is real.  Children who are traumatized certainly do communicate behaviorally.  Cognitive Behavioral Therapy (CBT) as well as Dialectical Behavioral Therapy (DBT) have a place in the treatment of childhood mental health problems.  When a child presents with certain behaviors, it’s imperative to assess the parents or primary care givers.  Sometimes there actually is abuse.  I was questioned by more than one of Grace’s therapists.  It’s part of the intake process.  It’s not fun, but it’s necessary.  You always want to make certain that a child is safe and living in a nurturing environment.  You also want to make sure that a child is not mimicking behaviors they have previously seen.  This does happen.

Where does this point of view, in my opinion, go off the rails? Medication is often a necessary and very appropriate part of a child’s treatment plan.  To assert that psychosis is partially normal and should be an appropriate part of a child’s life is absurd! Long-term psychosis causes brain damage.  Normalizing psychosis is never appropriate.  Teaching a mentally ill child to 1) make friends with potentially dangerous hallucinations that may give harmful instructions to either harm others or the self is wildly irresponsible and 2) accept a life that is ruled by mental illness rather than pursue every avenue of mental health cultivates hopelessness and myopia.

Yes, it’s true that the medications available to treat mental illness are not fabulous.  I’m the first to stand up and say that I don’t like the choices.  It’s a helluva lot easier to treat anxiety and depression in young people than it is to treat psychotic disorders, but I’ll pursue every avenue of treatment before I’ll let Grace sink into the depths of madness and neurodegeneration.

So, if you are of the mind that fish oil, magnesium, Asian mushrooms, yoga, talk therapy, CBT, and summer camps where kids do ‘trust falls’ while braiding each other’s hair is the only solution for pediatric mental illness, then I respect your point of view but respectfully disagree with you.  Part of that equation, however, involves your respecting my efforts to support my daughter.  Grace will not be making friends with the armed gunmen that follow her around because they are not her friends.  Guess what? They are not real! Grace will not be learning to live with her psychosis, her depression, and her mixed states because her mental illness is eating her alive–quite literally.  She is losing white matter.  If she has the radically neuroprogressive form of schizophrenia that I pray she does NOT have, then she could lose up to 20% of her brain tissue in the next 5 years! So, yes, I’ll be fighting for her with everything within me just like so many other families out there.  You do what you must when it’s your child.  So, please, stop harassing those families for attempting to build a life for their children.  Using medication to try to bring stability to an ever-increasingly unstable and ill brain is not child abuse.  Calling childhood-onset schizophrenia nothing but misdiagnosed autism or a manifestation of childhood brilliance, however, just might be.

::climbing off my soapbox now::


8 thoughts on “An Op-Ed

    • It’s a form of fundamentalism really–this strict belief that using drugs to treat mental illness is wrong. Always wrong regardless of the condition. There is a family in the public eye with a young daughter DXed with COS who is harassed often because their daughter is on some nightmarish cocktail of meds. Grace is headed that way because her condition is not responding to medication. Our last visit to the shrink went something like this: “I think Lithium is in your future.”

      A few people from this vocal anti-med group have called CPS on this family a few times for following her psychiatrist’s orders. They practically stalk the family, claiming that there is no way their daughter has COS. She must be acting out because she has been abused because “COS doesn’t exist in children”. Of course, she’s been evaluated time and time again by the best minds in pediatric psychiatry at UCLA, and these doctors are, of course, going to ruin their reputations by misDXing a child with one of the most serious mental illnesses, right? All this is to say that no parent easily chooses to put their child on something like Lithium! Or Haldol. These are nasty drugs. Depakote? Good grief! They are hard on the kidneys, and they cause weight gain. But, has anyone lived with a schizophrenic child? Do these people HAVE SCZ? Most notably, the most vocal of these people drawing the most attention to their “cause” don’t even have children much less children with mental illness or developmental disorders!

  1. Normally, I’d agree – if talk therapy can make the difference, without the use of drugs, I think that’s the way to go for children. BUT – it’s not going to work or be the best route in all cases – like you said, Grace’s white matter is at stake!

    When I was 18, I was diagnosed with severe anxiety and depression. I was offered the drugs, but I declined in favour of talk…I didn’t want to become dependent on anything.

    • Personally, I’m not a huge fan of drugs either. I did a huge amount of personal work sans drugs. I don’t like the notion of dependency either. However, in cases of bipolar disorder and schizophrenia, there is an organic illness occurring. Medication is one of the primary ways to bring stability coupled WITH very important therapeutic interventions. Depression, as awful as it is, is a disease that remits–even without meds. It would be hellish to endure it without any pharmaceutical support and only therapy, but it’s possible. SCZ doesn’t remit. (There is, however, a type of SCZ called Residual SCZ that does seem to remit on its own. One doesn’t know when the remission will occur and if one’s type of SCZ is that sort. Only time will tell.) Bipolar Disorder doesn’t remit either, and people can ruin their lives during a manic episode and the lives of their families. Drugs, unfortunately, are a necessary evil (or blessing) for those two diagnoses. Sadly, these two illness do occur in children–as much as certain groups would deny that–and CBT will not cure them of it (oh how I wish it would!). Some kind of pharmaceutical intervention coupled with therapeutic support is vital for the future success of these kids. To deprive them of either seems…morally and ethically wrong. One caveat: it is important, however, to know which drugs to use. SSRIs, for example, are not effective on children under the age of 8 because their serotonin receptors haven’t come online yet. So, prescribing an SSRI to a 6 year-old would be folly. It wouldn’t work properly. Psychiatrists specializing in neuropharmacology in the pediatric population would be very helpful.

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