Atypical Nation

Since last fall, I’ve been chipping away at questions about mental illness in children. It’s time for me to stop chipping. Something which I don’t trust is going on out there.

Yesterday, a paper came out in the Archives of General Psychiatry stating—oh, I’ll just quote from the New York Times:

” The use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday.

The use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday.”

That’s disconcerting enough. And, then, this from the paper's abstract itself:

” From 2000 to 2002, the number of visits that included antipsychotic treatment was significantly higher for male youth (1913 visits per 100 000 population) than for female youth (739 visits per 100 000 population), and for white non-Hispanic youth (1515 visits per 100 000 population) than for youth of other racial or ethnic groups (426 visits per 100 000 population). Overall, 9.2% of mental health visits and 18.3% of visits to psychiatrists included antipsychotic treatment. From 2000 to 2002, 92.3% of visits with prescription of an antipsychotic included a second-generation medication. Mental health visits with prescription of an antipsychotic included patients with diagnoses of disruptive behavior disorders (37.8%), mood disorders (31.8%), pervasive developmental disorders or mental retardation (17.3%), and psychotic disorders (14.2%).”

Male youths getting anti-psychotics twice as often as female youths. White youths getting antipsychotics almost 4 times (!) as often as non-white youths. A third of the anti-psychotics going to youths with behavior disorders and another third going to kids with mood disorders (speculating before getting the full paper: that’s shorthand for bipolar disorder).

Anything jump out at you there? Or do you buy that white male youths are that fucked up these days? I don’t buy it a bit. And I am so frustrated by the broader question of anti-psychotics in children and teens that I cannot even begin to address my concern about its extreme prevalence in white males. I’m sure there are many things driving this besides straight-up mental illness.

OK, I’ll just say it: There is a lot of pressure within white culture to have behaviorally conforming (“normal”) kids (This is very true in Asian cultures as well). I’ll leave it at that for now. I want to read the entire paper before I write things that will piss-off a lot of people.

I will say this: what came out today was hardly news to those who pay attention to the literature. Researchers at Vanderbilt University have been making similar assertions for at least a year, for example. What’s more the data used in the article stops at 2002. I wouldn’t be shocked if the rate of anti-psychotic use among youth is up even more from 2002 to 2005, given that annual US sales of anti-psychotics have gone from about $6 billion to $10 billion in that time.

I know there are parents out there who stoutly defend the use of anti-psychotics for their children. That’s fine. Your kids. Their blood sugar.

But somewhere in all of this news I smell a rat.

And all of this social pressure for behavioral conformity is what concerns me so much about the rhetoric around forced outpatient commitment. You can apply it to wildly psychotic street schizophrenics all you want, if that’s your thing (The Los Angeles Times won a Pulitzer a few years ago for making that essential argument Stupid Pulitzer jury!).

But how far are we away from a day when, for example, a school informs a parent that their child is acting out at school—maybe getting in school yard fights!—and that, by district policy, their child must be given Risperdal before they can return to school? (In Scotland, the government wants to inspect the contents of students’ lunches to remove “bad food.”) If the parents refuse to comply, then the district will get a court order forcing the child into outpatient treatment because as we all know the mentally-ill are so damn dangerous.

Having worked in one of the largest school districts in the country and having spent a good chunk of my adult life poking into the workings of government bureaucracies, I wouldn’t be shocked if that’s already happened.

Or am I being a bit too paranoid there?