The Age Of Anxiety: Let's Medicate The Freshmen

Henry Nasrallah, editor of the journal Current Psychiatry, penned an editorial in the journal's current issue in response to the Cho rampage in April at Virginia Tech. Nasrallah is a psychiatrist at the University of Cincinnati. The Last Psychiatrist has already taken up some of the questions posed in the editorial, so I'd encourage you to read his thoughts. He respectfully disagrees with the editorial.

Me too, although perhaps less respectfully. Because these questions are all self-fulfilling prophecies, leading to incursions into the minds and souls and bodies of American students and fast-tracking young adults for admission into a paradigm of treatment that doesn't work very well and injures their bodies. Besides, how the hell are students supposed to read John Milton if they are doped on Seroquel?

The Last Psychiatrist rightly calls this mission creep.

Anyhow, I've snipped a few of Nasrallah's questions to give you a sense of what he's getting at.

"If the university administration had known about the student’s psychiatric disorder, would he have received better treatment and supervision? Or would he have been stigmatized or expelled, whether or not he responded well to medications and counseling?"

There are all manner of privacy concerns raised here. But, beyond them, in my experience, university admins are the last people on the planet who ought to know anything about a student's medical condition or who should direct anyone's care. Generally, these are folks who couldn't hack it as teachers, so we should trust them with medical information? And last time I checked it was university admins who chased a student with depression out of a college Back East a few years back simply over his condition not his behavior.

"How can roommates or teachers receive adequate information to help a mentally ill student or monitor for treatment adherence when HIPAA rules prevent even families from knowing details of mentally ill adults’ diagnosis or treatment?"

What right do roommates or teachers have to such information? Isn't that breaking a very serious ethical barrier between professor and student? You know kind of like having sex with a student except without the fun. As for roomies...nevermind. And, once Johnny is 18-years-old, what right do Mom and Dad have to his medical information? None. Or is Nasrallah advocating for a college health care system in which anything deemed a transgression of public health models gets reported to the folks? Would Nasrallah support a system where parents are called if their little Julie has sex (at any school other than BYU)? What if Johnny stays up late smoking dope and playing GTA3?

"Because the home-to-college transition can be very stressful, should colleges require freshman courses on how to recognize distress and seek help?"

A course? Maybe the university admins can teach it! I think human beings are pretty well armed with how to sense distress in their own lives without the help of all these traumatized public health officials getting in front of students to tell them that any swing in mood necessitates a trip to the counseling center.

Let's just skip the class and put Zyprexa in the college water supply. Medicate the freshmen!

"Given that schizophrenia, bipolar mania, and psychotic depression often emerge between ages 18 and 25, why have colleges and universities not adopted early screening and intervention?"

Oh, because of minor things like the US Constitution and civil liberties and privacy rights. If I had a kid in college and the school insisted upon "screening and intervention" as a condition of admission, then they could expect the lawsuit from hell. What's next? Lie detector tests for entering freshmen to determine if they've ever had sex or listened to hip-hop?

"Are mentally ill persons more dangerous than the general population, or is that perception based on highly dramatized media reports of isolated incidents?"

You've read Jeff Swanson's research on this matter, right, Hal?

"Why are alcohol and substance abuse—-which cause morbidity and death among college students—-not 'feared' as much as mental illness?"

Oh, boy. It's a good thing Nasrallah wasn't around for my college days. Seriously, though, he shares a bit of white lightning with many psych docs, but one has to wonder why he and the others don't "fear" the dependency and tolerance problems associated with Seroquel and Paxil. In the hands of some docs, those are clearly drugs of abuse and can cause morbidity. I look forward to Nasrallah's editorial on this matter.

"Given that >25% of the U.S. population has a diagnosable and treatable mental disorder, why is our mental health system so fragmented, so inadequate, and so underfunded? And why is there no public outcry to fix it?"

Nasrallah doesn't offer a cite for the 25 percent prevalence number. I assume it comes from the recent World Health Organization survey of American households and is far higher than the 20 percent figure former Surgeon General David Satcher used to cite (a number that included Alzheimer's and Parkinson's). Beyond the bizarre fact that an arm of the United Nations is trying to declare Americans all messed-up--what do you want to bet they don't try that number in France?--that 25 percent estimate could only include every screwed up little Axis II personality disorder in the DSM (IED anyone?) and its use by Nasrallah verges upon a religious statement. Or a political one. Or a religio-political one. Crazy.

Another thing that troubles me about that estimate is that you'll see it trotted out by researchers and advocacy groups within the context of discussing "serious mental illness"--as Nasrallah is in his editorial--by which they mean schizophrenia and wildly-manic bipolar disorder. As far as I know, schizophrenia and bad bipolar I might get you to a 2 percent prevalence, tops. Nasrallah needs to stop mixing apples and oranges.

If this is how the thought leaders in the psych world are thinking, then it's time for a new set of thought leaders. Or maybe it's time to turn the whole party over to the psychologists. At least, they don't fear human behavior.

And, as for Cho, there's still a lot more to be known about his situation before one can start asking the kinds of questions Nasrallah is.

Posted by Philip Dawdy at June 25, 2007 12:03 AM
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