Furious Seasons

February 15, 2008

Judith Warner Is At It Again

Some of you have likely already seen Warner's post on the New York Times website where she throws all sorts of cold water on Charles Barber's new book, Comfortably Numb, as well as on Christopher Lane, David Healy and Joseph Glenmullen. BTW, for those of you in the Seattle area, Barber will be doing a reading at Elliott Bay Books on Monday evening at 7.30 p.m. I will be attending for sure.

I haven't received a review copy of the book yet because unlike Warner I am a nobody. From what I understand of the book and from reading Barber's excellent essay in the Washington Post, I think Warner may have ignored the book's larger message that recovery from mental illness happens in a social context and that we are doing a rotten job in our culture of addressing the social realities of mental illnesses. That's kind of an important point, given how many people we are diagnosing with mental illnesses in our country. I'd encourage one and all to read Barber's essay.

But Warner ignores that point (you can do this when you are a columnist at a major paper) and instead goes after the idea that Barber expresses in his book--and that Lane and Healy and many others have written about as well--that we have become a culture of the pill and that we are medicating ourselves into oblivion, and that that will have dire consequences for us as a culture. Warner is far more interested in a review of Barber's book written by Peter Kramer (Listening to Prozac) on Slate the other day, probably because Kramer savages Barber on the overmedication issue (he too ignores the rest of the book's points) and because Warner has sure made it her stock in trade in recent months to argue that medicating children is a good thing.

While I appreciate hers and Kramer's skepticism on this issue (both of them claim that there is no hard evidence that we are using meds in America more than any other culture), I think she's off the rails right here:

"Just because it feels like, just because it sounds like, just because soaring drug company profits and obnoxious direct to consumer advertising seem to indicate that everyone around us is popping pills like mad doesn’t mean that they are doing so. Nor does it mean that we’re in the grip of some new, previously unheard-of, and uniquely epoch-defining social phenomenon."

And here:

"Most of the critics decrying the over-medicalization of the American mind rest their arguments upon the bedrock assumption that people who have nothing wrong with them – happy-go-lucky types who essentially make a wrong turn on their way to Starbucks or soccer and end up in the consulting room – are being medicated for largely fictitious concerns."

Hers and Kramer's basic argument is that Barber is out of touch with history. You can read Kramer's review here for a much lengthier examination of the issue. While I get that point with adults (God knows Americans have been medicating themselves against whatever with all manner of booze, snake oil and pills since before we were a nation), I don't think it has nearly as much bearing on current times as she thinks. What's more, I think she's missing a very key point when it comes to kids and teens. And so I left her a comment on the paper's website:

"No disrespect Judith, but did you forget about the 4,000 percent increase in the diagnosis of bipolar disorder in kids that was revealed last year? Considering the split amongst mental health professionals on whether that dx is even real and the rise in the use of that dx in our country, I’d say you missed something that should’ve found its way into your writing. Or does it not matter because it mostly involves little boys? "

How she could've ignored the bipolar child controversy in what she wrote strikes me as sloppy work. How Warner could not have even referenced the recent studies showing that many ADHD kids turn out just fine with or without medication, that ADHD meds seem to retard brain development and so on strikes me, again, as sloppy work. How Warner could not have even flown the flag of concern around the use of anti-psychotics in children strikes me as a flagrant foul (she should be referencing it in adults too). I have no idea why Warner doesn't get that we are now diagnosing mental illnesses in kids where less than a generation ago we would've let the kids alone, and that all this dx'ing and treating with very serious medications has serious cultural implications--and last time I checked we had never done this with kids before in our entire history.

I don't think we gave little kids Valium in the 1970s. I don't think we gave them shots of whisky in the 1920s. So her argument--and Kramer's--that Barber and others, by implication, are losing sight of history utterly falls apart when it comes to kids and teens. I think it's weak when it comes to adults, as well.

Like I said, I do appreciate her skepticism. I simply wish she'd done more thinking and less reacting here.

This brings to mind two events from this week in my personal sphere. On Monday, I was interviewed by an NPR station in Massachusetts regarding the mandatory mental health screenings that the state is forcing upon children and teens. I have no idea if what I said will make it to air, but I pointedly objected to this diagnosing everything as a disorder culture we've created around childhood because there is much disagreement among doctors about whether some of these diagnoses are even valid, that we are using meds to treat them that are grossly underresearched in children (and adults in some cases) and that we've never done anything like this in our history. The reporter seemed a bit frustrated by my objections (apparently, she's got pediatricians telling her they are all in favor of this) and the fact that I couldn't point her to evidence that these screening programs are problematic in any way. So what I told her was that I couldn't point her to any evidence of problems because no state and no nation to my knowledge has ever done anything like this in such a sweeping fashion as is Massachusetts. We are in uncharted waters, I told her, and it'll be interesting to see how this plays out over the next year or so.

I'll let you know when I can when the piece airs.

Second, when I told students at UW the other day about just how much medicating of kids is going on in America these days, their mouths literally fell open. I really don't care if one is in favor of or against what's going on with kids these days, but to argue, as Warner is by implication, that there's nothing unusual in over 2 million children (and maybe more) getting anti-psychotics for things like child bipolar disorder and ADHD is to be wildly ahistorical. Perhaps even more than she and Kramer accuse Barber and others of being.

But then, like I said, Warner is a big shot, she's at the Times and she can say whatever the hell she wants and get paid well for it. I hate to sound too harsh here, but perhaps this is because most of the kids who are getting anti-psychotics are boys, Warner is a woman and I have noticed a trend amongst some women writers (certainly not all) that what's going on is OK because it settles rambunctious children (meaning boys) and makes them focus. To me, this is one of the ugliest strains of feminism, right up there with the "all men are rapists" school of thought. The discouraging thing is I support many of the precepts of feminism, but in the hands of some alleged intellectuals, it's gotten way out of hand.

During my talk the other day, I decided to finally say publicly what I've not had the nerve to write before: We have zero idea how these medications will affect the physical development of these children and I am especially concerned because of the propensity of some of these drugs to cause impotence. Do we really want to create a generation of little boys who can't get it up once they are men?

I assume most women would be against that. But maybe not.

Speaking of ahistorical times, during my talk I referenced Freud and Jung a few times and expected to see glimmers of recognition on the faces of students. I was trying to give students a sense that we used to use terms like neurosis to describe these issues--and that many of what are now considered valid dx's weren't even considered mental illnesses. I saw no glimmers and asked point blank if any of them had ever read Freud. These are honors students, as I was once, and I would've expected them to bump into Freud during some Western Civ class. No one had read him.

Regardless of what you think of Freud (I think he's lame most of the time), it's wildly out of touch with our cultural history that smart college students wouldn't have been exposed to his work.

Posted by Philip Dawdy at February 15, 2008 01:36 PM

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Comments

Great posting. I'm glad that you have come out and said that we have no idea what affect meds will have on the development of children. I wish more people were focused on that unknown, because it can (and I think will) be disasterous.

Posted by: Chloe at February 15, 2008 02:36 PM

I gotta take issue with you suggesting Warner's bullshit has anything to do with feminism. That accusation seems to come out of thin air. I don't think there is any strain of feminism that supports fucking with small children, whether they be boys or girls.

Posted by: Gianna at February 15, 2008 02:39 PM

Great post, Philip.

Children need protection more than ever even though we have child labor laws & other services for children that we didn't have at the turn of the century.

If children, especially little boys, in the olden days couldn't sit still it was no problem. They were sent outside to work on the farm. Nobody expected them to sit in school for 16 years so they could 'get a job'.

I think Judith Warner is way off track.

Also, am surprised that the students knew nothing about Freud [or Jung?]. If they can't go outside anymore to work or play on the farm, what is it that they are studying in school for 16 to 20 years?

Posted by: Rosie at February 15, 2008 02:44 PM

Xlnt post. As a bipolar currently undergoing ECT and a trained psychiatrist to boot, my prejudice is that too many are suffering from lack of medications, that given that the brain is the most complex organ it also suffers from the greatest variety of diseases. Many times I have had patients referred to me for whom I did not recommend medication; a good doctor develops a sixth sense about when an illness is primarily biological or psychosocial. You can't treat Sociopaths with Prozac, for example, and nothing cures a Borderline. Thanks for tipping me off to the review and the book.

Posted by: CE at February 15, 2008 02:56 PM

Excellent post!

Posted by: Stephany at February 15, 2008 03:39 PM

yes gianna that accusation does come out of thin air because someone finally has to have the nerve to state the obvious--the little boys who are being forced to take anti-psychs are of no concern to warner and her ilk, esp the many school teachers and counselors in america who press parents to force their boys onto meds--and at the root of this are liberal women such as warner who use the most important paper in the world to argue for the medication of kids (by which she means boys) because she flatout has no regard for their development. if this involved little girls i am sure you'd see the article by someone saying 'as a feminist thinker, it concerns me what we are doing to little girls.' but this is happening to little boys so it's of no account to the likes of warner.

bottom line is someone had to say this and i guess it fell to me. as i note in the post i am a supporter of most of the precepts of feminism, although they have certainly worked against me in my career, but i'm afraid warner is of the class of writer who just ignores certain issues because they involve boys. meaning future men.

Posted by: Philip Dawdy at February 15, 2008 03:56 PM

and nothing cures a Borderline

CE you are one hell of a scary psychiatrist. God help those who you label borderline.

Posted by: Gianna at February 15, 2008 04:15 PM

CE, i have to disagree with you on the borderline thing: as far as i know dbt has proven to be a very successful treatment with borderlines.

Posted by: Philip Dawdy at February 15, 2008 04:25 PM

thank you Philip for being much more diplomatic than I was. I've helped many so called borderlines when I was a social worker by simply respecting the people with the label and not buying what everyone else at my agencies said about them. And yes, DBT has been shown to help...but so does good old fashion unconditional positive regard, something many mental health practitioners have a hard time doing for those they label borderline.

Posted by: Gianna at February 15, 2008 04:40 PM

re: the haters
come on guys, we have all been oppressed and, if we have balls enough to question ourselves, we've taken in oppresson and have inturn oppressed. boys are born from a woman's womb, sharing bodies food, drugs, poision, hatred,for 9 months(what hurts the mother, hurts the son). if boys are in turn poised from drugs, from wars, from cruelty(that our mythology sometimes demands of men),they then bring that pain and violence to their family, home, to their communities, (what hurts the man hurts the woman, hurts the children, hurts the people). lets not fight eachother. the war of the sexes; i'm not here for that

p.s. i was diagnosed borderline at eighteen and was very symptomatic. at twenty eight i have learned how to balance my life. identified my triggers, learned what to eat, how much sleep i need, the type of people and relationships that support me, am off medication, in school, and displaying no outer symptoms. and i am by no means perfect. i don't need perfection, i have integrety.

Posted by: jenna at February 15, 2008 07:06 PM

To those who question my expertise: I am not currently practicing, so have no fear. Furthermore, I lost my eldest daughter, a borderline, this year to accidental overdose. Notice I said "no cure," not "no treatment." People should take the language more seriously instead of blindly attacking.

18 is too young, in my opinion, to make the diagnosis.

Did I love my daughter any less because of her diagnosis? God no. Do I think the suffering of borderlines any less because they can go from jubilant to despondent in a day or even an hour? No. I feel for them. Deeply. More than you'll ever know. The drama I could do without, but that is only a symptom of sensitivity gone wrong, seeking affirmation by emotional intensity. Enough. Or not enough.

Oh, and btw, I practiced as a family doctor, not as a psychiatrist, as soon as my diagnosis was discovered. I did have a fair amount of psych patients in my practice. Who better to treat them than one who has been on both sides of the couch? --C. E. Chaffin M.D. FAAFP (better known as a poet than a doctor).

Posted by: CE at February 15, 2008 08:46 PM

CE, i didn't see that my comment could be interpreted from that angle, so i was blind (though i am not blind to a good amount of angles). re-addressing the last half of my previous post: i was associativly throwing my borderline story into the ring. not meaning it to attack anyone's credibility. i wasn't trying to provoke hostility, i was patting myself on the back for my acheivments, it is hard work and i rarely get a chance to brag.
sorry

Posted by: jenna at February 15, 2008 10:53 PM

No, there is no cure for personality disorders, which means our focus on fixing the dysfunctional person is misguided and mean-spirited. There is no need to try to cure what can't be cured; our focus belongs on learning what it means to live with a dramatic PD, so we can understand and accommodate the person if we choose to be connected to them. If we don't want to to take the trouble, we can always abandon them like everyone else did.

This was a great piece Philip, but I feel obliged to do some myth-busting:

Warner is a woman and I have noticed a trend amongst some women writers (certainly not all) that what's going on is OK because it settles rambunctious children (meaning boys) and makes them focus. To me, this is one of the ugliest strains of feminism--

Lots of women are anti-feminist, and that what this looks to me. Ordinary fun feminism is about sex education, reproductive rights, and the end of mandatory motherhood, so that women who are ill-equipped to handle the above wild child won't feel pressured into reproducing in accordance with cultural imperatives.

And the "all men are rapists" trope comes from the extremist, separatist, radical feminist faction, it's simply not fair to equate that faction with normal liberal feminism, any more than it is fair for your critics to equate you with anti-psychiatry just because you are generous in giving them voice here. Same deal, the very vocal extremists make such a racket it appears they own the discourse, but they don't, and because they are extremists they never will.

Posted by: flawedplan at February 15, 2008 11:51 PM

Barber's essay reads so well, right on target with patient determination and support linked recovery, --path to wellness-- that it sounds like it could be one of the most encouraging new books to come out yet. Warner is completely out of touch with reality in with what she writes about, which bothers me that she has a column at any paper being read.

Posted by: Stephany at February 16, 2008 03:21 AM

I read Berber's Times article. I agree that healing a troubled mind takes more than a pill but disagree with Berber's redefinition of recovery.

"Another thing patients will tell you is that recovery exists, or can exist, within the context of illness. In other words, recovery doesn't mean cure. It means living with the illness, managing it and getting better within certain limitations."

It think this amounts to settling with the job half done, and that is not recovery but coping.

"No, there is no cure for personality disorders, which means our focus on fixing the dysfunctional person is misguided and mean-spirited. There is no need to try to cure what can't be cured; our focus belongs on learning what it means to live with a dramatic PD,"

"and nothing cures a Borderline"

Wow just wow.

As a former triple Dx, Bipolar 1, schizophrenia and ptsd I know that real permanent recovery is possible.

Few people are genuinely willing to do what it takes to get there while simultaneously claiming they have 'tried everything' which assuredly is not true. They tried everything they knew, but not everything that is available.

"too many are suffering from lack of medications"

that is like people with headaches suffer from lack of aspirin right?

For those of you that believe there is no cure for axis 1 mental disorders, patient or therapist or both, you are denying only yourselves and those you treat at a chance to truly live.

Recovery is not possible for probable, for those that want it bad enough.

Take Mr Dawdy himself. Asymptomatic for years of a supposedly uncurable diasease. Is that not a medical miracle? How many of you will step forward and tell him that because there is no cure, he must not really have been Bipolar?

Really.

Posted by: Jane at February 16, 2008 10:20 AM

Well he might say more in his book, which is more than an essay. I don't believe there are many words easily used in this category that aren't going to be "cured" "disorder" "illness" "mentally ill", etc. so the author, as all of us can hardly describe a situation, due to pre-existing word use/label.

At least the book author has opened a discussion to a broad audience to consider more than medications, which for now is the current standard psychiatric treatment the general public will receive.

Maybe the book has a chapter on DBT for Borderline. Who knows.

I for one, believe in saying mis diagnosed vs. the word cured.

Posted by: Stephany at February 16, 2008 11:33 AM

"Recovery is not possible for [but?] probable, for those that want it bad enough."

So if I'm not getting well on my own, it's because I don't want it bad enough. Gee, thanks for the insight, Jane.

Just go ahead and add empathy to the proud list of things you're not in danger of overdosing on.

Posted by: Garth at February 16, 2008 12:52 PM

Recovery is not only possible, but probable for those that want it bad enough.

You Garth, are not willing to do all that it takes, so, yes you do not want to be recovered badly enough.

Philip did it. Jenna did it. I did it. What are you waiting for? the cure does not come in a bottle or an affirmation, you have to make it happen Garth.

Until I was sick of being sick. I was unable to contemplate recovery.

Unless you have flatlined your own life through suicide, poverty and family ostracization I doubt you have the experience to empathize with the desperation required to force yourself to do what it takes to recover at all costs.

Like I said, you don't want it bad enough Garth. Don't project your failure and lack of motivation on my supposed lack of empathy.

Posted by: Jane at February 16, 2008 01:55 PM

So people who have learned to live satisfying lives by accepting and engaging with their voices and hallucinations that will not go away should STFU about recovery b/c Jane says so. Makes sense.

Stephany, I agree with the misdiagnosis explanation totally and hope for the day the the punitive BPD label goes away. The whole construct of personality "disorders" is awful, and offers nothing that can't be understood in terms in existing explanations of personality development. There is no justification for classifying personalities as disordered but bigotry and segregation.

Posted by: flawedplan at February 16, 2008 08:36 PM

if i were on a philosophy quiz show my answer to the question of who "wins" in life would be:
thoes who have learned to live satisfying lives, and
thoes who have learned and felt compassion.

Posted by: jenna at February 16, 2008 11:36 PM

I'm reading Comfortably Numb right now, put a hold on a copy through the public library and just got it.

I think Warner read a different book than I am reading. I have to wonder if she decided what the book was about before she even read it, and then only noticed what she believes proves her case. Looks like Kramer did the same thing.

Posted by: Sarah at February 17, 2008 08:24 AM

Jane, you see, I don't think you're "recovered" from anything, whatever you think that means. Otherwise you would not have such a desperate need to pass moral judgment on those who have taken a different route to dealing with their problems. I do not know what you are like in person, but your words here do indeed suggest a deep lack of empathy for other people and an inability to deal with them on anything but hostile, aggressive terms. Is that recovery? If so, give me sickness.

Garth

Posted by: Garth at February 17, 2008 11:01 AM