Judith Warner Uses Extreme Cases To Get Excessive

On Friday, New York Times "op-extra" columnist/blogger/sometime pharma apologist Judith Warner offered her take on news that some of those kids dumped on the State of Nebraska last year, during that state's doomed "safe haven" law experiment, were mentally ill.

"Recently, The Omaha World-Herald acquired 10,000 pages of case files concerning these children from the state’s Department of Health and Human Services. They paint a portrait of desperation – of out-of-control kids, overtaxed parents and guardians, and an overstretched health care system – that really deserves more widespread national notice.

"Because even though the mentally ill 'safe haven' children had extreme needs, and some of their parents and guardians had extremely limited capabilities (one grandmother said her charge had 'demons inside of him'; a mother who dumped her two teenagers in an emergency room said they were 'mouthy,' 'too much work' and 'need to be voted off the island'), what their stories have to say about children’s mental illness, parental limitations and the paucity of care available in our country is altogether typical. They illustrate how a lack of good care early on can create much bigger problems, for families and for society, in the long run.

"Their example also serves as a necessary corrective to the popular view that children being labeled mentally ill today are just spirited 'Tom Sawyers' who don’t fit our society’s cookie-cutter norms, with parents who are desperate to drug them into conformity...."

"This problem of lack of access to care – and lack of access to truly good care – is the real mental health 'epidemic' affecting children in our time."

As out there as the Nebraska story is, only 36 children were left with state authorities, hardly the wave of kid dumping that was bandied about the press last year.

To use such a small subset of the population of children and teens in this country as one's argument for an epidemic is simply lazy thinking, lazy editing or a prime example of someone rushing out their weekly missive from the DC Beltway. Because what Warner is saying in her piece is that 36 kids were so mentally ill that it proves how wrong are the critics of the pathologization and psychopharmacologization of American childhood (myself included) and that we're guilty of being simple-minded. Hence, the Tom Sawyer gibe (I'd argue for Huck Finn myself).

The trouble is she's using a statistically small, self-selecting universe of particular problems (and lack of access to care to fix those problems) to argue for a much broader epidemic in the land. The Biederman camp and his defenders do much the same based on another self-selecting universe, again statistically-small, of children and teens with extreme problems, as if they were the norm of the abnormal. Theirs voices are loud and listened to because they write for the Times and are connected with Harvard and are well-plugged into major media in a way that loads of critics aren't.

It's also the voice of a firm believer in the prevention paradigm in mental health. Screen kids for problems early, detect problems early before they erupt into full-blown syndromes, pack the kids off to the doctor, get them medicated and future problems will be prevented. If only that were true in either children or adult psychiatry (it sometimes looks true though, but in my experience not over the long term).

Remember the 2007 ADHD studies that generated so much controversy--because one of them showed that even ADHD kids ended up with normal brain development over time regardless of whether they were on or off-meds--and led Warner to declare:

"But where I differ (now) from those eager to pile onto the anti-ADHD bandwagon is that I’m not willing — anymore — to sacrifice real children and their parents on the altar of ideology."

That's a fine sentiment and Warner would do well not to use these kids who were dragged to Nebraska as an excuse to sacrifice "real children and their parents" on the altar of extreme cases in Nebraska.

To the degree that Warner is pointing to limited access to mental health care for kids and teens in rural areas (some of the Nebraska dumpees were from Oklahoma and Georgia), she has a fine point. It's not much better in big urban centers. But the trouble is once you get a kid into see whomever, often the diagnoses and solutions offered are not particularly workable. Just ask Rebecca Riley's parents.

While obviously some of the Nebraska kids were way out of hand, does Warner really think that putting them in a psych unit is goign to solve things? Short-term, sure. Long-term, more questionable. As fouled up as some of these kids appear to have been, it's interesting to note that Warner isn't the least bit interested in what kid of home environment these kids came through and assumes instead that we've just got all these naturally-disordered brains and kids flying around. Sure, there are some, but argue that some kids in America who have "issues" aren't Tom Sawyers and that they are baby John Hinckleys based upon 36 very extreme cases is a bit much.