At one point in a recent conversation about my new book, "We've Got Issues: Children and Parents in the Age of Medication," which was published by Riverhead on February 23th, an interviewer interrupted me in frustration. "Wait," she said incredulously. "You mean you don't think kids are overmedicated?"
That kind of thing happens to me a lot. An old friend came to my first New York book event, and grabbed "We've Got Issues" enthusiastically, saying she couldn't wait to read about "why we're drugging all those kids." No one tolerates normal kid behavior anymore, she said. Everyone's got to push their kids to be perfect. "That's why we get all these diagnoses, right?" she asked. "That's why all these kids are on meds."
"I don't actually agree with you," I said.
"You don't?" she froze. "So what's the book about, anyway?"
It was easy, six years ago, when I sold a book proposal about how parents were overdiagnosing and overmedicating their kids. About how psychiatrists and therapists and teachers and schools were colluding in labeling and pathologizing kids. It was no stretch to sell people on the idea that families were taking the easy way out of common problems, seeking "quick fix" solutions, and turning a collective blind eye to how the pathological aspects of our culture were making kids sick. (Or making kids seem sick, when in truth they were just "canaries in the coal mine" -- the first to fall victim to the unhealthy atmosphere pervading the lives of so many American families.)
This was what everyone was saying. It was what you read, heard, surmised all the time. Mental health diagnoses in kids had tripled since the early 1990s. The use of medications like Ritalin for Attention Deficit Hyperactivity Disorder or Prozac for depression and anxiety or atypical antipsychotics for bipolar disorder had skyrocketed.
No one knew kids who had these kinds of diagnoses, or took those kinds of meds in past generations. Everyone had the sense that living in our insane times -- in an era when academic, social and economic pressures had gone through the roof - had to be producing pathologies in today's kids. Everyone knew how badly behaved children generally were these days. How parents didn't want to say no or set boundaries or take a hard look at how they were living their lives; they preferred instead to find fault with their kids, everyone said.
When I put these ideas together into a proposal for a book -- the book that "We've Got Issues" was supposed to be -- everyone thought it was a great idea.
Everyone, that is, other than parents of kids with mental health issues.
These parents, whose children had "flavor of the month" diagnoses (as I was calling them) like ADHD and bipolar disorder -- didn't love my book idea. They didn't much like being told that their children's problems -- problems which, sometimes, had upended their entire family's lives -- were mere metaphors; society's ills speaking themselves through their offspring. Doctors I interviewed, even those I chose to interview because I believed they shared my point of view, tended not to be too impressed with my thinking when I started in on the unreality of disorders like ADHD and the utter sham that was medication. Sure, there was some overmedication of kids, they said. Sure, meds didn't work for everyone, and it was much better to try non-pharmacological solutions to problems first. But the biggest dilemma in children's mental health they said - pretty much unanimously, psychiatrists, psychologists, pediatricians alike - wasn't overdiagnosis. It was underdiagnosis, and undertreatment. Particularly of lower-income kids in lesser-educated families. Most of these kids never got any treatment at all.
There was a big disconnect, I quickly learned, as I widened my research further to talk to parents of children with mental health issues, between popular rhetoric and reality. As I stopped talking at people about my ideas, and started listening instead to real parents telling real-life stories, I heard of children struggling terribly with conditions that parents, very often, at first didn't want to see. I heard how parents fought the use of medication - accepted it only (if they accepted it at all) after much struggle and soul-searching, and often after trying out every alternative available.
I learned, too, as I started digging for numbers, that the statistics on mental disorder prevalence and the use of psychotropic meds didn't bear out the overmedication story: Five to 20 percent of kids in our country are believed to have mental health disorders, I discovered (the five percent being those with "extreme functional impairment," according to U.S. government statistics, the 20 percent being those with "at least minimum impairment.) Five percent of kids take psychotropic medication.
Try as I might, after considerable anguish and not-inconsequential effort, I was forced to conclude that I couldn't honestly write the book I'd set out to produce about lazy, neurotic parents and the Medicated Child. Those icons of our time, I realized, after hours upon hours of emotionally grueling interviews, were largely cultural fantasies. Their prevalence in our minds and their popularity as topics of conversation and, commonly, of media diatribes, said much more about where we were as a society, in terms of our fears, preconceptions and prejudices, than they did about children's mental health.
Learning more about those fears, preconceptions and prejudices became the new purpose of my book. It's titled "We've Got Issues" because it aims to hold a mirror up to our "issues" as a society and explore the way those issues keep us from engaging honestly and productively with the brave new world of children's mental health. (And adult mental health, too -- but that's perhaps another book).
"Brave new world" is defined by the American Heritage Dictionary not as the drug-hazed dystopia of Aldous Huxley's imagining, but as "A world or realm of radically transformed existence, especially one in which technological progress has both positive and negative results." The description perfectly matches our time. More is known than ever before about children's mental health issues. More and better treatments exist (including treatments, of course, that don't involve medication). More children are being identified and helped than at any other time in history. And yet science has advanced faster than our ability to use it well. Relatively few children have access to the best possible care. Most of those who need mental health services don't get any care at all. Too much power and influence has been given to drug makers, rendering the science the public relies upon for information highly unreliable. Too much stigma remains. We tend to believe that, today, we have moved beyond the age-old prejudices against people with mental illness. But, in fact, that prejudice is alive and well in our time and has a new and socially acceptable face: it expresses itself in the eye-rolling laments about "pushy parents" and "drugged-up kids."
It's time for us to rethink our certainties about the state of children's mental health in America. It's time to focus on real parents and real children, real science and real numbers. Maybe then we can move forward with making the promises of our era real for the children who need help the most.