One point made in Joe Bageant's transcript of his talks at Berea College and Adler School was that psychologists are prescribing so much Ritalin that the penguins are peeing Ritalin these days. I have to make a minor dispute - psychologists (except in a handful of jurisdictions) can't prescribe medications, so it should be the psychiatrists who are doing it. Except that most of the time it's the primary care physicians and pediatricians who are prescribing all these medications. And, if you really drill down to the heart of the matter, it's teachers who are the ones really doing a lot of the "prescribing." I've worked with a lot of kids who had ADHD, and a fair number who were thought to have it but didn't, and in all those cases I've never known a teacher who'd made up their mind that a kid needed to be on medication who didn't get their way eventually. That, or get the kid removed from the classroom.
Even when a psychologist tries to do a good assessment and really try to establish whether a kid really has ADHD, where's half of the information we need to rely on coming from? From the Conners Questionnaire that the teacher fills out. So one way or another the teacher is likely to prevail. And it's most often male students who are referred; a lot of boy behavior (and especially pre-adolescent and adolescent boy behavior) interferes with the orderly process of running a standard American classroom of the 2000's, so the behavior has to go. I don't know if it interferes with learning (at least for that individual student), but it certainly seems to distract the teacher. So we have a medicated classroom.
And speaking of primary care physicians prescribing medications, for the last few weeks my staff has had to deal with a parent who wanted their insurance to pay for Abilify for a 16 year old who was reportedly out of control. The school couldn't handle him, the mom couldn't handle him, and the family doc told them he was bipolar and should be getting dosed with a medication that was developed to treat schizophrenia in adults. Oh, by the way, mom has issues of her own that have been going on for quite a while, and the kid happens to be smoking blunts. No wonder she wants the kid medicated. No one in this whole situation wants the one thing that might actually stand a chance of helping, which would be family therapy. It's much simpler to give him pills. After all, what are we paying for this insurance for?
I own stock in a pharmaceutical company, (not that it's ever hunted very well), so I can't be too critical, but it really annoys me to hear commercials on TV that tell people they should try to talk their doctors into adding another medication - an atypical antipsychotic, for Pete's sake - to whatever other medication they're already taking, when they don't think they're feeling better enough quick enough. Nowhere does it say that they should be getting some help from a good cognitive-behavioral therapist, which is what the research would suggest, and nowhere does it caution them that a psychiatric evaluation might be a good idea if the general practitioner isn't able to control the depressive symptoms well enough with one medication. And even the misguided commercials specifically caution against giving Abilify to kids and teenagers.
One would think that getting the kid to stop smoking blunts might be kind of a good idea, too.
When someone had the kind of depressive disorder portrayed in those commercials back in he 1980's when I was working inpatient psychiatry, you'd probably have considered ECT - aka shock treatments - for the patient. And don't scoff - they actually worked pretty well for a lot of people. And for someone with cardiac risk factors, the doctors used to tell us that ECT was actually safer than medication a lot of the time. But that was "barbaric." Oh well, we make progress. Don't we?
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