My Journey – A Child Psychiatrist’s Struggle to Change the System

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After majoring in psychology in college, I entered medical school in 1986 with a strong interest in psychiatry.  While in medical school, I was exposed to the subspecialty of child psychiatry, and was very attracted to the idea of making a difference in the lives of vulnerable youth.  Child Psychiatrists were experts in understanding normal development through the life cycle.  This was particularly fascinating to me and I believed that it would be personally meaningful and fun to work with children.  During this time, child psychiatrists often directly provided individual psychotherapy and family therapy to their patients.   The use of psychotropic medications in children was not typically a first line treatment.

When I started my general psychiatry residency in 1991, it was common practice for patients admitted to the hospital to be taken off their medications for an observation period so that a clear, thoughtful diagnosis and treatment plan could be established.  We were meticulous in documenting symptoms, reviewing old records and spending time thinking about/discussing our patients before starting any psychotropic medications.  Social workers met with patients’ families, conducted therapy, and worked hard to develop a meaningful discharge plan for each patient. Many patients were in the hospital for a month or more.  This was, obviously, before the concept of managed care invaded the insurance industry.
When I began my child psychiatry training in 1994, most children admitted to our inpatient unit were on no medications or, at most, one medication.  There was caution in regards to the prescription of medications to children . . . after all, their brains were still developing!  Social workers spent significant time with families conducting family therapy sessions, and children received individual therapy as well. The length of stay was often a month or more.
Now, patients are admitted to inpatient units and the treatment plan generally involves getting them out of the hospital as soon as possible by any means.  What this translates to for children is the rapid prescription of multiple medications – usually sedating agents such as an antipsychotic.  The biggest risk for polypharmacy appears to come from hospital admissions.  Many vulnerable children will be placed on 3+ psychotropics as they are quickly discharged to the outpatient setting.
I have been a practicing child psychiatrist for the past 20 years, working in various treatment settings. I’ve attempted to “influence” the “system” by speaking out against the over diagnosis/overmedication paradigm that currently drives it . . .  teaching/training/consulting, caring for individual patients, and through my work for insurance companies. It has been quite a struggle and I have seriously considered leaving the field all together. I continue to care for vulnerable children on a part time basis at a local non-profit in Philadelphia.
I decided to join the Mad In America blog to share my experiences with like-minded others in hopes that such collaborations will help me more effectively advocate for the best interests of my patients and work toward system change.  You can see a paper I’ve written, The Overmedication of Vulnerable Youth with Psychiatric Medication: A Call for New Regulations, which explicates my perspective on the current state of the “industry,” and its problems. I look forward to engaging with the readers of Mad in America, as we learn together how to make the changes we need to, in our mutual interests and in the interest of society at large.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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29 COMMENTS

  2. Vicki,

    IMO, any use of “medication” with a child is “over-medication.”

    I appreciate your interest in changing the system.

    As well as your candor. In that spirit, I’d like to say that I think it’s time we made a commitment, as a society – to stop using mind-altering drugs on children.

    Once and for all. Period.

    http://breggin.com/index.php?option=com_content&task=view&id=38

    If it means that the vast majority conventional child psychiatrists are replaced, so be it. Kids come first.

    Duane Sherry, M.S.
    Retired Counselor
    discoverandrecover.wordpress.com

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  4. Thank you for your efforts and attention to creating vital change in the mental health industry.

    This is one of the most general things I notice as being problematic. There appears to be a complete breakdown in communication between psychiatrists and those who have suffered through the system, which, naturally, makes me wonder about the quality of the communication between clients and psychiatrists, in 1-on-1 office visits. I no longer receive mental health services, as I found alternative healing that completely did the trick for me, and got me grounded and reasonably clear-minded, allowing me to leave all medication behind after 20 years of multiple meds. That was 10 years ago.

    But when I did see psychiatrists, indeed, the communication was abysmal, in a variety of ways. It only poured salt into the wounds.

    There is this idea that psychiatrists, in general, do not know how to engage with clients eye to eye, that it is always through a lens that amounts to stigma, which compromises quality of life, at best, and which destroys lives, at worst. Diagnoses, socio-economic factors, and general personality traits that are perceived as ‘symptoms,’ due to their visibly creative nature which does not mimic the norm, seem to create a division that is not at all favorable to the client, creating a feeling of complete and utter powerlessness for the client, and, in general, a loss of civil rights. This only adds to the malaise and confusion that is trying to heal. I believe that counter-transference which is not owned nor recognized a really big problem in the field.

    There are so many issues to address when it comes to ‘reforming’ the system. For me, personally, this is one of the most vital, as it creates marginalization, which can be devastating to the human mind, heart and spirit.

    I am curious, what, if anything, can be done about it. I think mental health clinicians should be required to do a Shamanic journey or something like that. The ones that I knew–and there were plenty–had no self-awareness and even less self-responsibility. They mostly seemed narrow, angry, and defensive, not recognizing individual creativity, but rather were annoyed with it, and hence, they turned personality which they could neither understand or relate to, into pathology. This is what I’d like to see change.

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  5. Doctor Martin, when I was six years old, I was taken from my foster parents, the only family I ever knew, and experimented on with electroshock by the famous Doctor Lauretta Bender, probably the leading child psychiatrist of her time. I was then more or less given up for dead, and sent to a state hospital where I spent the rest of my childhood. No one in the psychiatric profession raised a voice against what was done to me and several hundred other children.

    Now there has developed a trend in child psychiatry to have parental custody taken away if the parents try to protect their children from psychiatric intervention. This has broken out into the open very recently with the case of Justina Pelletier in Boston and many similar situations.

    Given these and many other instances of human rights violations perpetrated by psychiatry, I was quite disappointed that in your discussion of reforms that you would support, you said nothing about these very common problems.

    I would greatly appreciate it if you would comment on psychiatry’s frequent human rights violations and your point of view about them.

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  7. Hi Vicki,

    I want to simply say thanks for taking the time to write and join the conversation on Mad in America. As you can see from my post at the bottom of the front page (When I Grow Up, I Want to be a Psychiatrist: Redefining the Conversation for the Betterment of All), I think there is great opportunity for psychiatrists today in the field, but it is going to take significant changes in many ways. I so appreciate your willingness to take up the critical cause despite huge obstacles, and to work with others both on MIA and beyond to really look at what are the best options for kids today. I think the number of “Likes” you received should be a testament to the appreciation others feel for taking these courageous steps in putting yourself out there as you have. I certainly would be interested in talking with you more.

    Regards,

    Jim Schroeder

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  8. I have read forums where parents talk about there kids ‘mental illness’. The scariest threads contain these phrases “thought it was ADHD” and “looking for the *right* meds”.

    For some reason these parents can’t seem to read there own posts and see the ‘medications’ keep making there children worse.

    I guess it’s easy for me to see, I have taken these ‘meds’ and know how they can twist up thinking and moods, cause anxiety rage insomnia ect and how withdrawal reactions do the same when the kids stop taking them or during med changes looking for the *right* one.

    I wish there was a name for “caught up in psychiatry disorder”.

    Seriously , it needs a name so it can be identified and treated.

    Symptoms include:

    “We thought it was ADHD”

    “Looking for the right meds”

    “Joined NAMI”

    Anyway, these kids need help.

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      • Copy Cat, sadly, you’re right. But, those moms were intentionally deluded also. The psycho / pharmaceutical industries have and still are intentionally deluding the world into believing their toxic drugs are “wonder drugs,” merely to get others’ money. Force medicating children with drugs known to cause violence, suicides, mania (bipolar), death, diabetes, extreme weight gain, atrophy of the brain, heart problems, shortened life expectancy, and death for profit is torture of children, and pure evil, IMO.

        Vicki, welcome, and I do hope the psychiatric community can change, but know the doctors I dealt with were and still are so blinded by their belief in their made up disorders and “wonder drugs,” it was pointless to even speak with them. And I know from my last eight years of research and from my personal experience of having “bipolar” (anticholinergic intoxication) created in me, completely with psychiatric drugs. That the DSM really is nothing other than a book intended to railroad people onto psychiatric drugs and lists of symptoms describing the serious mental illnesses your drugs CAUSE. The psychiatrists I dealt with were hands down the most delusional people I’ve ever personally met. But I agree, it is very difficult to get a powerful, albeit completely delusional industry, to see the light.

        Forced psychiatric treatment – and all children are forced to take their meds – is torture, according to the United Nations. Please try to help end the massive psychiatric torture of children, due to psychiatric greed, apathy, arrogance, and ignorance.

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  9. Doctor Martin, I am asking again that you comment on human rights violations in psychiatry. If you truly want to reform your profession, I don’t think it is credible for you to ignore these issues. As you know, my childhood and my humanity were violated by child psychiatrists, so academic discussions mean little to me (and they shouldn’t to anyone else either) if these very basic and serious issues are not addressed.

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    • I would also like you to weigh in on the issues Ted pointed out are missing. From a parent’s perspective, I am terrified that my daughter will be isolated from us, her birth parents, by her psychiatrists, if we support her right to choose or reject her court ordered treatment. It happened to my dearest friend, a mother of a psychiatric survivor because she advocated against psychiatric harm and abuse of her adult son. Consequently, her son was ‘disappeared’ put in an adult step down facility after discharge from WEstern State Hospital and she was not told the location. Furthermore, a social worker at the hospital asked the judge to issue a ‘protection order’ against my friend so she could not have any contact with her son, all because she questioned the psychiatric abuse. Fortunately, the community knows what a loving and good parent/person my friend is and this order was finally lifted and vacated.

      As concerned parents, we are terrified and bewildered by the undue influence of psychiatrists on the lives of our children and we are often afraid to speak up because of their power. They are considered the ultimate authority on all legal issues having to do with our children’s lives. When children who are not abused in the home where they grew up are separated from family and community where they grew up by institutionalization and court orders, in utter violation of the Olmstead Act, especially in cases where the parents are in solidarity with their children against psychiatric harm and abuse, this is madness and I would like to know where are the limits to your profession and how are you prepared to stand up to your peers in cases where a patient’s liberties are at stake? Also, I would like to know if you refer parents to NAMI or the writings of Dr. Torrey in cases of a first psychotic break or do you show people the wealth of alternatives that are out there?

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      • I’m sorry, ‘She questioned the abuse” is too soft of a description of what my friend did. My friend “exposed psychiatric harm and abuse” and with unwavering courage and faith, fought it tooth and nail. She uncovered abuse, not only of her son at Western State Hospital, but of other patients on the ward where he was incarcerated. She created a website, circulated petitions, made banners, organized walks, a fast, got her church involved, etc. The community got behind her, and justice is finally on the horizon, but what she and her son had to go through, is an incredible tale of abuse of psychiatric harm and abuse.

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    • Hi Ted. Thanks for your courage in sharing your story. I agree with your view that child psychiatrists are often willing participants in the violation of the human rights of children. As I noted in the paper, children have few rights and legal protections in the U.S. They are generally medicated with psychiatric drugs because their legal guardian has provided consent. Psychiatrists who prescribe these medications to children are expected to complete a robust informed consent process such that the risks and benefits are clearly outlined. There is currently no law that requires a physician to inform a patient or guardian that a medication is being prescribed off-label or outside practice guidelines.

      Many foster children are prescribed medication cocktails of 3+ psychotropic medications. It is important to ask WHO is providing legal consent for this and how is this dangerous practice funded? What I have seen is that an uninformed social worker consents because “the doctor said it was necessary”. As for those kids in foster care, whose parents retain parental rights, the parents often feel pressured to agree to the medications or risk being viewed as “non-compliant” by child welfare officials. As for the funding of these medications, we (taxpayers) are paying for these medications through Medicaid.

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      • “WHO is providing legal consent for this and how is this dangerous practice funded?”

        People who have never taken the ‘medications’ provide consent and approve funding, they just don’t know what it’s really about.

        I would like to give a child welfare official a 70mg Vyvance or a 10 mg Zyprexa and ask “what did you think of that?”

        What ever the answer their view of all this would be changed forever.

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  10. Hi Vicki. I’m a mother whose child died from suicide 15 days after being prescribed prozac. Both my government and Mylan Pharmaceuticals have conducted causality assessments and determined the causal relationship between my son’s death and the drug he was taking as ‘probable.’

    I established and am CEO of CASPER a charitable organisation run by families bereaved by suicide for families bereaved by suicide. Amongst our many services, we support families to present their cases at coronial inquests with a view to getting recommendations in relation to psychiatric drugs that may prevent more children killing themselves.

    We are assisted in our work by a small number of psychiatrists who, free of charge, review our childrens’ medical files and provide expert evidence to the court in those cases where he believes there is a causal link between the drug and the suicide or where breaches of best practice around diagnosing and prescribing practice need highlighting.

    Is this an area of work you are, or could see yourself involved in?

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  11. Dr. Martin –

    Thanks for writing here – it is always encouraging to hear from a psychiatrist who is willing to grapple with this stuff. Whatever you are able to do to bring some sense to it, will be a boon to some child.

    Dr Julie Zito of the U of Md school of medicine did a nationwide study about 8 years ago that showed kids in foster care were 16 times more likely to be on psych. drugs than other kids on MA. I saw this up close in my 15 years as a social worker, supervisor and program director in treatment foster care. I wrote a policy for our program: psychosocial interventions were to be given every chance to work before any drugs were to be considered; foster parents were to discuss it with our social worker if they wanted to request the drugs from a doctor; no psych meds were to be started or changed unless our social worker (not someone from DSS who isn’t really a social worker) is present at the appointment when the change is made. I gave several in-service trainings for foster parents and staff. I pushed the issue whenever I could.

    Very disheartening: Maryland now requires kids to see a psychiatrist when they first enter the system, resulting almost always in rx’s – so the kids would come to us already dx’ed and on drugs. We had a few successes getting kids off drugs, and a few in getting poly-pharmacy or dosages reduced. But in general, the docs acted like we were nuts.

    I am hugely disappointed in the social work profession, whose basic premise is person in environment. If anyone would fight against this tide, you would expect social workers to do it. But only a few social workers troubled themselves to read a single thing about these drugs or go out of their way to object to the drugging. My letters to statewide social work leaders have been ignored.

    And most of the psychiatrists (and primaries who often prescribe) were clueless. One sat with his back to the child and the foster parent, asking rapid fire questions and typing on a lap top. Another, sitting right next to an autistic girl who was vigorously flapping her hands, asked, “Any unusual gestures?” – nose in lap top, didn’t notice.

    The biggest thing they never realized: Many foster parents are loving and dedicated, but they can get overwhelmed by treatment foster children’s behavior. When I did home visits, I would often let the parent complain for about 45 minutes (hopefully out of the child’s earshot). Essentially, the parents were getting a session in, unloading their frustration. After a while, I could ask questions like, “How often did he do that last week? Last month?” and it would usually turn out that what the parent originally said he “always” did, was not nearly so frequent, and was often getting better. I would ask what’s going on in the child’s life that might cause such behavior, and if the parent noticed anything that was effective in de-fusing situations.

    Usually we came up with psychosocial solutions, and the parent would end our 2 hour visit saying, “Yeah, he’s really not a bad kid.” And life would go on.

    But at 15 minutes doctor visits, when the foster parent would blow off steam, the doctor would not realize he wasn’t hearing reportage but simply the foster parent getting his/her own distress off their chest. Then would come the rx. In effect, the doctor was drugging based on the foster parent’s distress – not on the child’s emotional or behavioral issues.

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  12. Hi Peter. Thanks so much for your thoughtful comment. It is quite clear that you “get it”. As for your disappointment with the social work profession, I think many feel uncomfortable questioning a doctor. At a child welfare agency where I consult, we have tried to attack this by education/training social workers about psych medications and ways they can better advocate for the best interests of their clients ie: question the doctor. It has been a heavy lift and am not certain how successful we are.

    I have pretty much given up trying to influence my colleagues (child psychiatrists) which I will expand upon in future blogs.

    At this point, I am wondering if the best way to affect change is through the legal system. The work of Jim Gottstein (an author on this site) pursuing the Medicaid fraud angle is a good example. My paper, (link above) recommends several new regulations. Though this may be unrealistic, I keep wondering if a class-action law suit with foster kids as the class would help. I have run this idea by a few attorneys but so far….. no luck. Thanks again for your input here.

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    • Thanks Peter for those thoughtful comments and thanks Vicki for writing here. As a therapist who works part time in inpatient hospitalization for adults, I have seen the shift towards faster and faster admits and discharges. I personally studied the numbers recently and saw that 25 percent of patients were discharged the next day. The vast majority were discharged within a few days, Undoubtedly they received a prescription and were sent on their way.

      As you say Vicki, this revolving door method of treatment has been really pushed by managed care and increasingly insurance companies will not pay for more than a very short period of inpatient time and are mainly paying for rapid stabilization via pharmaceutical drugs.

      While this is awful for adults, it truly seems criminal for children. Like you say Vicki, we need to look at a variety of ways of challenging the status quo, including examining regulations, class action law suits and in my mind…direct criminal negligence lawsuits. We need to take a giant step away from a pharmacy first approach…and a giant step towards a psychosocial approach.

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  14. It is good, Doctor Martin, that you criticize some of the bad practices of your profession. But I don’t think that safely making such criticisms from the shelter of this website will make much difference. The membership of the profession of child psychiatry is full of people who, to use what has become a legal term, have a depraved indifference to human life (part of the standard for second-degree murder in many states).

    Drugging children unto death is not a practice that will end because the people who do it will be made to see the error of their ways. This is not something that people do because they are mistaken. They know what they are doing, and what they do will only stop when their power to do so is taken away, by an educated public opinion and by vigorous criminal prosecutions.

    In particular, right now there is a growing scandal about the virtual kidnapping of children by Harvard’s child psychiatry department, where parents are stripped of their constitutional right to raise their own children, and the kids are held on the psychiatric ward and heavily drugged, even when such drugs are contraindicated and dangerous to the children, in the light of the metabolic problems they have already.

    Behind these atrocities is Doctor Joseph Biederman, the leader of your profession, whose practices I am sure are well-known to you.

    Since you hold yourself out as someone who struggles to reform your profession, I would hope that you would address what is going on in Boston right now, and especially, comment in a forthright way about the activities of the doctor who I think has damaged more children with the weapons of psychiatry than anyone else.

    I hope you will do this, and show your readers that you are willing to take some risks to make changes. Risks, yes. Standing up against the evil practices of your profession is not that easy, but if real change will happen, it is necessary.

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  15. Hi, Vikki,

    I am interested to hear how you see us addressing what I see as the underlying basis for most of this chicanery and corruption: the DSM diagnostic system. You sound like a person who understands that labeling a person is the first step to dehumanizing them and their distress, and we can all see the results. But anyone who wants insurance payments for providing service has to diagnose.

    What do you think of these DSM categories, and what can be done to remove this flimsy justification that underlies all of the drugging we are so uncomfortable with? I’d love to know what action we can take to change this pattern, because in my view, as long as we can label a child or adult with a “mental disorder” based on whatever subjective criteria we as a society decide constitutes such a disorder, we can continue to blame the victims and will continue to hurt those we purport to help.

    If the field can be reformed, how do you think we can do it?

    —- Steve

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  16. @Vicki Martin, MD

    What is the role of the public school system where you are?
    Does the Bio-MED Industry in some representative form actively go to the schools and “recruit” more psychotropic consumers. Do the schools have some kind of measuring and snitch program to funnel children to the psychiatrists?
    ..
    My next door neighbor’s kid is on meds for ADHD and “Oppositional Defiance Disorder” His parents are just ordinary workers, they could never understand psychiatric subterfuge or know they are being played. I think he was inducted into this at school – but this is Canada.
    I also met a District Co-coordinator in charge of Community Treatment Orders here in Alberta. She was actively involved in drugging of school children – I think any disciplinary or behavior problems got a kid hot lined to the psychiatric community.
    That CTO co-coordinator worked for Government Health from the Public purse and the Bio-med industry has the complete support of the Government politicians here. I’ve traced some politicians network of contacts.
    Given their awesome combined power political , economic and psychiatric it seems lie entire generation of nails sticking out are getting pruned.
    ..
    I expressed horror to the CTO Officer about a particular kid getting psych drugs – she completely misunderstood me and commiserate on “Yes , how terrible it is they have Schizophrenia at that age.” She didn’t even get what I was saying to her face so firmly was she locked in the ideology.

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