Book Review: “Overmedicated and Undertreated”


Overmedicated and Undertreated: How I Lost My Only Son to Today’s Toxic Children’s Mental Health Industry

By Steven Francesco

Reviewed by Edward Opton, PhD, JD


Don’t peek.  Can you guess the occupation of the author of these paragraphs?

[The] marketplace . . . is rife with financial and ethical conflicts of interest as well as, unfortunately, sloppy science . . . . increased . . . demand for pharmaceutical intervention . . . . [and] insurance  . . . schemes that reward the medication approach.

The “invisible hand” of the market has pushed the toxic children’s mental health industry toward a single-minded medication-only approach with drugs that are largely ineffective and have horrible side effects.  The invisible hand has caused pandemic overmedication and a corresponding gross undertreatment by squelching alternative therapies.  There is a large and growing body of literature on the ineffectiveness and dangers of psychiatric drugs for children, written by great professionals, and researchers.  Quite tragically, families are experiencing far fewer therapeutic alternatives to medication, and more coercion from schools to medicate.  Many “old-school” doctors are even being pressured by the insurance companies to reduce [non-drug] therapy . . . .

Meanwhile, the drug and insurance companies are profiting at amazing levels, as are some doctors.  There needs to be a pushback.


No, the author is not Peter Götzsche, Joanna Moncrieff, David Healy, or any of the other usual suspects who speak truth to power in’s pages.

The author is former pharmaceutical company executive Steven Francesco.  So far as we know, he is the first executive-level insider to confirm the charges that’s correspondents and other critics have been making for years.

The story of how Mr. Francesco arrived at these insights is almost unbearably sad.  His son, Andrew, suffered from an early age with complex, episodic, and severe behavior problems, problems that led to his expulsion from school after school.  At one point his parents felt compelled to hide their kitchen knives.  A succession of teachers and school officials insisted that he be medicated.  A parade of psychiatrists backed them up.   By the time Andrew was 15, his psychiatrists, schools, and parents required him to swallow several drugs a day.  “We were willing,” his father writes, “to make riskier choices, with even more off-label attempts.”  Andrew’s last psychiatrist prescribed 900 milligrams of the “antipsychotic” Seroquel, a dose 50% over the FDA-label-approved maximum adult dosage.  Andrew suffered an attack of neuroleptic malignant syndrome.  His heart stopped in the emergency room.

Most of the pages of this slim volume tell the story of Andrew and his family from his toddler days, through ever more drastic drug regimes, to his sudden and untimely death.  Mr. Francesco tells the story well, describing not just Andrew’s problem behaviors, but also how the adults in Andrew’s life behaved: his parents, teachers, school administrators, therapists, and physicians.

Steven Francesco’s book is remarkable in multiple ways:

  • He tells the painful story in plain English, not greyed-out by the abstractions of medical jargon.
  • In Andrew’s case, inadequate funding was not an issue. His well-to-do family, blessed with executive-level insurance, spent lavishly on his treatment and education.  He did not die because of not enough money, too few child psychiatrists, or too little special education.  Andrew received the best that money could buy.  Anyone who thinks that more generous government appropriations will remedy the problems of child psychiatry may reconsider while reading this book.
  • Andrew’s problems were serious and long-lasting. There can be no guarantee that he could have lived independently, with or without medications.  If Andrew’s doctors had reduced or discontinued the drugs, he might have functioned better, or worse, or the same.  His family will never know.  Andrew’s is not the mere story of “good lad, bad drugs.”  It is a more honest story: severely troubled boy, expensive and aggressive medical efforts, some of which may or may not have helped, and, in the end, a gross and unforgivable overdose of a powerful antipsychotic, unfortunately not uncommon, and, in this case, fatal.


Will Steven Francesco’s indictment of the psychopharmaceutical industry be the first of a wave of revelations by retired industry executives?  We can hope so.




    Seroquel has a black box warning in America and it is banned in the American Military for lethal heart rhythm reasons.

    I was getting ‘scary’ heart beats on a fraction of 25 mg per night (not 900 mg per day like this poor teenager).

    When I woke in the morning my chest and rib cage area were a soft red, and the rest of me white. When I stopped the drug, things returned to normal.

    My yearly UK Medication Reviews never asked about heart rhthym (or anything else).

    There’s nothing to say that Andrew would not have made complete recovery (with the right kind of help).

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    • Fiachra,
      I agreed with your last part about this phrase,

      “•Andrew’s problems were serious and long-lasting. There can be no guarantee that he could have lived independently, with or without medications.”

      My response was something like… well yeah, there are very few guarantees in life. But with good psychotherapy and good support from family and friends, there can be a very good chance of overcoming even the most severe psychotic states. And, this boy was very young, and the optimistic way to look at that is that he was at a malleable age with a lot of time to work on changing things. At the same time, being young he was vulnerable, and that may be part of what led to the tragedy.

      Responding to the article itself, I’m glad to hear about another insider speaking out against the System. But, a bit dismayed that it seems to take something personal and devastating like this in most cases to get someone to speak out.

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      • Although it is true, staggering injustice, is what forces one to speak out. If you’re happy, you just politely go along in life thinking the world’s a great place. Katy Perry does a nice job pointing out my take on this:

        “I used to bite my tongue and hold my breath
        Scared to rock the boat and make a mess
        So I sit quietly, agree politely
        I guess that I forgot I had a choice
        I let you push me past the breaking point
        I stood for nothing, so I fell for everything

        You held me down, but I got up (HEY!)
        Already brushing off the dust
        You hear my voice, you hear that sound
        Like thunder gonna shake the ground
        You held me down, but I got up (HEY!)
        Get ready ’cause I’ve had enough
        I see it all, I see it now

        I got the eye of the tiger, a fighter, dancing through the fire
        ‘Cause I am a champion and you’re gonna hear me roar …”

        And today’s massive over medication of children, and really all people, by psychiatry needs to stop. The “anti” drugs, including the antidepressants and antipsychotics, can cause “psychosis,” via anticholinergic toxidrome. And the psychiatrists seem to think anticholinergic toxidrome symptoms are their made up “bipolar” or the positive symptoms of “schizophrenia.”

        Glad the big Pharma executives are finally figuring out their appalling crimes against humanity, which the “two original educated professions” have apparently know about since the witch hunters were seen as too disgusting, sadly. However, it’s sad that they, too, are figuring out the complete fraud that is psychiatry, the hard way.

        Look at your dollar bill, there is a pyramid with an all seeing eye at the top. Those at the top, are behind the evil. And propagandizing and specializing all workers, no doubt also the pharmaceutical industry execs, so they may pull off their agenda. I was painting this image during my drug withdrawal induced super sensitivity manic psychosis phase. Trust me, it is the central bankers, and the “evil corporations that will surround them,” that Thomas Jefferson forewarned Americans regarding, that we are now dealing with worldwide.

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        • I will mention Seroquel is the drug that gave me “voices” in my head. And I was also put on completely unacceptably high levels of other neuroleptics, but neither I nor my family was told this, because my neurologist had concerns I had “hidden talents.” Are “hidden talents” a danger to society that mandate a polite suburban housewife and active volunteer actually be put on 1 1/2 times the maximum recommended highest dose of Geodon, plus some Zyprexa, and four other drugs? Since such inappropriately high doses of the neuroleptics do kill people, guess I’m right in thinking I was dealing with psychopathic attempted murderers.

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  2. Hi bpd, Someone Else

    Andrew could have made full recovery. When I was in Ireland years ago there was a young guy (not me) that was in and out of hospital on a revolving door basis with suicide attempts ‘paranoia’ depression and lots of other stuff and he had been like this for years.

    I heard from a mutual friend that he had since recovered completely: the problem had been the medication.

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  3. I’m very saddened and sorry you lost your son, Dr. Upton. All I know is the brief story above, and the other comments here. And my own story. I was first taken to the voodoo-priest, 20th Century phrenologist, quack shrink known as “psychiatrist” in 10th grad. (Yeah, it’s fun slammin’ ’em like that….)…. I got a bogus “diagnosis” for an imaginary disease, and a prescription. Within 2 years, I was in the State loony bin. I actually improved when I STOPPED taking the meds. The meds madee me very angry, and physically violent to objects. Looking back, thank God I never hurt anybody physically, or violently. But I raged, and destroyed property, and most of all I damaged myself.
    It’s been decades now, that I’ve been sober and off the damn drugs. Let’s get honest, and call it for what it is:
    “A.M.A.”&”A.P.A.” GENOCIDE*
    “Community Mental Health Center GENOCIDE”
    *american medical, & american psychiatric ass’n….
    Psychiatry & gross over-pharmacology need to be thrown on the scrapheap of history….
    (c)2015, Tom Clancy, Jr., *NON-fiction

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