Foster Youths Meet Psychiatry: First – Do No pHarm

Wayne Munchel
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When a foster youth encounters a Psychiatrist, chances are high that s/he will get medicated.  Traumatized foster youth are often prescribed powerful psychotropics due to exhibiting a wide variety of “normal reactions to abnormal events,” such as despair, agitation, anxiety and self-harm. The practice has been well documented; foster children are prescribed psychotropics at a 2.7 to 4.5 times higher rate than non-foster youth.  The National Center for Youth Law aptly summarizes the problem as; too many (25% of foster youth medicated), too soon (300 children under the age of 5 in California are given psychotropics annually) too much (adult dosages) and for too long (no planning or reviews for possible discontinuation). Many foster youth don’t even get placed on the category of medications that corresponds to their assigned diagnosis.  According to a recent analysis, 40% of foster children diagnosed with ADHD and Disruptive Behaviors were prescribed anti-psychotics.  Still others are medicated without even the pretense of treating a documented illness.  This pattern suggests that medications are being expressly used for behavioral control. Foster youth are at risk for being placed in chemical strait-jackets.

In California, belated progress is being made in effort to curb the egregious over-medication and under-treatment of foster youth.  Several key pieces of legislation have been passed with widespread support.  An ongoing workgroup has been convened to develop data collection methods to identify who is prescribing what to whom, as well as implementing prior authorization and second opinion mechanisms.  Attention is also being focused on building up the trauma informed care capacity to ensure that foster youth are offered “1st line” psychosocial treatments and make medications the last resort.  Funding for Public Health Nurses to monitor medicated foster children and youth for metabolic complications is also being requested.

But there is an unacknowledged conundrum waiting in the weeds.  Workgroup participants are discussing ways to distinguish between trauma impacts and true “mental illness”.  As if there is some way to sort through the many “symptoms” (trauma adaptations) and assign them to discrete categories of disease vs. distress.  The DSM 5 largely ignores issues of causation and context. (Let’s stipulate that virtually all foster youth and children have some form of traumatic stress reactions.)  When viewed through the distorting prism of the DSM 5, foster youth’s many understandably disturbed behaviors are seen as pathological indicators of an incipient brain disease.   “Psychiatric Bible” thumpers cast an ever expanding net that entangles most foster youth experiencing problems in thinking, feeling and behaving – the kinds of problems that most of them have in spades.

Perceptions of anguished foster youth are so shaped by the dominant bio-reductionist disease model that some have suggested that perhaps foster youth suffer from co-existing disorders – both trauma and a “co-occuring” brain disease.  This seems to violate the Law of Parsimony – explaining things in the simplest way, while making the fewest possible assumptions.  For example, let’s say someone’s lip bleeds due to being punched in the mouth.  From a biopsychiatry viewpoint, someone’s lip bleeds due to a genetically predisposed lip disease that was triggered when they got punched.  Poor Occam would throw away his trusty razor in disgust.

Developing trauma informed, (First – Do No pHarm?) alternatives will be key to the efforts focused on decreasing the high rates of psychotropic medications for foster youth and children.  But it won’t be easy and it won’t be cheap. (Perhaps some of the $226 million that California spends annually on medicating foster youth can be redirected?)  American culture has a long standing love affair for technological solutions in the form of pills.  Pills that can tamp down and suppress the howls of pain and anger brought on by chronic abuse and neglect. (“Zombify” in the words of many foster youth.)   The experience of trauma at early, vulnerable ages often results in grievous wounds that can take a life-time to heal.  Dr. Bruce Perry, author and Director of the ChildTrauma Academy, argues that most current treatments for these kinds of developmental traumas are inadequate.  That much trauma informed care is delivered for too short a time, at too low a ”dosage”/frequency,  and are misdirected at “too high” of a neurodevelopmental stage (focused on cognitive and language processing, rather than more somatic interventions) Clearly much work remains.

Perhaps, one day, after many more billions of dollars in myopic research, a true biomarker or mental illness gene will be identified.  (The dispassionate scientist in me, allows that it is possible).  In the meantime, can the prominent pachyderm in the room be acknowledged? – that the horrific, toxic stressors that foster youth have endured can lead to many disturbances in their young lives and they will require all the care and support we can muster.  It is unacceptable that after suffering so much from the collapse of their family systems, foster youth and children are further subjected to potential abuses by misguided treatments that carry such high health risks and stigma.  Understanding and compassion for “what has happened” to foster youth, rather than “what’s wrong” with them is imperative.

36 COMMENTS

  1. Wayne

    Overall, this was an excellent article. However, one of your last sentences weakened the power of your argument and gives up unnecessary ground to the biological determinists who dominate Psychiatry and the “mental health” system.

    You said “Perhaps, one day, after many more billions of dollars in myopic research, a true biomarker or mental illness gene will be identified. (The dispassionate scientist in me, allows that it is possible).”

    The dispassionate scientist in you should, on the contrary, know more than enough at this time to not even remotely encourage this possibility, and also be ridiculing ANY efforts to pursue these bogus searches for Biological Psychiatry’s “genetic Holy Grail.”

    Even if we say it is within the realm of scientific possibility for there to be some type of genetic predisposition for a less hearty human response to severe environmental stressors, this would not be (nor could it be) the discovery of a single gene. It could only be multiple sets or grouping of genes, and, of necessity, require “ENVIRONMENTAL TRIGGERS” to set off any biological processes that in some way could remotely influence thought formation and/or behavior.

    Without emphasizing the role of “environment triggers” none of this discussion about the role of human genetics makes any sense. And even IF some aspect of genetic predisposition (relative to the multiple sets of gene interaction) were discovered this would represent a tragic waist of time spent for scientific endeavor and for the allocation of human financial resources.

    Would a truly humane society, based on the highest degree of morality and scientific discovery, focus on tinkering with multiple sets of genes in the human genome (in these cases) OR focus on doing everything possible to radically transform the forms of social organization and production in such a way as to minimize (and eventually eliminate) all forms of human exploitation, violence, and other related forms of trauma? These represent the sources of the various form of human stressors and related behaviors that end up leading to disease/based labels and the massive amount of drugging by modern Psychiatry and organized medicine.

    All these “genetic theories of original sin” are a diversion away from focusing on all the oppressive forms of social organization and institutional control that form the present backdrop for the current “mental health system.” Let’s not give the “powers that be” one iota of room to move on these vital questions of emphasis.

    Respectfully, Richard

    • Richard, you said All these “genetic theories of original sin” are a diversion away from focusing on all the oppressive forms of social organization and institutional control that form the present backdrop for the current “mental health system.”

      I’m not sure if you realize that these biological/genetic theories are diversions away from oppressive social organizations and institutions as a whole by design. Not only those higher up in psychiatry, but those in power who run the entire system (not just the mental health system) seek to maintain and expand the status quo of power, profit, and control. The whole system that includes government, corporations, education, media, banks, etc, are all systems of control designed to give those in power absolute power and control. Psychiatry, by pointing the finger at the individuals biology/brain/genetics, seeks to redirect the ‘blame’ onto the individual and away from society and social institutions (controlled by governments and corporations). Those in power don’t want you to look at, let alone disable/remove, the many wider systems of oppression and control.

      In this way, psychiatry has been an incredibly useful form of social control that those in power will be unwilling to part with easily (unless forced). Psychiatry can be used by the State against anyone that either gets damaged by the system (depression, PTSD etc), or those that wake up and see the corruption and evil that pervades the higher echelons of power throughout the world (by labeling them as oppositional defiant, delusional, or anti-social etc). Psychiatry is used as the systems guard dog. Anyone that challenges the system (controlled by governments and corporations) can be labeled with any of 374 (or more in the DSM-5) mental illnesses and then forcibly kidnapped, detained, restrained, and forcibly medicated or electroshocked against their will because psychiatry says they are mentally ill and the media constantly pushes that mentally ill people are unstable and dangerous/violent and must be forcibly treated against their will because they are a danger to society.

      The oppression of psychiatry is by design, used by the wider system of oppression to quell dissent and to incapacitate as many people as possible so there are fewer people who aren’t brain damaged that can figure out how psychotic the entire system and people who run it really are.

      • Ragnarok

        I agree with your broader analysis. Thank you for expanding and deepening these important political points. I have been arguing for this kind of viewpoint for many years here at MIA.

        You said “The oppression of psychiatry is by design, used by the wider system of oppression to quell dissent and to incapacitate as many people as possible so there are fewer people who aren’t brain damaged that can figure out how psychotic the entire system and people who run it really are.”

        The “design” word must be further explained so as to not devolve into conspiracy theories devoid of an actual material analysis of how things developed in the real world. I don’t believe there was a grand scheme concocted 40 years ago by Psychiatry and other institutions of authority to come up with a “medication/drug revolution” to control the masses.

        I believe it was more of an alliance between Big Pharma to expand its profits and markets AND Psychiatry to provide itself with a scientific/medical veneer in order to advance its guild interests which had been severely discredited and weakened in the 1960’s.

        Once their massive campaigns to advance DSM diagnoses and their related psych drugging took hold on such a grand scale, they (a long with other institutions of power such as governmental forces, police, and prison authorities) began to understand the important role the disease/drug based medical model could play in maintaining and enforcing the status quo.

        Psychiatry and the “mental health” system have become so powerful, and such an integral part of the entire capitalist/profit system, that their future existence together is now inseparably bound. Their demise is equally bound up in our hope and desire for the joining of multiple human rights struggles into a broad revolutionary movement that can radically transform the world.

        Just as the environmental movement to save the planet from human destruction requires a radical transformation of the way we produce and distribute goods on an international scale, so does the way society supports those people suffering from extreme forms of psychological distress require the SAME kind of revolutionary change.

        Correctly understanding the interplay of a trauma based environment with the human genome is critical to advancing our efforts to create a more humane world.

        Richard

        • We frothed at the mouth about how Russian dissidents were drugged and labeled as mentally ill. I am not a conspiracy theorist type but what I do know is that in the “hospital” where I work the majority of the population on the units is African American. And almost to a person the “diagnosis” that they carry is schizophrenia. We begin drugging children at the age of two years old in the social welfare system as bi-polar and we drug kids in the foster care system. There was an attempt in the early 70’s to drug inner city children in the large cities of our nation but Peter Breggin got wind of it and stopped it not once but twice. I’m beginning to wonder if there isn’t a very subtle attempt going on by the system, both the mental and the governmental, to control an element of our society that it fears. The African American community is up for grabs I do believe and the system is certainly not out to help them in any way, shape or form.

          • Stephen

            You make some very good points. The Black population has been hit especially hard by Biological Psychiatry.

            It is common knowledge among those in the know that drugs like heroin became readily available in urban ghettos when Black rebellions erupted during the 1960’s. It is not a stretch to make comparisons with today’s high rate of psych drugging among oppressed minorities.

            Richard

          • Richard, you mentioned The Black population has been hit especially hard by Biological Psychiatry.

            I don’t remember the name of the article off the top of my head, though I could probably find it if required after a little digging, but there was an article (psychological published article) that reported links between Big Pharma (and by extension psychiatry) and eugenics.

            Most people think eugenics was discarded years ago, but it just stayed behind the curtain and behind the scenes. Such a suggestion may have been shrugged off as a ‘conspiracy’ years ago but the severe damage that psychiatry and Big Pharma do on a daily/yearly basis should be impossible to argue against a eugenics agenda.

        • I agree that all these genetic and bio theories are just another version of Original Sin, trying to find fault with and delegitimate to induce compliance. I am glad to finally see someone else talking about this.

          The best way to understand middle-class child abuse is to study medical child abuse, formerly known as Muchausen’s by Proxy. Why would a parent want to spend their time and money driving a kid to the doctor, what is the payoff. Understand that and you understand why people even have children in the first place.

          Nomadic
          http://freedomtoexpress.freeforums.org/index.php

          • Nomadic

            Thanks for the positive feedback on my analysis of “genetic theories of original sin.”

            You may want to be careful about too much praise for my words for I still make a living as a part time therapist. I worked for over 22 years in community mental health as dissident therapist opposing the takeover by Biological Psychiatry.

            I have read some of your criticisms of therapy/therapists and while they contain many truths I believe they represent a one sided analysis. I have been a writer at MIA for several years and all my blogs (including one on CBT therapy) can be reviewed by you, so you can make a more complete evaluation as to whether or not my viewpoint warrants further praise and/or criticism.

            Respectfully, Richard

  2. Wayne – Thanks!!!

    I worked 15 years in treatment foster care – 3 as a social worker, 3 as a supervisor and 9 as program director. I used to tell social workers, “Don’t tell me what’s wrong with him, tell me what happened to him.”

    About 10 years ago, the U. of Md. School of Pharmacy’s Dr. Julie Zito’s national study found foster kids 17 times more likely to be on psychiatric drugs than other kids receiving Medical Assistance. It is inconceivable that foster children have “brain based mental illnesses” (which have never shown to exist) at 17 times the rate of other kids on M. A.

    Random observations of Foster care’s entanglement with psychiatry and PhARMA:

    –Every child entering foster care is traumatized, simply by being placed in foster care. Even children from the most harrowing environments are almost always loyal to their parents and family. They can feel it was their fault they were removed; they can long for an idealized relationship with their parents; they often wonder if they are “just like” the tortured parents who neglected or abused them (they can face identity crises in their teens, struggling to choose between their parents’ life paths vs. those modeled by foster parents); they can feel it’s disloyal to “succeed” where their parents “failed’; they can feel they must have deserved their treatment. The list goes on …

    –Foster children are likely to be confused, grief stricken, terrified and angry – sometimes all at once. My state required each child entering foster care to be evaluated by a psychiatrist. Imagine the labels they got from psychiatrists whose specialty ignores context, places “blame” within the child’s head, and “medicates” them “for their own good” (really, to dampen behavior caused by their multiple traumas). Many children – even young ones – were already on several psych drugs when they were referred to us.

    –Don’t get me started on specific labels; just one example will do: Any kid who was sad, and occasionally got mad or into a fight was “bipolar.” Then bang – on to SSRI’s and “antipsychotics.”

    –Ditto “care” provided by the psychiatric system: Evaluations were generally 10 -15 minutes, resulting in Rx., then 10 – 15 minute monthly med checks as follows: Psychiatrists in nationally known institutions might greet children and foster parents without turning around from their desks – and ask a series of questions without looking up. One social worker sat next to a hand-flapping autistic foster child, with psychiatrist sitting next to them, nose in laptop – psychiatrist asked, “Any unusual gestures?” Social worker just stared in disbelief.

    My favorite: psychiatrists didn’t seem to realize that many foster parents came to appointments full of frustration and worry (many are heroic in their patience with the “acting out” of traumatized foster children).

    When I made home visits, my first order of business was to listen as foster parents vented fears and frustration: “He’s always …”; “He never …”; “I can’t get him to …”. It is so important that foster parents be heard. After an hour or so, I could ask re-framing questions: “How often did he do this last month? Three weeks ago? Last week? This week?” “Any encouraging things happen lately?” Often enough, having released the pressure, foster parents might say, “He’s done it less and less lately; he’s not doing too bad.” and we could find psychosocial ways to deal with problems.

    Yet psychiatry’s 10 – 15 minute med checks didn’t get to this point. Psychiatrists heard foster parents begin sessions of their own; they often mistook the un-processed opening statements of such sessions for factual reporting, and then “medicated” kids based on foster parents’ frustration.

    Foster children frequently moved from foster home to foster home – a product of too many systemic irrationalities to catalogue. Often this meant changing psychiatrists. One social worker was greeted with amazement by a new psychiatrist because she had prepared a history of the other psychiatrists the child had seen, and all the conflicting diagnoses and drugs she received over the years. This was the first time the psychiatrist had gotten such a rudimentary history.

    Once children were put on the drugs, it was almost impossible to get them off. I wrote a policy for our program requiring that no child be started on psych. drugs without the consultation and agreement of our social workers; and no medication was to be changed without prior consultation with us. It did little good. Med checks were perfunctory, many of our recommendations were brushed aside, and the overwhelming majority of foster parents reported that psychiatrists did not discuss possible adverse effects when prescribing new drugs.

    Psychiatrists paid scant attention to context provided by social workers. I once documented with a social worker a child’s traumatic history, the connection of her behavior to that trauma, the psychosocial measures in place to support the child and her foster family, the progress since those measures were implemented, the FDA warnings about the dangers of the child’s drugs (and how her behavior fit with those warnings). The psychiatrist simply said, “Who’s the expert here?” and ignored us.

    Our program employed only MSW social workers, most with the state’s highest clinical certification. Our average caseload was only seven children per social worker. We made a minimum of two home visits per month, and could make 3 per week when needed. We advocated for all children at school IEP meetings; we prepared and presented court reports for children’s periodic court reviews; we met with school personnel and sometimes made random classroom visits; we did in vivo counseling with children, foster parents and sometimes bio parents. Every contact was viewed as an opportunity for us to make therapeutic interventions (car rides were great opportunities for children to open up about their trauma histories and feelings). We arranged other services – educational, recreational, cultural, psychotherapeutic – for children, and maintained contact with service providers. We were relentless advocates for the kids with public agencies – courts, DSS, “mental health providers” and others.

    And with all our involvement, most psychiatrists pretty much ignored us, justifying their monthly med checks with a polite or brusque, “Who’s the expert here?” There were some exceptions – but they were not the rule.

    I agree, Wayne, that the attempt to “tease out real mental illness” is the kiss of death. Foster care is a high stress environment in which the temptation to drug our way out of frightening jams is seldom resisted. Most psychiatrists and primary care providers will agree that “medications” are “sometimes (even often) overused.” But, especially when the stakes are high, they almost always decide, “This kid really needs it.”

    • I’m in Australia and while all children are required to have full trauma therapeutic assessments done within 6 weeks of entering care along the lines of those done by Bruce Perry, they are also required to have a mental health assessment by a psychiatrist with no training in trauma within 2 weeks of entering care. It is very much the idea, that we need to make sure we do not miss anything!! All kids entering care have to have full medical, dental, eye and other assessments on entering care, and mental health is included in that. Yes the therapeutic trauma stuff is there as well and is now compulsory, but does not override the mental health, and none of the kids are ever given a PTSD diagnosis, even though that is what is should be. They are usually placed on anti-depressants, which are not even approved for use in anyone under the age of 18 and anti-psychotics, again without any evidence to support their use. From my reading of Bruce Perry’s work, ADHD drugs can help to reduce the level of hyper vigilance, and so if any medication is going to help it would be that one, but they are very rarely offered it. While the kids are getting now trauma informed care of good quality, it is all mixed in with so much harmful stuff that you wonder how many of them can truly gain from it. If they are so doped up they cannot cope with anything at all. There is also a push from many places to stop doing much of what is being done and to instead focus on cognitive approaches which are supposedly more evidenced based and of course simply focus on telling the child not to think this or that, when many of them due to poor language and other issues are very delayed in cognitive development anyway. The push is now to focus on improvement of that at the expense of trauma informed care!!

    • Wow, Peter, can you come work in our child welfare system in Oregon? I have worked for the CASA program locally for almost 20 years, and have seen exactly what you document here. Kid after kid is diagnosed with a “brain disorder” and their traumatic histories are ignored. Many kids get WORSE under the “treatment” of these doctors, and yet the answer isn’t changing the treatment plan, but adding yet MORE drugs and MORE diagnoses. Bringing up any kind of objection is often met with disdain or outright hostility. The system is set to meet the needs of the adults, just like it was in the kids’ abusive homes. It sounds like you and your team set up the best system possible to counter the systemic issues, and it still didn’t really get to the core of what is needed to help these kids. Thanks for all your commitment to these kids, who really need folks like you to help them see that not everyone in the system is untrustworthy or corrupt!

      — Steve

  3. Thanks for the information, Wayne Munchel and commenter Peter C. Dwyer. Forced drugging of society’s arguably most vulnerable population is something out of the psychological horror film genre. Thanks to Richard Lewis for his comments.

    Evidence to support all this drugging will never be found, but it doesn’t matter. The fantasy/notion that we suffer “mental diseases” “in our brains” “from our genes” is so deeply embedded in the culture – and is so profitable to so many – that I wonder how the facts, which are all out there, will ever be accepted by the mainstream.

    Liz Sydney


  4. Traumatized foster youth are often prescribed powerful psychotropics due to exhibiting a wide variety of “normal reactions to abnormal events,” such as despair, agitation, anxiety and self-harm.

    Yes, but when anyone goes to a psychotherapist the odds are very close to 100% that they will be talked out of their awareness and told that it is better to live by denial. And so nothing happens. It is always a kind of second rape. And do psychotherapists report to CPS when they are presented with a child who would seem to be showing the effects of psychological abuse? And when the parents are looking to the psychotherapist to make the child more compliant, like marriage counseling, but for the child involuntary? Does the therapist report to CPS, or do they sell their services to the parents?

    And why are these non-reporting and complicit therapists not in prison?


    In California, belated progress is being made in effort to curb the egregious over-medication and under-treatment of foster youth. Several key pieces of legislation have been passed with widespread support. An ongoing workgroup has been convened to develop data collection methods to identify who is prescribing what to whom, as well as implementing prior authorization and second opinion mechanisms.

    And so with these doctors operating in Josef Mengele territory, how many have been convicted of Crimes Against Humanity and executed?

    https://www.youtube.com/watch?v=vjR1PH41Vkg

    Always therapists and doctors of all types, and always complicit with the parents. All of these cases should be handled in civil and criminal courts, not in the office of another therapist.

    Nomadic
    http://freedomtoexpress.freeforums.org/index.php

  5. I would like to establish common sense again to you people, foster children are naturally abandoned and without love from parents.

    Are you going to adopt foster youths and provide them with a loving family so they can naturally be happy?

    Or are you going to criticize the drugs used to treat them for their unhappiness and lack of love?

    • In my program, many foster children were placed in very loving homes, remained for years, and their lives greatly improved. It was not uncommon for such children to be adopted by their loving foster parents.

      The drugs are not “used to treat them for unhappiness and lack of love.” Psychiatry, uses made-up diagnostic labels that supposedly represent “mental illnesses … medical illnesses just like diabetes and heart disease.” These labels have no validity, per Thomas Insel, former Director of NIMH; yet they are the pretext for giving children “medications” that have numerous dangerous adverse effects, and all by themselves can ruin people’s lives. If you knew anything about foster children or the drugs they are given, you would know the drugs do NOT make them happy or make up for lack of love. Reliance on the drugs distracts from what can actually work – love, relationship, well thought out psychosocial interventions, persistence and the ability to hang on for a long time during what is often a very bumpy ride.

      • Brilliantly said. Also true that courts and governments decide if children get to be adopted. Children can and do experience love and belonging in foster homes. In Australia many children remain in care as that is the only place they can access trauma informed therapy services and if the foster families take them on permanent care or adoption orders they loose access to that, which is what is holding the child together.

    • You can’t treat a lack of love with a drug!! Trust me, I’ve talked to hundreds of foster youth, and not one has ever identified a drug as helping them cope with a lack of love. The thing they report as most healing is ALWAYS a relationship with someone whom they found they could trust, someone who cared about them despite them not always being polite or kind or rational. Lack of love can only be treated with LOVE! Drugs simply make it easier for the adults involved to avoid their responsibility to figure out a way to understand what is going on and DO something about it.

      — Steve

  6. The toxic drugs do not cure or help anything at all. They do not bring happiness. All that the drugs do is tranquilize individuals and make them into zombies so that the adults supposedly working to “help” them don’t have to put up with their behavior caused by trauma, anxiety, and sadness. The drugs treat nothing at all. They numb the poor kids so that they can’t even begin to process what caused their problems.

    How dare you be so arrogant as to lecture any of us here. So you are the big expert who is going to “establish common sense” to us???? Give me a break You need to get a grip and realize that the only thing that you are an expert on is your own life. Don’t be trying to lecture us as if we’re some group of incompetent idiots.