Note: The video interviews can be found here
This post introduces a series of thirty video interviews with leading experts from around the world called Parenting Today: Raising Strong, Resilient Kids. This series is designed to help parents better understand how to raise strong, resilient kids and how to deal with the pressures exerted on them by the current dominant “mental disorder” paradigm. In this post, I’d like to present a bit of an overview.
This may be an especially hard time to be a parent. In addition to all of the other stresses put on parents, from paying bills to dealing with a child’s toothaches, earaches and teenage years, now a parent has to deal with—and quite likely protect herself from—the epidemic of “mental disorder” diagnosing (some would say labeling) that currently threatens millions of children and their parents. Many of you may find yourself in this predicament and under this precise stress. What exactly is going on?
We have certainly come a long way in our compassionate treatment of children. We no longer look at children as a workforce; we see them as having rights and deserving not to be abused; we believe that they have a right to be educated. Now, suddenly, in the course of just a handful of years, it looks as if we have taken a huge step backward. We are rushing down the road of turning every feature of childhood into a “symptom of a mental disorder” and turning every child into a “mental patient.” Recently we have started down a new, even more dangerous road of “predicting mental disorders” in children and treating children prophylactically with chemicals called “medication” before they show any symptoms of a “mental disorder.” Children and their parents are being besieged in these ways.
The number of children being diagnosed with a mental disorder and being put on so-called psychiatric medication is increasing rapidly. What has happened? Primarily, certain ideas about “mental health” and “mental illness” have taken hold, promoted by special interest groups including psychiatrists, other mental health service providers, and pharmaceutical companies. This way of thinking became the dominant paradigm and continues as the dominant paradigm today. If you are a child and behave in certain ways that might plausibly have completely non-medical causes, you are nowadays routinely and immediately presumed to have a pseudo-medical-sounding affliction called a “mental disorder.”
Beginning in the 1950s, mental health professionals announced that if you displayed certain behaviors or had certain thoughts or feelings called “symptoms” you had a “mental illness.” Despite the fact that they made this claim without any scientific justification whatsoever, this claim stuck. It continues to stick today—still without any scientific justification. The “symptom picture” model took hold—and now it looks to have grabbed us by the throat. Although this model makes no scientific or logical sense, it is our current standard of care and an extraordinarily profitable cash cow for pharmaceutical companies, researchers, mental health professionals, and other vested interests.
Because this is the dominant paradigm and because it is touted everywhere, including in the media and by parents themselves, wherever parents turn they hear about little Bobby on ADHD medication or little Sally on a cocktail of meds for her childhood depression. Bombarded with news about this supposed mental disorder epidemic and about the rising rates of diagnosis and chemical use, if their own child shows certain unwanted behaviors, thoughts or feelings they are bound to suddenly fear that they have a “mental patient in the making.” What could feel more terrible? Naturally feelings of helplessness, hopelessness, and failure well up as a parent’s very connection to her child shifts from loving parent to frightened watchdog and prospective caretaker.
Parents are bombarded on all sides—from mainstream media, school teachers and administrators, mental health professionals, pharmaceutical companies, and their own peers—with the following message: something called “the mental disorders of childhood” exists and your child may well have one (or more) of them. Isn’t your child restless? Isn’t he squirming? Isn’t he sad? Doesn’t he say “no” a lot? All of these are symptoms of mental disorders! Watch out: your child probably has one.
Critics of the current paradigm have pointed out that the constructions of psychiatry are classic examples of pseudo-science employed to gain prestige, make money, and avoid the hard task of understanding what is actually going on in the mind, being, and environment of a given child. Sharna Olfman, professor of clinical and developmental psychology at Point Park University, a psychologist in private practice, and the editor of the Childhood in America book series for Praeger Publishers, explained to me:
“Parents have been led to believe that popular childhood diagnoses such as ADHD and Bipolar Disorder are well understood illnesses that can be effectively treated with drugs that correct underlying chemical imbalances in the brain. In fact, even the former director of the National Institute of Mental Health, Dr. Thomas Insel, has stated publicly that DSM diagnoses [that is, diagnoses based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders] are premised on questionable science. Furthermore, not a single DSM diagnosis has been credibly linked to a chemical imbalance. While these widely held and highly persuasive beliefs are mere pseudoscience, there is a rich body of genetic and brain research with far reaching implications for diagnosis and treatment that has gone under the radar.”
Dr. Brent Robbins is Chair of the Department of Humanities & Human Sciences at Point Park University and a Past President of the Society for Humanistic Psychology. Brent explained to me:
“The DSM-5 is the diagnostic manual that is produced by the American Psychiatric Association and is used by clinicians to diagnose people with various categories of mental illness. There is a growing concern that the diagnostic categories in the DSM-5 are not based on good science. The categories seem to lack reliability and validity. They lack reliability in that the same individual is likely to get diagnosed differently and inconsistently if he or she were to visit different clinicians. A good diagnostic instrument would, by contrast, lead to precision in diagnosis. The DSM-5 diagnostic categories, in most cases, are far below minimal expectations for reliability.
The issue of validity is the concern that the DSM-5 diagnostic categories are often treated as if they point to underlying mental illnesses. But, in fact, we do not see evidence for this. Rather, DSM-5 diagnoses are descriptions of symptoms that often happen together, but they are not themselves an explanation for the symptoms that are being described. There are many reasons to be concerned about this beyond scientific concerns. The weakness of the DSM-5 has real implications for real lives. Because the instrument lacks scientific reliability and validity, many people get diagnosed and get put on medications when they don’t merit a diagnosis and do not need the treatment. This puts the individual at risk of side effects from unnecessary treatment, and it takes resources away from individuals who really do need the treatment.”
If what ailed your child were anything like a broken ankle, you would know exactly what to do and where to go. You would go to a medical doctor and get your child’s ankle cast. But what does one “do” with an odd child, an angry child, an anxious child, a moody child, an obsessive child, a withdrawn child, an addicted child, or an out-of-control child? For that child, what is the equivalent of casting their broken ankle? And who should do the casting? Who is the right “doctor” for this sort of problem?
Let’s say that you are the parent of an angry child who is in emotional pain, who is acting out and making it incredibly difficult for you to feel loving toward him or her, and who rejects your helping advances. At the same time, you can’t help but feel that you or your circumstances must have contributed to all this anger and pain—on top of feeling helpless, you also feel guilty. Then, in addition to the difficulties your child is experiencing and the guilt you are carrying, comes the third strike. You look for some help and you are advised (or commanded) to enter our mental health system.
Our mental health system, with its particular way of making up a label for what your son or daughter is experiencing and its penchant for offering up chemicals as your child’s best hope, steps in, labels your child, and starts its regimen of chemicals. Maybe you are relieved that your child has been “diagnosed” and is now receiving “medical help.” Maybe you are rather doubtful about this “diagnosis” and suspicious of a “chemical cure.” In either case, you may soon find that your situation is worse rather than better. Now you may find yourself living two nightmares instead of one, the nightmare of your child’s difficulties and the nightmare of insufficient and perhaps downright dangerous “solutions.”
Let’s try to tease apart the many difficulties that make this picture so poignant, painful and maddening for parents.
First, as you quite possibly realize very clearly in your gut—no one really knows what is going on. Your child does not know. You do not know. No mental health professional really knows (though they may claim to know). What if your son is harboring some deep-seated sorrow or has turned his anxious feelings and his natural childhood awkwardness into a hatred of life? How could this be known with any certainty? What if your daughter has been battling with her sister all of her life without anyone being quite aware of the damage done to her by this daily warfare? How could this be known with any certainty? What if a seemingly small thing has happened that has produced out-sized consequences? How could this be known with any certainty?
Second, we do not know what part a child’s natural endowments are playing. We do not know the contours of any child’s original personality or how that original personality is making itself felt in that child’s forming (and formed) personality. We do not know how the mind he arrived with actually works. Surely that really must matter—and we do not know anything about that. What difficulties will him possessing a high intelligence likely or inevitably produce? What difficulties will him coming into the world already addicted likely or inevitably produce? What difficulties will him being born a “feminine” boy or being born a “masculine” girl likely or inevitably produce? Mustn’t “who we are” matter?
Third, we do not know what part “biology” plays in all this. When “biology” is introduced into a discussion of this sort as a possible explanation, typically the following is meant: that maybe this crisis isn’t “psychological” or “social” or “environmental” or “familial” but is instead the result of something being broken or out of whack. For example, maybe there is a “chemical imbalance” or a “genetic” explanation for the crisis. “Biology” used this way naturally leads to ideas like “mental illness” and “mental disorder.” But that “biology” in this sense is implicated is not at all known. To many it seems logical that it must be implicated and to others it seems completely illogical. But who knows?
Fourth, we simply can’t get into another person’s head. A child is somebody with an inner life. Children think, imagine, feel, dream, remember, and hope. But we can’t get “inside there” to see all that thinking, imagining, feeling, dreaming, remembering, and hoping, or to see how our child is constructing his or her reality. How do trips to church to hear a pastor decry homosexuality combine with a child’s budding guilty feelings of attraction to members of the same sex? How does being told by one parent that you are special and being told by the other parent that you are worthless “come together” in a child’s psyche? If only we could know what was going on in there! But we can’t.
Fifth—and this is very difficult to talk about—what if you are a significant part of the problem? What if your mate is? What if another one of your children is? What if the visceral anger between you and your mate is making your child anxious? What if, just to make ends meet, you must stay so busy and so unavailable that your child feels abandoned? That is, to what extent will your desire to help your child be compromised by your defensiveness around the part you may be playing in her difficulties? This defensiveness is such a human problem and such a human reality! Can you reduce your defensiveness and change “your part” in the equation?
Sixth, your child may not have the problem—your culture and society may have the problem. If, for example, many or most of the typical features of childhood, from squirming to feeling anxious to defying authority, are deemed “symptoms of a mental disorder”—and that is the current trend—then your unfortunate child will become “abnormal” and “different” by definition. Once defined that way, he (and you) will have to deal with a system that has a particular way of “treating” what it has defined as “disordered,” a way dominated by chemicals-with-powerful-effects called “medication.” This is just one of the many ways that culture and society may be “making problems” for your child and your family.
Seventh, we don’t know what, if anything, can counteract the damage done by early trauma. If, for example, a given infant feels abandoned, experiences what is called “insecure attachment,” and learns not to trust, not to care, and not to love, what will help the most or help at all to rewire that child into a trusting, caring, loving human being? We hate the idea of having to reply: “Nothing.” Nor do we know if “nothing” is the right answer. Maybe multiple efforts, including loving parenting, supportive psychotherapy, compassionate mentoring, focused life skills training and some real-world successes might heal and transform him. But we do not know.
Eighth—and this flows from the preceding seven—we aren’t very clear on what helps in general or what helps in a given situation. Maybe “talking it out” with a trained listener like a psychotherapist can help—but to what extent can that really help if what is going on is connected to some aspect of your child’s original personality or to some stressor that is out of your child’s control to change, like a tumultuous or traumatic family situation? When is something like “talk” appropriate or even relevant, even if the talk is “expert”? Given how little clarity we have about what actually helps, it’s important that we look at a given child’s distress through multiple lenses and with many different sorts of help in mind. I hope that this series does just that!
If the instruments of society—your child’s pediatrician, your child’s teacher, your child’s principal, your child’s guidance counselor, etc.—suggest, imply or announce that your child has a mental disorder, that he or she ought to be treated as soon as possible with a regimen of chemicals, and that to do otherwise is irresponsible on your part, endangers your child’s future in school and in life, and is tantamount to child neglect, how can you be expected to think clearly about what’s going on, research alternatives, or not succumb to that enormous pressure? When the deck is stacked against you and your child in such powerful ways, how can you successfully resist or calmly proceed?
Step one is to recognize that you are being pressured. If someone in a position of power or a supposed expert provides you with exactly one explanation of what is going on—the mental disorder explanation—and you know that there are and must be multiple ways to conceptualize what’s going on, you should appreciate that their “one explanation” amounts to implicit pressure to believe a certain thing, to react in a certain way, and to grant the powers that be a certain blanket permission. You are having the experience of being pressured because you are being pressured. Internally nod and say, “What I’m feeling is real. They are pressuring me!”
Whether your child is four years old, fourteen years old, or forty years old, his or her presence is your life is a profound, poignant and pressing part of your reality. We sincerely hope that this interview series will open your eyes and provide you with helpful ideas that you may not be able to get anywhere else. I hope that you’ll enjoy and benefit from the upcoming series of thirty video interviews. And if you know of a parent or parents who might benefit from the series, please do alert them to its existence!
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.