July 28, 2008 6:06 PM | Posted by Colin: | Reply

Are they being medicated more because foster children are more problem children or are they being medicated more because foster children are just routinely put on pills immediately without any other options tried first?

Score: 1 (1 votes cast)

July 28, 2008 7:01 PM | Posted by Jade: | Reply

No doubt kids NOT in foster care are just significantly under-diagnosed. And of course those 13,000 children are given all the supportive attention they need.

"Society doesn't have any other options" - ? Bulls**t. Not using or even creating other resources and options is not the same thing as not having any. The kids don't have any other damned options.

Score: 0 (2 votes cast)

July 28, 2008 10:39 PM | Posted by : | Reply

Hey, they're poor AND they're insured. It's a no-brainer. You get to "treat poverty" and be paid for it.
I was unable to find in that piece how much the percentages varied from other, non-foster kids on Medicaid.

So let's take this to the next step. Let's get solid evals on the identifiable parents of these kids. Let's get a picture of what their parents actually have going on in their lives that has led to the kids being displaced to foster homes. I don't know how many of the parents have serious mental illness, how many are 'just' choosing to interact with drugs/booze instead of their families, and how many are just... inadequate parents, in the eyes of a caseworker, for whatever reason.

How much is promotion of undesirable behavior from kid to kid within the foster kid culture? What about kids who are solo foster kids, rather than the ones in the more common group-home type environments?

Score: 4 (4 votes cast)

July 28, 2008 11:24 PM | Posted by Jack Coupal: | Reply

Further on the comments by Mrs. Anonymous above. In addition to the parents and quality of their parenting, I'd guess that the majority of kids arrive in foster homes from a single parent family.

And, that single parent is also most likely a single mother who just can't handle the kid anymore. Well, what a kick in the head!

Score: 0 (2 votes cast)

July 29, 2008 7:00 AM | Posted by Sally: | Reply

As it's always been, being unwanted is what defines mental illness. These poor kids.

Score: 1 (1 votes cast)

July 29, 2008 1:45 PM | Posted by NAP: | Reply

You definitely seem like you have reasonable opinions, but why the dianetics ad below this article? Are you affiliated with the group, or is it one of the target ads google adsense generates based on content?

Score: 0 (0 votes cast)

July 30, 2008 4:06 PM | Posted by Anonymous: | Reply

The dianetics ads are there because this guy has never said a single positive thing about psychiatry. Whatever his beliefs and/or affiliations, every single post he's ever done has been written in some kind of negative light. How psychiatry is used and abused, awful people, how to fix things (i.e. things are already bad, why else would they need fixing?), and, hell, even his story about how he mistook caffeine withdrawal with a more serious illness is not exactly upbeat or amusing.

Having dealt with people in mental health, I always dread when they discover the internet. The future is bleak, bleak, bleak.

Score: 2 (4 votes cast)

July 30, 2008 4:16 PM | Posted by Dave Johnson: | Reply

I'd like to congratulate the psychiatrists, doctors and radiologists of Texas for making it easy for the state, as a whole, to contain it's health care costs re: foster children. WOAI
news in San Antonia reported:

Who is prescribing these meds? You would think psychiatrists, right? Well, after pouring through thousands of documents, the News 4 WOAI Trouble Shooters found that's not always the case. Many are family practitioners.

State records show one of the biggest prescribers in San Antonio is a radiologist. Sure it's legal, but what does a radiologist know about a child's mental health?

The Trouble Shooters also found some of these doctors have documented drug problems of their own. One case is Dr. Charles Sargent, a San Antonio psychiatrist. He's listed as one of the state's top prescribers of antidepressants to kids on Medicaid. The records we obtained show he also prescribes stimulants and powerful antipsychotics.

The Texas State Board of Medical Examiners put Dr. Sargent on probation in recent months because state records show he was busted for prescribing narcotics to himself, his girlfriend and her son. As part of his probation, he must submit to random drug testing.

Representative McDermott's response moves past pious hand wringing in order to propose some basic reforms:

Section 421 of McDermott’s Invest in KIDS Act (HR 5466) requires the state agency responsible for foster children to put together a coordinat-ed health care plan for each child that would identify and respond to, among other things, mental health needs and would include oversight of any prescription medicine use.

No doubt there will be some gentle reader who will be able to explain to me why a radiologist can prescribe psychotropic medications ... or a family physician ... without being required to have some sort of certification in this area.

Of course, that still leaves my final question begging an answer: given the fact the majority of prescribers are psychiatrists, why is the association so terribly remiss and ineffectual in addressing these well documented cases of egregious malpractice? Or is that too naive a query to even mention?

Score: 1 (1 votes cast)

July 31, 2008 1:30 AM | Posted by Alone: | Reply

Alone's response:

I should respond to the above comments. Dianetics is there because it is Google Adsense. It "senses" an anti-psychiatry bias in a post, and boom-- scientology. (I am not a scientologist.)

But I'm not anti-psychiatry. I _am_ a psychiatrist, I do clinical work as well as forensic. I like my job. What I am against is the expansion of psychiatry beyond its real purview. An analogy would be if lawyers suddenly wanted to help decide if Christianity was better or worse than Judaism by interpreting the Bible. Hey, yust because there are words in the Bible, doesn't make it the legitimate realm of lawyers... etc.

I am also against using psychiatry as a default welfare system. People seem to misunderstand this position. It's not that I don't want to help people who are, for example, indigent; it's that it makes no sense as a general policy to send people whose main problem is social to a quasi-medical field. Consider the incongruity: psychiatry wants so badly to be biologically based, yet it expands more and more into realms that have no biological premise. Hence this post: there's no biological determinant to being a foster kid, yet that single fact is most predictive of being mentally ill. In other words, we (psychiatry) must be making crap up.

Score: 6 (6 votes cast)

July 31, 2008 2:23 PM | Posted by Sue: | Reply

Many children wind up in foster care because they have such severe emotional issues/mental illnesses their families can't care for them.

Included in this group are middle-class families with "cadillac" health insurance. Even the best policies tend to terminate benefits after 10 psychiatric in-patient days. For those children who clearly need more care, hospitalizations become a revolving door. Unless a family can pay for the $900+/day care themselves, they have no option but to put their children in the foster care system when their health benefits run out. Once in the system, the state can access foster care funds to place the children in long-term residential care.

The mentally ill kids in the Texas foster care system don't all come from poor, disadvantaged backgrounds. Quite a few are there because neither private health insurance nor the public health care system gives the parents any other choice.

Score: 1 (5 votes cast)

July 31, 2008 3:56 PM | Posted by theskepticalshrink: | Reply

This is another great article. The problem is that hardcore biological psychiatrists will claim that 1) mental illness is genetic; 2) many parents with mental illness are either too sick to take care of their kids or their kids are too sick for their parents to take care of them; and 3) a disproportionate number of those kids end up in foster care. Under this paradigm, foster care has no causal relationship with mental illness, but is at most a "trigger" for pre-existing biological illness, as another recent post on this site pointed out. That's the beauty of a tautology; you can use it anytime, anywhere to promote your agenda, no matter what it is.

Score: 0 (0 votes cast)

August 1, 2008 10:01 AM | Posted by Diane Abus: | Reply

Thanks,the comments and post excellent.From a foreigner.

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August 1, 2008 12:32 PM | Posted by Sally: | Reply

In case anyone cares, I don't get Dianetics ads from Adsense on this site, I get health insurance, particularly health insurance for children, ads. Google adsense is somehow context sensitive so I assume this guy rambling about Dianetics is coming here from anti psychiatry sites and/or searches.

Score: 1 (1 votes cast)

August 2, 2008 12:22 AM | Posted by Steven Morgan: | Reply

I think that - except for the most extreme cases where benefit so clearly outweighs costs that no one (and I mean no friends, family members, doctors, lawyers, advocates, judges) can possibly see a better solution - sedating children with antipsychotics is child abuse. And I hope that when these thousands of children who are forced to eat powerful medications turn 18, they sue the hell out of everyone involved and bring utter despair to the guilty parties to the same effect of big tobacco being drained.

What the hell are we talking about here? Has our culture really progressed to this...labelling and drugging kids who've been abandoned by their parents?

Can we please open our eyes just a little bit and perhaps think: "Geeee, that whole family love thing may have an impact on emotions, and hmmmm, maybe foster kids by their very predicament of being wards of the state are not getting that whole family love thing, and ahhhh, maybe we need to invest in and create MUCH healthier environments for kids who are severely neglected."

You know, here's a magical thought: maybe children who act out aren't always "the problem." Maybe the parents and schoolteachers (and society) need to change. Why don't we drug the hell out of them? I'm sure that an angry father would be much more tolerable once he's getting a shot of Zyprexa every two weeks.

Drugging foster children is a by-product of the insane reductionism inherent in biopsychiatry that seeks to create a "blame-free" ideology where no person is at fault for major mental illness (even when one's voices are those of an abuser) except the diagnosed person's brains and genes. This is what we get when we hack away at the soul and only believe what is seen through microscopes.

And you know what? It's getting worse, not better. Where the hell is the outrage? Have we all learned to be "compliant"?

Score: 4 (4 votes cast)

August 2, 2008 7:54 PM | Posted by theskepticalshrink: | Reply

"Sue the hell out of everybody...?" Mr. Morgan, please remember that holding someone else responsible is not the same as taking responsibility. Alone's point, if I understand it correctly, is that psychiatrists have been thrust into the unenviable position of having to use a medical paradigm to address social problems that the rest of society isn't willing to deal with. Scapegoating psychiatrists for carrying out this unwelcome duty will not help the situation.

Score: -1 (1 votes cast)

August 3, 2008 12:20 AM | Posted by Steven Morgan: | Reply

"Scapegoating psychiatrists for carrying out this unwelcome duty will not help the situation."

Yes, I understand Alone's point, and I agree that psychiatry extends way outside its bounds, but I disagree with your above logic.

Do you think that most psychiatrists consider medicating children to be an "unwelcome duty"? If yes, then why the hell isn't the APA condemning it? Or why aren't psychiatrists gathering in huge numbers to protest it?

I'm rather shocked that you make pscyhiatrists into victims here. They hold most of the power in the doctor-patient relationship, meaning that they can say "no" to medicating children. Yes, they are asked to "deal with" people who they cannot really help, but that doesn't mean that they have to comply with that request in the form of medication.

I tell you what, here's a better solution: why don't the "victim" psychiatrists get together and use their wealth to form a lobbying group that demands that our government stop utilizing their services to fix problems outside their reach, and why don't the "victim" psychiatrists write into the APA about this passion, and why don't the "victim" pscyhiatrists run TV ads making the public aware of the problem?

Come on. Psychiatry as a profession IS to blame for the drugging of children because they create and promote the diagnoses that justify it. Without psychiatry, there is no "Childhood Bipolar Disorder"; instead, in the aforementioned examples, there are "Neglected Foster Care Kids". And there's no data to back up Zyprexa for neglect.

So, let's continue this discussion, b/c I'm fascinated by the worldview that psychiatry is innoucuous in this equation. What are your thoughts?

Score: 4 (4 votes cast)

August 3, 2008 3:42 PM | Posted by theskepticalshrink: | Reply

Morgan, I question the utility of continuing this discussion with you, because the tone of your post suggests that you are not receptive to rational arguments and will probably become more self-righteous and indignant. Nevertheless, I will try. Here are some concerns I have about your post:

1. You seem to believe that all psychiatrists are the same, based on their membership in the semantic category "psychiatrists." This conceptualisation does not leave room for the idea that individual psychiatrists may differ markedly in their philosophical approach to their work, their clinical competence, their degree of investment in the dominant psychiatric paradigm, or even their scope of practice. For example, although your primary objection to psychiatrists appears to be that they medicate children, child psychiatry is actually a relatively small subspecialty and the vast majority of psychiatrists treat only adults. At a broader level this lack of distinction represents confusion between the properties of classes and the properties of their members, a fundamental logical error. You are not the only one to make this error; it is pervasive even among scientists and certainly among psychiatrists. For a good explanation of what I am talking about, read just about anything by Bateson.

2. The tone of your post makes it clear that you think psychiatrists and psychiatry are fundamentally harmful to patients and society. I do not dispute that psychiatry does great harm. However, there is REAL scientific evidence that psychiatric treatment also improves certain outcomes, such as suicide, substance abuse and hospital admissions. This means that psychiatrists do some good, and they do some bad. The notion that some things can be partly good and partly bad is extremely difficult for many people to understand. Psychiatry itself calls this failure "splitting" and categorises it as a defence mechanism; however, I suspect that it runs deeper than that and is actually another manifestation of the difficulty with abstraction to which I alluded above.

3. I did not say that medicating children was an unwelcome duty, as you incorrectly paraphrase in your third paragraph; I said that being forced to treat social problems as if they were medical problems was. This conflation is a transparent rhetorical device that will not fly among seasoned debaters. It also implies that medicating children is categorically wrong, a proposition which is categorically false. For example, even if we accept as true the proposition that childhood bipolar disorder is overdiagnosed, it does not hold that no valid cases of childhood bipolar disorder exist, nor that no children exist who require or benefit from medication, for, say, mood stabilisation or behavioral control. If you believe that all children are healthy and should never be medicated based on their membership in the semantic category "children," then that is a faith-based assumption that I cannot address with any rational argument.

4. I did not say that psychiatrists are victims nor that they are innocuous (and if I had, it would represent an opinion, not a worldview). I said that they are part of a larger system upon which society places expectations, albeit conflicting ones. You seem to believe that if individual psychiatrists disagree with those expectations then they should simply act independently and ignore them--but the sanctions for failing to meet those expectations are very real. For example, for every person like you who derides the profession for medicating poor innocent children, there are ten others who demand accountability for the profession's failure to "appropriately treat" the perpetrators of Columbine, Virginia Tech and other massacres before they grew up to be mass murderers. On a more individual level, a child psychiatrist who "says no" to medicating children faces legal liability for failing to treat to the standard of care; professional alienation for failing to fall into line with his or her peers; and financial ruin, since parents will simply take their kids to another psychiatrist who will give them the medications they want for their kid.

5. Whether or not one believes that psychiatrists are "to blame," they "create and promote" psychiatric diagnoses precisely in response to society's demands that they treat social problems with a medical model. They are expected to construct a medical narrative and make a medical diagnosis, and whether or not it is accurate, it will always speak to proximate rather than ultimate causes. Psychiatrists are not alone in this regard. For example, internists diagnose AIDS, not poverty, ignorance or lack of access to affordable treatment, even though these factors cause the disease just as surely as HIV does.

6. Not all psychiatrists are involved in creating or promoting the DSM diagnoses that you find so far off the mark. Like the members of any profession, psychiatrists look to their leaders to provide a coherent conceptual structure in which to practice. Those leaders include the authors of the current edition of the DSM, but they also include critics like the author of this blog. When you suggest that psychiatrists get together to form a lobby group for reform, I think that's a great idea. Realistically, however, that can't happen until rational critique of the dominant psychiatric paradigm gathers enough steam that mainstream psychiatrists (most of whom are simply undereducated and intellectually limited, not nefarious) actually stop and start to question what they are doing. If on a broader level you support the rational critique and well-articulated dissent that may eventually lead to reform, well...that's exactly what's happening on this blog.

Score: 0 (0 votes cast)

August 3, 2008 6:50 PM | Posted by Steven Morgan: | Reply

“Morgan, I question the utility of continuing this discussion with you, because the tone of your post suggests that you are not receptive to rational arguments and will probably become more self-righteous and indignant.”

That’s rather presumptuous and diagnostic of you. I am definitely a passionate person, but that does not eclipse my ability to reason.

Anyhow, thank you for your well-reasoned response (I was being sincere in my inquiry for it). I would like to respond to some of your points individually, then further assert my own opinion.

“You seem to believe that all psychiatrists are the same, based on their membership in the semantic category "psychiatrists."”

This is absolutely not true. Besides having seen several psychiatrists myself, I have worked in the mental health world for several years and have been exposed to a wide variety of perspectives. I totally agree that pscyhiatrists, much like us who are labelled with “Bipolar” and “Schizophrenia,” are of an infinite variety and cannot be pinned down to one universal manifestation of thought or practice.

“At a broader level this lack of distinction represents confusion between the properties of classes and the properties of their members, a fundamental logical error.”

Fair enough, and I don’t think I made that error. Please reread my original post. I said, “sue the hell out of everyone involved,” which you then manipulated to read, “sue the hell out of everybody…” in your initial response. There’s a big difference between those two statements. I’m not recommending that children who are drugged and harmed sue all of psychiatry, just the parties involved, which may include big pharma and a specific psychiatrist.

"The tone of your post makes it clear that you think psychiatrists and psychiatry are fundamentally harmful to patients and society."

This is also not true at all. I think some psychiatrists do a lot of good, some do a lot of harm, and some do a lot of both, and I’m thankful that good psychiatrists exist to provide assistance to some people who benefit from their services. And I’m well aware of “splitting,” as well as “projection,” which you seem to be doing all over me.

I know there is “REAL scientific evidence” that psychiatric treatment works for some people in some ways, and there is also “REAL scientific evidence” that it doesn’t (which I see you acknowledged, so I’m not accusing you of neglecting that side). I just compiled this document, which you may be interested in: http://www.vermontrecovery.com/files/Download/TheOtherSideofMentalHealthScience.pdf

“For example, even if we accept as true the proposition that childhood bipolar disorder is overdiagnosed, it does not hold that no valid cases of childhood bipolar disorder exist, nor that no children exist who require or benefit from medication, for, say, mood stabilisation or behavioral control.”

Well, this is really too large and wide of a debate to have here. I have problems accepting that “Bipolar Disorder” as a singular medical disease of the brain exists, so I obviously have problems with “Childhood Bipolar Disorder” as well. Now, I’m not an anti-psychiatrist or a scientologist, so please don’t lump me in with that often hostile group. I’ve done a fair amount of research into the brain, and what I see is enormous complexity and mystery, and dare I say it, uniqueness. But in any case, I agree with you that there are examples of children who benefit from medication for “mood stabilisation or behavioral control.” Again, if you reread my original post, I acknowledge this fact second-handedly. Personally, I would like to see a thorough process for drugging children that is more accountable than a doctor’s discretion. I’m not 100% sure what that would look like, but maybe you can add some of your own expertise?

“I did not say that psychiatrists are victims nor that they are innocuous.”

Okay. I was perhaps drawing conclusions and being presumptuous. My apologies.

“You seem to believe that if individual psychiatrists disagree with those expectations then they should simply act independently and ignore them--but the sanctions for failing to meet those expectations are very real.”

Well, this is a good point. What I would like to see is MORE psychiatrists being critical of their profession and their work, and being louder about it. You are right that there are people doing this, but it does seem to be a huge minority. And still, I do think we have to hold adults accountable for their behavior, so I do think that the individual psychiatrist who prescribes medication to a child is liable for some responsibility towards that child’s health. I hear you that there is a larger systemic paradigm that creates the scenario in which a doctor prescribes meds to children, but there are also larger systemic paradigms behind any action, whether helpful, harmful, or criminal, and our the way our current legal system is setup, adults deemed competent are accountable for individual discretion (and pscyhiatrists should not be exempt from this principle).

“Whether or not one believes that psychiatrists are "to blame," they "create and promote" psychiatric diagnoses precisely in response to society's demands that they treat social problems with a medical model. They are expected to construct a medical narrative and make a medical diagnosis, and whether or not it is accurate, it will always speak to proximate rather than ultimate causes.”
I disagree with this logic. I think most of the power resides in psychiatry, and that they willingly wed themselves to the medical model. I think that if the majority of psychiatrists came out tomorrow and said that schizophrenia was caused by trauma (I’m not saying it is, just using an example), that the public would believe it overtime (albeit there would be dissenters). In other words, I think psychiatry sets the standards for how the masses view mental illness, not the other way around. Afterall, doctors are enshrined in this culture as having knowledge that laypeople do not and cannot possess.

“For example, internists diagnose AIDS, not poverty, ignorance or lack of access to affordable treatment, even though these factors cause the disease just as surely as HIV does.”

Well, I don’t know enough about HIV and AIDS to really understand your reasoning here, but isn’t HIV an actual biological virus? If so, it’s fundamentally different than “schizophrenia” or “bipolar disorder,” and cannot really be categorically compared. Just like people compare diabetes to bipolar disorder - usually with the touch that both require medical treatment - yet I think the fundamental assumption that bipolar disorder is a medical disease is off, so the comparison falls apart.

“Not all psychiatrists are involved in creating or promoting the DSM diagnoses that you find so far off the mark.”

I don’t think that they are all so far off the mark at all. In fact, I used to fit the criteria for Bipolar Disorder II and OCD rather well. But it still doesn’t make them legitimate, singular diseases of the brain. I also fit the criteria for American and Musician quite well…

So, in the end, I still think that IN MANY CASES, medicating children is the equivilent of child abuse, and that individuals and organizations need to be held accountable for it. Children have inalienable rights, though I think we often forget that. For example, why isn't anyone doing subjective studies where they ask children how they feel about taking antipsychotics? Hell, why isn't the media asking them? Do we really think that children are too incompetent to express a reasonable reaction? Why do parents have the right to "speak for their children," when there is not almost no litmus test for their competency as parents?

And I still think that if pscyhiatrists who are drugging children feel oppressed, then they have way more power to fight back than children. And in my view, that power translates to responsibility.

Score: 2 (2 votes cast)

August 4, 2008 12:59 AM | Posted by Diane Abus: | Reply

I think Steve's points also represent my experience with psychiatry in general.There is a huge feeling of whoa hey what are you all doing here?Hyperbolically,there's a "shoah"(destruction) occurring with forced drugging for many persons...........and the prescription pad is the ticket to it.signed by whom..............?
Respectfully,Diane,

Score: 0 (0 votes cast)

August 4, 2008 3:11 PM | Posted by Diane Abus: | Reply

TheRx also opening the door to a lifetime of pillioring,. continuing the pain of the original unwantedness of many childhoods."Culprits here often the professions(general practice and psychiatry). This occurs to often in my view of the world ,as a person with such a Rx and seven years of post secondary education as one of my main accomplishments in l life........... Roc on all.

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August 12, 2008 3:20 PM | Posted by Jim: | Reply

I must respectfully disagree with the opinions of Mr. Morgan and Ms. Abus. Not because either of you are not drawing reasonable conclusions from your observations, but because neither of you acknowledge the need of a "plan B." As Alone says in the original post, if one isn't categorizing these children as mentally ill, then what's the alternative treatment course?

In my own view, I don't think that the real issue is over-medication or over-diagnosis, as I think those issues are just symptoms of a larger social problem. I don't have evidence, but I am willing to bet that many of these children are symptomatic in that they present with many of the same behaviors and traits that are observed in patients who are legitimately diagnosed with a mental health disorder.

There is just simply a lack of resources to treat these children behaviorally, by which I mean with love, support, talk therapy, and all the other non-medication options. Medication becomes an option because there are not real alternatives. Outcome for this children is poor; many will have criminal problems later in life. In the end, outcomes remain poor, and the system as it currently stands continues to support itself. I don't think things will change unless non-medication options can produce better results for less money.

I am not speaking with direct experience of the Texas foster care system, but I have worked in the mental health field serving foster children and lower income families. In the end, I believe it comes down to cost, and, in the long run, medication often can produce results for less money than other treatments.

To theskepticalshrink: your points re: the biology-based skeptic's arguments are a welcome addition to this discussion, although they have not received others' comments, thank you.