Posted on Wednesday 22 June 2011

I seem to be writing about cases after almost every volunteer day. This week, it was a little 7 year old girl with a difficult story. Her parents were addicts who had 6 kids. By the time she came along, they were living in a car or in one room of a hotel/motel. Four years ago, it came to an end and the kids were taken away from them. The four youngest 10, 8, 7, and 4 are with their single thirty-something aunt [called "mom"]. All but the 7 year old are doing great. The little girl is cute, engaged, and well behaved in the office. That’s the problem. So long as the aunt/mom is around and paying attention to her, she’s fine. At school, she reads poorly, but is always in trouble for lying and stealing. She does the same thing at home. She’s provocative and destructive at times. If the aunt works on Saturdays and they are watched by someone else, the little girl becomes so disruptive that the aunt has to come home to calm her down.

My clinical impression was disorganized attachment disorder and a very weary aunt whose sainthood is growing thin – on the verge of giving up. "She takes all the resources and energy from the family – all of it." But "I love her and would hate to lose her." Why am I mentioning her here? This child has been on most every ADHD medications and most Atypical Antipsychotics in fairly high doses. Most medications have made the child worse. At one point, a local Pediatrician turned the aunt into DFACS because she stopped a stimulant that was making the child "wild."

My impression is that the child’s absurd history lead to an attachment problem and resultant behavioral problems, but that the little girl is treatable. Our plan is to try to get her into a residential program because the aunt needs a break and because it’s unlikely that the child can be treated if the aunt is involved early on because of the desperateness of the little girl’s ambivalent attachment to her. But that’s not the point. This kid hasn’t got ADD, or ADHD. In fact, she doesn’t have any disorder I can see that one might treat with medications. Yet she has been on all of them. All of them. It’s not right to do that. There are indications for medications in children, sure enough, but this kid has none of them. The age of psychopharmacology has created a world where the medication of patients, particularly children, is completely out of hand. Now to the inevitable fight with the insurors…
    June 22, 2011 | 10:25 PM

    Isn’t it amazing what one may find when one takes the time and effort to elucidate and understand a patient’s symptoms in the context of his or her developmental history and environmental circumstances? Such practice, in “modern” psychiatry, is regarded as voodoo!

    June 22, 2011 | 10:27 PM
    June 23, 2011 | 9:35 AM

    I stopped working with kids years ago because they just broke my heart. This little girl is so lucky she saw you and not someone who would look for another cocktail of drugs to “fix” her.

    Allen Jones
    June 23, 2011 | 10:08 AM

    This little one is lucky to have found you Mickey. I have heard soooooooo many stories of overdrugging of kids with very tragic results. Some states are beginning to get a grip on the problem. Let’s hope the rest follow suit. This from Texas this morning.

    Evelyn Pringle
    June 23, 2011 | 11:10 PM

    Ditto to all of the above and Bless your heart Doc!

    Evelyn Pringle
    June 23, 2011 | 11:10 PM

    And yours too Mr Jones!

    June 24, 2011 | 11:37 PM

    (Directed more at the comments than the post, but with an eye over the shoulder.)

    Yes, you’ve heard the stories about children being overmedicated. People love to hear those stories, because it tells them exactly what they want to hear.

    And then no one has to read the research, because they already know (wink, wink, nudge, nudge).

    I tend to be on the low end of the aggressively-medicate scale, but I resent far more the decades of patients who are untreated because they or their parents have “heard” that professionals just want to drug kids. Absolutely heartbreaking.

    Many conditions are revealing their heritable (or prenatal) components. That is to say, identifying a bad environment does not suggest that a child doesn’t really have an illness. If anything, it may suggest the parent has a condition the child could have inherited.

    Come walk in my shoes and sit next to suffering before you so blithely pretend to expertise.

    June 25, 2011 | 10:46 PM

    Mr. Idiot (!)

    Well, I’m speaking as one of those kids who WAS medicated and boy do I wish my parents had listened to consensus that professionals just want to drug kids, as my psychiatrist did when I was 14 and put on Paxil. Fast forward to 13 years later and I’m still on SSRIs. I couldn’t get off the stuff because the withdrawals were so debilitating and my psychiatrist had no advice on how to get off the medication without these withdrawal effects. Now the long-term symptomology has surfaced: blunted emotions, little motivation, and sexual dysfunction such as low libido and, most disturbingly, genital anaesthesia. These symptoms cost me my first romantic relationship, which was utterly heartbreaking. And there is no guarantee that the symptoms will remit once I’m off the med, since syndromes such as PSSD (Post-SSRI-Sexual-Dysfunction) are now not just on the internet but in the literature (for starters, see: “Genital Anaesthesia Persisting Six Years after Sertraline Discontinuation,” Bolton, Sareen, Reiss, Journal of Sex and Marital Therapy, 32:327-330, 2006 and “Persistent Sexual Dysfunction after Discontinuation of Selective Serotonin Reuptake Inhibitors,” by Csoka, Bahrick, and Mehtonen, Journal of Sexual Medicine, 2008, 5:227-233).

    And then there is the issue of protracted withdrawal from SSRIs, which can debilitate patients for years. See for such case studies and related journal studies. TO THIS DAY, there is not ONE study on proper and safe psych med withdrawal protocols. I think it’s pretty obvious that’s not in the interest of big pharma who would prefer to have their patients (read: customers) for life, but I still think it’s worth saying again and again. To be medicated for life or throughout childhood imposes a powerful world-view that a patient has some kind of “disease” or their brain is “broken.” In fact, I think this worldview is more toxic than the medications. In the current paradigm of care, a child could grow up despairing that they’ll never be normal and will have to take meds indefinitely. This is not a paradigm of recovery, but of med maintenance. The child could become a frozen river and never move on beyond the drugs. I’m not saying this will happen to EVERY child, but with more and more kids on drugs, the frequency of this happening will increase. To sum up: the current paradigm of care often takes a moment of crisis and turns it into a lifetime diagnosis, courtesy of pharmaceuticals.

    You said, “Many conditions are revealing their heritable (or prenatal) components.” What studies can you cite that these conditions are genetically predisposed? You HAVE read the series of articles on this site about genetic biomarkers and “personalized medicine,” haven’t you?

    I’m not entirely anti-psychiatry and anti-meds. I think I can safely say that the author of this blog isn’t either — he’s just calling for an absurdly overdue roundtable discussion between patients, psychiatrists, and policy makers about the TRUE evidence of how effective (and safe) these meds are, the toxic role of pharmaceutical companies in the poisoning of so much of the medical literature, and just how exactly DSM diagnoses are created, such as childhood bipolar, which can have a massive (and often negative) impact on children. These are vital questions that MUST be addressed — now.

    June 25, 2011 | 11:18 PM


    Elegantly stated!


    June 26, 2011 | 5:24 PM

    Thanks so much for your compliment Mickey! It means a lot coming from you, whom I consider to be THE premier online investigative reporter on the debauchery of psychiatry. Your articles are admirable exercises in sustained logic that would be exhilarating if they weren’t so disturbing. It’s a dirty job, but someone’s gotta do it. Bravo!

    June 28, 2011 | 7:22 PM

    AV Idiot, you’re on the rude side but I think you’re making a good point too.

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