ORIGINALLY PUBLISHED @ BESTTHINKING.COM – OCTOBER 2012
I wrote the essay – The Era of Chemicals – in 1988. A year earlier, I was awarded my Ph.D. in Clinical Psychology. I was in my second year as the Director of a 66-bed residential facility in Southern California for boys placed from probation, social services, and mental health agencies. It was the first of three large mental health facilities than I’ve managed. I wrote this essay late one night in my office.
I never did much with it. I used to give it to my colleagues to read. I continued to do that over the years until I retired. Now I write and blog. (SEE: https://doctorcima.wordpress.com/) I dusted it off to publish it now, because, well, it’s time. In fact, as you will see, it’s overdue.
When I managed facilities as the Director, I didn’t allow children to be given chemicals for their behavior. Admittedly, it was a lot easier in the mid-1980’s. The psychiatric Medical Model didn’t have the stranglehold on our profession as it does now. I just said no.
I had my reasons – professional, theoretical, philosophical – and they all added up to “no.” There was no “wiggle room” either, by the way. You’re either all in or all out with this failed model, so I didn’t allow any “dabbling.” There were many times I had therapists – especially new therapists – in my office cajoling, begging, angrily advocating, with articles-in-hand (no internet back then), to allow them to encourage the psychiatrist to prescribe a chemical “just for this one kid – please!” I said no. Luckily, they liked working with me, and I liked their work too – and we did good work together. By the time I started my third agency in 2003, I was more seasoned, less strident, more clever and, I’m happy to say, as successful.
The essay is a little awkward and stiff and some of the sentences go on forever. I ask for your patience, please. This was my first attempt at writing something serious about the subject. Nonetheless, other than some grammar and structure and other similar kinds of things, I wouldn’t change anything, so I didn’t.
I admit, though, there is the one thing that haunts me. The last paragraph. I used the word “perhaps” four times, including the last word of the essay. I was naïve. I was hoping the essay would have lost its relevance by now. It didn’t, I’m sorry to note.
I’ll tell you this now, a quarter century later: there’s nothing “perhaps” about it. We’ve gone from a few hundred thousand children given these toxic chemicals, to eleven million – and counting. It’s our shame, and our responsibility to put an end to it.
For now – The Era of Chemicals – from 1988.
We learn early in life that there are simple solutions to complex life problems. Whether a headache, tension, stress, depression, excessive activity, insufficient activity, insomnia, bed-wetting, bad grades, bad dreams, hallucinations, poor reading skills, too much appetite, not enough appetite, and so on, a simple trip to the drugstore, to the liquor cabinet, or to the “corner connection,” will ease these annoying and sometimes pervasive life-symptoms.
It’s as if unpleasant personal interactions, disappointments, tragedies, elations, moods, lack of skills, uncomfortable thoughts, undesirable physical appearance, and other events experienced by most human beings are best dealt with by the ingestion of one type of chemical or another. There may be a day when medication will carry the disclaimer: “Caution: The Surgeon General has determined that livingmay be hazardous to your health.”
The Medical (or Disease) Model is the prevailing theory in the helping professions. When discussing people who are “sick” or “ill” pertaining to a psychological description of behavior, the Medical Model is inferred. Indeed, the body’s chemicals do have an effect on behavior. As the chemist will state, in some ways “it’s all chemical.” Neurons are chemically stimulated, and they, in turn, chemically stimulate muscles and organs, and so on. Yet with some theorists, scholars, and students of human nature there exists a vast difference between the physiology of motion and the cause of behavior.
When someone behaves in a socially inappropriate way the physician seeks to explain the behavior by discovering the chemicals that are either missing, are in short supply, or are in overabundance within the individual. This is the cause of the disturbance, and they will treat the anomaly with chemicals of their own.
When questioned, the physician will claim there is an imbalance of some kind, in less than understood ways. Yet there is offered little, if any, explanation of what “balance” means. The fact the depressive is “elevated” by Elavil is enough to conclude the effects are beneficial, and that this is evidence of the efficacy of the drug. Most often the physician is at a loss to explain why the chemical works, how the chemical works, what can be predicted about its effects, or how long the person being treated will have to use the chemical.
Another concern is found in the term “side effects.” This euphemism is used to “water-down” the stigma of the unwanted physiological and psychological consequences of chemical use. Drugs only have effects. With chemotherapy, for example, hair loss, loss of appetite, and other effects of the chemicals used are well known. For the life-threatening physical disease of cancer, discomfort and distress may be well worth the option of not taking the treatment. (There are, of course, those who argue against this position as well). However, when psychotropic medication is given to human beings for a psychological disturbance of some sort, unavoidable problems arise. The term “thorazine shuffle” was coined by the lay-employees in psychiatric settings, as their observations of the “side effects” of this drug were noted.
The use of Ritalin, or methylphenidate hydrochloride, provides another example. This overused and misused drug has been around for over a quarter of a century and is almost exclusively used for children. Its main purpose is to “calm” the hyperactive child. How does this work? How does a stimulant have just the opposite effect with very active children? No one seems to know. Turning to the Physicians’ Desk Reference, a volume of over 2200 pages that give a detailed description of all legal chemicals, you find some interesting remarks about Ritalin. The PDR, states:
Ritalin is a mild central nervous system stimulant. The mode of action in man is not completely understood, but Ritalin presumably activates the brain stem arousal system and cortex to produce its stimulant effect. There is neither specific evidence that clearly establishes the mechanism whereby Ritalin produces its mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system. (Physicians Desk Reference – 1987 edition)
The authors of the PDR also state Ritalin should not be given to children under six, and it is contraindicated when the child has marked anxiety, tension, and agitation as Ritalin may aggravate these symptoms. Continuing, they note that data on safety and efficacy of long-term use of Ritalin in children is not yet available, and “although a causal relationship has not been established, suppression of growth (i.e. weight gain, and/or height) has been reported with the long-term use of stimulants in children.”
And what are the “side effects” of this stimulant? Nervousness and insomnia are the most common reactions, along with hypersensitivity, skin rash, anorexia, nausea, dizziness, palpitations, headache, dyskinesia, drowsiness, blood pressure and pulse changes (up and down), tachycardia, angina cardiac arrhythmia, abdominal pain, and weight loss, to name some. An overdose may induce vomiting, agitation, tremors, hyperreflexia, muscle twitching, convulsions, euphoria confusion, hallucinations, delirium, sweating, flushing headache, hyperpyrexia tachycardia, hypertension, hydrias, and dryness of mucous membranes.
The most common place that a child first comes in contact with medication is in school, due to “disruptiveness” or “inattentiveness,” or in general, “poor school performance.” Dr. David Keirsey, author and professor emeritus has these remarks about the use of medication with school children:
The parents blame the school, as they should, but the school blames the child. He’s “dyslexic,” has “minimal brain dysfunction,” is “hyperactive,” has a “learning disability.” Therefore, says the school, he “needs medication.” Then some well meaning but ill-advised physician prescribes massive daily doses of some stimulant drug, parroting others’ assumption that the stimulant has a “paradoxical effect” of acting as a depressant. The victim is thus given his daily fix and its false high, his teacher claiming that he’s “calmer and works better.” Who wouldn’t be with that big a fix? And of course the child need not aspire to much; after all, what can you expect of a person with a bent brain? And later on? No. The child’s real problem is the school, not his brain; his brain is just fine.
Portraits ofTemperaments – Pg. 26
So why is the use of medication so pervasive with particular children? Usually because the child is a management problem, although this is most often denied. The child is ostensibly given drugs “to help him.” Yet close observation will note it is the teacher who needs help, or the mother, or the counselor. The belief is if someone is in profound psychological distress due to chemical imbalances, and this is interfering with more traditional treatment, then chemicals are prescribed to ease the distress in order to enter into a therapeutic conversation. Yet this seldom, if ever, occurs.
Instead the teacher is initially relieved she was heard, and while the child’s behavior doesn’t really improve, “at least he’s being treated.” Mother is now reluctatant to take her child off medication for fear of a recurrence of past events, even though her son is tired all the time and doesn’t eat right, and in a “bad mood” constantly. Ironically, even the most ardent disciples of the Medical Model make no claim chemicals used for psychological disturbances “cure” the disturbance. Instead most will say some people will have to be on medication for “the rest of their lives.”
All professionals, including therapists, teachers, child-care counselors, teacher’s aides, social workers, and others, should become familiar the with the PDR. There are good reasons for this. Once a child is placed on medication designed to treat a psychological shortcoming of some sort, it soon becomes impossible to distinguish with any degree of accuracy between behavior that is due to the child’s psychological distress and behaviors due to the “side effects” of the prescribed chemicals.
Is the child agitated, now, because of internal strife, or is the prolonged use of medication affecting him? Is the child awake at night because of a sense of unbelonging, or is she simply exhibiting an effect of the particular chemical she is taking? When the child becomes disruptive at school and breaks another window, does this mean an increase in the medication, another type of medication, a decrease in medication, the medication is an irritant, or what?
Medical personnel refer to this process as “adjusting the meds.” The pursuit, really, is to “adjust” the child. Many experienced physicians are adept at creating just the right “high” so the child is awake, yet sedate. Often out of frustration and desperation – and genuine care – a child is referred to a doctor for his “medical problem.” However, when chemicals are used to manage the recalcitrant child, other more damaging “side effects” inevitably follow.
Once medicated, the child has a “disease” in addition to stressful life experiences he may have to endure. This disease is something beyond his control, something he and his family now may have to “cope” with. The child is seldom told of the prescription until it has been decided by others “for your own good.” He is given vague reasons as to why he has to take the medication (‘to help you”), can soon become dependent (“I can’t go to school without my meds”), loses control over his behavior (“I can’t help it/it’s not my fault/I’m not responsible – I’m hyperactive”), lowers his own expectations about his future (mimicking the view others’ have of him), because of his “handicap.”
Chemicals have the effect of altering the physical-emotional-psychological affect or consciousness of human beings. About that there is not doubt. Yet this is a poor reason to give medication to children in psychological distress. “Why Mellaril instead of a ‘shot of booze’” asked one professional.” There is no good answer. Chemicals, for the most part, create dependence rather than independence. Most disturbing is the dependence created in many professionals and lay persons alike. After a confrontation it is not unusual to hear in some settings: “somebody take him to the psychiatrist and get his meds straight!!”
Chemicals taken into the body do have an impact on the human being. Give a child Ritalin, and his body is affected. Introduce Valium to the overworked bank teller, and watch him calm. Allow the lonely housewife her vodka for the day, and see a different housewife. Many simply can’t go to work without a cup of coffee. Others must smoke a cigarette as soon as they wake in the morning. And so on.
The use of drugs permeates every level of contemporary society. If one was to include all legal drugs in addition to the illegal drugs, then there are very few of us who are truly drug-free. In fact, one could argue the cause of the drug problem in our society lies not in the area aimed at by our “war on drugs,” which is the attempt to eliminate the use and distribution of illicit drugs. Instead one could defend the thesis the origin of the drug abuse problem in this society falls at the feet of the 3200+ legal drugs, and the permeating idea of “quick-fixes” that begins at a very early age. Moreover, as the distribution of legal drugs is a multi-billion dollar industry, new “breakthroughs” are common as the relief of life-symptoms can be done even more effectively with the “new and improved” products.
George Washington, after retiring from his two-term presidency, lived his final days in Mount Vernon. It’s likely this national hero and “father of our country” would have had the most updated and best medical professionals of his time at his calling. The state-of-the-art, unfortunately for Washington, proved to be unsuccessful. He was inadvertently bled to death in an attempt to cure him.
With hindsight, his treatment seems uncivilized and uninformed. Yet within the medical profession this was the best solution at the time. With foresight, one may wonder how our progeny will view the use of drugs in our current society. Perhaps they will look back and view us as uncivilized and uninformed. Perhaps they will wonder what we were doing to ourselves. Perhaps they will, as they review their history, refer to us as living in the “Era of Chemicals.”