Culture & Society Blog

"Of all the animosities which have existed among mankind, those which are caused by difference of sentiments in religion appear to be the most inveterate and distressing, and ought most to be deprecated. I was in hopes that the enlightened and liberal policy, which has marked the present age, would at least have reconciled Christians of every denomination so far that we should never again see the religious disputes carried to such a pitch as to endanger the peace of society." - George Washington

Oct 28, 2011

Education Part 1 - The Problem Of Psychiatric Drugs

To understand why psychiatric drugs have become a problem in the educational system of the United States first it is important to understand what it is these drugs are meant to control and why.

Understanding why drugs are so popular (from PBS)...

It is tempting to view this pattern as suggesting that the ADHD diagnosis provides teachers with a new technique for regaining control of the classroom in a world where many of the traditional methods of control have been eliminated. Drugs have replaced the reprimand.

But it seems to me that the real problem may be that the concept of compulsory, cookie-cutter education needs rethinking. In spite of the rhetoric in schools of education about the importance of taking into account the individual needs of the children in a classroom, the current system of public education is designed to make that nearly impossible. State curriculum guidelines and requirements, coupled with further requirements from the local community, prevent teachers from making any serious effort to tailor materials and assignments to the differing abilities and dispositions of individual children. Nor is there any mechanism, of the sort one would find in a school-choice-based system of education, for parents to seek out schools tailored to the temperaments and capabilities of their children. Instead, it becomes necessary to find ways of making children able to perform in the environment as they find it. And, in late twentieth-century America, when it is difficult or inconvenient to change the environment, we don't think twice about changing the brain of the person who has to live in it. The rise in consumption of Ritalin is only one manifestation of this cultural practice. Consider Prozac or, in previous decades, Valium.

None of this should be taken to suggest that there are no cases of genuine brain damage or dysfunction that require medical intervention. There have always been diseases of the brain, as of any other organ, and they should be treated as such. But difference does not automatically equal disease. Is changing the child's brain chemistry, by prescribing Ritalin-like drugs, really the most appropriate response to the child who doesn't perform well in the modern school environment? Perhaps it's time we asked ourselves whether the fact that so many children can't learn well in our schools is a reflection on the schools, not the children.Read more

CEVIN SOLING 11/30/2009 Cevin Soling says public schools have been transformed into prisons because of an overdependence on security.

Notes:

1. Author of 'The War on Kids'

2. Schools started as a model to train people for military

3. Then, with the industrial revolution, the school model was based on the factory model (repetitious and boring job)

4. Latest model he compares to prison because of the harshness of the rules. For example; one school fired a bunch of kindergarderners for using thier fingers as guns in a cop and robbers game. And it is common to handcuff kids for spitballs (something that is an integral part of Archie comics and even cartoons) - Soling says that this shows a zero tolerance attitude to any kind of misbehavious and this is similar to the prison model.

Trailer to the movie to provide an overview...

The modern problem of 'psychiatric labels' to which aspects of modern education psychology seems to be tied to (from Psychology Today)...

I have been thinking a good deal about normality lately. It's a concern in the medical world. The complaint is that doctors are abusing the privilege implied in Jack's query, to define the normal. Ordinary sadness, critics say, has been engulfed by depression. Boyishness stands in the shadow of attention deficits. Social phobia has engineered a hostile takeover of shyness.

A spate of popular books—The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder by Allan V. Horwitz and Jerome C. Wakefield, The Last Normal Child by Lawrence H. Diller, and Shyness: How Normal Behavior Became a Sickness by Christopher Lane—challenge what they believe is psychiatry's narrowing of the normal. The National Institute of Mental Health reports that in any given year, over a quarter of Americans—and over a lifetime, half of us—suffer a mental disorder.

The fate of normality is very much in the balance. The American Psychiatric Association is now revising its diagnostic and statistical manual—the next version, DSM-V, should preview in 2011 and become official the following year. It may, indeed, be that as labels proliferate, mental disorders will annex ever more territory. But claims of a psychiatric power grab are overstated. The real force behind a proliferation of labels is the increasing ability of technology to see us as we've never been seen before. Still, the notion of a shift in the normal invites unease: To constrain normality is to induce conformity. To expand diagnosis is to induce anxiety. Is anyone really well?

It's a short hop from critiquing narrowed normalcy to claiming that we are an overmedicated nation. As Lane writes, "We've narrowed healthy behavior so dramatically that our quirks and eccentricities—the normal emotional range of adolescence and adulthood—have become problems we fear and expect drugs to fix." Psychiatry's critics also complain that doctors medicate patients who meet no diagnosis, who practice what I have dubbed "cosmetic psychopharmacology," to move a person from one normal, but disfavored personality state, like humility and diffidence, to another normal, but rewarded state, like self-assertion.

Labels matter even when medication has no role in treatment. A wife complains that her husband lacks empathy. Does he have Asperger's syndrome, a lesser variant of autism, or is he simply one of those guys who "don't get it," who simply don't see social interactions as ordinarily perceptive women do?

Diagnosis, however loose, can bring relief, along with a plan for addressing the problem at hand. Parents who might have once thought of a child as slow or eccentric now see him as having dyslexia or Asperger's syndrome—and then notice similar tendencies in themselves. But there's no evidence that the proliferation of diagnoses has done harm to our identity. Is dyslexia worse than what it replaced: the accusation, say, that a child is stupid and lazy? (Read More)

More about modern psychiatric/psychological labels...

ETHAN WATTERS 1/27/2010 Ethan Watters explains why America's science behind mental health is problematic for the rest of the world

Notes:

1. Redefining mental health can be very profitable

2. The world expects the west's science to be good

3. Problems with dugs for depression

Given how much relabeling/reframing/repacking is going on for the definitions of mental disease, theories like the following are bound to increase...

NASSIR GHAEMI 8/8/2011 Psychiatrist Nassir Ghaemi believes that mental illness can foster great leadership, but the Republican presidential candidates are too "normal."

New York Times did a review: What Befits a Leader in Hard Times? An Intimate Knowledge of Insanity

The premise of Dr. Nassir Ghaemi’s book about leadership and mental illness is simple. It need not be reiterated as frequently as Dr. Ghaemi repeats it. But he begins “A First-Rate Madness” by writing, “This book argues that in at least one vitally important circumstance insanity produces good results and sanity is a problem.” To put it only a shade differently: “When our world is in tumult, mentally ill leaders function best.” Or: “In the storm of crisis, complete sanity can steer us astray, while some insanity brings us to port.”

The quick survey of the field of education and psychiatrists/psychology makes it clear that no one is qualified to be prescribing powerful drugs on a long-term basis to anyone much less children whose brains are still forming. As an adult if you want to experiment with drugs that is one thing, but to give them to kids is just plain wrong. If you are not yet convinced, here is a small collection of evidence:

One study that looks at just one of the angles of ADD/ADHD misdiagnosis...

Nearly 1 million children in the United States are potentially misdiagnosed with attention deficit hyperactivity disorder simply because they are the youngest -- and most immature -- in their kindergarten class, according to new research by a Michigan State University economist.

From Salon.com: "Anatomy of an Epidemic": The hidden damage of psychiatric drugs...

What about stimulants used to treat ADHD. How effective are they?
These stimulants alter behavior in a way that teachers can appreciate. They subdue finger-tapping and disruptive symptoms. But in the 1990s, the National Institute of Mental Health started looking to see if things like Ritalin were benefiting kids with ADHD, and to this day they have no evidence that this drug treatment improves long-term functioning in any domain -- the ADHD symptoms, lower delinquency rates, better performance at school, et cetera. Then the NIMH studied whether these drugs provide a long-term benefit, and they found that after three years, being on medication is actually a marker of deterioration. Some patients’ growth has been stunted, their ADHD symptoms have worsened. William Pelham, from the State University of New York at Buffalo and one of the principal investigators in that study, said, "We need to confess to parents that we’ve found no benefit." None. And we think that with drugs, the benefits should outweigh the risks.

What's so risky about Ritalin?
For one, a significant percentage -- between 10 and 25 percent -- of kids prescribed medication for ADHD will have a manic episode or psychotic episode and deteriorate in such a way that they’re diagnosed with bipolar disorder. A similar study in 2000 on pediatric bipolar disorder reported that 84 percent of the children treated for bipolar illness -- at the Luci Bini Mood Disorders Clinic in New York -- had been previously exposed to psychiatric medications. The author, Gianni Faeda, wrote, "Strikingly, in fewer than 10 percent of the cases was diagnosis of bipolar disorder considered initially." The reality is that until children were medicated with stimulants and antidepressants, you didn't see juvenile bipolar mania.

But if these studies are so groundbreaking, why have they gone unreported in the media?
Because the NIMH didn’t announce it. Just as they didn’t announce the 2007 outcome study for schizophrenia patients. In that study, the recovery rate was 40 percent for those off meds, but only 5 percent for those on meds. I checked all the NIMH press releases for 2007, and found no release on this study. I found no announcement of it in any American Psychiatric Association publication or textbook. Not a single newspaper published an account of the study. And that’s because the psychiatric establishment -- the NIMH, the APA, even the National Alliance on Mental Illness, an advocacy organization -- did not put out any press release about it or try to alert the media in any way.

Are you suggesting that psychiatrists are beholden to pharmaceutical companies?
Not exactly, although most of the leading academic psychiatrists act as consultants, advisors and speakers for them. The problem is that psychiatry, starting in 1980 with the publication of the DSM-III, decided to tell the public that psychiatric disorders were biological ailments, and that its drugs were safe and effective treatments for those ailments. If it suddenly announces to the public that a long-term NIMH-funded study found that the 15-year recovery rate for schizophrenia patients was 40 percent for those off meds and 5 percent for those on meds, then that story begins to fall apart. By not reporting the results, psychiatry maintains the image of its drugs in the public mind, and the value of psychiatrists in today’s therapy marketplace.

So do you think psychiatric drugs should be used at all?
I think they should be used in a selective, cautious manner. It should be understood that they’re not fixing any chemical imbalances. And honestly, they should be used on a short-term basis. But beyond this, I think we should look at programs that are getting very good results. This is what I love about Keropudas Hospital’s program in Finland. They have 20 years of great results treating newly psychotic patients. They see if patients can get better without the use of meds, and if they can’t, then they try them. It’s a best-use model, not a no-use or anti-med model. It fits with our studies done in the 1970s that found if you use this model, you get better outcomes, and a good number of people get better and go on with their lives.

Miscellaneous Information on the Side Effects of Ritalin...

U.S. DEPT. OF JUSTICE: “Of particular concern is that ADHD literature prepared for public consumption does not address the potential or actual abuse of methylphenidate. Instead, methylphenidate is routinely portrayed as a benign, mild substance that is not associated with abuse or serious side effects. In reality, however, the scientific literature indicates that methylphenidate [Ritalin] shares the same abuse potential as other Schedule II stimulants. Further, case reports document that methylphenidate abuse can lead to tolerance and severe psychological dependence.”

Ritalin (methylphenidate) is an amphetamine-like prescription stimulant commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children and adults.

Many think Ritalin (methylphenidate) is safe, or mild, because so many children use it. However, the government classifies the psychoactive drug with cocaine and morphine because it is highly addictive.

Long-Term Effects of Ritalin: Changes in Brain Development

Ongoing research shows early-life use of Ritalin (methylphenidate) has complex effects that endure later into life. A study published in Biological Psychiatry suggests that exposure of Ritalin in youth may later disrupt development of brain cells in the hippocampus, region of the brain critical to memory, spatial navigation, and behaviorial inhibition. Damage can lead to memory problems, disorientation and depression in adulthood.

Ritalin is a Schedule II Substance, which means Ritalin has a "high potential for abuse" that "may lead to severe psychological or physical dependence," and the federal government sets limits on the amount of these amphetamine drugs that may be manufactured each year.

A review of 20-years of scientific literature on using stimulant medications, including Ritalin, to treat children with ADD and ADHD found a consensus: there is no documented long-term benefit (academic achievement or pro-social behavior) in using psychoactive drugs.

Abrupt cessation of stimulant drugs such as Ritalin can cause extreme fatigue and severe, even suicidal, depression in adult patients.

The question of whether methylphenidate (Ritalin) impairs creativity in children;

Ritalin may have subtle impacts on cognitive and intellectual processes. Both parents and researchers have noticed that children taking Ritalin sometimes answer questions in ways that seem overly compliant or narrow, suggesting the drug might restrict creative thinking. One study found hyperactive children taking Ritalin offered less varied answers to open-ended questions.

How much do the “neuro-enhancing” drugs really help? And there's the question of what we mean by “smarter.”

The psycho-stimulants help students bear down on their work, but with odd effects. One college student says he spends “too much time researching a paper rather than actually writing it.” Another student looked back at papers he'd written while on Adderall and found them verbose: “I'd produce two pages on something that could be said in a couple of sentences.”

Could enhancing one kind of thinking exact a toll on others?

All these questions need proper scientific answers, but for now much of the discussion is taking place furtively, among an increasing number of Americans who are performing daily experiments on their own brains (or their children's brains)