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We've Got Issues: Children and Parents in the Age of Medication Hardcover – February 23, 2010
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From Publishers Weekly
Author (Perfect Madness: Motherhood in the Age of Anxiety) and New York Times columnist Warner turns an investigative eye to the epidemic of diagnosed childhood psychiatric disorders and widespread use of prescription psychotropic drugs to modify children's behavior. Major questions are raised: are drugs a substitute for proper parenting? Is there something more socially significant underlying the labeling and drugging of kids? Following an awkward introductory chapter about why the subject confounded and eluded her, Warner serves up more bad news than good. The book is hampered by a great deal of diverse and conflicting professional opinion and research, with references to just about every prominent expert on child psychology, from mainstream to fringe. Although readers may end up more confused than hopeful about the status of children's mental health in America, they will discover that 5% of all American kids do have psychological issues for which they receive proper medication and counseling. Not as heartfelt as The Elephant in the Playroom nor as helpful as books on individual disorders, this examination will still function as a wakeup call for lots of parents. (Mar.)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
In this manifesto for change, New York Times blogger Warner (Perfect Madness: Motherhood in the Age of Anxiety, 2005, etc.) examines the argument that Americans are overmedicating their children.
The author wanted to write a condemnation of American parents for hysterically spotting mental disorders where there are none. When she began interviewing parents and mental-health professionals, however, she reversed her position. Only five percent of American children take psychotropic drugs, she writes, yet that many suffer from extreme mental illness, while another 15 percent endure at least minimal illness. Not only has Warner never met a parent who lunged for the medicine cabinet to dope up their kids, but some fought the medication route as long as they could, to the detriment of their child. It's true that antidepressant prescriptions for children have skyrocketed, but that's because primitive understanding of the brain left many sick children undiagnosed in the past; we now have more effective drugs for some illnesses; and the stigma of mental illness is blessedly diminished. Warner cites research that girls, minority children and those with less-educated parents are undertreated for ADHD. Careful reporter that she is, the author acknowledges that some experts might dispute parts of her thesis. Other signs of childhood trauma-teen pregnancy, school violence, crime, substance abuse and suicide-have declined, and Warner reports special professional skepticism about exploding rates of bipolar diagnoses in children. Meanwhile, too many laypeople are spooked by drug companies' ads plugging their latest products, which doctors might not recommend. Curtailing those ads and more insurance coverage for pediatric mental-health screenings are among the author's welcome common-sense proposals.
Parents of mentally ill children will find this tonic reassuring, while all parents will find it a valuable reminder that it's not poor parenting to seek medical help for your children.
"Warner, New York Times columnist and author of the best-selling Perfect Madness: Motherhood in the Age of Anxiety, set out to write a follow-up volume exposing what she believed were capricious diagnoses and medication of children's mental and learning disorders. Instead, she fell down the rabbit hole to an alternative reality. Although she found the stereotype of pushy parents who shop for prescriptions or educational accommodations to fit their overscheduled children, Warner's heartbreaking conversations with pediatricians and the parents of children with mental issues such as attention deficit/hyperactivity disorder, autism, serious depression, or bipolar disorders led her to see beyond her prejudices. As Warner passionately writes, appropriate care for childhood mental illness, if possible, is not necessarily probable. The perceived stigma of mental illness, deep-rooted suspicions of the medical and educational establishments, and, above all, merciless economic factors deny a shocking number of children with learning or mental disabilities the care and medications they need to succeed in school and society. Parents, social workers, and educators will find Warner's compelling study troubling but enlightening. Highly recommended.
"This is a groundbreaking, thoughtfully argued book. My experience with families in the consulting room supports Judith Warner's nuanced argument exactly. The myth perpetrated by a breathless news media is fals: In reality, parents don't want to medicate their children. And every one of us has family members and friends (or ourselves!) who could have led richer, less anguished lives had they been given appropriate medication during childhood for learning or emotional problems."
-Wendy Mogel, Ph.D., author of The Blessing of a Skinned Knee
"This is an important book, a landmark book, a triumph of honesty over bigotry and of patient learning over the the rush to judgement. I see every day in my office the awful, preventable damage done by zealots and reductionistic 'thinking'. Judith Warner rejects the panicky sound-bites that have plagued the discussion of children's mental health for the complexity of truth. She brings to all who read her book the resoundingly good and hopeful news of how much we have learned over the past few decades, how trasforming the best help can be, and how all children can turn into responsible, joyful adults. We owe her a huge debt."
-Edward Hallowell, M.D., co-author of Super Parenting for ADD and author of The Childhood Roots of Adult Happiness
"Readers love Judith Warner because she is open, honest, attuned, and curious. In We've Got Issues, Warner considers children and psychotherapeutic medicine: whether drug companies hold too much sway, whether doctors over-prescribe, but also whether troubled boys and girls might sometimes need more help than they get today. The result is a caring and informed book that will earn the trust and loyalty of a wide audience."
-Peter D. Kramer, author of Listening to Prozac
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Top customer reviews
I am so grateful to Judith Warner for writing a prosaic, thoughtful, honest (she goes into great detail right out of the gate about her faulty premise when she first planned to write this book), compassionate book. Before I read this book, I had vague, uninformed, holier-than-thou notions about children "with issues" and their parents, and Warner not only changed my mind, but she has made me a vocal advocate for better children's mental health care, and for the parents who, by and large, struggle exhaustively to find treatment for their children.
Warner lays out the case for the reality of children's mental illness, without avoiding the sordid history of psychiatry and the pharmaceutical industry. It is a complex topic, and she manages to advocate on behalf of children without ignoring the very real reasons that many people have for doubt and distrust of mental health care.
The bottom line is that there is a pervasive, accepted notion in our culture that children would be fine, normal, if we would do any number of things differently. If we moms would quit our jobs and focus on the kids, if we fed them organic fruits and vegetables, got rid of our televisions, and moved to the countryside, we could avoid the specters of ADHD, depression, bipolar disorder, and the myriad of other, *very real* mental illnesses that affect children in our communities.
Rather than sitting atop our high horses, criticizing parents and children who are truly suffering, it's time we rejected the flat, antiquated meme about "bad children and worse parents," and started talking compassionately to those folks, and talking--as a society--about what we could and should be doing to give our children and their parents a hand.
I am truly, truly humbled by this book, and by the lack of compassion I didn't even realize I had been showing toward people who are grasping in the dark for solutions. They don't need us throwing hand grenades at them while they do it.
I have one major criticism of this book, however. I am not at all sure that the author is correct and that there are no "epidemics" of childhood mental illnesses and developmental disorders except those caused by societal pressures and better diagnoses. Ironically, she uses the words "toxic" and "environment" and "canaries in a coal mine" when discussing the social pressures and hazards of living in today's families and schools, but fails to realize that these terms could also be taken literally--in terms of the numbers of exogenous chemicals to which our children are exposed in the environment. Because of genetic diversity, some children (the "canaries") are going to be more vulnerable to these chemicals than others. The "blood-brain barrier" is not as absolute a protection, nor is the placental-fetal circulation as benign a filter as was once thought. Our newborns are born now with more chemicals than ever in their blood already. Medical treatment (yes, including added vaccines), household chemicals, plastics, etc. all add even more after birth. Pesticides, mercury in the atmosphere from coal powered plants, plastics, air pollution from paper mills and other industries add to the stew. There is NO scientific data says (or really, can possibly say) that all of this is safe, that there are no synergistic effects of all this on the most delicate and complex organic structure in all of nature: our brains. A deficit in nutrition, toxic carpets, lead paint on toys, a genetic vulnerability to mercury (like lupus-prone mice have), social stress (the author does discuss the effects of long term high cortisol levels), incidents like the PBB contamination in 1976 of the food supply (and consequently the bodies of the population) in Michigan--the list goes on and on. It is not possible by good parenting or just eating organic foods, or by avoiding articial colors and flavors,positive though these steps may be, to avoid all these factors. The damage caused may well require medication. It is toxicity, but in a more literal sense.
Yes, some children are the "canaries in the coal mine." Yes, genetics loads the gun and the environment pulls the trigger, as the author quoted...but please remember that, like other animals, we still breathe, drink, and eat. We even absorb chemicals through our skin. These exposures are just as real a part of the influence on the development of our children as parental nurture. Affection and appropriate attention cannot correct poisoning. Social policies that fail to take into account the effects of mercury on the brain when that mercury is breathed in by vulnerable children or eaten in the form of fish by pregnant mothers, are not looking at all the cost of coal-powered power plant.
Increased mortality and morbidity and also developmental defects of many kinds, are found in places like Love Canal where industries have been irresponsible. I strongly suspect that this is only the tip of the iceberg. No, we do not have enough information to prove it. But it isn't sufficient to blame parents (which this author does not do, to her credit), or pharmaceutical companies (even if sometimes, as she documents, their practices are unethical), or psychiatrists. Our schools are failing a large number of children because they really are facing novel situations--and not just lack of funds or the latest Department of Education rulings. Our children are affected more by these issues in every subsequent generation. We need to take responsibility for the health of our environment in a literal, not just a metaphorical way.
Other than this one glaring omission, this is an excellent book. I can understand the author's avoidance of these questions to some extent because many parts of the overall whole are controversial. But at least a disclaimer would have been helpful.
Kathleen Eickwort, PhD, Ecology, Cornell University
On top of that struggle, it is awful to have to deal with well-meaning (or not) friends and others who do not believe in learning disabilities and/or medicating in order for my daughter to achieve anything in school. Of course these people either have no kids or have never encountered a learning disability.
Thank you, Judith Warner, for speaking the truth!!!