Children on psych meds raise these ethical concerns

Desire for “quick fix”

It is vital for providers caring for pediatric patients not to jump to a diagnosis just because it is in the Diagnostic and Statistical Manual of Mental Disorders (DSM)V, argues Harold J. Bursztajn, MD, associate clinical professor of psychiatry at Harvard Medical School in Cambridge and co-founder of the Program in Psychiatry and the Law at Beth Israel Deaconess Medical Center. Bursztajn is president of the American Unit of the United Nations Educational, Scientific and Cultural Organization Bioethics Chair.

“The differential diagnosis needs to includes psychosocial or situational difficulties, rather than simply what is only in the main sections of the DSM,” says Bursztajn. “There is also the problem of false positives, due to the search for a quick fix promoted by some pharmaceutical companies aimed at vulnerable families and clinicians desperate for help, and the problem of false negatives due to denial of major mental illness.”

Providers should not overlook the possibility of Munchhausen syndrome or shared paranoid disorder in formulating the differential diagnosis, adds Bursztajn. “One needs to respect family values, as well as consider such fundamental values as maintaining children’s autonomy and authenticity — and the cumulative effects of both suffering from an illness and the increasing risk burden of many psychotropic medications when used chronically,” he underscores.

Lack of appropriate workups

For children and their families, the ethical considerations in psychiatry should be no different than those that apply to other fields of medicine, according to Grace E. Jackson, MD, a Wilmington, NC-based psychiatrist, and the same principles of patient autonomy, beneficence, and non-maleficence should be foremost.

“There is always a risk versus benefit calculation in all medical treatment decisions,” says Jackson, author of Rethinking Psychiatric Drugs: A Guide to Informed Consent. “However, the stakes of this calculation are necessarily higher when speaking about child psychiatry.” This is due to the frequent lack of appropriate medical workups and diagnoses, the deflection away from resolving root causes of mental suffering, and the application of psychologically and physically harmful drugs, she says.

“One of the problems in psychiatry today — especially as it pertains to children — is that many patients are not receiving appropriate physical or diagnostic exams — tests, brain scans, electroencephalograms — prior to the application of psychiatric diagnostic labels,” says Jackson. “Even in the absence of a confirmed biological condition as the cause of problem behaviors or emotional distress, psychiatric labels are often applied to patients based upon an assumption of faulty brain function.”

Even after a medical clearance comes back “normal,” patients are led to believe that they have a “mystery” defect which awaits medical correction, says Jackson. “This assumption leads to aggressive interventions with pills or other technologies,” she says. “This emphasis on ‘pretend’ pathology commonly precludes interventions in other domains.”

Opponents point to risks

Jackson says the primary ethical concern with the labeling of healthy children is the fact that American psychiatry “now attaches an absolute priority” to the use of medications. “Although psychiatric drugs are frequently successful in quieting or restraining youngsters in a classroom, it should not surprise our society to see that these same children grow into teenagers and adults who have never practiced or mastered the capacity for law-abiding behaviors or self control,” she says.

Jackson says that on a physical level, the pills present “devastating risks” for children in terms of maturation and survival. “Because of the fact that most psychiatric drugs are “endocrine disruptors” and mitochondrial toxins, they exert particularly damaging effects upon the central nervous system,” she says. “A significant number of children die each year because of the physical and psychological adverse effects of these drugs.”

Randy L. Cima, PhD, was the CEO of several mental health agencies for children in California. He is now a board member of the International Society for Ethical Psychology and Psychiatry, an organization founded by doctors, psychologists, therapists, social workers, and psychiatric survivors opposed to the medical model. “From our perspective, the model is scientifically unethical and pragmatically ineffective,” says Cima.

In the 1970s, about 200,000 children were taking psychotropic medications, and the number is now at 10 to 12 million, according to Cima. “In the 1980s, these chemicals were sold as miracle drugs. Now, all therapists at the masters or doctorate level are schooled on pharmacology,” he says. “The pharmaceutical industry has been marketing these toxic chemicals for the last 25 years.”

Cima says that increasingly, the idea of medication is first initiated in school settings. “When kids act up in the classroom, teachers and school psychologists are trained to suggest chemicals to help with their child management problems. That, too, is, in our view, unethical and unwise.” Children often require additional medications for side effects such as upset stomach or trouble sleeping, notes Cima.

“I had many parents in my office who had children on medication for years. They all complained things were worse, not better,” Cima said. “You won’t find legitimate science to support the miraculous claims made by pharmaceutical companies, other than their own self-financed ‘studies’ designed to support their advertising departments.”