CONTENTS

EDITORIAL

If You Meet The Pill Fairy Along The Road, Kill It

This editorial is considerably longer and more detailed than usual but the position we have taken on the use of psychotropic medication requires the inclusion of specific background information. Eds.

Of the 1827 e-mails I received at the journal office between May and December last year, 1342 were from drug companies promoting their latest products. 1137 of these messages were specifically peddling psychotropic medications for children and youth. Designer labels aside, the two substances being pushed were stimulants like methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD) and selective seratonin reuptake inhibitors (SSRI’s) such as fluoxetine( Prozac) for depression. While many of the ads were presented as “information bulletins” for the medical profession, they were clearly designed to appeal to anyone looking to fix problem kids. In some cases I was told how these products could be ordered on-line, with guaranteed 24-hour delivery. I should add that all of this “information” was unsolicited.

Whatever you might choose to believe about the benefits, or otherwise, of psychotropic medication, there’s no question that this multi-billion dollar industry knows how to advertise and distribute its products and that labeling and drugging kids is now a major marketing strategy. Actual figures are difficult to come by but, in a recent survey, psychologist John Breeding estimated that over six million kids in the U.S. have been diagnosed with ADHD and eighty percent of these are on Ritalin. The diagnosis of childhood depression still has some way to catch up but, according to the same survey data, approximately two million kids are taking some form of antidepressant. Breeding’s figures suggest that, in total, over eight million school children in the United States (15% of the population) are taking some form of psychiatric medication. In Canada over 200,000 prescriptions for antidepressants were written for children in 2003 – a seventy five percent increase in five years. Even more alarming is a study published by the Journal of the American Medical Association in which researchers found that the use of antidepressants and stimulants for children two to four years old tripled between 1991 and 1995. For obvious reasons, no current figures have been made available but, given the larger picture, we might conclude that they are many times higher in 2004.
What we do know is that we are dealing with a massive global industry that employs sophisticated, complex, and frequently covert, marketing strategies to

create demand and satisfy its consumers. With the power drawn from its enormous revenues, this corporate machine has managed to convince governments and professionals to support, promote and distribute its products. A decade or so ago, for example, the diagnosis of “depression” was relatively rare but now, with the arrival of SSRIs, the prevalence of this psychiatric ‘disorder’ has escalated to epidemic proportions. In 2002 alone, twelve billion dollars worth of SSRIs were sold around the world.
Within the service delivery system, the drug companies have used their influence to create the mechanisms whereby agency funding and professional fees are based upon the psychiatric diagnostic labels used to justify pharmaceutical intervention. At the community level, they have used slick advertising and misinformation to convince the public that every human problem has a biological base and can be remedied through chemical intervention. Even community advocacy groups like the Canadian Mental Health Association, are being paid to go out on the streets with quick and dirty questionnaires to round up potential patients – they call it mental health ‘screening’. Most of these consumers are adults but similar strategies are now being used to target the schools under the guise of mental health ‘education.’
While we might be prepared to allow adults to make their own choices in this matter, children are usually at the mercy of those responsible for their care, education and well being. Thankfully, a growing number of individuals and groups are now beginning to voice their opposition to the legalized drugging of children but, in general, caregivers and professionals have chosen to participate in this medical madness, or have little to say on the matter. But what disturbs me the most is that child and youth care workers are among the most silent. Shame on us all. I can understand why professionals who ply their trades within the medical systems might be reluctant to challenge their own mythology but, for the most part, child and youth care workers are not bound by such interests. Every week I hear front line workers complaining bitterly about having to work with medicated kids yet, when challenged to air their grievances in public, choose to abandon what they know and slink away because they feel unsure or unqualified in their opinions. But you don’t have to be a neurologist or have a doctorate in psychopathology to see what’s going on here. For those who are prepared to step up to the plate, I humbly offer the following information and commentary for your consideration ...

For the most part, the psychiatric classifications of children used to justify chemical intervention are lies – pure and simple.
The category of attention deficit disorder (ADD) manufactured by the American Psychiatric Association in 1980 and the classification of attention deficit hyperactivity disorder (ADHD) created in 1987 have no scientific validity whatsoever. Despite the millions of dollars invested to prove otherwise, there is absolutely nothing in the independent scientific literature that confirms the existence of any physical or biochemical abnormality in kids that carry these labels. Diagnostically, these young people are tagged on the basis of crude and highly subjective behavioral observations, primarily by adults who lack the time, curiosity, skill and inclination to find out what kids might be experiencing on the inside. Ironically, the questionnaire used to identify ADHD is not that different from the one used to identify “gifted” kids. As far back as 1996, John Breeding noted, “No medical person correctly diagnosis ADHD and these (DSM V1 classifications) are not real diseases in any legitimate scientific meaning of the term disease. To declare otherwise is not medicine, it is fraud.” From 1993 and 1997, neurologist Fred Baughman persistently badgered the medical authorities and the Novartis company (the manufacturers of Ritalin) to provide him with any shred of evidence that ADHD exists as a definable disease and came up with nothing. Eventually his tenacity paid off with an admission from these sources that “no objective validation of the diagnosis of ADHD exists.” Many others have raised the same questions about such categories as childhood depression and oppositional defiance disorder but, regardless of such challenges, the machine rolls on.

The assertion that psychotropic medications “work” is a deception. Like most drugs they can certainly alter mood, thought and behavior. Children who are given Ritalin, for example, do seem to become more goal- oriented, less aggressive and more compliant in the short run. For this reason alone, it’s not difficult to understand why this particular drug has become so popular among desperate parents and frustrated school- teachers. But contrary to the claims of the industry, there is no evidence to suggest that children who take Ritalin become more self-responsible or improve their academic performance in the long run. In fact, as psychiatrist Peter Breggin points out, Ritalin does not enhance cerebral activity. On the contrary it routinely induces brain malfunction from which many kids become “robotic, lethargic, depressed and withdrawn.” In other words, they become candidates for more medication.
It is clear that psychotropic drugs interfere with, or bypass, the natural physiology and, in particular, we have every reason to question what effects such chemical meddling might have on a brain during its critical phases of development. But the answer given by those who medicate ten million kids is also very clear – “We don’t know. Sorry about that.”
Even less understood is the impact of such interventions on perceptual, cognitive and emotional development, particularly the child’s fragile emerging sense of self. Even at the broadest level, the belief that that a child is sick, inadequate, unable to cope and essentially not responsible for his or her thoughts, feelings and actions, will establish attitudes that can last a lifetime, with disastrous consequences. On the inside, the manipulation of thoughts and emotions, combined with the severing of bodily awareness, are almost bound to ensure that psychological and personal development will not take place in any coherent or integrated way. From a developmental perspective, one of the most damaging consequences is that children who grow up this way are robbed of the opportunity to learn from their own experience. This is an unimaginable price to pay for any short-term ‘symptom’ control and behavioral compliance. Sadly these concerns are unlikely to be addressed since those who have the research resources to ask the questions have every reason to fear the answers.
One of the major ‘independent’ studies most frequently cited by proponents of the legalized drug culture as a demonstration of the superiority of medical over behavioral treatments for ADHD was published by the U.S. National Institute of Mental Health in 1999. Yet despite the pro-drug conclusions in this report, independent reviewers have subsequently dismissed these findings as a methodological sham driven by the vested interest of the sponsors (guess who). In this particular study, Peter Breggin notes that the ‘behavioral alternatives’ used for comparison were grossly inadequate and designed to elicit the desired outcomes. He concludes: “In summary, the study failed to adhere to basic scientific standards for clinical trials of medication efficacy and cannot be used to draw valid conclusions about stimulant efficacy. Furthermore, the data it generated tends to indicate that stimulant medication produced no different results than any of the other interventions. The study does not demonstrate the superiority, or even the usefulness, of stimulant medication in the treatment of children labeled with ADHD or any other presumed psychiatric disorder.” It is interesting to note that virtually all of the comparative research has used behavior modification as the alternative to medication with little or no attention being given to any approach that attempts to understand the subjective experience of the child.

Any assurance that psychotropic medications are “safe” is sheer fabrication.
Beyond the obvious concerns about the addictive nature of psychotropic drugs and the tragedy of labeling, there now appears to be a distinct possibility that methylphenidate (Ritalin) may induce psychosis in children. This is hardly surprising since methylphenidate is classified by the U.S. Drug Enforcement Administration as a ‘Schedule 11 drug,’ comparable to cocaine, opium and morphine – only more potent. In a 1999 study, researchers Cherland and Fitzpatrick reported that 9% of children diagnosed with ADHD and treated with Ritalin at a Canadian clinic developed psychotic symptoms, including hallucinations and paranoia.

No such symptoms were reported among children who were given the diagnosis but not the medication. More convincingly, the symptoms displayed by the treatment group disappeared when the medication was removed.

To sound the alarm bell even louder, the Ablechild organization in the U.S. has begun to document the cases of children who have died as a direct consequence of the extended use of Ritalin, primarily due to heart damage. Lawrence T. Smith, a member of this organization whose 14-year- old son Matthew died this way asks “Why should hundreds of thousands have to die before we are outraged and act? Is the profit of so many worth more than our children’s safety and lives? Sadly the deaths of these children have remained unexposed and suppressed for so long because there is a tremendous amount of money and profit at stake for so many. My son’s voice will not be one of those suppressed and quieted.”
In his own practice, psychiatrist Peter Breggin finds himself increasingly dealing with children who were prescribed stimulants for ADHD and ended up taking multiple adult psychiatric drugs that caused severe adverse effects. “It is time to recognize,” he says, “that the supposedly increasing rates of ‘schizophrenia’, ‘depression’ and ‘bipolar disorder’ in children are often the direct result of treatment with psychiatric drugs.” In an article published in the International Journal of Risk and Safety in Medicine in 2003, he takes evidence from multiple sources to conclude that SSRI antidepressants (including Prozac) can induce a range of reactions including mild agitation, manic psychoses, agitated depression, obsessive preoccupations and akathisia (psychomotor agitation) that can result in suicidality, violence and other forms of abnormal behavior. Rather than recognizing these conditions as adverse drug reactions, doctors often assume that they are primary psychiatric disorders unmasked by the medications and more drugs are added to the list. In reality the initial drug is more likely to mask serious, and potentially fatal disorders that lie beneath the presenting symptoms. Breggin warns that unless this reactive pattern is understood by those who diagnose and administer medication, increasing numbers of young people will be labeled psychotic to become the consumers of an ever-increasing array of drugs.
In the U.K., where prescriptions for Ritalin have been doubling every year, medical practitioners are now being told that stimulants should not be given to children under the age of five and no new SSRI prescriptions should be written for patients under 18, with the exception of Prozac (doubtless the effective lobbying of the manufacturer, Eli Lily). Similar warnings have now been issued in the U.S. and Canada. While this might seem like a glimmer of sanity in the madness, the political will is distinctly political and when it comes to influencing governments, controlling professional peddlers and duping the general public, no industry is more powerful and resourceful than the drug racket (just check your e-mail). And even if legislators could be forced into formulating policies of child protection, the reality is that drugs available to adults can easily find their way to kids, covertly or through the system by what is termed “off-label prescriptions”. A cynical observer might well conclude that, whatever rules and restrictions might be applied, the pharmaceutical industry will continue to find ways to create its own demand in its own inimitable way.

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So what can be done to stem the tide in a world in which drugs, legal and otherwise, have become an integral part of everyday life? Based upon the belief that “feeling good” is a fundamental right and that we are not the creators of our own discontent, we have readily embraced the ubiquitous pill fairy for relief from the challenges and responsibilities of daily life. Every day we learn of new discoveries that show how even our most profound human experiences can be explained and modified through the biochemistry of our brains. And as we become increasingly dependent on the medications that fix us up, the corporations that service our addictions, and the leaders that promise to look after us, we drift further into helplessness. Meanwhile we talk to our kids about staying healthy, being responsible and “saying no to drugs” while we label their uniqueness and transgressions as “diseases” and dole out their daily medication? And what kind of relationships can we possibly have with children when their senses have been muddled by chemicals to the point where they (or we), are not even “there”? To understand this, you need only look directly into the eyes of a child who has been drugged.
On the bright side, many parents and caregivers, and a growing number of organizations are now expressing their opposition to the legalized drug culture. But where can such parties go for independent information and advice?
Alan Cassels, a professor of health policy at the University of Victoria answers this question very clearly; “ … these days it’s nearly impossible to find anybody who doesn’t have a conflict of interest because virtually all of the medical experts in every field have taken money from the pharmaceutical companies to continue their research.”
But what about those of us who have already concluded that we are witnessing a massive biochemical assault on our children and youth? If governments are failing miserably in their tedious “war” on ‘illegal’ drugs that provide no revenues to the industry, what chance is there that a handful of renegades can do battle with the highly organized political and economic forces that operate within the legitimate and legal structures of society? One possibility might be for non- medical professionals like psychologists, academics, social workers, schoolteachers and child and youth care practi- tioners to speak back with some degree of authority and unity. But even if such courage collaboration and resolve could be generated, such a movement would be quickly sabotaged and dismantled by the interests that pervade every sector of our personal and professional lives. Whether we like it or not, we are all part of the system and, in many ways, our actions serve to perpetuate the problems.
While medical doctors are usually considered to be the primary peddlers of psychotropic drugs, many physicians report that they feel pressured by other professionals and parents to make a diagnosis and provide the appropriate prescription. As mentioned earlier, much of this pressure can be attributed to a system in which agency funding and professional fees are contingent upon a child being placed in a specified diagnostic category. In many places, even schools are given additional funds for kids who carry these labels. But the problem runs much deeper than this.
Frustrated parents are often relieved when told by the experts that their child’s problems are the symptoms of a disease and not a consequence of neglectful or inadequate parenting. Others are ready to grab at anything that seems to promise behavioral compliance. Even well intentioned parents who simply want the best for their kids will demand the latest technology to ensure social and academic success. But, in turn, parents themselves are often pressured by professionals who see medication as a way of making their own lives easier. This pressure may range from the induction of guilt through statements like “If your child has diabetes you’d give him insulin wouldn’t you?” to downright coercion, as in Albany, New York where parents who decide to take their children off medication have been listed as “child abusers’ and subjected to prosecution by the child protection agencies.
Schoolteachers struggling for control and obedience in the classroom are certainly at the center of this vicious cycle of coercion but they are by no means the only villains. More often than not it involves the collaboration and collusion of other agencies and professionals to make the strategy work. As John Breeding puts it, “Ritalin absolves each person of his or her responsibility. The child is not responsible, he is ‘sick.’ Parents, doctors, the community, the medical and educational services – the society at large – are relieved of their duty to meet the real needs of the child.” In short, it’s not kids that have to change, it’s the adults and services that purport to act on behalf of, and in the best interests of, children.
Of all the professional groups involved in this madness, I would argue that child and youth care practitioners have the best opportunity to speak back with authority. Being directly involved in the day-to-day life of kids, this is the one profession that can truly claim to understand and reflect the experiential world of the child. The diverse and ubiquitous nature of child and youth care means that it is relatively free from the prescriptions and pretences of the more regulated professions. This profession is not about exclusive knowledge wrapped up in esoteric jargon; it is about real communication with people – and the time has come to communicate, with clarity, reason and passion.
Of course I realize that practitioners who speak out are likely to find themselves smothered under a deluge of pseudo-scientific bullshit, derided by the self-proclaimed experts, threatened by the agencies that pay their salaries and by the vested interests and general ignorance of society in general. It’s not a very pleasant prospect but, unless child and youth care workers are prepared to accept that most of the kids they work with are suffering from some form of medical disorder, the only other option is to lay low, say nothing and continue to participate in a diabolical mythology concocted by vested interests and held together by lies and deception.

What Can Child and Youth Care Professionals Do?
Doing nothing is certainly an option. But if you believe, as I do, that all children are unique individuals seeking to be seen and heard, that their growth and development stems from their own natural resources and that their essential needs are for open, caring and loving relationships, then step up to the plate NOW – for all kids – everywhere. But, once you have stepped out of the bullpen, be prepared for a long and arduous campaign that will test your personal and professional resolve to the maximum. In this regard, I humbly offer the following suggestions for your consideration:

1. Become informed. This doesn’t mean simply reviewing what the experts have to say and what the research studies would like you to believe. It means reading with a critical eye. Become familiar and comfortable with the medical terminology but don’t be seduced by the power it brings. Remember, however much you are overwhelmed by the complexities of neurophysiology, nobody understands what effects psychotropic drugs have on the human brain, let alone the Self.
2. Ask yourself if you would willingly take these drugs if someone told you that you were “clinically depressed,” defiant of authority or considered by your colleagues to be to be a pain in the ass. Given what you already know, would you give these drugs to your own children?
3. Based upon your own knowledge and experience in working with kids, identify what you believe to be their basic needs and the approaches you consider to be in their best interests. Then proceed with confidence.
4. Carefully articulate your own stance on the use of these drugs. Write it down and review it periodically.
5. Regardless of the diagnosis and recommendations of the ‘experts,’ be prepared to offer the alternative of drug free intervention. Rather than assume that the youngster is “sick,” work from the perspective that he or she is a unique human being who already has all the inner resources needed to create a full and self-responsible life.
6. If given this opportunity, conduct your own research based upon your own subjective experience, the experience of your client and whatever behavioral outcomes are appropriate. Your ‘study’ may not be very rigorous or sophisticated but at least it will contain the curiosity, honesty and integrity so often missing in what passes for ‘scientific’ research. Write up your study and send it along to this journal (publication is almost a certainty)
7. Be prepared to challenge those who argue that psychotropic medication is a preferred and effective form of intervention. Don’t get into arguments with the ‘experts’ simply ask to see the evidence. In the final analysis, you can’t lose on this one.
8. Refuse to accept the notion that these drugs can be used in conjunction with relational approaches. You already know that chemical intervention masks the real self and prevents relational contact.
9. If you are asked to administer these drugs, simply refuse and muster up the courage to face the consequences. In other words “say NO to drugs”.
10. If you are working in an environment where kids are already being drugged, become a skilled observer and document what you see. Again, send your observations and conclusions to us for possible publication.
11. Promote your own work as an alternative to chemical intervention and don’t be afraid to go out into the community and the professional arena to express your views and provide training for anyone interested.
12. Develop your own models and strategies based upon what you know these young people really need – personal relation- ships with people who are caring, curious, knowledgeable and committed.
     

Finally, if you wish to explore some of the backup information included in this editorial, you might begin with the following internet web-sites.

1. http://www.ritalindeath.com/
2. http://www.naturalchild.com
3. http://www.breggin.com/ mta.html

6. http://www.212.net/crime/ ritali.htm
7. http://www.scn.org/~bk269/ r-ball.html
8. http://www.thomasarmstrong. com/articles/empower.htm
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Gerry Fewster
 

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