Back in August, Ian Welsh drew our attention to a report from the Orwellian named President's New Freedom Commission on Mental Health. This august group proposed making mental health screening a routine part of physical examinations for both adults and children. And in the case of the latter, it would be mandatory and wouldn't require parental consent.
After providing some relevant quotes and background material, Ian summed it up rather nicely:
Let's put it together. The government will screen kids in school and adults during routine examinations - people who didn't go looking for mental health help. If it's determined that they are mentally ill, they'll be treated with drugs that cost a great deal more than generics and may or may not be safer.This is another way to subsidize drug companies. I don't want to trivialize mental health issues, and certainly we want people to get the help they need. But this does smack of coercive drugging of vulnerable populations with drugs that could have side effects much worse than the some of the problems they're treating.
Sound like a conspiracy theory? Guess what?
Congress Funds Psychological Tests for Kids
One of the nation's leading medical groups, the Association of American Physicians & Surgeons (AAPS), decried a move by the U.S. Senate to join with the House in funding a federal program AAPS says will lead to mandatory psychological testing of every child in America ? without the consent of parents.When the Senate considered an omnibus appropriations bill last week that included funding for grants to implement universal mental health screening for almost 60 million children, pregnant women and adults through schools and pre-schools, it approved $20 million of the $44 million sought, Kathryn Serkes, public affairs counsel for AAPS, told NewsMax.
...
Last September, AAPS lifetime member Rep. Ron Paul, M.D., R-Texas, tried to stop the plan in its tracks by offering an amendment to the Labor, HHS, and Education Appropriations Act for FY 2005. The amendment received 95 ?yes? votes, but it failed to pass.According to Serkes, Paul is now mulling offering stand-alone legislation in the next session to once again try and get a provision for parental consent.
The federal bill on its face does not require mandatory mental health testing to be imposed upon states or local schools, explained Serkes.
However, the HHS appropriations bill contains block grant money that will likely be used ? as is often the case with block funding ? by the various states to implement mandatory psychological testing programs for all students in the school system.
...
Officials of the AAPS decry in the measure what they see as ?a dangerous scheme that will heap even more coercive pressure on parents to medicate children with potentially dangerous side effects.?One of the most ?dangerous side effects? from antidepressants commonly prescribed to children is suicide, regarding which AAPS added, ?Further, even the government?s own task force has concluded that mental health screening does little to prevent suicide.?
While I was googling around looking for other sources on the story, I came across a piece by Phyllis Schlafly at Town Hall in which she expresses the same concerns.
"State-of-the-art treatments" will result in many thousands of children being medicated by expensive, ineffective, and dangerous drugs. The long-term safety and effectiveness of psychiatric medications on children have never been proven.The side effects of suggested medications in children are severe. They include suicide, violence, psychosis, cardiac toxicity, and growth suppression. Several school shooters, such as Eric Harris (Columbine) and Kip Kinkel (Oregon) had been on antidepressants or stimulants when they committed their crimes.
The validity of much scientific research has lost its credibility because the Food and Drug Administration has allowed the pharmaceutical industry to withhold data not favorable to their products and because people in the pay of the pharmaceutical companies are the ones recommending medications.
But I had to laugh at this, from early in the piece.
Like most liberal big-spending ideas, this one was slipped into the law under cover of soft semantics.
Liberal, Phyllis? This is the Bush adminstration you're talking about and it's the GOP that's in control of both houses of Congress. Don't go blaming liberals for this one.
I guess it really is the War on Some Drugs™. Here's hoping this is an idea that doesn't catch on in Canada.
Nice catch Pogge. Blech. ;)
Both you and Ian (whose posts I usually find quite excellent) have written about this in such a way that the facts should outrage us all without you having to do any convincing. I'm sorry, but I'm not convinced. At least superficially, though, this actually looks like one of the minuscule number of things the Bush administration is getting *right*.
All of the stuff I've read from the contra point of view has seemed to come from a place that's very suspicious of mental health care in general. "But, but, they're doing it without the consent of parents!" Well, you know, parents don't have the right to consent or not consent to things like feeding their children and giving them homes to sleep in and getting treatment for their broken bones, either. "But, but, this will lead to more children being prescribed Dangerous Psychiatric Drugs That They Don't Need!" Possibly, but isn't it just as likely to lead to more children being prescribed reasonably *safe* psychiatric drugs that they *do* need, and for that matter being put into therapeutic situations when most of them would have otherwise slipped through the cracks? These arguments remind me a lot of the anti-vaccination crew. Psychiatric Drugs Are Bad (while antibiotics and other drugs to treat physical ailments are just fine).
I tend to think of mental health care as a part of any other medical care, so this sort of thing seems not only positive to me, but long overdue. The potential I see here is for a better understanding of the effects of mental health on the public health, and a population that receives mental health care as a matter of routine medical care right alongside regular physicals, in a country where mental health problems may arguably be wreaking havoc on a lot of the decisions being made there.
I'm willing to be convinced that I'm Dead Wrong -- you certainly know a lot more about this particular programme than I do -- but I'm not there yet.
-J
Jennie,
Who is going to do the screening? The GPs and pediatricians? Isn't that a little like seeing a gastroenterologist when you have a sinus infection?
I'm offended by this proposal, it is part of the general degradation of mental health care in this country: mood disorders are best treated by talk therapy. Anti-depressent or anti-cyclic drugs are adjuvent to best practice, not a replacement for it.
I think who's going to do the screening is a valid question, and one I hope they would get straightened out before passing any laws on this. I would hope that professionals in the field would do it, just as professionals in the medical field are the ones who give kids physicals.
You're also right in saying that mood disorders are best treated by talk therapy -- I'm not a psychologist, but I've read enough work in psychology written by psychologists to be aware of that. So yeah, I agree that kids shouldn't just be given drugs willy-nilly if it's decided that there's a problem. But I think that about medical ailments as well, and I don't think that's reason enough to stop taking kids to see doctors.
In any case, my point wasn't that there are no problems with the idea -- like I said, I'm willing to be convinced -- but that pogge and Ian seemed to be taking the attitude that if they cited a couple of newspaper articles, the outrage would follow, and I need a little more evidence than that to be convinced that this is a bad idea.
-J
Good post. I would expect most true conservatives to consider this a bad idea as well.
I was pointed to this blog as being left wing. Is this mistake?
MB:
I guess it depends how you define left wing. I'm not trying to be smart. Most right wingers seem to think I'm a lefty but sometimes I think the dichotomy gets in the way.
Jennie:
I have enough to say in response that I need some time to write it out properly. But I'll definitely respond when I have time.
The history of and current practice of psychology and psychiatry and the drug company practices leave me unable to be sanguine about this sort of thing. The number of people on valium in the eighties, the repressed memory craze, the current overprescription (and yes, it is overprescription) of anti-depression meds, going further back the hysterectomies and the lobotomies...
I am very wary of psychology and psychology - because the truth is that we still have only a butcher's understanding of how the brain works and doctors are as prone to fads in treatment as everyone else is in clothes. Scary to contemplate, but it's my considered judgement after reading the history of psychology.
Phyllis Schafly? I thought she retired to the kitchen.
What's most frightening about this idea is how they'll define "Mental illness". Will doctor's be forced by state-enforced definitions to medicate students who oppose government policies? Who are angry at Bush? Who don't want to go to church? Who smoke weed? Who need an abortion?
THE PHARMACEUTICAL SERPENT'S EGG
In Bergman's classic "Serpent's Egg" we see Nazi scientists experimenting with the effects of drugs, chemicals, gases, on subjects. Put a mother and child in a room, squirt some gas, and they will want to kill each other. Horrible stuff. Made me want to puke.
At the end of the film, the central evil character is caught, and we think: "alas, an end to the evil!"...but he assures us that the Serpent has eggs that have yet to hatch.
Ah! The soft bigotry of low expectations! The experiments are so user-friendly now!
Tentacle one. Now consider the illegal drug connection. Are the pharmaceuticals in competition or cooperation?
When something so small can reap such large profits, trouble is sure to follow. Blackmails, extortion, impolite stuff.
What about the alcohol/tobacco tentacle? Legal drugs. Competition or Cooperation? Kicks cigs, hooked on patches, gum. Or as Woody Allen put it, "I used to be a heroin addict, now I'm a Methadone addict."
Methinks the industry needs a vision adjustment... toward one that places healing at the top of the priority chain.
Sugar pill may be harmless, but they still bankrupt families. And these are the innocuous drugs.
Some of the major drugs on the market seem to have this effect on kids, where it makes them want to kill their parents and grandparents. Sounds too much like a Serpent's Egg to me.
Time to rethink what we are doing to our young'uns. Time to get over our blind trust in the medical world, who, after all, have opted for the profit model, and are thus fully open to all appropriate caveats.
-Dave
Ian:
I think there are good reasons to be concerned about laws like these, but I simply don't buy the reasons you give. Show me the evidence (in the form of systematic scientific studies) of widespread overprescription of psychiatric drugs. I'm willing to believe that it's true -- I don't know any better, myself -- but not simply on your say-so.
You're demonstrating here quite a knee-jerk reaction against the mental health profession, and that alone is enough for me to be suspicious of your perspective. From my own meager knowledge of both psychology and medicine, it seems that psychology professionals know about as much about the mind as medical professionals do about the body. Which is to say "not nearly enough, but some, and enough to actually reasonably treat most people much of the time." And as we all know, medical doctors screw up, sometimes, but that doesn't prevent me from thinking that the people who refuse to take their kids to doctors are crackpots.
-J
jennie, I believe in scepticism too, but I wonder about the direction in which you first leap as a sceptic.
Unlike people, drugs don't have civil rights. Like pesticides or herbicides, they aren't innocent until proven guilty -- quite the reverse. The same should be understood to be true of all broader and fuzzier medical therapies until we are sure not only that they work but also of how they work -- as we do, eg, of antibiotics, and even there, we seem to be forced now to write new chapters beyond the certainties we used to think we had.
I am writing as someone immersed in two different medical pickles, my own and my husband's. Both experiences have taught me to trust the direction of Ian's scepticism, and pogge's, more than yours.
My own pickle doesn't matter so much, except that I am assuming that most women have been convinced, by the scandal of the hype surrounding HRT, which continues to deepen, that doctors are indeed capable of succumbing to fads. (And if the collapse of the HRT fad isn't enough for you, I can take you back to the IUD enthusiasms of the 70s ...)
Over the last several years, I have been watching a number of experiments with psychotropic drugs, anti-psychotics and SSRIs, some of those done on the person I love most (who is now, thank God, on no meds at all). I've seen and heard enough to know that all those experiments are ... experimental. The good doctors will admit that ... they don't know. (There are still many creepy patriarchal doctors who won't -- and to me, that's become the standard: a good doctor admits what he doesn't know for sure.)
Ian says above that our knowledge of the brain is still "a butcher's understanding," and in my experience, not only is Ian right, but the best doctors will agree with Ian. A great many of us have seen psychotropic drugs cause psychotic episodes, and we've seen those episodes stop when the meds stop. We've sat with the doctors and asked them to explain to us what is happening, and if we've been lucky enough to have smart doctors, we've heard ... that they don't know.
All brain science at the moment is experimental, as far as I know, and I'm working hard to keep up. We have a lot of data, but our interpretations so far mainly fail us -- that's why the researchers are working so hard, because they know that we are not doing well so far.
And that, to me, is why a true sceptic would defend any citizen's right to resist treatment, for herself or for her child. Psychology and psychiatry are still experimental. Sometimes they can help -- maybe. But there are no absolutely trustworthy authorities. No free citizen should be forced to believe that there are -- there is just too much evidence against that view.
And beyond the scepticism that is based on purely scientific and democratic principles, there lies the knowledge we all have of power and its desire for a pacific citizenry.
I have known doctors who were happy to rationalize the use of certain drugs just because it made their lives easier. That was conventional psychiatric medicine, not so long ago -- and not just in the Soviet Union.
Mandatory psychological testing? For what? How? When human psychology remains so much of a mystery, even to the cutting-edge researchers, and that at every stage of life, including dementia?
For heaven's sakes: the AAPS is objecting. I can't seen any motive for such testing and treatment but a political one, and political prescriptions for anyone's brain must always offend us.
skadadi:
Exactly who is making this All About Drugs? If they are seriously talking about prescribing psychiatric drugs willy-nilly to children without parental consent, then I'm going to have to oppose it, too, but the only people I'm seeing claiming that's what would go on are on this blog and Ian's. From what I can tell, this proposal is about screening, not about prescriptions: like, say, the screening for vision or scoliosis of the spine that already goes on. When they screen you for scoliosis, they don't slap you in a brace as soon as they find something wrong -- they refer you to a doctor for further consultation. If children with potential mental health problems were detected in a similar screening and referred to professional psychologists for further consultation, then that would be quite different from some screener saying: "Oh, you've got ADD. Take home these pills, and pop one every morning. Don't tell your parents."
My concerns about the idea of screening are more along the lines of how the screening is done and by whom, and what happens with the results. Will professional psychologists be involved at every step of the process: development of testing, screening, further consultation, and treatment? Will the results of these screenings be made public or otherwise obvious in schools? Will teachers (or future employers) discriminate against kids whose screenings show mental health problems? Will they go along with the majority of the psychological profession and treat most kids with talk therapy, or will they try to make medication a cure-all? If a child *does* need medication or talk therapy, who is going to pay for it? I don't think we know nearly enough about these things, and I'm afraid the lawmakers don't, either. *This* is what I want to hear more about. Not about personal prejudices against the psychology profession.
I know the AAPS is objecting, and that intrigues me as well. I would love to hear more about why. I'd bet a big handful of money that they've got a bunch of good reasons that don't resemble Ian's and pogge's in the least.
-J
jennie, with respect, I wasn't writing only about the dangers of psychotropic drugs above, although anyone who has dealt with MDs, psychologists, psychiatrists, or geriatricians over the last two decades or so knows that that has become those professions' first line of defence, not to mention defensiveness.
My difference with you is that you seem to believe in some Aristotelian category called "mental health problems." And you seem to think that "professional psychologists" are to be trusted to detect those problems ("screen" for them) and prescribe for them.
Where on earth do you get such faith?
Even in those cases where we can detect genuine damage to the brain or other irregularities, as with schizophrenia or dementia, I think there are few researchers now talking with the certainty that you do.
You are quite right to wonder who will be doing the screening and how, and what will happen with the results. Since we still don't know what competent "screening" would be, those questions become even more urgently important than you seem to credit.
skdadl:
The "faith" (I would prefer the term "knowledge") that I have about psychology comes from being acquainted with a number of professional psychologists and discussing their research from them, and from having read a small number of psychology works myself (books and academic papers) as a result of a non-professional intellectual interest in certain particular areas. Thank you for asking. I would like turn the question back on you, and ask the same. Where does *your* knowledge about the psychology profession come from?
I'm certainly not saying that psychologists have all the answers. It's very clear that there's still an awful lot to learn about the mind -- if there weren't, research psychology wouldn't exist as a profession. But there is an awful lot to learn in medicine, too, and we still take our children to doctors. It's not that I think that psychologists know everything about the mind (or for that matter, that doctors know everything about medicine) -- it's that I think they know a lot more than I do. I don't have absolute faith in them (as I don't have absolute faith in doctors), but I know enough about what they do and how well they do it to not have a knee-jerk distrust of the entire profession.
-J
skdadl:
The "faith" (I would prefer the term "knowledge") that I have about psychology comes from being acquainted with a number of professional psychologists and discussing their research from them, and from having read a small number of psychology works myself (books and academic papers) as a result of a non-professional intellectual interest in certain particular areas. Thank you for asking. I would like turn the question back on you, and ask the same. Where does *your* knowledge about the psychology profession come from?
I'm certainly not saying that psychologists have all the answers. It's very clear that there's still an awful lot to learn about the mind -- if there weren't, research psychology wouldn't exist as a profession. But there is an awful lot to learn in medicine, too, and we still take our children to doctors. It's not that I think that psychologists know everything about the mind (or for that matter, that doctors know everything about medicine) -- it's that I think they know a lot more than I do. I don't have absolute faith in them (as I don't have absolute faith in doctors), but I know enough about what they do and how well they do it to not have a knee-jerk distrust of the entire profession.
-J
I know the AAPS is objecting, and that intrigues me as well. I would love to hear more about why. I'd bet a big handful of money that they've got a bunch of good reasons that don't resemble Ian's and pogge's in the least.
You'd lose that bet. From the NewsMax article I quoted from in the post:
Officials of the AAPS decry in the measure what they see as ?a dangerous scheme that will heap even more coercive pressure on parents to medicate children with potentially dangerous side effects.?
If you read Ian's original post, you'll see that Bush implemented a similar program in Texas when he was governor, and that the program involved a built-in bias towards the use of expensive, patented drugs instead of their cheaper, generic counterparts. Such a provision has the fingerprints of the pharma industry's lobbyists all over it.
We now have four years of Bush history to review and his pattern is to commission programs or write legislation with lofty, idealistic names and goals that end up meaning something quite different. No Child Left Behind is an example of a program that sounded like it was meant to improve public education. But it's been underfunded and is having exactly the opposite effect. That's Bush's pattern.
But it isn't just all about drugs. Had this been announced with the more modest goal of first improving the delivery of mental health care to those who have sought help, perhaps my alarm bells wouldn't be ringing. It's the over-reaching aspect, and the mandatory nature of the screening, that makes me deeply suspicious.
A diagnosis of physical illness seldom has implications with regard to your civil liberties, the exception being a highly contagious disease that might involve temporary quarantine. But a diagnosis of mental illness can lead to enforced confinement and even a court ruling that deems you incapable of making your own decisions and managing your own affairs.
I'm on the side of those in this thread who maintain that our understanding of mental illness, and the brain's functioning in general, lags behind our understanding of many physical ailments. The definition of mental health remains too subjective and a program like this, for the reasons raised by many commentors including you, remains open to the possibility of abuse.
Consider how recently even many mental health professionals believed that homosexuality was a mental affliction. Given the current atmosphere in the U.S., how hard would I have to look to find some who feel that way even today? As others have suggested here, what happens if political dissent or questioning authority becomes defined as "emotional disturbance"?
Sound paranoid? Certainly. But this is the Bush administration we're talking about. They politicize everything. It isn't the lofty goals in the original Commission report that concern me (I've read the Executive Summary). It the potential for abuse in the implementation that worries me and the fact that no allowance is being made for the right to refuse.
If you've been reading me for very long, you'll know that I don't always automatically come down on the side of small government. But I do object when the government over-reaches and demands too much authority because authority can be abused.
Let them implement all the recommendations for improving the delivery of mental health care on a voluntary basis first and demonstrate that they're on the right track. Then we can talk about mandatory screening.
pogge:
That is a *much* better set of arguments than the original post. Thank you for delivering on my request!
I share your stated concerns that don't have to do with doubts about the psychology profession as a whole. I have asked a friend who is an American research psychologist and blogger to look into this further and post about her opinions. If and when she does this, I'll point you in her direction.
Thanks again.
-J
You're most welcome. And please do point me to your friend's opinions. I'd be interested.
Be aware that comments to this post will close in 7 days. It's not that I don't want to hear from you, it's part of spam control. But you can always email me using the link at the top of the sidebar on the main page. I'd appreciate it.
Good for nothing federal government...*mumbles*
To be fair, most like me on the Right don't consider George a conservative in any sense. Sure, he has some conservative tendencies in the social and foreign arenas, but his tendency towards protectionism and government spending slow conservative support for the president a lot o fthe time. All this "compassion" crap is keeping us back, and we don't form a majority in either chamber, only a majority of a majority.
Goodness, jennie: you are asking for my CV?
I have learned a good deal about psychotropic drugs and about how the brain dies from some of the good doctors who have treated my husband, who has Alzheimer disease. I have learned even more from watching, now, about fifty people taken on and off these drugs, with, as far as I can discern, no real benefit to them or to anyone else, unless the drugs simply knock them out -- an obvious benefit to the caregivers.
I also have a good friend who has what I believe is now called bi-polar disorder, and who has become an activist against the kinds of conventional therapy he received as a young man. He now works as a counsellor to others.
Although the condition that he knows best has nothing to do with actual damage to the brain, which is the problem that I am puzzling through, it is still true that he has been the greatest help to me in thinking about the bad treatment we now give dementia patients.
He believes, as I do, that when there is a genuine "mental illness" in play (the brain is dying, or there is a measurable chemical imbalance), the best therapies have to do with touch, tone of voice, body language, constant easy physical affection. And he recognizes, as I do, that almost no one but us believes that we can "afford" such therapy. They are, after all, labour-intensive, a swear-word in these neo-con times.
He also believes, as I do, that there are many other "mental illnesses" that are the obvious direct consequences of social stress -- and the cure for those is obvious, or it would be, if we thought that we could "afford" to lift the social stresses.
Well: you asked.
Jennie:
this is one of those areas where you'll have to mostly do your own reading - there's plenty out there. You can see that as a cop out, but I read extensively in this in the eighties and early nineties, and haven't kept up since. Knowing what I know of insitutitonal inertia and human nature I see no reason to believe things have changed. I also spent a fair bit of time in that period reading in psychology and it's a rat's nest of theories and practices whose empirical support is minimal. As for neuroscience - most psychoactive chemicals are the equivalent of sledgehammers on the brain - sweeping brushfires flashing through connection after connection in ways that are very dangerous. Although we've made astonishing progress, in other respects we still know startlingly little (for a non drug related book I reccomend Antonio Damasio's "Descarte's Error".)
However - as for drugs, you might want to start with the ex-editor of the New England Journal of Medicine: http://www.bopnews.com/archives/002537.html#2537.
The sad truth is that after economics I cannnot think of any discipline which has done more harm to people than psychiatry/psychology by prescribing treatment based on flawed knowledge. You can take that as an overly strong statement and discount it if you please - hopefully you'll never learn you're wrong the hard way.
As an aside, one of my best friends for a time (and only a time) was a PhD student in psychology. You think I say scathing things about the state psychology?
Heh.
Ian Welsh - I'm a little shocked by what I've just read, so I want to clarify: are you really saying that you haven't read any of the psychology literature in nearly twenty years, and yet you still feel qualified to comment on the state of the science?