We’ve Got Issues: Children and Parents in the Age of Medication

For those of us who treat seriously emotionally disturbed children, We’ve Got Issues is a welcome change from the invectives of those who believe that the use psychotropic medication is virtually criminal. Ms Warner began with that supposition-and when she dug deeper into the matter, she found that most parents and doctors do the best they can for children whose psychological problems are anything but trivial.

“Issues” is a clever word. I had first heard the term from the mother of a boy with high-functioning autism. She called his explosive meltdowns “issues.” I thought, “What kind of euphemism is that?” It is a nice disguise, though, for the many behavioral difficulties parents face with their children when they don’t want to use a more stigmatizing label.

Ms Warner turns out to have other “issues” too. Her first was finding that much of the ambient information that depicts doctors as “drugging and pathologizing kids,” “profit-mad scientists” and parents who are looking for a quick fix comes from uninformed and oversimplified “public opinion and most media treatment.”

Hunkering down with well-referenced research, she fills her chapters with “observation, scores of interviews with mental health experts, critical thinking and, above all, the compassion gained from talking to dozens and dozens of the parents who stare at the whole ‘issue’ of children’s mental health.” Ms Warner then returns to a discussion of how public understanding of children’s mental health treatment has gone wrong.

Among other things, the author recognizes that “kids with serious problems are no longer routinely institutionalized . . . they’re kept functioning with medication,” and there are real risks in not being properly treated. She debunks what she calls the MedScare-the “now common conviction that psychiatric drugs are being used to control and denature normal and healthy children and adults who don’t conform to society’s expectations.”

Ms Warner says “Industry/BigPharma” has corrupted medicine and psychiatry. However, her understanding of how drugs are studied is naive, and her notion of “conflicts of interest” is limited only to financial ones. Like many in the public sector, she doesn’t recognize that more is broken than overzealous marketing. She fails to realize that if there were no connection between academic clinicians and pharmaceutical companies, drug development would be seriously compromised.

Any practicing child psychiatrist can get behind the book’s most serious concern that “science has outpaced our capacity to use it well. Progress has been betrayed by commercial interests, political complaisance, and a lack of policy directed at making sure that new scientific advances are safely . . . made available to . . . the public.” While Ms Warner tends to be redundant and oversimplifies matters-and diehard opponents of the practice of mental health medicalization will not be persuaded-worried parents and caring doctors have an articulate champion in their corner.