I think it’s interesting that the Diagnostic and Statistic Manual of Mental Disorders, the so-called ‘psychiatry bible,’ used to be very Freudian in the way it defined illnesses until it underwent all these big changes in the 1980s. Can you talk about that, and especially what it meant for kids?
KBB: The old paradigm was very much influenced by Freudian thought, which held that your experiences in childhood and your environmental exposures created your neuroses or various mental problems that showed up later in life, and there wasn’t actually a biological basis for problems. In terms of children, the old Freudian view had held that kids weren’t developmentally sophisticated enough to be able to have psychiatric disorders.
The big shift that occurred in the 1980s version of the DSM is they stripped out the references to the why’s of what caused the illnesses, because the fact is that we still really don’t know the mechanisms behind these diseases. So they focused instead on the symptoms, and that’s the way they diagnosed it — if you showed these symptoms, you have depression, if you showed these symptoms, you have OCD, etc. etc. It reflected a new type of thinking in psychiatry that was more biologically based and downplayed the influence of environment.
And boomer parents liked this, were drawn to this.
Well, the old paradigm had held parents responsible for mental disorders a lot of the time–if you had a mother who was distant and frigid, a child might have autism. That’s not a very nice thing for parents to hear, so it’s appealing in a way for them to hear, no no no, it’s not your fault, it’s a biological problem in your child’s brain.
Okay so flash forward to all these medicated kids who are now young adults — what are some of the biggest obstacles or impediments they face in getting proper mental health care?
A major one would be lack of health insurance. The Obama health care law has now allowed parents to keep kids on their insurance plans up to age 26, which has helped a lot of people, but that’s only a very recent development. Also young people are just more mobile, changing jobs a lot, moving from city to city, and it can be hard to establish a relationship with a single doctor. You have to tell your story all over again to a new doctors, there’s no continuity of care. And most people don’t bother to dredge up their old medical records from childhood doctors, or … the college health center. There’s a spotty kind of care that happens in late adolescence and early adulthood.
Another issue is if you grow up taking medications, going off to college or starting out on your own … for a lot of kids, it can feel like, ‘Wow, I’m free of this medication I had to take for all these years,’ especially if they had a negative view of their medication. So they may just be likely to go off of it.
And a lot of the people you profile or interview in the book don’t like the side effects. Some even feel like it’s making them age prematurely?
Young people for the most part are healthy, and in the prime of their lives; the idea that you need to take a medication every day as a young person can already make a lot of people feel like they’re damaged in some way. Then you throw in the side effects, which can really make you feel less vital, less like a young person — it can be very discouraging. For instance, the sexual side effects. There’s a lot of pressure, especially for young men, to have these raging libidos, but antidepressants and mood stabilizers really dampen your libido and your sexual response and just interfere with all aspects of sexual arousal and satisfaction. That’s a really weird thing, and I’ve talked to men who were really embarrassed — do you tell the person that you’re just casually dating? When do you disclose that? … Some of the anti-anxiety meds can cause memory problems. A number of stimulants can cause constipation. Type 2 diabetes is caused by these atypical antipsychotics … These meds can cause side effects that make people more aware of their own physical limitations in a way that most young people aren’t.
What were you most surprised about in researching and doing interviews for the book?
Something I was really surprised by is that even young people who had been on meds for many years and had found them to be effective had a very strong desire not to be on the drugs, not to rely on a ‘chemical crutch.’ Some people were totally comfortable with it. But so many tried again and again to go off the medication, for one reason or another — because they wondered if they had changed and matured and the drugs were still necessary, or they thought they could do it on their own if they were tough enough — and then had to go back to the medication. I thought there would be more people who were okay with taking medication long term, but I was struck by this very deep desire by people to be free of them, to feel like their emotions and behavior were in their own hands.