The Psychiatric Drugging of America’s Foster Children

by Peter Breggin

The most vulnerable among us are the littlest victims. Young children, torn from their birth families through various, often unspeakable tragedies. These children end up in state supervised foster care and too often are passed from hand to hand, house to house. There were approximately 662,000 children in foster care in the United States in 2010.

Now there is a Government Accounting Office (GAO) report confirming that foster children in five states — Florida, Massachusetts, Michigan, Oregon and Texas — are receiving shocking amounts of psychiatric drugs. In the words of ABC News, they are „being prescribed psychiatric medications at doses higher than the maximum levels approved by the Food and Drug Administration (FDA) in these five states alone. And hundreds of foster children received five or more psychiatric drugs at the same time despite absolutely no evidence supporting the simultaneous use or safety of this number of psychiatric drugs taken together.“ The ABC News report shows one 7-year-old holding a bag filled with 13 psychiatric medications that she had taken.

During the FDA drug-approval process, the maximum dose of a drug is determined by giving that drug by itself without any other psychoactive substances. When two or more psychiatric drugs are given together, each at its maximum dose, toxic levels of exposure can occur. In addition, some of these children are being given higher than the FDA-approved dose of individual drugs.

One young child interviewed by ABC News described the effect of the antidepressant and antipsychotic drugs he was taking: „They made me feel like I had a thousand bricks on my head.“ Another child said, „Some of the medications were for ADHD but I’m not ADHD, I’m just naughty.“ A teen in foster care on multiple psychiatric drugs told ABC News she felt like a „guinea pig.“

Foster children are provided government insurance in the form of Medicaid that includes „mental health“ services such as psychiatric evaluations and prescription drug coverage. Individual states administer Medicaid and the U.S. Department of Health and Human Services is responsible for overseeing the state programs.

In the states surveyed by the GAO, children in Massachusetts fared worst. Thirty-nine percent of the foster care children aged 0-17 on Medicaid were prescribed at least one psychiatric drug. By comparison, 10 percent of non-foster care children in Massachusetts were prescribed at least one psychotropic medication under Medicaid. It’s serious enough when 10 percent of non-foster care children from our poorer communities are receiving psychiatric drugs; it’s even more tragic when 39 percent of our most poor and abandoned children are being inundated with these drugs.

Other states in the GAO study had total numbers of foster care children on Medicaid being prescribed at least one psychiatric drug: Oregon — 19.7 percent; Texas — 32.2 percent; Florida — 22 percent; and Michigan — 21 percent. The statistics reported are eye-opening, and it is worthwhile to see the full GAO report. In Texas, for instance, 9.1 percent of foster care children aged 0-5 years old are on at least one psychiatric drug, and 58.2 percent of foster care children aged 13-17 years old are on at least one psychiatric drug. Massachussetts has 53.4 percent of foster care children aged 13-17 on at least one psychiatric drug, and almost 5 percent of foster children aged 0-5 are on at least one psychiatric drug.

Is this widespread psychiatric drugging medically appropriate or indicated? Absolutely not. First of all, these are young children, even infants, who have already been through extremely traumatic experiences. All of them have been taken from their homes and most of them will not have had a stable replacement home. Beyond that, one can only imagine their horrendous living conditions prior to being removed from their families of origin. These children do not need psychoactive substances — they need the best human, caring services that our society can provide. The drugs may make them temporarily more docile, but by disrupting and suppressing normal brain function and development, they add new stressors to their lives and prevent them from adapting and growing as best as possible.

ABC News reports, „Of all the psychiatric medications, antipsychotics are, by far, the most prescribed, especially for foster children. Foster children are given anti-psychotics at a rate nine times higher than children not in foster care, according to a 2010 16-state analysis by Rutgers University of nearly 300,000 foster children.“

These antipsychotic drugs — including Abilify, Risperdal, Seroquel and Zyprexa — can lead to obesity, elevated blood sugar and diabetes, pancreatitis, cardiovascular abnormalities and a disfiguring and sometimes disabling movement disorder called tardive dyskinesia. It’s been suggested they could shorten lifespan by up to 25 years in patients exposed to them for decades. Evidence is accumulating that they can also lead to shrinkage of the brain in those patients exposed to them for years.

Why are these highly-toxic drugs being given to so many children in foster care? The antipsychotic drugs can suppress the highest centers of the brain — the frontal lobes — leading to indifference and apathy, which makes the children more docile and easier to manage. The use of multiple psychiatry drugs (polydrug therapy) produces similar effects. In the extreme, these children become zombie-like.

The newer antidepressant drugs such as Prozac, Paxil, Zoloft, Cymbalta, Lexapro, Wellbutrin, Effexor and Pristiq and have been shown to cause an increase in suicidal behavior in children. In addition, as the FDA-approved label and medication guides for these drugs confirm, they also can cause a general worsening of the individual’s condition, including depression, anxiety, hostility, aggression, impulsivity and mania. Many studies also suggest that a high percentage of children are driven into abnormal mental states by these drugs. When a child develops any one of these adverse reactions they are likely to have additional psychiatric drugs added to their drug cocktail rather than being carefully withdrawn from the offending substances.

As ABC News documented with one mother, parents or foster parents who object to the prescriptions of mind-altering psychiatric drugs for their young children are likely to be threatened with removal of the child from their care. In a separate case in Detroit, a child who was on Medicaid due to physical disability was taken off her mind-altering psychiatric drug by her mother when she displayed adverse effects.

The prescribing clinic called child welfare services and reported the mother. Welfare services removed the child from her mother’s care for a time. Fortunately, this child was later returned by court order to her mother and criminal charges against the mother were dismissed.

But word gets around. Complain about your child being placed on drugs and social services may intervene.

A mother in Millbrook, NY, was charged with medical neglect for not continuing her 4th grade son on a cocktail of psychiatric medications that was making him angry and listless. Off the drugs his energy returned and his mood improved, but public school officials kicked the boy out of school and reported the mother. The mother prevailed and was exonerated of „medical neglect“ charges. Her son attended a private school and thrived. He is now a grown man and responsible citizen. His mother explained, „Kids don’t need drugs, they need individualized education and better family life. The priorities are all screwed up.“

In two of the ABC news foster care cases, the clinics that were authorized to deliver services to the children were also promoting themselves as being research facilities for „CNS Conditions“ (central nervous system conditions, a misnomer for psychiatric conditions.) As research facilities those clinics have ties with pharmaceutical companies.

And what about the drug companies? Are they doing all they can to prevent the inappropriate use of their products? To the contrary, several of the largest drug companies have paid billions to settle claims they illegally marketed antipsychotics to children and other off-label populations, such as the elderly.

What is being done to these children should be viewed as chemical battery and child abuse. The misguided parents and foster parents are not the perpetrators. The psychopharmaceutical complex is the perpetrator, including the drug companies, the federal government and organized medicine and psychiatry.

The drugging of America’s children raise many issues including parental rights, children’s rights, child safety, off-label prescribing of the drugs and fraud and malpractice on the part of the researchers, psychiatrists and other prescribers. Most tragic is the silence! The stifled voices of victimized children and the self-serving silence of health professionals throughout the country who fail to take a public stand against the escalating drugging of our children.

Drugging traumatized foster children shoves them under society’s rug and is in no way therapeutic for the child. There are humane and effective approaches to helping our most vulnerable children. First, they need to be protected from predatory psychiatrists and other prescribers. Second, they need improved social services that could keep many of them in their homes or provide better assistance, training and supervision to improved foster care homes. When they inevitably become emotionally distressed and at times behaviorally disturbing, they do not need chemical readjustments of their brains — they need better attention from adults in the form of improved home-life or foster care, improved educational opportunities and psychosocial therapies aimed at helping them overcome and move beyond the trauma and stress they have endured and continue to endure as children and youth.

Sure, it’s easier to give them drugs. But has anybody noticed — it doesn’t help them in the long run. Exposure to psychiatric drugs in childhood is dangerous and over time can be damaging, disabling and even deadly.

No agencies and no associations — not NIMH, the American Medical Association, the American Psychiatric Association, the American Psychological Association, and the many other mental health associations — are willing to call a halt to the massive tidal wave of mind altering psychiatric drugs being thrown at America’s children. Several states, including Florida, Louisiana and New York have expelled „high prescribing“ doctors from Medicaid but this is like nipping off the top of the iceberg. The primary problem remains: Placing children on psychiatric drugs instead of offering genuine help.

Dr. Robert Nelson, M.D., Ph.D. of the FDA Office of Pediatric Therapeutics, squirmed when challenged by Diane Sawyer in the ABC foster child series, but said the FDA had no plans to strengthen their warnings about psychiatric drugs and children.

The GAO, while courageously illuminating the great number of foster children on psychiatric drugs as well as the seriousness of children being exposed to multiple psychiatric drugs, falls far short of calling for the curtailment of the drugging of American children.

Twenty-five years ago, a tiny fraction of children were prescribed psychiatric medications, and that was largely confined to stimulants. In the early 1990s we were blowing the whistle on the increasing attention psychiatry was paying to children. I wrote an op-ed piece in the Wall Street Journal in 1989 and spoke frequently through the media about how children being blamed and diagnosed for problems in families, schools and in society. From 1990 to 1995 the increased prescribing of psychotropic drugs for preschoolers had begun.

What is to be done?

It is time for state attorney generals to launch full-scale investigations into the practices of these Medicaid psychiatrists. When appropriate, they should be charged with battery and with fraud, and sued for malpractice. But the psychiatrists are largely responding to the campaigns conducted by the psychopharmaceutical complex.The entire system, from the drug companies and insurance companies to the medical and psychiatric associations, and also the researchers and universities, need to be investigated for participating in this widespread medical abuse of children.

This Christmas, as many of us gather around a Christmas tree watching the children in our families wake up with shining eyes and happy laughter… remember. Remember that there were approximately 662,000 children in foster care in the United States in 2010.

Remember that many of these children will be waking up on Christmas morning to count out their multiple mind-altering psychiatric drugs that they have been prescribed by psychiatrists and other prescribers hired by the states in which they reside and paid for by tax dollars. These kids don’t need psychiatric drugs, they need human „angels“ to rescue them from a system that is stacked against their well-being.

Only an outraged citizenry will change this. Write your Congressional representatives and senators. Write your state representatives and senators. Write your state attorney general’s office requesting a full investigation in your state of the crisis with foster children and psychiatric drugs. If you are a parent or a foster parent being pressured to keep your child on psychiatric drugs, call your local paper, referencing the ABC News investigation. If you are a reporter, plan a local series on this issue. If you are a teacher, a social worker or professional in the Medicaid system, consider becoming a whistleblower against the chemical assault of these children. If you are a medical professional learn how to help children safely taper off their psychiatric drugs while assisting their families in obtaining more useful services. Always remember that withdrawal from psychiatric drugs can be hazardous and needs to be done carefully with experienced clinical supervision.

It’s the Christmas season. Let’s not forget the kids who are so drugged their eyes cannot sparkle anymore. Become one of their real-life angels.

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Who Will Protest Against the DSM Harm?

Integrity, Concern, and Action is needed for DSM Protest

by Paula J. Caplan

Problems

The good news: More people than ever before are learning that psychiatric diagnosis is not grounded in good science and causes a vast array of harm to people who have turned for alleviation of their suffering to those who are called helping professionals. The bad news: The forces keeping the psychiatric diagnosis juggernaut rolling and misleading the public are more powerful than ever.
I have written about these concerns here before, as well as elsewhere (They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal and Bias in Psychiatric Diagnosis, as well as at psychdiagnosis.net), so I will not repeat most of what I have already said. Today I focus on the danger of assuming that organized protest against the Diagnostic and Statistical Manual of Mental Disorders (DSM) is well in hand and likely to be effective in stopping the harm. There is no reason to believe that this is the case.

You may have heard about the petition started by several divisions of the American Psychological Association, who express concern about possible harm to children, adolescents, and the elderly and ask for an external group (the DSM is published by the American Psychiatric Association) to evaluate the proposals for the next edition, called DSM-5. This petition has garnered thousands of signatures and the support of additional American Psychological Association divisions. Although it is wonderful that these brave divisions have at last spoken out about the devastation caused to untold numbers of people over the many decades of the DSM’s existence, it is stunning that they would specifically omit mention of harm to adults who are not elderly. When I wrote petition coordinator David Elkins to inquire about this, he did not respond to the question. (Note added December 19: Please see in Comments section after this article that Dr. Elkins has now responded there to the question I had emailed him about this awhile back. I am delighted to hear that his group is also concerned about adults who are not elderly, and I hope they will take pains to make clear in the future that they are concerned about everyone who has been hurt by psychiatric diagnosis. This does not change the other concerns in this essay, and in his comment here below, Dr. Elkins did not address those.) It is hard not to wonder whether this is due to the association of Allen Frances with this petition.

Former Psychiatric Manual Chief Demonizes Those Hurt By His System

Frances, the psychiatrist who headed the work on DSM-IV – on which I served as a member of two committees before resigning in horror at the way they ignored, distorted, and even lied about the scientific basis for their diagnoses – recently wrote in an article called „The user’s revolt against DSM-5: Will it work?“ in the November 10, 2011, Psychiatric Times that he was worried that the „harmful anti-psychiatry movement“ would damage this petition campaign. He pointed out that, although „DSM-5 is such a mess,“ nevertheless, psychiatry „is essential and extremely helpful – DSM-5 is nor more than an unfortunate and temporary aberration.“ His intense need to defend and protect psychiatry in general is clear.

I simply could not believe my eyes when I read Frances‘ opening statement in that article. He wrote: „When it comes to DSM-5, experience has proven conclusively that the American Psychiatric Association (APA) will not attend to the science, evaluate the risks, or listen to reason. A user’s revolt has become the last and only hope for derailing the worst of the DSM-5 suggestions.“ I thought of the many years during which he steadfastly ignored the questions that were raised about the woeful state of „science“ in his edition of the DSM, his dismissive attitude when concerns were raised directly with him about the patients whose lives had been ruined because of psychiatric diagnosis, and his claim, when asked, „Is there at least some evidence that more people have been helped than harmed,“ that „Well, of course there’s no way of knowing that.“ Hardly the response of someone who understands that science is useful in answering exactly such questions.

Frances‘ disdain for those adults (who include some proportion but by no means the majority who are elderly members) who joined the anti-psychiatry movement because they were so profoundly harmed by the traditional mental health system is revealing…and terrifying. Are the only good ex-patients those who stuff deep inside themselves the ways the system hurt them? And I have to wonder, does he not grasp the point that, even though he believes the anti-psychiatry movement is harmful, he might want to refrain from publicly tarring a movement that includes such sterling organizations as MindFreedom International, The Icarus Project, PsychRights , the National Empowerment Center, and the International Society for Ethics in Psychology and Psychiatry (which includes some survivors as well as some professionals)?

This would matter less if the APA petition had a prayer of leading to change. I fervently hope I am proven wrong, but here are two of the major reasons for doubt:

(1) In the mid-1980s, beginning at the Association for Women in Psychology conference, I coordinated the first petition campaign in which any DSM categories were challenged. This was in regard to then-forthcoming DSM-III-R, whose Task Force was headed by Robert Spitzer, who is now, like Frances, suddenly speaking out about the lack of science and the harm from psychiatric diagnosis. Did they suddenly discover this once they were no longer in command of the manual? Our 1980s campaign ultimately netted signatures and letters from individuals and organizations representing more than six million people (in contrast to the thousands so far signing the Elkins petition), but that did not stop the DSM authors from steamrolling ahead. And it certainly did not stop Allen Frances from including in his edition, DSM-IV, categories that he knew had led to harm. How do I know he knew? I told him in a telephone conversation, and I sent him documentation of harm. If another major lobby group, the American Psychological Association, which long ago raised serious concerns about the DSM but now refuses to challenge it as a body (hence the courage of those of its divisions that started this petition) and in fact profits from offering Continuing Education courses about the DSM that lack critical components, would get on board with any anti-DSM petition, that would carry considerable weight. Up to now, they have refused to do so. In a recent press release (December 2, 2011), they stated that any psychiatric classification system „must be based on the best available science and serve the public interest.“ The disingenuousness of that statement is striking, given that unless they have spent many decades under a rock, they know full well that the DSM is unscientific and causes harm. Furthermore, according to the press release, they share the belief of the petition’s authors that „the purpose of any diagnostic classification system should be to improve treatment outcomes.“ Yes, it should be. But as I have learned through reading the research, diagnosis of mental disorders does not help (except to get insurance coverage, and I have a proposal for how to deal with that), does often cause harm, and does not correlate with outcome. We learn from the press release that the American Psychological Association has „called upon the DSM-5 Task Force to adhere to an open, transparent process based on the best available science and in the best interest of the public.“ They might as well shut themselves in a closet and whisper that request.

(2) So many powerful systems have a stake in maintaining the fundamentals of psychiatric diagnosis that it strains credibility to think that the DSM-5 heads would turn over the evaluation of their work to some outside group. Historically, under Spitzer and Frances, the DSM chiefs boasted about „consulting“ with many hundreds of professionals (note: they included hardly any, if any, people who had been patients in their system) in constructing their manuals, but I know from my experience and the experiences of others that they compile an impressive list of all these consultants but freely reject any opinion that goes against their aims, no matter how grounded in science and/or humane concerns those conflicting opinions might be.

Actions

Concerned about all of the above, a number of organizations and individuals recently formed the PLAN T Alliance (Psychiatric Labeling Action Network for Truth) and decided that it is time to stop asking the DSM heads please to listen to reason, to look at the science, and to consider the ways diagnosis hurts people. Instead, the PLAN T Alliance decided to take action. Two actions are for those professionals who use the DSM to boycott it and for Congressional hearings about psychiatric diagnosis to be held. The federal government through Medicare, Medicaid, the military, and Veterans Affairs relies heavily on the DSM, as do many hospitals, clinics, and other practices, which is the reason for the focus of the boycott on the DSM. This should not be taken to indicate that the International Classification of Diseases (ICD), which also includes some psychiatric categories, is based on science and does not cause harm. But the initial target of the boycott is the DSM, because it garners huge profits for the American Psychiatric Association, which is actually a powerful, wealthy lobby group. It remains to be seen what is done with the profits from the ICD, but perhaps its publisher, the World Health Organization, uses them for compassionate purposes.

The rationale for calling for Congressional hearings is that no entity regulates psychiatric diagnosis, and because of its lack of scientific basis and the harm it causes, we need a national airing of whatever anyone would like to say about it. Those who report feeling relieved to be given a label for their suffering can testify, as can those who report that they were harmed. (The former ought, however, to be given the option of hearing from us, „We will listen to you and believe that you suffer and will try to help you without requiring you to accept a psychiatric label.“). And this would lead to a national conversation about how to prevent the harm and still provide help and support for those who suffer. (Many such ways are already known, of course.)

The PLAN T Alliance petitions are:

Boycott the DSM
http://www.change.org/petitions/boycott-the-dsm

and

Call for Congressional Hearings About Psychiatric Diagnosis
http://www.change.org/petitions/everyone-who-cares-about-the-harm…

Another kind of action, one in which anyone can take part in various ways, is MindFreedom International’s „5/5 Against DSM-5,“ a protest that will take place in and around May 5, 2012, in Philadelphia, when the American Psychiatric Association will vote on whether to accept the proposed contents of DSM-5 and send it to press. MFI will have space near the convention for people to assemble to make speeches, do performances, and there will be events right in front of the convention area itself. Information will increasingly appear on the MFI website at http://mindfreedom.org/

My own view, first expressed in 1995 in They Say You’re Crazy, has long been that lawsuits would potentially be the most effective way to stop the harm from psychiatric diagnosis. In a later essay, I may write further about this.

In the meantime, it remains to be seen whether the APA divisions‘ petition or the abovedescribed kinds of action will be effective, but not to act is to be complicit with the destruction of people’s liberty, health, and peace of mind through psychiatric diagnosis.

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PSYCHIATRIE HALL

Dem Gedenken einen Ort…

Eines der Ergebnisse der Geschichtsaufarbeitung soll ein „Forschungs-, Lern- und Gedenkort“ sein

„Psychiatrie HALL: Dem Gedenken einen Ort, der Auseinandersetzung einen Raum, dem Lernen einen Platz…“

Innsbruck – Im Landeskrankenhaus in Hall in Tirol soll ein „Forschungs-, Lern- und Gedenkort“ über die Geschichte der seit 1830 bestehenden psychiatrischen Einrichtung und der Psychiatriegeschichte im historischen Raum Tirol – Südtirol allgemein entstehen. Damit solle eine „nachhaltige Infrastruktur“ geschaffen werden, die sich unter anderem mit den im heurigen Jahr aus einem Gräberfeld exhumierten 228 Opfern eines möglichen NS-Euthanasieprogrammes befasse, erklärte Wolfgang Markl, kaufmännischer Direktor des Landeskrankenhauses, am Montag bei einer Pressekonferenz in Innsbruck.

Man greife damit ein Konzept auf, das von WissenschafterInnen der Universität Innsbruck im Rahmen eines dreijährigen sogenannten Interreg-IV-Projektes und in Zusammenarbeit mit dem Südtiroler Landesarchiv entwickelt wurde. Im Zuge dessen habe man beispielsweise auch das „Herauspsychiatrisieren“ von erkrankten Kindern aus Südtiroler Familien und die darausfolgende „massenweise Umsiedelung“ nach Süddeutschland und Hall während der NS-Zeit erstmals aufarbeiten können, berichteten die Verantwortlichen.

Entstigmatisierung

„Der Gedenkort ist ein Meilenstein zur Entstigmatisierung psychischer Erkrankungen und zum transparenten Umgang mit der Vergangenheit“, meinte Markl. Dort wolle man unter anderem Ausstellungen organisieren und Führungen für Schulen durchführen. „Das bereits bestehende historische Archiv des Psychiatrischen Krankenhauses soll dabei erweitert werden und zudem neue Quellen wie etwa Zeitzeugeninterviews erschlossen werden“, ergänzte Michaela Ralser vom Institut für Erziehungswissenschaften der Universität Innsbruck. In vier bis fünf Jahren solle der Lern- und Gedenkort im Haus 1 des Psychiatrischen Krankenhauses des Landes Tirol umgesetzt sein.

Fünf Projekt-Ergebnisse

Neben dem Konzept für den Gedenkort seien aus dem Interreg-Projekt in interdisziplinärer Zusammenarbeit eine bereits gestartete Wanderausstellung, ein Buch über die „Psychiatrischen Landschaften“ im historischen Tirol seit 1830, ein Lehr- und Lernfilm sowie ein Online-Archiv und -Themenportal hervorgegangen. Die bereits 2009 präsentierte Website dokumentiert Materialien wie Bilder, Quellen und Tabellen und stellt sie der Öffentlichkeit zur Verfügung.

Die zweisprachige Wanderausstellung „Ich lasse mich nicht länger für einen Narren halten“, die von Lisa Noggler-Gürtler und Celia Di Pauli kuratiert wurde, rückt in ihrer Darstellung die PatientInnen in den Mittelpunkt. Ausgehend von den Krankenakten und Fallgeschichten berichtet die Ausstellung von medizinischer Behandlung ebenso wie vom Alltagsleben in der Psychiatrie. Die Ausstellung ist noch bis zum 29. Februar 2012 im Zentrum für Alte Kulturen der Universität Innsbruck zu sehen.

Hintergrund

Der Ausgangspunkt für das groß angelegte Projekt war der Mangel an Wissen und das fehlende Bewusstsein hinsichtlich der Geschichte der Psychiatrie in der Region. Von den wissenschaftlichen Ergebnissen sollen in erster Linie die Menschen in der Region profitieren, so das Ziel der InitiatorInnen des Projekts. Die Menschen sollen die Möglichkeit erhalten, sich über dieses wichtige Stück Geschichte aufzuklären und nicht zuletzt: sie sollen einen Ort erhalten, ihrer zu gedenken. „Das Bedürfnis der Bevölkerung, mehr über die Geschichte der Psychiatrie zu erfahren, ist beträchtlich. Das haben wir im Laufe der dreijährigen Projektarbeit beobachtet“, erläuterte Elisabeth Dietrich-Daum vom Institut für Geschichtswissenschaften und Europäische Ethnologie. (APA/red)

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