The Controversial Power of Child Psychiatry

This year’s Mental Health Awareness Week has an unconventional backdrop. Humans are social creatures; that is a given. Preserving the life of the nation has required us to abandon this instinct and reframe our lives within the proximity of four square walls. 

Being lonely can be as lethal as smoking 15 cigarettes a day, and when isolation is a state policy, we are all suffering. I worry about my 90 year old Nan’s mental well-being. She was brought up in a time where mental health meant mental hospitals, and where memories of war served as a constant reminder that it could be worse. 

Mental Health Awareness Week is here to loosen the hold of this ‘stiff upper lip’ attitude – a repressive norm which has been proven to contribute to the tragic volume of male suicides in the UK. It is a week which is helping to normalise introspection and acceptance of the spectrum of feelings we humans exhibit. It is so important to vocalise struggles, and not ignore problems just because they can’t be seen. 

Yet the growth in psychology, counselling and treatment for mental health problems isn’t welcomed by everyone. 

The anti-psychiatry movement has been promoting a counter narrative against psychiatry for centuries. They were vocal critics of electroconvulsive therapy, lobotomies and the long-term hospitalisation of patients at the hands of ‘arbitrary’ psychiatrists. More recently, they oppose the growth in medicating children, particularly in America.

“Psychiatric diagnoses are getting closer and closer to the boundary of normal. That boundary is very populous,” said Dr Allen Frances, one of the leading psychiatrists in the US. Maybe this explains the growing sentiment that some conditions are being over-diagnosed. For instance, in some schools in Virginia, 28% of boys had been diagnosed with ADHD by the 5th grade. The sudden and rapid growth in ADHD diagnoses was partly due to recognising milder forms of the condition, making it further reaching. The outbreak was so startling that many (incorrectly) perceived it to be linked to the MMR vaccine and boycotted the injection.

Perhaps more worrying is the growth in children being diagnosed with bipolar disorder. The vast majority of psychologists outside of the US don’t even believe this condition to be present in young children. Professor Ian Goodyer of Cambridge University said, “It is an illness that emerges in late adolescence.” Mislabelling children as bipolar poses the obvious risk of unnecessary treatment, and permanently pathologizing behaviour which may be the product of the hormonal turbulence of early years.

Medicating children is controversial, but let’s not forget that the alternative can be worse. Leaving children to struggle with mental health problems in cramped schools can be highly distressing and can’t simply be dismissed as something the child will grow out of. Between 2008 and 2017, there has been a shocking 71% increase in serious psychological distress in 18-25 year olds.

A US nationwide study of ADHD in children found diagnosis rates grew from 6.1% to 10.2% over 20 years. (Source: ABC News)

This is immense. The question is: Why?

Is the growth of social media leading to a detached, narcissistic society, failing to meet our basic needs? Is the education system stifling creative potential and churning out disillusioned young people; jacks of all trades, except how to think for ourselves? Or has the rate of mental health problems remained steady, but awareness of them increased?

Anti-psychiatrists are sceptical. Some suggest it represents an expansion in the boundaries of ‘problematic’ mentalities. Others say pharmaceutical institutions are worrying people into feeling insufficient and abnormal.

Anti-ageing creams are a prime example of these damaging pharmaceutical campaigns in action. As Matt Haig wrote in ‘Notes on a Nervous Planet’, “Clarins and Clinique have produced a ton of anti-ageing creams, yet the people who use them are still going to age – thanks in part to billion dollar marketing campaigns.” The power these companies have in creating widespread insecurities is huge, and, in fact, the foundation of much of the beauty industry.

Commercial drug companies are not purely altruistic either – it can’t be denied that they profit from each diagnosis, and each sale of their drugs.

How far are psychologists acting as a compassionate safeguard against these corporate forces? In 2008, the San Francisco Chronicle wrote that Joseph Biederman, Chief of Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital and professor of psychiatry at Harvard Medical School, had such influence over child psychiatry that ‘when he merely mentions a drug during a presentation, tens of thousands of children, within a year or two will end up taking the drug. This is in absence of a drug trial of any kind’. 

It was later discovered that his unit received funding from Johnson & Johnson, the maker of the anti-psychotic drug Risperdal. Bierderman had promised to try and ‘move forward the commercial goals of J&J’ in a private memo.

Rather than mental health awareness espousing a more tolerant society, some say it is the product of people being less tolerant of those who diverge from the norm, and less accepting of difference. Nonetheless, if psychiatry and counselling can lead people to feel happier, lead to better well-being and greater value in life, surely it isn’t something to oppose?

Mental health awareness has curated a society that is more accepting of different mental states and conditions – being aware of our mental, not just physical health, and supporting others with their own mental battles. This is, undeniably, a positive change, which is benefiting many people.

Yet mental health problems have drastically increased too. This could be a result of the age we live in, or a direct product of the growth in awareness of mental health problems.

One thing is certain: the psychiatry industry is ballooning in size. They must ensure that health is their primary goal, not commercial gains, and rigorous testing must be a precondition for sweeping statements. There is a lot of power stemming from our faith in psychiatry. The Diagnostic and Statistical Manual of Mental Disorders lists every known psychiatric condition and is a bookshelf essential for psychiatrists. It is now in it’s 5th edition, with more entries being added over time. Dr Frances, who chaired the group that created the 4th revision of the DSM, was outspoken in criticising this latest version, saying, “It’s very easy to set off a false epidemic in psychiatry… and we inadvertently contributed to three of them that are ongoing now”.