It was June and we were there for a diagnostic evaluation. We hoped that getting input from a clinical psychiatrist would help us understand our oldest daughter’s recent behaviors — moodiness, irregular sleep pattern, preference towards isolation and detachment, difficulty maintaining personal relationships with peers, lack of interest in her romantic relationships, lack of motivation and interest in future plans (graduation, college), weight gain and using food as coping tool, among others.
We sat in the waiting room distractedly flipping through magazines and glancing at each other. I nursed my nervous tension by channeling the familiar waiting selves I know from decades of visits to dentist and doctor visits and recall visits that hold little weight. I sat with the the ‘no big deal, nothing to worry about’ mantra in my mind that accompanies teeth cleaning and flu shot appointments. In reality, I knew better. No, I have felt that occassional tug of preordination, that jab at the nerve endings that sits next to you as you wait for the MRI, the X-ray, the biopsy or the chart to be interpreted by a “specialist”.
My hope was that whomever we saw with would say, “No worries. Typical teen angst stuff. It’s all good. Get her a summer job and she’ll be fine.” I examined other patients waiting and wondered about the face of mental illness. Everyone was different except for the fact that all the patients held the white form that, I would later learn, accompanied them into their med-check appointments. It was the same one I held in my hand now. I remember thinking,”Answers are a good thing. One way or another.”
We waited for longer that necessary it seemed, half an hour beyond our appointment time. When the psychiatrist brought us to his office, he explained that while he would offer his diagnosis we would not be seeing him again. No, we’d be seeing the equivalent of a Physician’s Assistant. His role in the office was becoming chiefly administrative. “So let’s start,” he said turning to my daughter. “Any trouble sleeping?” What followed was a series of similarly innocuous questions which, in reality, I could answer “yes” to.
While filling out the form we held in the waiting area the psychiatrist occasionally glanced at his computer. His Facebook page was open. In between jotting down answers my daughter gave him, he was Facebook-ing. Finally, he decided she had clinical depression. He showed us a photocopy of some medical journal or another that held brain scans. “If we scanned your daughter’s brain, which we can’t because insurance companies won’t pay for this diagnostic, this is what we would see,” he point to a brain scan in the article which showed parts of the brain darker and parts of it lighter than the “normal” brain right next to it.
“I recommend drug therapy,” he said, “in combination with talk therapy.”
My wife asked, “Do you do talk therapy here?” I know she was thinking that perhaps another therapist, a different viewpoint might get at some of the underlying mess that my daughter’s current therapist wasn’t seeing. Fresh eyes on the problem.
“No,” he said. “We just handle drug therapy maintenance.” My wife also asked about the rates of suicide among teen taking these types of anti-depressants. “I wouldn’t worry,” he said. “Prozac is safe. We’ve been prescribing it for years.” And, with that he stood. We were done. My daughter left with a script to fill and an appointment in roughly a week to see how she was handling the initial dosage. The diagnosis seemed to make sense, it did explain quite a bit. To this day I don’t think we doubt the diagnosis, just the process by which we arrived there. I mean, he was distracted by Facebook! His manner seems perfunctory, and he brushed off my wife’s concerns over use of the medications in teens. Nonetheless, we accepted everything he said and hoped for the best.
Is this really the best approach? Is this the best we can ask for from this system? A number of clinicians have remarked to me well it’s what we have, it is the system that has developed. But is it the best we can hope for?
What if more lay beneath the surface? The rest of our story seems to suggest that there is/was more going on. Something deeper. So how is it that clinicians feel that spending a ridiculously limited period of time with another human being provides them with enough information to render a complete decision about that person’s mental state? And then how do you go from that limited exposure to rendering treatment options that become meaningful and productive in the short and long term?
Next, who knows your child best? The psychiatrist that spends 15 minutes diagnosing? The psychiatrist at the inpatient facility that spends a total of 7 hours over the course of a week “analyzing” her? The hospital staff that oversees group sessions for roughly twice that amount of time? The therapist that has provided treatment for several years but hasn’t really scratched the surface? Or, the parent that has lived with them for 17 years?
Our experiences have led us to people with similar parenting struggles. Our interactions with others through our social media presence has led me conclude that there needs to be reform in the psychiatric industry, and make no mistake it is an industry. According to the CDC:
- 11% of Americans age 12 and over take anti-depressants
- Approximately 6.0% of U.S. adolescents aged 12–19 reported psychotropic drug use in the past month.
- From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%
- Twenty-three percent of women aged 40–59 take antidepressants, more than in any other age-sex group.
- More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
- The use of antidepressants (3.2%) and attention deficit hyperactive disorder (ADHD) drugs (3.2%) was highest, followed by antipsychotics (1.0%); anxiolytics, sedatives, and hypnotics (0.5%); and antimanics (0.2%).
In 2011 the antidepressant Cymbalta had sales in excess of $ 4 billion — that is just one drug. Depression costs employers in the United States roughly $44 billion in lost productivity. In 2003, studies indicated that mental health cost the US over $100 billions dollars. Given the costs associated, I would think that investing more into researching this trend and meaningfully engaging stakeholders — the APA, the patients, the families, the insurance industry — might produce a system that has a “healthier” result for those suffering from mental illnesses such as depression. Tossing medication at the problem cannot be the only solution.
Depression and ADHD are the most common mental health disorders among adolescents. About 4.3% of adolescents aged 12–17 experienced depression in any 2-week period during 2005–2006 (8). Approximately 9.0% of children aged 5–17 had ever been diagnosed with ADHD during 2007–2009 (9). Treatment options other than prescription medication are available for depression, ADHD, and other mental health disorders, including psychosocial treatment and dietary management (10,11).
Number 135, December 2013 (cdc.gov)
Now, I am not suggesting a war on anti-depressants, or mental health professionals. Far from it. What I question is the process by which we diagnose and the conditions under which we medicate. What I question is the efficacy of a system that turns illness, any illness not just depression, into profit.
Scientifically and socially our culture excels at breaking complex things into little parts in an effort to understand them. However, what we don’t excel at is reassembling those parts back into the greater whole and instead the system expends tremendous energy blindly labeling maladies and marketing “cures”. If we were to shift this paradigm of practice and thought to extend beyond a mere “band-aid” approach perhaps we might make progress towards meaningfully addressing these social relationships and their impacts upon individuals.
In collectively choosing not to change we might as well just keep saying “Yes” to drugs.