Do Children Really Need Psychiatric Medication?

What parents really need to know.

Posted Oct 06, 2017

Let me begin by introducing myself. I am not an anti-psychiatrist. I have never thought of myself as such. I am a family therapist in practice since 1987 specializing in children. I was trained and supervised by Jay Haley, arguably one of the greatest family therapists of all time.

I am not skeptical about psychiatry. In graduate school, I was trained by Jarl Dyrud, a respected psychiatrist at the University of Chicago Medical School. I have the greatest respect for Dr. Dyrud. Milton Erickson, the founder of strategic family therapy, was a psychiatrist by training. Not everyone who believes that treating children by methods other than medication is an anti-psychiatrist. 

Let's start with suicide threats. When a five-year-old boy grabs a steak knife out of the dishwasher, holds it to his throat and says "I am going to kill myself," psychiatry and family therapy have two different ways of approaching this situation. A psychiatrist might think this child has a mental disorder called "depression." A family therapist, on the other hand, asks herself,"What is it in this child's social or family environment that is stressing him to this point?" The family therapist looks at he child's whole life situation, not just at symptoms that might indicate depression. 

Talking with this boy and his parents, the therapist learns that his parents have been heatedly arguing for several months and have even threatened divorce. The child tells the therapist privately that he is worried about his parents arguing so much. He is scared that they will separate. He worries that his father yells at his mother.

The therapist then addresses the family problem and solves it. After a few weeks the child is back to normal. No medications needed. I have had hundreds of cases like this one (this was an actual case), and when I address the problem or problems in the family system, the child returns to his normal self. 

Children with "serious emotional problems" have these problems for a reason-—and the reason (or reasons) is/are most often in the child's family or social context. But discovering causes is a lot more difficult than counting up symptoms and medicating them away.

Are the child's parents arguing? Is the child being abused or molested? Does the child witness domestic violence? Is the child being bullied or harassed at school or on the way to/from school? Is one of the child's parents ill or injured? Is the child living in poverty? Is the child playing video games or watching inappropriate TV programs for 4-6 hours a day? Is the child the youngest in his classroom and not socially mature enough for the grade level? Is the child's teacher picking on him? These are the most common causes for a child's "serious emotional problems."

I would argue that "complex mental health issues" can be traced to causes in the child's social environment. No consensual medical research has unearthed biochemical or genetic causes for emotional issues. If the mental health professional (whether psychiatrist, pediatrician or family therapist) gets to the root causes of the the issues and resolves them, the child gets better. Even the lowest effective dose of medication is unnecessary. Unfortunately, psychiatrists are no longer trained in family therapy (they used to be), which has highly effective methods for getting kids back on track without medication.

Recently a pediatrician called me and asked me to evaluate a five-year-old girl whose parents were requesting an antidepressant medication for her. This girl was the saddest child I had ever met. She was sad because she had been sexually abused by her uncle without her parents' knowledge. This child needed treatment with play therapy, family therapy and for her uncle to apologize to her and her parents. She did not need antidepressants to cover up the real problem. Fortunately, the pediatrician agreed.

I agree that lifestyle remedies can work and that often they are not enough. Reducing sugar, artificial food coloring and preservatives, and gluten can help a child calm down. So can adding Omega-3 fatty acids to a child's diet. A Mediterranean and low-carbohydrate diet can also help reduce symptoms of what psychiatrists call "ADHD." But if a child is being molested or exposed to other toxic stress, nutritional interventions are not sufficient. The toxic social stressors must be removed as well.

Certainly what is called mental illness can be fatal. But so can psychiatric medications. A four-year-old Massachusetts girl named Rebecca Riley died from taking a "cocktail" of three psychiatric medications. Her parents were convicted of murder, but her psychiatrist was negligent as well. Where's the common sense in psychiatry? What doctor in her right mind would give a three year old anti psychotics and stimulants? And studies show that adolescents taking anti depressants have a higher risk of suicide than teens who don't take them.

I cannot agree more that a good doctor should monitor for side effects. But I have seen children treated with psychiatric medications for too many years to know that doctors do not monitor carefully enough for side effects. And sometimes they simply add more medications to treat the "new" symptoms that are actually side effects of the medication the child is taking. 

Psychiatrists have been saying since the 1980's that if a child has "ADHD" he has to take stimulants for the rest of his life. The analogy doctors like to use is diabetes. They argue that just as the type 1 diabetic must take insulin for his whole life, so a child with ADHD must take stimulants permanently (presumably because of a deficit of stimulants in his blood.)

Are children in America today over medicated with psychiatric medication? You bet they are. Just compare the rates of child medication in the United States and in other advanced countries. Europe has a long tradition of psychotherapy and family therapy. The biological model of mental illness is a distrusted parvenue. As I point out in "Why French Kids don't have ADHD," European psychiatrists look to a child's whole life context—family, school, friends—before reaching for their prescription pads. 

The opposite of irresponsible psychiatry is not anti-psychiatry. It is a safe effective treatment like family therapy. Family therapists do not deny that mental illness exists. However, they believe that it is best treated by treating the cause, not merely the symptoms.