Two-thirds foster care children in Mass on psych drugs_Globe
Psychiatry: Soviet Experience–American Fallacy
Wed, 11 Aug 2004
The Boston Globe reports that 2/3 of children in state care in Massachusetts are being “treated” for mental illness with psychotropic drugs. Marie Parente, a legislator, and parents call for disclosure of “how many children in state care are being given psychotropic drugs, and for government agencies to take a critical look at the procedures for allowing these medicines to be prescribed.” Parente suggested that “the state may be motivated to label children as mentally ill because of the reimbursement checks they receive from the federal government, which compensates Massachusetts for half of all Medicaid expenditures.” (below)
If psychiatry is sometimes regarded as “a mirror of society,” then America is mindlessly heading in the wrong direction, driven by an unproven biochemical theory for mental illness. Inasmuch as psychiatry lacks scientific diagnostic tools, and no proven cures or safe medicines, the skyrocketing prescribing of harmful psychotropic drugs to America’s children can only be classified as child abuse. [1, 2]
Spiraling state Medicaid expenditures for psychotropic drugs are best explained by the drug industry’s inordinate influence on psychiatric practice–not these drugs’ effectiveness.
Dr. Irwin Savodnik, a psychiatrist and philosopher who teaches at UCLA, has studied the shifting winds in psychiatry in the former Soviet Union. He found, that once psychiatrists were freed from Soviet dictatorship in 1992, they shed the straightjacket of “biological determinism.” Today, those psychiatrists are avidly reading Freud in an effort to regain a humanistic perspective of human nature that biological psychiatry had eradicated.
“The great irony,” Dr. Savodnik observes, “is that American psychiatry is moving in exactly the opposite direction. In the past 30 years, the overriding ideology of American psychiatry has shifted to a biological model. Psychopharmacology has become its therapeutic backbone.” Dr. Savodnik points out, that the problem is that “this model doesn’t tolerate free agency. It views psychiatric problems — moral problems, really — as medical ones, just as Soviet psychiatry did.”
“The Soviet example places in bold relief the deficiencies and fallacies of a truncated view of human life…as the Soviet system came undone and its psychiatrists freed themselves from the confines of a strangulating ideology, American psychiatrists have embraced uncritically the same narrow vision. But as the Soviet example demonstrates with distressing clarity, a conception of people as little more than biochemical bundles fails to address those aspects of ourselves that make us human.”
Soviet psychiatry was used primarily as a political tool to control dissident adults: psychotropic drugs were used to punish political dissidents and others the government deemed to be “troublemakers.” American psychiatry is more ambitious than Soviet psychiatry ever was. US psychiatrists collaborate with government agencies by providing a seal of approval for involuntary “treatment” of persons loosely deemed to have a “mental disorder”, or to be unruly. US psychiatrists also collaborate in the formulation of state-sponsored mental health policies–such as, “screening for mental illness”–initiatives which primarily target children. In Illinois, pregnant women are targeted for screening as well.  Psychiatrists serve as experts on pharmaceutical industry sponsored “consensus” panels, issuing practice guidelines that promote the extensive use of psychotropic drugs to control behavior-and to enrich the drug industry.  For these services, the drug industry provides psychiatry with high financial rewards.
The most expansive (and expensive) US mental health initiatives are sure-bet profit enhancers: Leading psychiatrists, primarily from the University of Texas, backed by funding from Eli Lilly, Johnson & Johnson and 9 other major pharmaceutical companies, formulated the Texas Medication Algorithm Project (TMAP).  TMAP is a template for physicians, purporting to improve their prescribing practices for antipsychotics, antidepressants, mood stabilizers, stimulants, anticonvulsants and other psychotropic drugs. TMAP has been endorsed by a dozen or so state mental health agencies, and by President Bush’s New Freedom Commission on Mental Health (NFC). The TMAP algorithm model “is limited to medication strategies,” and TMAP recommendations require the use of the most expensive (profit generating) psychotropic drugs.
For depressed children, TMAP recommends SSRI antidepressants as first line treatment “because of supporting efficacy data” from fluoxetine, paroxetine and sertraline.  This statement is patently false as the scientific evidence refutes it. [6, 7]
NCF recommends mass screening for hidden mental illness–with emphasis on school children.  This dubious initiative is a radical invasion of privacy, leaving no room for individual choice–or the freedom for parents to say no, to psychotropic drugs for their children.  Such mandatory, government-endorsed screening programs contradict the freedoms guaranteed in a democratic society.
If implemented, this “new freedom” initiative establishes a coercive selection policy that opens the door to discrimination and forced treatment with powerful, psychotropic drugs that have caused more harm to children (and adults) than the conditions for which they were prescribed. Children and adults who will be labeled mentally ill on the basis of unreliable, subjective tests (essentially questionnaires), can expect to lose their autonomy as a brigade of mental health providers intrudes on their lives and takes over their decision-making authority. It is insidious because the built-in full employment incentive for the mental health service industry-including psychiatrists, psychologists and social workers-is dependent upon taking away freedom from those declared “mentally ill.”
Inasmuch as drugs are the backbone of psychiatric treatment in the US, screening for mental illness is a strategy that will increase drug sales. The TMAP psychotropic drug guidelines promote the increased use of particular antidepressants and antipsychotics–even as the evidence raises doubts about these drugs’ safety and therapeutic efficacy.
Ironically, the failed Soviet approach of using psychotropic drugs to subdue political critics, is now being applied en masse in America–vulnerable children are especially targeted. Just as Soviet psychiatrists disregarded the harm done to patients, American psychiatrists who embrace the same dehumanizing biological approach disregard known and foreseeable adverse consequences. American psychiatry (and the mental health industry) has an added motivation that the Soviets lacked; namely, a financial stake in the profitability of the pharmaceutical industry.
A Whistleblower Report by Allen Jones, the fired Investigator in the Office of the Inspector General (PA), documents the pharmaceutical/political alliance that led to the dubious recommendations of TMAP and NFC: http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf
An editorial in Psychiatric News confirms Allen Jones’ allegations that TMAP is a pharmaceutical industry funded model. It helps explain why TMAP is biased toward the most expensive drugs and why state Medicaid budgets are being depleted by TMAP recommended drugs:
“TMAP received a total of $285,000 from 11 pharmaceutical companies for start-up of the project. In the development of the guidelines for depression, schizophrenia, bipolar disorder, ADHD, and pediatric depression, TMAP to date has spent more than $6 million. The list of funding sources is long.” 
1. Prozac Found In System Of CYA [California Youth Authority] Teens Found Dead – Drugs forced on children without parental permission. Feb. 26, 2004 http://www.thekcrachannel.com/news/2878886/detail.html;
2. Lawsuit: State fired shrink for exposing abuse By NICOLE WEISENSEEEGAN. Philadelphia Daily News: http://www.philly.com/mld/dailynews/news/local/9095033.htm; http://www.ahrp.org/infomail/04/07/07.php
3. Florida Medicaid Mental Health Drug Recommendations, FY 2004-2005 http://www.fdhc.state.fl.us/Medicaid/deputy_secretary/recent_presentations/m ental_health_options_021004.pdf
4. IL launches compulsory mental health screening for children and pregnant women Monday, July 19, 2004. http://www.illinoisleader.com/news/newsview.asp?c=17748
5. The Texas Children’s Medication Algorithm Project: Report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. Carroll W. Hughes. Journal of the American Academy of Child and Adolescent Psychiatry Nov, 1999.
6. Jon N Jureidini, Christopher J Doecke, Peter R Mansfield, Michelle M Haby, David B Menkes, Anne L Tonkin, Efficacy and safety of antidepressants for children and Adolescents, British Medical Journal, online free at: http://bmj.bmjjournals.com/cgi/content/full/328/7444/879?
7. Craig J Whittington, Tim Kendall, Peter Fonagy, David Cottrell, Andrew Cotgrove, Ellen Boddington. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. The Lancet. Volume 363, Number 9418, April 24, 2004, online free at: http://www.thelancet.com/journal/journal.isa
8. Bush Plans to Screen Whole US Population for Mental Illness by Jeanne Lenzer – BMJ 2004;328:1458 (19 June) http://bmj.bmjjournals.com/cgi/content/full/328/7454/1458
9. Putting Clinical Trial Results in Perspective. Psychiatric News August 6, 2004 Volume 39 Number 15, p.35.
Contact: Vera Hassner Sharav
THE BOSTON GLOBE
Prevalence of drugs for DSS wards questioned
By Jessica E. Vascellaro, Globe Correspondent
August 9, 2004
A lawmaker and some parents are calling on the Commonwealth to disclose how many children in state care are being given psychotropic drugs, and for government agencies to take a critical look at the procedures for allowing these medicines to be prescribed. They cite what they call an alarming statistic about the number of children in the care of the state Department of Social Services who are being treated for mental illness.
Figures from the Massachusetts Behavioral Health Partnership, an organization contracted by DSS to coordinate mental health coverage for children in foster care, guardianship programs, and some adoption cases, show that almost two-thirds of children in DSS care received either inpatient or outpatient mental health counseling or treatment during the 2003 fiscal year.
According to the data, the partnership provided 12,722 of 19,856 DSS children with mental health counseling or treatment. The organization says it does not keep track of how many children are prescribed psychotropic medicines such as Ritalin, Adderall, and Prozac. “We need to look into the use of these drugs on children,” said state Representative Marie Parente, chairwoman of the state special committee on foster care. “We need a commission to examine the whole practice of administering these psychotropic drugs to children in foster care.”
Parente said the two-thirds percentage demands a closer look because it is inordinately high, compared with the incidence of mental health disorders in the general population. For example, the National Institute of Mental Health estimates that up to 2.5 percent of children and up to 8.3 percent of adolescents in the United States suffer from depression, and 4.1 percent of 9- to 17-year-olds suffer from attention deficit hyperactivity disorder, two of the most common mental illnesses for which the young are treated.
“Many children come from problem homes, but the children are really fine,” said Parente. But Dr. Elizabeth Childs, commissioner of the state’s Department of Mental Health, said the high number of children in state care receiving mental health services is logical, given the children’s tumultuous family histories. “These numbers are absolutely high, but if anything we need a heightened awareness, since these children might have an increased need for mental health services,” she said. “I would rather see that we did intervene with 64 percent of the children than have 50 percent of the children who need access not get it.”
For the past two years, Parente has sponsored state budget amendments that would create a task force to study how many children in state care are prescribed psychotropic drugs. After her latest measure was approved by the House and the Senate, Governor Mitt Romney vetoed the amendment earlier this summer. Richard Powers, spokesman for the state Executive Office of Health and Human Services, said the governor supported an investigation but opposed the creation of a task force. “We don’t oppose the study, but we didn’t think a separate study was necessary,” he said. “We also thought that a study might be expanded beyond the psychotropics to all medications that children in foster care are taking.”
Others say they are skeptical of the state’s current approach. Gail Wilson-Giarratano of Springfield, who adopted her son in 2002, said that Richard, now 12, came out of the state foster care system on more medications than she could count and that she and her husband have been trying to get him off the prescriptions ever since. “He has been on meds for so long that nobody knows why they were issued,” she said. “He has been labeled as having behaviors he doesn’t show.”
Parente also suggested that the state may be motivated to label children as mentally ill because of the reimbursement checks they receive from the federal government, which compensates Massachusetts for half of all Medicaid expenditures.
She said the state files a pre-expenditure report outlining expected costs and each patient’s eligibility for Medicaid and other federal aid. While the state is not reimbursed until it submits a report of services actually provided, Parente said there is a lot of room for the state to fudge numbers and list services that were never delivered. “I am very concerned that they not label these children as having mental health problems in order to receive federal reimbursement,” she said. Powers said that such suggestions are baseless. “DSS does not label children to get more money,” he said, adding that the department depends on the assessment of mental health professionals for medical decisions.
While national statistics on the number of children in state care being treated for mental illness do not exist, a 2004 study by the Chapin Hall Center for Children at the University of Chicago found that only 37 percent of 17-year-old foster children surveyed in Illinois, Iowa, and Wisconsin had received psychological and emotional counseling in the last year and almost one-quarter had been prescribed psychiatric drugs. Those numbers are much lower than the two-thirds figure recorded by the Massachusetts Behavioral Health Partnership. Loretta Kowal, a Massachusetts social worker on DSS’s professional advisory committee, said Massachusetts doctors strongly endorse the use of psychotropic medicines. “We have seen them be successful over and over again,” she said. “There probably is a belief in the Massachusetts community that when all else fails, you try what’s in the cabinet.”
Copyright 2004 The New York Times Company
Technical Central Station
Freeing the Soviet Mind
By Irwin Savodnik
MOSCOW — Psychiatry, sometimes thought to be a mirror of society, has undergone a dramatic transformation in the former Soviet Union that offers an ironic vision of ourselves. From the austere view of man as a Pavlovian organism, the new Russian psychiatrists are reading Freud with a vengeance and retaliating against what one psychiatrist called the “attack on the mind” that the Soviets sustained throughout their tenure.
Psychiatrists here and elsewhere in the former Soviet Union provided nearly univocal views of the changes that have transpired in their profession since 1992. They varied in age, background and ethnicity but they all felt strongly that the decline of the Soviet system was the best thing that had happened to them. Briefly, they were no longer bound by an ideological straight jacket that prevented them from inquiring into the basis of various psychiatric conditions. They were able to buy psychoanalytic books, learn psychoanalysis and other forms of psychotherapy and view their patients as free agents.
The old Soviet psychiatry subscribed to a harsh biological determinism. The psychiatric physician was an absolute authority while the patient’s words mattered little more than raindrops at sea. That the patient might have something to add to the doctor’s assessment of him made little sense since the origin of his difficulties was thought to be a disordered biology that had to be set right. The idea of a person was quaint but irrelevant.
Part of Soviet psychiatry involved the well-known use of psychiatry as an instrument for political ends. Indeed, there were few other ends in the system. The brothers Zhores and Roy Medvedev offer a shocking, though typical, picture of what things were like in the Stalinist era. In the Soviet scheme of things, political dissent was interpreted as a psychiatric disorder, a difficulty in reality testing, which justified confinement in a mental hospital. Such niceties as due process, length of stay and an appeals process meant nothing. In a state where individual freedom was a bourgeois myth, there was no need to respect basic human rights.
Treatment modalities included medications, electroconvulsive therapy, insulin coma therapy and various other so-called “somatic treatments.” These aversive procedures were thought effective against political heresy. I suspect they were. For a psychiatrist to engage in Freud ‘s “talking cure” during the Soviet period would have been a criminal act. The reason: such a treatment presumed the patient was free to make his or her own decisions.
Today in Russia, there are patient protections against involuntary psychiatric hospitalization similar to those in the United States. While some may argue that unwilling confinement is always wrong, such hard-core legislation recognizes the freedom of the individual, which represents a radical change from the pre-Gorbachev era.
The movement from a narrow-minded, highly politicized, biological view of human nature to what we might call a libertarian one says a great deal about the way Russian life has changed. While many people I spoke with were reticent to declare that a revolution — at least in thought – had occurred, none regarded this liberalizing process as routine.
The great irony is that American psychiatry is moving in exactly the opposite direction. For the better part of the 20th century, psychiatry was dominated by psychoanalysis, so much so that in the public eye the two were nearly synonymous. Five-day-a-week-on-the-couch treatment was de rigueur. Psychoanalysts authored most of the prominent textbooks in the field. Gradually, though, psychoanalysis, under attack from some sectors of the intellectual community, perceived as too expensive and unscientific, began to lose its grip on the psychiatric community. Just as political science, history and sociology have strived to emulate the scientific methods of physicists, so too did psychiatry decide to embrace a mainstream biological approach to its subject matter. In the past 30 years, the overriding ideology of American psychiatry has shifted to a biological model. Psychopharmacology has become its therapeutic backbone.
The problem, however, is that this model doesn’t tolerate free agency. It views psychiatric problems — moral problems, really — as medical ones, just as Soviet psychiatry did. It has become more prominent in the courts as the hefty influence of medical diagnoses has replaced the literary-like “assessments” of psychoanalysts. Always, the emphasis is on relieving the individual of moral responsibility. Interpersonal problems, family conflicts, sexual malaise, even shyness, have become medical problems.
So, as the Soviet system came undone and its psychiatrists freed themselves from the confines of a strangulating ideology, American psychiatrists have embraced uncritically the same narrow vision. But as the Soviet example demonstrates with distressing clarity, a conception of people as little more than biochemical bundles fails to address those aspects of ourselves that make us human — the moral and esthetic dimensions of our lives about which chemical equations have little to say.
To be sure, the United States is nothing like the Soviet Union. Nor are we in danger of descending into such darkness. Psychiatry, though, is a leading indicator, a barometer of social practice and political change. The Soviet example places in bold relief the deficiencies and fallacies of a truncated view of human life, one without freedom, without a soul. The metamorphosis of American psychiatry portends the danger of a loss of freedom as we relinquish a sense of ourselves as moral beings. We can’t tolerate such a loss and the lesson of Soviet psychiatry is that we shouldn’t.
Irwin Savodnik is a psychiatrist and philosopher who teaches at UCLA. He has recently completed a book on the nature of consciousness and has written widely on philosophy, psychiatry and politics. His articles have appeared in the Baltimore Sun, the Chicago Tribune, The Jerusalem Post, TCS and other publications.
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