Medicalizing childhood

EVERY TIME another middle-class school becomes the site of yet another deadly shooting spree, there is a rush to find larger social ills to blame. One increasingly popular target is society's failure to address mental illness. But is this just another attempt to find a simple answer to a baffling problem?

Serious mental illness, according to experts and pundits, is rampant among America's children and adolescents, striking as many as one in five before they reach adulthood. Yet, we are told, most of it remains undiagnosed and untreated—all because of antiquated cultural attitudes that stigmatize such afflictions and label sick youngsters as "bad" or weak.

The call for expanded mental health intervention for children is part of a larger campaign directed at all Americans. In 1999, the US Surgeon General's office released a report on mental health which claimed that nearly one in four Americans—22 percent—suffer from a diagnosable mental disorder and lamented that two-thirds of those affected do not seek treatment. If the numbers of sufferers seem staggeringly high, it's because mental illness has been defined down to include narcissism, excessive devotion to work, crankiness, attention-seeking, and the like.

In 1952, the Diagnostic and Statistical Manual of the American Psychiatric Association listed 60 diagnosable disorders; now, it has well over 300. Often, a fuzzy line separates these disorders from ordinary personality traits. One survey determined the prevalence of social phobia (shyness) by asking respondents if they thought they were more nervous than others at social gatherings and if this bothered them. The trouble is, this approach essentially reduces the human condition to a clinical condition, leaving no room for such stodgy notions as character or human spirit—or for deviations from a rather rigid norm of mental health.

According to the Surgeon General's report, grief over the loss of a loved one makes you a candidate for treatment if it lasts more than two months. This evokes shades of Aldous Huxley's dystopia, "Brave New World," where unpleasant emotions are medicated away. The other danger is promoting treatments of dubious value.

As science writer John Horgan argues in his 1999 book, "The Undiscovered Mind: How the Human Brain Defies Replication, Medication, and Explanation," science still knows little about treating mental distress. The field of psychotherapy is rife with quackery (consider "recovered memory therapy," which encouraged thousands to believe falsely they had been sexually abused by parents). Highly touted drugs such as Prozac fail to help as many as half of patients and offer only temporary relief to others.

While some people want to bring more children into the mental health system, others worry that far too many are being steered into it for no good reason. In Horgan's view, "we've already gone too far in medicalizing childhood."

He points out that millions of children are being diagnosed with such conditions as Attention Deficit Hyperactivity Disorder and that children under 18 comprise the fastest-growing market for Prozac and other anti-depressants, even though little is known about these drugs' effects on children.

"Kids need all the love and compassion we can give them, but I don't think putting more of them in the hands of psychiatrists and psychologists is the answer," says Horgan, who has two elementary school-age children. Indeed, those who believe that therapy would prevent school murders and save lives "as surely any vaccine"—as columnist Anna Quindlen has asserted—might ponder an embarrassing fact: The perpetrators of several school shootings that shocked the nation were no strangers to the mental health system.

Kip Kinkel, the Springfield, Ore., teenager who killed his parents and then opened fire on his classmates; Mitchell Johnson, one of the two shooters in Jonesboro, Ark.; Eric Harris and Dylan Klebold, the Columbine High School killers—all had previously received psychotherapy or psychiatric counseling. Kinkel and Harris had been taking psychotropic medications.

One could argue that the real problem lies in the inadequacy of resources for mental health services, or the societal prejudices that subvert treatment (Quindlen makes much of the fact that Kinkel's father disapproved of his therapy). But one could also admit that mental health treatment is no more of a "vaccine" against school shootings than, say, school prayer. There is no single vaccine against tragedy.

Certainly, there are children and adults who need treatment for mental illness. But in reaching out to troubled kids, we should stress the human bonds and cultural values that make for a meaningful life before we medicalize childhood—and humanity itself.