Prudence and the Pill

In his recent National Post article Robert Fulford opines that Erik Erikson’s psychotheory of human development is now passé.

As a therapist, Erikson was particularly attuned to youth and adolescence. He advocated a psychotherapeutic approach to the adolescent in crisis, where a young person was prompted to examine his situation in light of his social context and family history. Ideally, the therapist would then be able to lead the enlightened adolescent back to health.

This approach is no longer viable. Most third party payers don’t sanction psychotherapy—it’s too long, too expensive. Something else happened as well: the culture of youth changed. Along with the rest of us, Erikson could not conceive of a paradigm shift where adolescence would be transformed by Madison Avenue and changing attitudes toward sex and authority—and by prescription drugs.

In three decades of general pediatric practice, I have witnessed this transformation first hand. With the advent of newer widely-available psychotherapeutic medications, pediatric clinicians are assuming the mantel of child psychiatrists. Citing a study published in the Archives of General Psychiatry, a recent New York Times article documents a 40-fold increase in the number of children and adolescents treated for bipolar disorder from 1994 to 2003. Has the incidence of this disorder truly increased, or are clinicians more aggressively applying this diagnosis to children? If the latter, then what is driving factor?

Because treatment of childhood psychiatric conditions now almost always includes medication, the spread of these diagnoses has become a boon to the pharmaceutical industry. Drug makers and company-sponsored psychiatrists encourage clinicians to consider these disorders with the advent of newer, more expensive drugs. The diagnostic label gives doctors and parents a quick way to manage children’s behavioral outbursts in an era when long-term psychotherapy and inpatient care have become outmoded.

The Times article quotes Dr. John March, chief of child and adolescent psychiatry at Duke University School of Medicine: “From a developmental point of view we simply don’t know how accurately we can diagnose bipolar disorder.…The label may or may not reflect reality.”

Erik Erikson’s concept of treating the adolescent identity crisis is dead. Psychotherapy has been supplanted with the pill. Given that psychiatric drugs have few proven benefits in children as well as potentially serious side effects, which therapeutic approach seems more prudent in today’s brave new world?

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