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Generation Rx Grows Up: A Response to Judith Warner

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We've Got Issues, Judith Warner's new book about children, parents and psychiatric medication, gets one big thing right in three little words. Americans have definitely got issues when it comes to understanding and dealing with childhood mental illness. As Warner persuasively argues, our default position -- railing against medication as a quick fix for bad behavior or lazy parenting -- results more often from our own insecurities and anxieties than from real concern for the parents and children involved.

I have spent a third of my 26 years on these much-maligned drugs and have devoted the past year to interviewing my Generation Rx peers for a book about growing up on psychiatric medications. Based on my own experience and dozens of interviews, I can confidently attest that the drugs are anything but a quick fix for the young people who take them. Rather, they are complicated and imperfect remedies that raise perhaps as many issues as they resolve.

In deconstructing the "overmedicated kids" storyline, Warner has taken an important first step toward reframing the debate. But we need to go further in our reassessment of kids and medication. Increasingly, doctors prescribe psychotropic drugs -- even ADHD treatments, like Adderall -- as maintenance medications, treatments for chronic conditions that may well last a lifetime. As such, we need to take a much closer look at how different meds affect kids over time.

Unfortunately, most of the discussion is stuck in the here-and-now. Scientific research on long-term safety and efficacy remains woefully inconclusive. Children's clinical treatment, if they get it at all, is usually split between a rapidly shifting combination of caregivers. Few doctors, therapists or social workers even have time to monitor adequately their young patients' current treatment, let alone encourage them to reflect on the shifting nature of their relationships with medication.

Yet, a wealth of information about children's long-term psychopharmacological treatment is readily available. The first generation of "overmedicated kids" -- the people who were children and teens when prescribing took off in the 1990s -- have now reached adulthood.

Like me, they have spent their formative years coming to terms not only with their conditions, but also with their treatment. They are real-world case studies of long-term medication use from a young age, about what happens when "overmedicated kids" transition into college, romantic relationships, careers, and, eventually, raise children of their own.

The young adults I have interviewed -- even those whose parents or doctors pushed treatment on them as young children -- have presented more varied and more subtle accounts of their experiences than you might assume, given the tenor of the current debate. That is, they weren't just passive receptacles for psychopharmaceuticals. Nor were they "drugged" into some never-ending state of unthinking acceptance or comfortable numbness. Ten or fifteen or twenty years into their relationship with medication, they have had plenty of time to consider the drugs' potential impacts on their day-to-day lives and long-term development.

Yet, even among my peers -- the people who spent our school-age years learning about chemical imbalances during TV commercial breaks -- the conversation never goes that deep. Instead, people moralize, almost always in the abstract, about the pitfalls of using medication as a crutch or a quick fix. Or else they talk pityingly about a friend or coworker who's been swimming in pills since childhood, courtesy of pushy parents or a prescription-happy psychopharmacologist.

In conversations like this, who feels like getting into all the messy details and existential quandaries of one's personal experience? I know I don't. If you've been taking pills for a substantial portion of your young life, you have, to a certain extent, embraced a biological model of mental illness. Start talking too much about the developmental and psychological implications of medication use, and it seems like you're capitulating to the naysayers.

Refusing to acknowledge ambiguity, though, doesn't do anyone any good, including, most of all, the current and future generations of young people. If we want to yield some useful insights -- and to understand who we are, where we came from, and where we're headed -- my medicated generation needs to speak up.

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