THE BLOG
10/06/2010 12:35 pm ET Updated Nov 17, 2011

Psychiatry and the Media -- a Strange and Strained Relationship

As a practicing child and adolescent psychiatrist for almost 30 years, I cannot believe the major role sensationalism plays in determining what gets published in the popular media about mental illness and its treatment, especially concerning children. Recent examples include the September 2, 2010 New York Times front page article, "Child's Ordeal Reveals Risks of Psychiatric Drugs in Young," the September 8, 2010 piece in the Huffington Post, "Psychotropic Drugs, Our Children and Our Pill-Crazed Society" and the September 23, 2010 Huffington Post's, "Making a Market in Antipsychotic Drugs: An Ironic Tragedy."

Where is the balanced approach to journalism that the public is entitled to expect from a free press? Most people get a substantial amount of their knowledge from what the media chooses to print, and sadly what is disseminated these days is often quite biased. Frequently, it is the off center, brash, highly emotional and clearly outrageous stories and/or the unorthodox physicians or therapists who write them or serve as their sources which make headlines much more than those with more reasonable views and approaches.
 
Recently I had a conversation with someone who had no idea what I do for a living. He explained to me how the doctors and drug companies have a good deal going. He was under the misleading belief that most psychiatrists get money from drug companies when they prescribe medication...the more they prescribe, the more money they make. I suspect many people share this erroneous belief. Not only would this be morally wrong, irresponsible, and reprehensible if it were true, most importantly for the majority of practitioners this is patently false!

For the vast majority of physicians (including psychiatrists) there is no connection between a doctor's choice of medication and drug company money because none ever changes hands. It's clear that the pharmaceutical companies have not always been above board. I was shocked to learn that they actually are able to track the types and number of prescriptions that individual practitioners write. As a physician, I feel that the tabulation of such data is a violation of my privacy and practice. In reality, most psychiatrists are honest, hardworking, caring physicians, who enter their chosen field to help those with mental disturbances.

Psychiatry requires one to spend four years in medical school and then another four to seven years in training. If the motivation for becoming a psychiatrist were financial, a surgical specialty would definitely be more lucrative. Psychiatry is an evolving field that is still too many years behind the rest of medicine, but significant progress is being made. That is the reason why diagnostic labels continue to change and our arsenal of medication to fight mental illness continues to grow. The disorders we treat are not the result of some professionals' overactive imaginations, be they those of the medical or pharmaceutical communities. Psychiatrists are constantly and severely criticized because as yet there doesn't exist the equivalent of a blood sugar level test to demonstrate that depression, like Diabetes Mellitus, is due to a biologic deficiency; however there is enough evidence to demonstrate a variety of biologic changes in those who suffer from clinical depression.

It has been said that people fear what they don't understand. Mental disorders are not a comfortable topic for most people, made even more so by the embellishment of misconceptions, especially those presented by publications in which the public places its trust. The media is too often guilty of perpetuating this anxiety by giving focus to those whose views are more extreme and biased.

I think most of my colleagues would agree that giving an 18 month old a psychiatric medicine as discussed in the New York Times article should be a rare if ever occurrence. The fact that the child had been tried on multiple medications by age three is disturbing. The September 1, 2010 Huffington Post piece by Drs. Ronald Ricker and Venus Nicolino on childhood mental illness and psychiatric medication makes light of what is really a very serious and disturbing reality. But it does make for highly provocative reading.

Statistics gathered by the Department of Health & Human Services indicate that: mental health problems affect one in every five young people at any given time; serious emotional disturbances affect 1 in every 10 young people at any given time; and an estimated two-thirds of all young people with mental health problems are not getting the help they need.

Articles like those mentioned above contribute to this last statistic. One wonders how many lives are becoming increasingly damaged because of parental fear, not infrequently encouraged by articles such as these. It is crucial to understand that mental health intervention for a child isn't, or at least shouldn't be, synonymous with taking medication and I am confident that the majority of my child and adolescent psychiatry colleagues would agree.

The post by Drs. Ricker and Nicolino seems to minimize the potential devastation and biologic roots of childhood onset mental illness. It seems as if they belong to the "All you need is love" school of child intervention. I thought we as a society and especially as professionals were past the "blame the parents" view of mental disorders. Proper treatment often includes patient and parental education about the illness, some form of talk therapy (e.g. analytic, supportive, or cognitive behavioral therapy etc.), and sometimes medication.

An extremely important aspect of treatment is making the person - adult or child - aware that his or her mental disorder is not their fault but it is also not an excuse for inappropriate behavior. The individual is responsible for his or her own actions.

In his September 23, 2010 Huffington Post article, Dr. Peter Breggin promulgates myths about psychiatry when he states his beliefs that the increase in the number of people diagnosed as bipolar came "from the fertile imagination of drug company sponsored psychiatrists who found bipolar disorder in everything from toddlers with temper tantrums to adults with bursts of energy followed by a natural period of feeling fatigued." If it's seen "in everything" and "natural" then why would anyone call it a disorder?

During my training at Columbia University in the late 1970s (a decade and a half after Dr. Breggin's) I saw only one 11-year-old child who fit the classic description of bipolar disorder. But times have changed and people have changed. Girls are reaching the onset of menstruation at an earlier age; breast cancer is no longer rare in 20-30 year old women; the number of children diagnosed with autism has dramatically increased, etc. Should we say these changes in rates are untrue because they are different than what we observed 30-40 years ago?

Some of the increase in these disorders is due to better and earlier recognition and diagnosis, but that is an incomplete and understandably insufficient explanation. Other factors, many of which are still unknown, come into play here. It is easy to focus on the outliers (i.e. the extremes): the kids and situations for whom almost everyone would question the rationale of the doctor's and the family's decisions. What about all the kids whose problems have been helped so that they are able to have successful childhoods, not to mention the secondary effects of a better functioning family unit due to good and appropriate therapeutic interventions (some of which may have included medication)?

I would strongly recommend the authors of the above-mentioned articles, as well as others who have an interest in learning more about the use of psychiatric medication especially in children, read Judith Warner's, We've Got Issues: Children and Parents in the Age of Medication (Riverhead Books, 2010). She describes her journey from starting out to do an expose about children being victims of overmedication, to becoming much more aware of how many children and families are truly suffering and that most doctors work hard to help improve their patients' situations.

Just as in the rest of medicine -- cardiology, endocrinology, neurology, etc., the field of psychiatry is ever changing and our knowledge base is rapidly expanding. Most psychiatrists want to enrich the lives of their young patients to enable them to have the chance to become the most productive and mentally healthy adults they can be. Not only do I find the media's preferential coverage of sensationalist stories personally offensive, I find them an affront to the hundreds of young people and their parents I have seen over the years who bravely struggle to overcome not just a mental illness, but the stigma still associated with it.