A recent article in The New York Times dramatically chronicles the quiet mental health pandemic we are undergoing as a society. The last twenty years has seen a drastic rise in the prescribing of psychiatric drugs for teenagers and younger children. These children are receiving not one, but often multiple drugs, sometimes heavy-duty medications, many not approved for use on children, and all without the support of research on long-term side effects.
Why this cavalier attitude toward our young people and their mental health? How did we become so misguided as a society that we lost our way? When did we divorce the child from the family, believing that a child’s well-being was their own responsibility, their own creation? When did we come to believe that a child’s brain was the determinant of their mood, not their family and life circumstance? Why did we forget that families are the most powerful influence on a child, and that by working with the family, we can help the child? Isn’t that common sense? As a family therapist who has worked for many years with families with depressed or anxious adolescents, I, along with many of my family therapy colleagues, have watched in dismay how, over the last twenty years, mental health has been rebranded as a problem of brain chemistry. This framework, suggested by the pseudo-scientific phrase “chemical imbalance”, developed largely as the result of the lucrative alliance between the pharmaceutical industry and academic psychiatry.
I was fortunate enough to train with one of the creators of the family therapy model, Dr. Salvador Minuchin in the mid-1980’s. At this time, much was learned about how powerful family dynamics contribute to distress in children and methods were developed to treat these children in the context of the family. In this way of working, the Family is the patient. What we have learned, what we know, is that children feel deeply the tensions in the dynamic patterns of the family. Their distress is often a response to these disturbances, which they register with their feelings, their mood, their behavior. When we focus only on the child, treating their “symptoms” outside the context of the family, we increase the pain and responsibility that this young person already feels in spades.
Those of us who do therapy with whole families, who treat an adolescent’s emotional disturbance as a part of the larger family landscape, know the relief that the young person feels when they realize they are not “the problem.” If the therapy goes well, parents take responsibility for their contributions to distress in the family and for the child. This occurs with full support of the parents, since any damage they do is often inadvertent and a result of their own emotional wounds. The teen’s symptoms often recede as a result. If psychiatry and the broader psychotherapy community keep the focus on the young person’s brain instead of the family, we will continue to sacrifice these young people on the altar of the psychiatric/pharmaceutical industry. I believe as a society we can do better.