KIDS AT RISK – MEDICALIZATION OF NON-MEDICAL CONDITIONS PREDICTS HARM
From adult outcomes, we can predict those for kids exposed to medical care for obesity, depression, other mental health issues, and compulsive substance use – increased illness and risk of death
by Clark Miller
Published April 5, 2024
One of the most profound and lasting lessons from my training and education in mental health and psychology has more the feel of an aphorism than clinical model or finding – “Under every dysfunctional behavior is a healthy human drive“, the observation itself underlain by solid, congruent knowledge from developmental, neurobiological, psychological, sociological, developmental and especially evolutionary fields, providing understanding of child (and adult) “mental illness” and associated behaviors like compulsive use of substances for self-soothing, of compulsive behaviors including self-harm, of “tantrums” and “acting out”, of opposition, defiance, and childhood aggression, depression, anxiety, problems with attention and focus, of course PTSD and the broad range of trauma-driven responses.
Those and more “signs and symptoms” in children that are pathologized as mental health conditions, “mental illness”, bad behavior, medical conditions to be treated medically, are nothing of the sort.
They are the natural and healthy, unconscious, compelled attempts of healthy children to cope with environments that are toxic to them, experienced as a threat, in the worst cases traumatizing, at the least inadequate in providing their basic developmental needs for sense of safety, predictability, responsiveness, freedom for growth, respect and unconditional love. In the terminology of the guiding psychodevelopmental theory, for a supported, growing sense of autonomy, competence, and relatedness.
That environment of course is the family, in which parents and/or other responsible, competent, functioning adults provide the modeling of behaviors along with attention and care that support child psychological and emotional growth and resilience, that avoid psychological and emotional injury and deprivation that predictably set kids up for poor coping and self-regulation and associated problems with mood disturbance and self-defeating behaviors including compulsive substance use.
Therein lies the problem, the idealized fiction of healthy American families persistently and increasingly belied by the signs of problems, everywhere – in homes, in schools, in measures of youth trends in mental health, suicidality, self-harm, and compulsive substance use. And in epidemics of obesity – a condition caused by compulsive use of food for soothing, modeled by adults and driven by stressors in the household – and of prediabetes and diabetes.
So, family mistreatment, neglect, and abuse of children sets them up for emotional disturbance, emotional and behavioral dysregulation, compulsive substance use, and worse?
There’s little impetus for families to change and stop the harms to kids when medical professionals offer a pill to fix the problem, like a prescribed amphetamine for the diminished focus and concentration predictable with childhood anxiety or PTSD. No wonder ADHD misdiagnoses and prescriptions are trending. The needed, required alternative is rarely palatable – parents and other family members talking about and changing their behaviors that have been exposing their children to the associated stressors.
Some will remember that it was America’s top medical journal that endorsed the FDA’s “innovative plan” to promote vaping of nicotine to address smoking.
That’s when American Medicine comes to the rescue to medicate a child’s “disease” or disorder, sparing the family from facing uncomfortable, or worse, realities about the real causes of their child’s distress and behaviors. It’s a win-win, for the adults and helpful medical prescriber, but not for the child, whose misprescribed amphetamine, or antidepressant, or sedative is no more the answer than they are for adults, adults whose chronic pain was treated with addictive opioids, adults trapped in lethal substance use crises and dispensed more addictive opioids, adults poisoned by antidepressant medications, all conditions that are entirely non-medical in nature.
Rarely, very rarely, an alternative view appears, buried under the medical/media collusion for consensus, exposing some truths, as here, in a “Second Opinion” piece at MEDPAGETODAY.
After decrying the narrow focus in pediatric and other guidelines on medication use for juvenile overweight and associated risks, Dr. Dennis notes what should be the obvious, that –
My biggest issue with current approaches to “obesity” as a public health problem is the lack of attention to mental health, trauma, weight stigma, eating disorder screening, and social determinants of health. Food is a decent anesthetic for kids who are lacking in basic developmental needs (safety, nurturance, structure, consistency, attention). Food insecurity and the food environment are largely skimmed over in these guidelines. . . .
Any set of practice guidelines for pediatric primary care that fails to fully integrate mental health is at best incomplete.
She adds the question,
What about the mental health impact of telling a 12-year-old child that they have a “disease” because of their body size, and they need to take medication for it.
In very important ways, that mental health impact is predicted to be similar to that of telling youth and adults that their compulsive use of a substance is a disease that can be treated with medication or their depression is a disease, a medical condition requiring use of medications.
To the extent that they believe those lies, they remain exposed to medical care for entirely non-medical conditions, by practitioners entirely out of scope of practice, predicting harm and diversion away from the evidence-based psychological and psychosocial interventions that would otherwise benefit them.
In being deceived about the nature of their conditions, they and their families are trained to be dependent on passive interventions provided to them, at the same time diverted from, robbed of the key factor of motivation and confidence for change that is required to activate health behaviros for improvement.
Trained to rely passively on a medication that will not benefit them, they are robbed of the key factor for overcoming compulisve behaviors and engaging in health behaviors – self-efficacy, the acquired, curative belief, reinforced by self-initiated changes, that they are capable of making the changes needed to regain and protect health.
From a prior post –
Self-efficacy: The Opposite of Helplessness and Powerlessness
Another, complimentary factor strongly supported by extensive research as protective against relapse and required generally for change is self-efficacy, or sense of confidence in one’s own choices, abilities, and effectiveness to make the changes needed to resolve a problem or regain health and safety.
Self-efficacy is developed, reinforced, experienced and strengthened in a process of interaction with skilled therapists over which experiences that include active changes (not passive changes like taking a pill) are experienced as effecting positive changes in the patient’s life and resolution of problems.
That is, a key factor established by research as required to stop and protect against return to problem substance use requires work in therapy over time in order for patients to internalize, own, and self-affirm personal agency and effectiveness, control, in behavioral and other changes that protect against problem substance use.
Medical visits and the sham “treatments” are a barrier to self-efficacy, that is a barrier to healing and wellness. That process is subverted when vulnerable patients are reinforced, by medical visits for a non-medical problem – in the false belief of a passive fix for substance use, a pill.
The trained belief in a non-existent condition “addiction” as a medical condition with medical treatments was predicted, all along, to generate illness, “treatment” failures, ultimately lethal epidemics.
Back to our current post.
Against the warnings and anomalous emergence of truths, the tsunami of media/medical misinformation is relentless and lethal, as deaths due to substance use and mental health epidemics mount.
As here and here at NPR, where experts and science writers lament that more teens and adolescents are not being provided the substitute, addictive opioid Suboxone for problem opioid use, Suboxone established as without benefit and driving the worsening opioid crisis.
And here, where top expert pediatricians lament that until new medications are developed for children, there is not much that can be provided for those at risk of prediabetes.
Our most vulnerable population of all has no voice and is barely seen, unprotected.
“Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.”
– Pierre Bourdieu Outline of a Theory of Practice (1972)
In Bourdieu’s Theory of Practice, heterodoxy is dissent, challenge to what “goes without saying” – the accepted, constructed doxa, “knowledge”, reality, that goes without saying precisely because it “comes without saying”, without real scrutiny, untested, unquestioned. The function of doxa is not knowledge or truth or promotion of the collective good, but to protect and serve the interests of those with the power, the cultural capital, to create it.
