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We've Got Issues: Children and Parents in the Age of Medication
Reviewed by Jerrold F. Rosenbaum, M.D.
Am J Psychiatry 2011;168:214-215. doi:10.1176/appi.ajp.2010.10101511
View Author and Article Information
Boston, Mass.

Book review accepted for publication october 2010

Dr. Rosenbaum has served on the scientific advisory board for MedAvante; he is also a shareholder with MedAvante.

Accepted October , 2010.

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Judith Warner's We've Got Issues: Children and Parents in the Age of Medication weaves three narrative threads together into a potentially important contribution. It is the story of the often silent suffering of parents and children with psychiatric syndromes; it is a story of a society's blindness to that suffering and the convenient antipsychiatry bias that sustains it; but it is powerfully the story of Judith Warner's own journey of discovery and re-education. The title We've Got Issues is her declaration of our society's need to get the facts straight.

Judith Warner, author of Perfect Madness: Motherhood in the Age of Anxiety and other books as well as a New York Times feature writer, set out to publish a definitive volume detailing the overreach of psychiatry into the lives of children and their families, the overdiagnosing, overprescribing, and pathologizing of normal developmental behaviors, which she "knew" to be the case because of how many times she had read articles saying this was so by her journalist colleagues or viewed such stories elsewhere in the media.

She believed a volume documenting these excesses would be a big seller, and she obtained a contract and an advance to write such a book. Because she is honest, open, and thorough, she encountered her own barriers to delivering the contracted manuscript. Along the way to fulfilling that obligation, interviews of parents and caregivers ultimately led her to do something apparently unique among her peers: she actually set out to do comprehensive research to see if her thesis, based on the multiple stories written by her colleagues (e.g., at the New York Times, Wall Street Journal, and elsewhere) was actually true, whether the often repeated and widely believed "narrative" about psychiatry, medications, and children fit with reality. And what she learned turned her completely from her starting position. Early in her book, she sets the record straight about her conversion experience and the embarrassment and shame she now feels about the stance she had been preparing to take:

Armed with her research and personally ascertained case examples, she emerges as a passionate advocate for recognition and treatment of psychiatric disorders. And the story of her journey, from belief to knowledge is a worthy read as she attempts to set the record straight. She goes on to indict the common narrative as follows:

Although not explicitly addressed in her book, Warner indeed must know of the power of some of the groups, agencies, and individuals who are invested in her original beliefs. Sadly, the original book she could not in honesty have written likely would have been the better seller. Indeed, countervailing facts are now said only to strengthen the firmly held false beliefs of others. Warner's conversion will, however, reassure that the effort to educate will at times yield change.

The initial disruption to her original views came from the words of one friend, a parent whose child had "issues," who upon hearing of the original book proposal simply challenged her with, "How do you know that?" At first defensive but ultimately empathic, honest, and thoughtful, she absorbed the challenge and suffered with it, nearly abandoning the book project and deferring it for years until she had done the research herself.

Warner does an excellent job of incorporating intellectual history as it bears on understanding of antipsychiatry themes (e.g., by Sartre, Foucault, Laing, Szasz, and others), epidemiologic data, research literature, interviews with psychiatrists and psychologists, and the voices and stories of parents struggling to offer their children a life as mainstream as possible. She recognized the gulf between the millions who know firsthand the suffering of children with mental health issues and the majority who have either no understanding or misperception of the difference, for example, between sadness and mood disorder. She recognizes that almost all major psychiatric disorders have antecedents or onset in childhood.

Warner dismisses the assertion that these parents are medicating their children in order to get an edge, a leg up in the competitive world, as opposed to just praying that their kids could function at all and have a chance at reasonable emotional and intellectual development. She disabuses the reader of the notion that parents were eager to medicate their children, since almost all were fearful, worried, and viewed drugs as a last resort. Her appeal ultimately is for greater recognition of these difficulties and far greater access to expert care.

Psychiatrists and psychiatry as a field come in for some of the blame for the antipsychiatry views of our larger society, in large measure because of the perception of their having been in league with pharmaceutical companies, that is, ironically, the developers and marketers of some of the treatments the author now respects. Ironically, her view about the "evils" of the pharmaceutical industry derived mainly from believing some of the same sources that so misled her before about children, medications, and psychiatry. With further scrutiny, she may find again a more nuanced story than the common journalistic narrative. Some of her original bias still leaks unwittingly into her writing as she pairs "antipsychotic" with the modifier "powerful," which is commonly found in antipsychiatry writings as code for the brutal force of psychiatry against defenseless patients. If only we had "powerful" therapies!

I forgive her for this small intrusion of the common antipsychiatry narrative, as I forgive her for not naming names of the groups, agencies, and writers who simply continue to restate and reassert an essentially distorted or strategically hostile message that harms those who suffer and those who try to care for them. I strongly urge all colleagues to order this volume. Warner deserves the sales, and maybe then she will be able to continue to use her openness, honesty, and hard work to address other issues relevant to our patients.




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