Thursday, February 25, 2010

Should children be medicated to deal with their psychological issues?

In this book review that's probably a more worthwhile read than the book, Alison Gopnik writes:

Within the past few years more and more children have been given powerful brain-altering drugs to deal with a wide range of problems. . . .

You can sympathize with the impulse of parents to do something, anything at all, to help their children. But that doesn't alter the fact that the scientific evidence just isn't clear about what to do. On balance, though, the evidence suggests that we should be conservative about prescribing drugs to children, and much more conservative than we actually are. Even the scientists who advocate some use of drugs acknowledge that they are overprescribed and badly managed. Brains are complex enough, children's developing brains are even more complex, and determining the long-term effects of drugs that alter those brains is especially difficult. Children are different from adults, often in radical ways, and many childhood problems resolve just as part of development.

On top of that, each generation of doctors discovers that the last generation was disastrously misguided in its medical interventions, from lobotomies to estrogen replacement, at the same time that they assure the patients that this time is different.
I'm also glad to see that the review highlights the importance of compatible "levels of description":
[Judith] Warner's book [We've Got Issues] also reflects a common confusion in popular writing about psychology. She writes as if there are just two kinds of explanations for human behavior. Either the everyday narratives are right—so that children are unhappy because their parents don't care about them, or they fail at school because they are lazy. Or else the right answer is that the children's problems are the result of "something in their brains." Warner's logic seems to be that since the parents do care about their kids, the problem must be in the children's brains and therefore drugs will fix it.

But everything about human beings, cultural or individual, innate or learned, is in our brains. Loss and humiliation change our serotonin levels, education transforms our brain connections, social support affects our cortisol. Neurological and psychological and social processes are inextricable. The work of psychological science is to identify causes at many levels of description—social, cultural, individual, and neurological.
There was a very insightful blog post (on Psychology Today's website) that makes a similar point about evolutionary psychology: "Is it evolutionary, or is it . . . ?" (That post speaks of "levels of causation," which is the same thing as the "levels of description" in the above block quote.) I've also blogged this concept before: "Can you give a neurological or evolutionary explanation of love without debunking the whole idea of love?"

By the way, that book review has several points that could be added to my list of ways blogs are better than books. The bias in favor of conclusions that come from riveting stories is huge.


Jason (the commenter) said...

Doing something horribly wrong to your children seem to be a natural part of child rearing. Today we use drugs, generations ago they used Freud, generations before that they'd farm their children out to nursemaids who raised them on pap, and generations before that they'd bind them in cloth, hang them from a nail, and come back from working in the fields to see that they'd been eaten by the pigs.

Humanity has survived it all. I think people worry too much about children, to the point of sounding like nuts. Children are a lot more resilient than most give them credit for. And even if you do raise them perfectly, there's still a pretty good chance they'll end up resenting and hating you anyway.