Anatomy of an Epidemic (37 page)

The Epidemic Hits America’s Children

SSI Recipients Under 18 Years Old Disabled by Mental Illness, 1987–2007

Prior to 1992, the government’s SSI reports did not break down children recipients into subgroups by age. Source: Social Security Administration reports, 1987–2007.

That is where we stand as a nation today. Twenty years ago, our society began regularly prescribing psychiatric drugs to children and adolescents, and now one out of every fifteen Americans enters adulthood with a “serious mental illness.” That is proof of the most tragic sort that our drug-based paradigm of care is doing a great deal more harm than good. The medicating of children and youth became commonplace only a short time ago, and already it has put millions onto a path of lifelong illness.

There are an endless number of stories of medicated children that can be told, and as I worked on this book, each visit to a place where such children can be found—to a family’s home or to a foster care provider or to a psychiatric hospital—offered at least a brief glimpse of this new society we have created in the past thirty years. There are, of course, many parents who will tell of how their children have been helped by psychiatric drugs, and given the spectrum of outcomes that occur with this paradigm of care, that is undoubtedly true (at least over the short term). But this book is about the epidemic of disabling mental illness that has erupted in our country, and so the stories that follow tell, at best, of ambivalent long-term outcomes, and of how diagnosis and treatment during childhood may lead to a life of disability.

I met the young woman I’ll call Jasmine for only a short time, and even that brief encounter left her visibly agitated.
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Born in 1988, Jasmine resides today in a somewhat dilapidated group home for the severely mentally ill in a suburb of Seattle, and even as her mother and I approached the facility, we could see Jasmine through a window, pacing back and forth. Once we stepped inside, Jasmine took once glance at me and quickly retreated, huddling next to the wall, very much liked a frightened creature of the wild. She wore jeans and a light blue jacket, and she also kept her distance from her mother—Jasmine won’t let anyone hug her now. We drove in two cars to a nearby Dairy Queen, as Jasmine would not have been willing to go if I had been in the car with her, and after we got there, Jasmine stayed in the backseat, staring straight ahead and rocking back and forth. “If she ever speaks again,” her mother says quietly, “she will have quite the story to tell.”

Photos of Jasmine as a young girl are a good place to start her story. Her mother had shown them to me earlier, and they all told of a happy childhood. In one, Jasmine is joyfully lined up next to her two sisters in front of a Disneyland ride; in another, she is showing off a gap-toothed grin; in a third, she is playfully sticking out her tongue. “She was very smart and funny, pretty much the light of our lives,” her mother recalls. “She would be outside playing, riding her bike up and down the street, just like a typical kid. She would even go around to the neighbors and tell them she would sing ‘Row, Row, Row Your Boat’ for fifty cents. She was such a hellion—you can see in these photos how spunky she was.”

All was fine in Jasmine’s life until the summer after fifth grade. Because she still occasionally wet her bed, she was anxious about going away to camp, and so a doctor prescribed a “bed-wetting” pill, which happened to be a tricyclic antidepressant. Very quickly, Jasmine became agitated and hostile, and one afternoon she told her mom: “I’m having all these horrible thoughts. I feel like I’m going to kill people.”

In hindsight, it is easy to see what was happening to Jasmine. Her extreme agitation was a sign that she was suffering from akathisia, a side effect of antidepressants closely linked to suicide and violence. “But nobody ever asked about whether the drug might have triggered the homicidal ideation,” her mother says. “I didn’t learn that imipramine could do that until years later when I went on the Internet.” Instead, Jasmine was referred to a psychiatrist, who diagnosed her with obsessive-compulsive disorder and bipolar illness. He put her on a drug cocktail composed of Zoloft, Luvox, and Zyprexa, and by the time she entered middle school that fall, she was a changed person.

“It was horrible,” her mother says. “She gained over a hundred pounds on Zyprexa, and she is petite, five feet, three inches tall. Kids who knew her from elementary school said, ‘What happened to you?’ Boys began calling her ‘the beast.’ She ended up with no friends, and she would cry and cry, and ask to eat lunch in the principal’s office to stay out of the cafeteria.” Meanwhile, Jasmine’s rages at home continued, and her psychiatrist upped her dosage of Zyprexa so high that her eyes would roll up into her head and get stuck. “It was like she was being tortured. She would lie on her bed and scream, ‘Why is this happening to me?’”

Eventually, after the Zoloft was finally withdrawn, Jasmine stabilized fairly well on a combination of Zyprexa and Depakote. Although she rarely socialized with classmates, she did well academically, and during her first years in high school, she regularly earned A’s and kudos for her photography and artwork. She immersed herself in volunteer work, too, helping out at a humane society, a senior center, and a food bank, her school giving her an “unsung hero” award for this work. She had come to accept that she was bipolar, and even made plans to write a book that would help other teenagers understand it. “She used to tell me, ‘Mom, when I graduate from high school, I am going to stand up and ask, Has anybody ever wondered what happened to me?’ She was so brave.”

Toward the end of her junior year, Jasmine read on the Internet that Zyprexa could cause weight gain, hypoglycemia, and diabetes. She suffered from the first two of those problems, but when she asked her psychiatrist about Zyprexa’s side effects, he dismissed her concerns. Enraged, Jasmine “fired” him, and in June of 2005, she took herself off both medications, stopping them rather abruptly. Ten days after she took a final dose of Zyprexa, she was on an excursion with her mother when she suddenly turned ashen, sweat beading up on her lip. “This is really bad,” she muttered. “Mom, fight for me.”

Jasmine has been more or less lost to the world ever since. By the time they arrived at the hospital, Jasmine was screaming and tearing at her hair. She was deep into a withdrawal psychosis, and doctors began giving her one powerful drug after another, trying to get it to abate. “They put her on eleven medications in thirteen days, which essentially fried her brain,” her mother says. Jasmine began cycling in and out of hospitals, and every time she was discharged home, it ended badly. At times, she was so psychotic that she would call the police to tell them that she was being kidnapped or that men were building bombs in her front yard. On several occasions, she “escaped” from her house and ran screaming into the streets. Another time she kicked and punched her mom; afterward, she ripped a soda can open and slashed at her wrist. “This is the most psychotic person we have ever seen in the history of this ER,” hospital staff told Jasmine’s mom after one such episode.

In late 2006, a doctor put Jasmine on a single antipsychotic, Clozaril, and that led to a brief respite. Although Jasmine rarely spoke, she calmed down and entered a school for disabled children. At night, her mother read to her for hours, seeking to nurture the spark of sanity she now saw in Jasmine. “I also noticed that if I sang to her, like to an Alzheimer’s patient, she would sing back, communicating through singing.” But in early 2007, Jasmine suffered another severe bout of psychosis, which ended with her screaming in the middle of a busy road. “There is no hope for her,” doctors said, and soon Jasmine was placed at the residential facility, where today she passes her days, shying away from contact with other people and, except for an occasional word now and then, mute.

“The doctors tell me she was always going to be schizophrenic,” her mother says. “But no doctor ever asked about this history, about what she was like before she was put on drugs. And you know what’s so hard to accept? We came in for help that summer when she was eleven years old for a minor problem that had nothing to do with psychiatry. In my mind, I can hear her laughing, like she was back then. But her life has been stolen away. We’ve lost her, even though her body remains. I see every minute what I’ve lost.”

Senior year was a good time for Andrew Stevens. Diagnosed with ADHD and put on medication when he was in first grade, he’d had up-and-down times in school until his senior year. But then he took a course in auto mechanics, and bingo, he excelled in a way he never had before. “I’m in the zone,” he explains. “I enjoy it. It doesn’t feel like school.”

On this afternoon, Andrew, who is slight of build and perhaps five feet, six inches tall, looks very much like the skateboarder he is: short-cropped hair, black earring, and wearing a T-shirt, shorts, and tennis shoes splashed with a kaleidoscope of colors. I had met his mother, Ellen, a year earlier, at a conference in Albany, New York, and she had expressed a sentiment that, I thought, neatly summarized the moral aspect of our society’s medicating of youth: “Andrew has been a guinea pig for the medical field,” she’d said.

Very early on, she and her husband had realized that Andrew was different from their other two children. He had speech problems; his behavior seemed eccentric; he had “rage issues.” In first grade, he was so wound up he regularly needed to go into the hallway and bounce on a mini-trampoline in order to refocus. “I remember crying when he was diagnosed with ADHD, and it wasn’t because my kid was labeled,” his mother says. “It was, ‘Thank God, we know something real is going on with him and they know how to help him. It’s not our imagination.’”

Although she and her husband worried about putting Andrew on
Ritalin, doctors and school authorities led her to believe that she would be “remiss as a parent” if she didn’t give him the medication. And at first, “it was like a miracle,” she says. Andrew’s fears abated, he learned to tie his shoes, and his teachers praised his improved behavior. But after a few months, the drug no longer seemed to work so well, and whenever its effects wore off, there would be this “rebound effect.” Andrew would “behave like a wild man, out of control.” A doctor increased his dosage, only then it seemed that Andrew was like a “zombie,” his sense of humor reemerging only when the drug’s effects wore off. Next, Andrew needed to take clonidine in order to fall asleep at night. The drug treatment didn’t really seem to be helping, and so Ritalin gave way to other stimulants, including Adderall, Concerta, and dextroamphetamine. “It was always more drugs,” his mother says.

Meanwhile, Andrew’s success in the classroom fluctuated according to the talents of his teacher. In fourth and fifth grade, he had teachers who knew how to work with him, and he did fairly well. But his sixth-grade teacher was impatient with him, and Andrew’s self-esteem took such a nosedive that his mother homeschooled him the following year. Andrew’s anxieties worsened during this period, and often he would be “hyperfocused,” worrying all the time that his mother might die. He also was notably smaller than his peers, and his parents thought the drugs were probably curbing his growth. “That has been the most frustrating part. I never know what is my son and what is the drug,” his mother says.

Today, her ambivalence about the medications is such that she wishes she could turn back the clock and try a different tack. “My Andrew is not a circle or a square, he is not even a triangle,” she explains. “He is a rhombus trapezoid, and he will never fit into those other molds. And I do think that if we had never put him on medicine, he would have learned many more coping mechanisms, because he would have had to. And we should be able to help kids like Andrew without making them feel so different, without suppressing their appetite, and without worrying about the long-term effects of the drugs—all the things I am sitting here worrying about.”

When Andrew was younger, he was allowed “medication breaks” now and then, and when I ask him what that was like, he
recalls how nice it was to fall asleep without having to take clonidine. Being off meds, he says, “feels less constricted, more free.” Still, he tells me, he is about to graduate from high school, and he has ended up at a good place. He has a girlfriend, he enjoys skateboarding and playing the guitar, and thanks to the auto mechanics class, he now has career plans, as he intends to one day open his own garage. “It’s hard to think back to a time when it could have been different,” he says, shrugging, thinking about his life on medications. “I don’t think there was a right or wrong choice—this is just how it’s been.”