Richard Hogan: Is it right, prescribing heavy medication to teenagers?
Richard Hogan: We generally tend to treat depression at the individual level, with medication such as anti-depressants.
Primum non nocere - first, do no harm. This is the fundamental ethical principle in the Hippocratic Oath taken by doctors before they practice medicine. Over the years, I have really struggled, ethically, with how quick the teenagers I met in my clinic were prescribed heavy medication before they came to see me.
It seemed to me, the majority of teenagers I was meeting were presenting with a rupture in their ecology, family or peer group. A selective serotonin reuptake inhibitor, as far as I could see, wasn’t going to ameliorate an issue in their family, it might numb it but whatever issue they were dealing with would be there waiting for them as soon as the medication wore off. I have often found myself questioning, does the rapid rollout of medication for normative ups and downs of life, do no harm?
I also questioned why was it we were seeing such a surge in the numbers of children presenting with mental health dysphoria. Particularly, when you take into account the fact that we have never had it so good - Financially, longevity, opportunity, equality, war, living conditions, food supply etc are all remarkably better today than any other time in our history to date. So, why has there been such a massive increase in teenage mental health issues?
Interestingly enough, up until the 1990s clinicians and researchers had assumed that children and adolescents did not experience depression. However, recent studies show that adolescent depression has reached almost epidemic proportions in modern society. Research also illuminates a rather interesting fact: depression is far more prevalent in Western cultures, such as the US, Canada, France, Germany and New Zealand than in Eastern cultures, such as Taiwan, Korea, Japan and China. This seems to clearly delineate that depression is a modern health epidemic that is also culture-specific.
Yet, we generally tend to treat it at the individual level, with medication such as anti-depressants. We are moving towards a dystopian society where our children are consuming heavy psychotropic drugs to manage the normative strains of life. As parents, we have to ensure that we protect our children from this phenomenon. A lot of money goes into defending the individual approach.
It is almost impossible to traverse the floor of any reputable bookshop without encountering a plethora of self–help books on depression. Pharmaceutical companies have developed a Trillion Dollar industry pushing their products on a thriving market. Tablets are designed, not to make us well, but to make us better! Coupled with this trend, I think the mental health promotion in schools has, in some ways, endorsed mental health issues in our children.
The mental health industry currently reminds me of the diet industry of the 90s. That was a huge industry, often populated with charlatans or people giving advice without any insight or training, and as history illustrates caused harm. In schools currently, the message is, ‘it’s okay not to be okay’.
This is a nice message as it attempts to take the stigma out of mental health issues. Empirically, has this messaging helped? You’d have to conclude, most certainly not. The rise of self-harm has stunned me over recent years. In most of the conversations I have with teenagers on this issue they all generally delineate that they heard about self-harm through a friend, a talk in school or social media.
So, what does all this mean? Well, I think another message, and a more important one, that is sorely missed in a teenager's world today is, ‘it’s okay to be okay’. I think our teenagers are given the idea that if they do not have a mental health issue they are just normal and average. That is not an attractive identity for a teenager. There is very little positive messaging out there for our teenagers to consume.
As far as I can see, they are surrounded by negative messaging and too much talk about how they are feeling. They are being forced into extreme introspection that is only ever going to lead to a negative conclusion. Teenagers are incredibly suggestive and if all the talk and messages are negative they will come to a negative conclusion about how they feel. Of course, some teenagers need medical intervention and this can be lifesaving in some cases. But in my experience, the majority of teenagers I meet, are suffering with issues with their peers, family or school community.
All the tablets in the world aren’t going to help them to navigate this relational issue. But there is very little money to be made from looking at the wider world of the adolescent when it comes to treating an emotional disturbance. It is very hard to monetise that, and therefore the individual medical model is far more lucrative and gets pushed more and more. Prescribing drugs is a quick fix that can have devastating long-life consequences.
The moment you bring medication into your child’s life you are placing the locus of the issue within the child. In my experience, this is rarely the case. We have to stand in the gap, as parents, and make sure our children receive the appropriate care for the issue they are dealing with.
