“He’s hyperactive, doctor. He needs that Ritalin or he’ll have to go into special education.”
“She’s so down I’m frightened she’ll do something to herself. Can’t you give her antidepressants?”
“He’s anxious all the time and he can’t sleep for worrying. I’m sure Valium would calm him down.”
How many times have I heard the demand for pills as an answer to young people’s problems like those above – a young lad with such a low opinion of himself that playing the fool in the classroom was the only way of getting attention. A teenage girl who had been driven to the end of her tether by being bullied physically in school and online at home. And a boy with no idea of how to cope with his anxieties about himself and the world.
Now let me make something clear: I am not against medication itself. I’m a doctor, I have treated many children who needed medication as an adjunct to talking therapy, and I have a recurrent depression myself that has needed both in the past. And I would never blame worried parents for seeking a magic bullet; blame will get us nowhere.
But the vast majority of young people I have seen over the years have had no formal diagnosis and would not have been helped by medication. Their lives had been made miserable by a whole host of factors in the family, in school, in peer group relationships and in the wider community. What they really needed was the chance to explore their problems and to find strategies to deal with them more successfully when they arise in the future.
This is exactly what young people told me they needed; it’s exactly what I offered them in my 30 years of working with them and their parents; and it’s exactly what has most long-term effect. Spend a pound’s worth of help with the young and you’ll save six times as much in individual and social breakdown in adulthood. And if you don’t tackle the underlying issues in childhood, they will be passed on to the next generation, and the next, in a cycle of harm.
So why are more and more doctors reaching for the prescription pad to ease young people’s pain? Why are record amounts of pills being doled out to them in lieu of a deeper and more long-lasting help?
The answer, I think, is that doctors are under enormous pressure, from distraught parents below and managers trying to balance the books above. They want to be seen to be doing something – and quickly. Giving a young person a formal diagnosis and putting them on a course of medication, whether they warrant it or not, might satisfy all their demands.
The alternative is to stick with the young person’s problems and to offer them the chance to tell their story in the time and space it requires for them to find a happier ending. But that may be a long process that does not fit easily into hard-pressed services with limited resources to go round, in which throughput of patients is seen as an indicator of good practice, as if these young people were commodities on a conveyer belt. And it is complex work for which few doctors are trained and for which they feel insufficiently confident in their interests, ability and experience.
But there is something more, and it’s even harder to talk about. Medication lets us all off the hook. If the young person can be said to be suffering from an illness that is curable with a pill, then we cannot be accused of having any part in causing it, as parents, as teachers or as a wider society. The unhappiness of our young people is the price we pay for our unwillingness to look at ourselves, our actions and our responsibility for how they feel.
In other words, young people are being made scapegoats for the wrongs being done to them by adults. Pills have become the panacea for all our ills.
Mike Shooter is a former child psychiatrist. His new book Growing Pains is published by Hodder (£7.99)
