Children - The Mental Health Catastrophe

Excerpted from
Home-Alone America: The Hidden Toll of Day Care, Behavioral Drugs and Other Parent Substitutes
By Mary Eberstadt

As with ADD, ADHD, ODD, and OCD, the diagnostic criteria for bipolar disorder, or what used to be called manic depression, have similarly been redesigned. Here, too, the criteria now bear a close resemblance to a list of the more troublesome aspects of children themselves. Bipolar babies, the Juvenile Bipolar Research Foundation reports, may be hard to settle down, overly responsive to sensory stimulation, and suffer from "separation anxiety." As children they may be "hyperactive, inattentive, fidgety, easily frustrated," and prone to tantrums and nightmares. Some may be bossy, others silly; some have "social phobia," while others are "charismatic and risk-taking." Getting up in the morning is hard for these children; their energy seems to increase as the day goes on. As before, the suffering of the children and families who are dealt the inexplicable hand of real mental disorder is not to be minimized. Also as before, however, there is a great deal more to the story of OCDs apparent ascendancy. Merely to read the symptom list is to wonder what child might not qualify for a diagnosis at one time or another.

Then there is the conundrum known as autism. Not so long ago this would have been the preeminent "know-it-when-l-see-it" disorder for its classic and long-identified tragic symptoms: isolation, lack of eye contact, inability to play with others, and the rest. They are terribly and obviously distinct. Today, however, these symptoms are seen as just one extreme of what is called more broadly PDD (pervasive developmental disorders)-an umbrella term for several disorders and syndromes including autistic disorder, Asperger's, and more. At the other end of the spectrum lie a number of behaviors that some people (including many writers and academics, for instance) might find uncomfortably close to home: "lack of desire to interact with peers," "clumsiness," "formality," exhibiting a "pedantic" manner, and more.

It is little wonder, given the scope of symptoms so generalized, that autism, too, has apparently galloped at astonishing speed throughout the child population. In the course of the 1990s, to take the most dramatic example of the many statistics one can choose from, autism was documented by California's developmental services system to have risen 273 percent. Federal education officials report that of some 5 million "special education" children in 1992-93, only 20,000 were considered autistic, and ten years later that number had grown to 120,000. Nor is the United States alone in the autism epidemic. One 1998-99 study of 15.500 children in central England likewise found roughly three times the rates of autism and PDD among its subjects than previous studies had suggested. Like American researchers, the authors are uncertain whether this rise is actually or diagnostically created. In the words of their report, "Whether the higher prevalence rates reported recently arise from a secular increase in the incidence of the disorder or merely reflect a broadening of the concept of PDD together with improved detection and recognition cannot be assessed from these data."

In a literary reflection on the new diagnostic order titled "OCD," Harvard Medical School authority and New Yorker writer Dr. Jerome Groopman offered some interesting insights.29 "More and more children are being diagnosed and medicated every year, and at younger and younger ages." In reflecting on this trend with some scientist friends over dinner, one of whose sons had recently been identified by a teacher as a likely candidate for behavior disorder, Groopman realized something interesting: "This anecdote provoked a startlingly sympathetic response around the table: Most of us, it turned out, identified with the chemist's son." The "symptoms" that had triggered scrutiny in that boy's case, Groopman and his colleagues recognized, were exactly the sorts of behaviors that make scientists in particular excel: perfectionism, spending more time than one is "supposed" to on a task, and checking and rechecking and rechecking work that ought to be finished by now.

Unlike some critics, Groopman does not go on to dismiss the idea that OCD and assorted other disorders have some claim to reality independent of social forces. But his point, like that of this chapter, is to focus not on the hard and obvious cases of juvenile mental problems-the know-it-when-I-see-it ones-but, rather, on the wide swath of other, more ambiguous ones. And what he observes is both obvious and important: that a great deal of what was yesterday judged normal behavior is now pathologized and stigmatized in unprecedented degree. In sum, he wonders: "If my colleagues and I were in school now, would we be considered abnormal?"

There is a way of turning that subjective point on its head that almost never appears in the professional literature, though it should. It is the observation that yesterday's children-which is to say today's adults-enjoyed the luxury of being considered "normal" in ways that today s children increasingly do not. In a famous essay published in 1993, Daniel Patrick Moynihan coined the phrase "defining deviancy down" to explain how behaviors once seen as bad or pathological had come to be redefined as normal due to social pressures he outlined in detail. In the case of the juvenile mental problem explosion, as a review of the diagnostic criteria makes clear, just the opposite is going on: We are defining deviancy up so that children who would have been considered normal a quarter century ago are now judged to have intrinsic "brain problems" and are treated accordingly.

And here is where the DSM-IV revisions join a long list of other innovations that have been influenced by our ongoing social experiment in child-adult and child-family separation. The new diagnostic criteria do indeed reflect something real, albeit inadvertently, about the differences between the previous generations of experts, parents, and children and the one in which we now find ourselves. What the innovations of DSM-IV amount to is a medical restatement of what is acceptable juvenile behavior, with every innovation erring in the direction of less tolerance on the part of adults, not more. In that sense they faithfully reflect one psychological fact of the home-alone world: Adults who are not often around children and adolescents find their behavior more problematic and in need of alteration.