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ADHD: Attention Deficit Hyperactivity Disorder
Childhood Mental Disorders and Illnesses
Parenting
Child Development and Parenting: Infants
Child Development and Parenting: Early Childhood

by Peter R. Breggin
Perseus Books, 2000
Review by Lara Winner on Oct 16th 2001

Reclaiming Our ChildrenA long-time critic of mainstream psychiatry, and of the recent near-exclusive emphasis on the biological aspects of mental illness in particular, Peter Breggin makes sure his voice is among the many offering post-Columbine recommendations for the future of America's children by writing Reclaiming Our Children: A Healing Plan for a Nation in Crisis. Breggin is particularly disturbed by the focus and recommendations of the first-ever White House Conference on Mental Health, held two months after the Columbine shootings in June 1999. Featuring the biologically-oriented director of the National Institute of Mental Health (NIMH), Steven Hyman, as well as laypersons such as Tipper Gore who agree with his views, the conference, says Breggin, was simply "a public relations event for biological psychiatry and especially for the use of psychiatric drugs to treat all the emotional and behavioral problems of our children-in effect, all of their individual suffering and all of their conflicts with adults."

The new initiatives announced at the conference--$61 million for the NIMH for clinical drug trials involving children as well as a new nationwide program to train schools and communities to identify and get mental health services to troubled children--are also criticized by Breggin as a thinly disguised bonanza for biopsychiatry, a gilt-edged invitation into a huge new market, as well as a renewed governmental blessing for the use of medicine to achieve social control. Continuing work he began in The War Against Children, which focused on federal efforts to isolate a "violence gene" in part by experimenting on inner-city children, and other books, Breggin argues in Reclaiming Our Children against biological reductionism and for a broader psychosocial approach to dealing with troubled and sometimes violent kids.

Instead of viewing violent children as themselves the problem, something he sees as roughly equivalent to blaming the victim, Breggin offers an alternative vision, one that considers the extreme violence of some American children as a cry for help for all of America's children. The Eric Harrises and Kip Kinkels, Breggin argues, are like the canaries in the mine, alerting us to how poor conditions are for all children trying to grow up in contemporary American society. The lure of biopsychiatry is that its emphasis is on individual defects, in this case defects in the child, not on parents who work ever-longer hours, get divorced, or fail to provide consistent discipline or societal-level stressors such as overcrowded schools that value quiet, calm children or racism and poverty or violent entertainment. Ours is a society that is geared toward the needs and pleasures of adults at the expense of our children, Breggin argues; it requires radical restructuring to become child-oriented and child-affirming.

On a more personal level, Breggin contends that his theory empowers parents; even if they are not the source of the problem (although Breggin characterizes many child-behavior problems as conflicts between children and well-meaning but problematic adults, he goes to great lengths to say that not all problems originate with parents), they are the most important part of the solution. Parents should look to make changes in themselves and their families rather than hand all responsibility for helping their children over to medical professionals and pills. This is not an easy solution or one that earns profits for the mental health establishment and drug companies, Breggin acknowledges; it is simply the most effective and ethical one.

The first few chapters of Reclaiming Our Children are devoted to analysis of the Columbine shootings and other school shootings in the year leading up to it in places like Oregon, Mississippi, and Kentucky, and a critical look at the federal government's response. Breggin points out that it has been confirmed that several of the child shooters, including Eric Harris, were already in the mental health system and on psychotropic medications at the time of their respective incidents; the medication status of the other shooters is unknown because their medical records are still sealed for privacy reasons. He notes that not one of the speakers at the White House Conference on Mental Health mentioned that the "identify-and-drug" strategy they were advocating was already at work (or not working, some might say) in several of the school shooting cases. Rather than continue with and expand the status quo, Breggin suggests a new approach. He lists a series of environmental stressors that he claims the biological approach completely ignores: lack of meaningful adult relationships, conflict and divorce between parents, physical and sexual abuse, death of a sibling, violent entertainment, abuse by peers, legal and illegal drugs, guns, and poverty, among others. Only by addressing some of these larger-scale issues, rather than just medicating individual children, Breggin argues, can we truly address the problem of the growing amount of violence perpetrated by children.

The second and perhaps best section of the book lays out Breggin's views on children and the problems they face growing up in modern society. He uses case studies from his own private practice to show how his methodology of convincing adults to change, not drugging children, has been effective in changing the so-called "problem child's" behavior, children biological psychiatry was convinced needed years of drug therapy. He devotes chapters to his concepts of "warrior children" and "critical intelligence." Children are often better at seeing injustice and hypocrisy than the adults around them, Breggin says, and they will sometimes fight to the self-destructive death rather than give in to such perceived injustices. Breggin's approach emphasizes the importance of respect between all parties in human relationships; he treats all parties as capable of rational dialogue, or in the case of very young children at least capable of responding to rationally devised behaviors. Philosophically, his views prioritize narrative, context, the interrelatedness of all humans and the importance of relationships over a reductionism of all mental problems and anguish to biochemical interactions and the fitting of behavior patterns into prefabricated diagnostic molds.

Breggin ends the book by identifying institutions and practices he believes are in need of reform and suggesting appropriate changes. He discusses the potential dangers of psychotropic drugs, including studies suggesting that 4-6% of children being treated with Prozac or similar drugs developed manic symptoms. (For more on this topic, see Breggin's Toxic Psychiatry.) Could some of these manias cross over into violence, the very violence the prescribing of the drugs was meant to prevent, Breggin asks? He cites some cases as examples, including one in which Prozac was blamed by the adult perpetrator's doctor in a mass shooting in 1989 in Kentucky that killed eight and injured twelve more. Breggin also points out that some medications are being routinely prescribed "off-label" to children; in other words, their safety and effectiveness have only been tested in adults.

Appropriately enough for a post-Columbine book, he also addresses contemporary schools and youth culture. He calls for an end to what he calls "school slavery"-hours of homework a night for children as young as second grade and a relentlessly competitive, test-driven environment-and school scapegoating, the adult-sanctioned (or at least tolerated) culture of jocks and nerds, teasing and humiliation that makes kids on the lower end of the social scale feel like they must fight back. He holds some schools, such as Thornton Friends in the Washington, D.C., suburbs, up as examples and distills thirteen principles of a good school, including small class and overall size, the embodiment and teaching of principles (religious or otherwise), emphasis on self-motivation over competition and test scores, and ensuring that every student has a meaningful relationship with at least one teacher. Breggin ends the book by suggesting similar ideals for the improvement of families.

While Breggin has long provided and continues to provide a valuable counterpoint to the drugs-and-biology emphasis of modern mental health research and treatment, he sometimes goes a bit overboard in his attempt to make a point and/or make his nearly lone voice heard. His credibility will suffer among many, for example, when he insists that no child should be given psychotropic drugs. Perhaps most, even the vast majority, can be treated without drugs, but to use universal terms like "all" and "none" is to invite trouble. At the same time, to suggest moving the focus of treatment away from medication is to call for bold changes in today's quick-fix obsessed, managed mental health care world. Also, Breggin occasionally tries to use the same types of evidence that he criticizes others for using. For example, he rejects as speculation the idea differences in brain scans are evidence of abnormal biology in the mentally ill because not enough is known about how the hundreds of chemicals in the brain interact. In the very next paragraph, however, he insists that it is not speculation but fact that psychotropic drugs cause biochemical imbalances by interfering with normal brain function. A hard argument to make, if Breggin is right in claiming that we don't know what "normal" is.

These criticisms are relatively minor, however. In Reclaiming Our Children, Peter Breggin marshals arguments he has been making for years in an attempt to oppose what he sees as a new threat to America's children in the form of the White House Conference on Mental Health. Like many others, he may have seen the post-Columbine mood of the nation as a rare opportunity for positive change, a chance to resist the growing medicalization of all of society's problems. He may have overestimated the moment; even stricter gun controls failed to pass in the wake of the school shootings. One doubts, however, that this will deter Breggin from continuing to fight the good fight for alternatives to individually-oriented, biochemically-based solutions to the social problems of violence and mental illness.

© 2001 Lara Winner

Lara Winner, M.A., is a doctoral candidate in philosophy with a concentration in medical ethics at the University of Tennessee, Knoxville. She is interested in mental health/mental health ethics both because it is a traditionally underserved area of medical ethics and because it can provide valuable insights into the interrelationship of mind, body, and spirit.

This review first appeared online Sept 1, 2001