My Fault, Really?

Arnold Solof, MD

I was listening to a politician commenting on the recent mass shooting in  Marjory Stoneman Douglas High School in Parkland, Florida.  He stated that we are medicating our children too much with drugs for ADHD and depression, implying that is was an underlying cause of the outbreak of mass shootings.

I’m thinking, “what planet does he live on?” Unless you are a recluse living away from civilization, deep in the woods, or up in a mountainous, snowy wasteland, you are living with people.  There is no shortage of “messed up” people on our planet.  I sometimes wonder whether overpopulation is underlying what seems to be a progressive underlying erosion of the moral fabric of our society.

Nikolas Jacob Cruz, was a 19-year-old former student at the school.  State investigators reported Cruz had depression, autism, and attention deficit hyperactivity disorder.

As a pediatrician, I take care of children of all ages.  Many of them exhibit “issues”/”problems” right from birth.  Sometimes they become apparent later in infancy or early childhood.  But, I can assure you there is a significant proportion of our population which has problems with mental issues.  The common ones are ADHD (Attention Deficit Disorder) and Mood Disorders such as Depression and Anxiety.  There is a smaller group who suffer from even more severe problems such as Conduct Disorder & Psychosis (eg. Schizophrenia).

There is a severe shortage of quality, available resources to treat people with these problems.  There are just too many people affected, overwhelming the system.  So, as a pediatrician, all but the most severe cases tend to get left to me.

So, what do I do?  Do I say “It’s out of my area of expertise” and refuse to treat them?  Or, do I learn the basics and offer the standard available treatments within the scope of my practice in a “best effort” to help them with their problems.

If you look at the available treatment options, by far the most effective and the ones with the “most bang for the buck” are medications.  Commonly stimulants (eg. methamphetamine/amphetamine) for ADHD and SSRIs (eg. Prozac, Zoloft, etc.) for depression).

When I think of the quantity of psychoactive drugs I prescribe I feel like a drug pusher.  I hate it when I look at it globally.  But, when I am treating an individual child or adolescent and I consider his/her options, I frequently come to a different conclusion.  If, by treating with meds, I can greatly improve the child’s learning and success in school and life; if I can improve his/her mood so as to not feel chronically depressed and suicidal; if I can improve his/her ability to interact socially with other people and successfully integrate into society, should I decline to do so because I am contributing to the proportion of children who are medicated?

Now repeat this situation patient after patient, day by day, year after year, and what have I done.  So, yes, I am guilty.  Guilty of having contributed to the number of children medicated.

These children are not medicated (or at least should not be) for frivolous reasons.  The fact that such a high proportion of our population have issues/problems that can benefit from the use of mental health treatments does in no way imply that those treatments are the cause the children’s problems or are responsible for the acts of dysfunctional people.

What to do?

Instead of blaming people attempting to do something about the lack of available mental health resources in our country we should be figuring out ways to make those resources better and more available.