Standing in Line

When my daughter Laural started school, a friend of mine asked what she was learning. After a moment, Laural answered, “How to stand in line and how to take tests.” There you have it: social order and stability are the foundation of education—which should make us ponder the relationship between education and learning.

That memory was stirred when I read an article in the New York Times titled “Drugs Used for Psychotics Go to Youths in Foster Care.” Based on a study published in the journal Pediatrics, children in foster care are given psychiatric medications at twice the rate of other children. In absolute terms, the number treated this way is about 3%—around 15,000 children out of the half million in foster care.

A researcher at Washington University acknowledged that “the psychiatrists who are treating these kids on the front lines are not doing it for the money; there are very low reimbursement rates from Medicaid.” He informs us that there’s “enormous anguish” among the people doing this work because they know that the solutions are psychosocial and not pharmaceutical. Yet nowhere in the article does anyone discuss what might explain the greater use of psychotropic drugs among foster children.

I think the cause is the need to maintain social order and stability.

As I’m sure you’re aware, schools have increasingly worked to suppress disruptive behavior through medication. Counterpunch recently published an article titled “How America’s Shrinks Collude with Drug Industry in Turning America’s Children into Zombies.” Somehow I don’t think I need say much about the perspective from which the article is written nor the conclusions it draws. However, I want to review some of the horrors discussed there.

In 2005, 11 million children were prescribed antidepressants. During the decade of the 1990s, use of drugs like Ritalin for ADHD increased by a factor of 20—at 3 times the rate for boys as for girls. But these are passé. Today’s medication of choice is the antipsychotic—taken by half a million children.

The horror is that the FDA doesn’t require testing of how these drugs affect children. One of the common effects is massive weight gain. Another is symptoms similar to Parkinson’s Disease.

There are three basic forces at work here. The big dog is the pharmaceutical industry. The second is the institutional psychiatric profession that defines what counts as a mental disorder and prescribes the standard of care for those disorders. And third is the administration of schools and Medicaid.

This last point needs a little explanation. It turns out that parents receive more aid if their child has a diagnosis, which is encouraged by the school, which is controlled by the psychiatric profession, which is heavily influenced by the pharmaceutical industry: three quarters of the people responsible for defining mental disorders for the psychiatric profession have ties to the pharmaceutical industry. Ironically, all of these institutions are trying to help.

Although this is all quite awful, I’m struck by how ordinary it all is. After all, most parents don’t drug their children. Most children aren’t disruptive. Most know how to stand in line and take tests. It is for the sake of those stable citizens that something is done to those who are disruptive. And, of course, for those disruptive children themselves who need to be helped in their capacity to stand in line and take tests.

As social beings, we crave stability. We do not like chaos. We actively suppress it. This creates a powerful tailwind for institutions in the business of maintaining social order and stability. On the other hand, we crave the new and better—things which are inherently disruptive. The drugging of children is an example of the balancing act our institutions perform in satisfying those conflicting cravings.

Most cultures have myths of the trickster. In general, the trickster is a troublemaker. He follows his own interests, usually violating taboos and social norms. Trickster is the ultimate in disruptive behavior. He would almost certainly be given antipsychotics.

While people hate him because he ruins things as they are, taking pleasure in his punishments, they also take guilty pleasure in his antics as well as the changes he makes with gifts such fire.

Traditionally, trickster is an outcast, an outsider. Today, tricksters are in charge. We celebrate ambition and change and the new and the better. We celebrate progress.

As I mentioned, there are three driving forces behind the rise in the use of antipsychotics on disruptive children: the pharmaceutical industry, the psychiatric profession, and the administration of Medicaid and schools.

Like all capitalist enterprises, the pharmaceutical industry has at its very heart ambitious people seeking to change things. It’s clear that they set out to change the way psychiatric medications are used on children. I’m sure they don’t think of it as chaos any more than the traditional trickster does, yet chaos it is. It is the engine that has showered us with the new and the better.

The psychiatric and other professions as well as for Medicaid and other institutions of social welfare have followed in the pharmaceutical industry’s wake: progress; change for the better. The trickster is right in the middle of social order and stability.

And it all works. After all, most children and adults don’t exhibit disruptive behavior. Most children and adults know how to stand in line and take tests.

An alternative is almost unimaginable. Almost.