I once ran a therapeutic school in London for kids with complex trauma. Sam was one of our most brilliant and most challenging students. Bright-eyed and freckle-faced, when he first arrived at the school aged 13 he bounded straight up to me and gave me a high-five before running past me up the stairs drumming his hands against the walls and singing out loud. He was funny, loving, cheeky as hell and full of energy. Sam had been diagnosed with ‘ADHD’ when he was younger and had been heavily medicated for many years. Because of his wild energy, he had been kicked out of every other school. We were the last chance saloon.
One day, I was reading through his case notes and discovered something that shocked me. Sam had been given his diagnosis of ‘ADHD’ after neighbours found him crawling on the roof of his house. He was just three years old. Unfortunately, nobody picked up at that time that Sam’s dad was a violent drug dealer, and his mum was a chronic alcoholic. In truth, Sam’s wild energy was a deeply intelligent, resilient response to a horrible situation. If you grew up in that environment, you too would find it hard to sit still and concentrate. You too would want to crawl onto the roof. But the ‘ADHD’ diagnosis and the drugs covered up the intelligence of his ‘symptoms’. Sam grew up thinking there was something deeply wrong with him. He believed his brain was broken.
Imagine going to the dentist with toothache from an infected root and, instead of doing a root canal surgery, the dentist gives you some painkillers and sends you on your not-so-merry way. This is how most child mental health problems are treated today. We focus almost exclusively on surface-level, quick fixes for children’s minds instead of getting to the root of the problem.
Child psychiatrist Sami Timimi has dubbed the rapid growth in child psychiatric diagnoses and the use of drugs to deal with unwanted behaviour or emotions the ‘McDonaldisation’ of children’s mental health. In the past five years, there has been a 40 per cent rise in antidepressants prescribed for children in the UK, while in the US, one in ten children are now diagnosed with ‘ADHD’ and the number of children taking Ritalin (a powerful amphetamine-like drug) is growing all over the world.
Some say that the rise in psychiatric diagnoses is just a sign we are getting better at recognising and treating mental health problems. But the evidence suggests the opposite. Clinical outcomes for treating mental health problems are not getting better, and according to some measures they are getting worse, as I will explore below.
This does not mean that diagnoses are bad. Nor does it mean that taking psychiatric drugs for mental health problems is bad per se. In our current health and education systems, a diagnosis is sometimes the only way a parent can get extra support and funding. I recently spoke with a parent whose two children were thriving, until they got to school. It took this parent several painful years to get her children diagnoses that helped the school adapt to these children, rather than these children feeling stupid and broken because they weren’t easily adapting to their school. And psychiatric drugs can help someone get through a difficult time. But the story behind this approach says that mental health problems are primarily a function of faulty brain chemistry or other problems in our biology or brains.
This is what Sam grew up to believe. This story says the ‘madness’ is to be found within the individual child, excluding the possibility that the ‘madness’ may be better diagnosed in the world the child is born into. With this story, could we be gaslighting a whole generation of kids?
Raising Children In A Mad World
I recently launched a book called How The World Is Making Our Children Mad, And What To Do About It. It is a guide for anyone who is concerned about the state of the world and the impact it is having on our children’s minds. I’ve devoted my whole working life (over 20 years now) to protect vulnerable children from harm. I’ve done this in my child and family psychotherapy practice, working in a psychiatric unit for teenagers, as a child protection social worker, running a therapeutic school and co-founding a charity called Apart of Me that helps children through loss and trauma. I do this work because I believe there is something precious about our children. They carry the seeds of a more beautiful tomorrow.
But these seeds only grow when we provide the right environment for our children and for their minds. We don’t raise children in a vacuum. The causes of the experiences we call mental health problems are complex. But we don’t focus anywhere near enough on the ways in which this mad world affects our children’s minds.
The Chemical Imbalance Lie
You or your child may be on ‘anti-depressant’ drugs, and if you are finding them helpful then I am glad for you. What follows is just one perspective on the history, marketing and efficacy of these drugs. So please take what is helpful and leave what isn’t. I’m sharing this slice of history because I am really worried about the way our children growing up feeling like their brains are broken, instead of thinking that their emotional responses to the world around them might be completely reasonable, intelligent, beautiful even.
In July 2022, a major scientific review was published finding that there was “no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.” Although this study got a lot of national media coverage, the news wasn’t that new. Since the early 2000s, studies have questioned the ‘serotonin imbalance’ theory of depression.
Unfortunately, these studies did little to shift the public narrative. The UCL researchers behind the July 2022 study note that 85% to 90% of the public still believe that depression is caused by low serotonin or a chemical imbalance. Why is the chemical imbalance theory of depression so pervasive, so difficult to shift? To understand this, we need to look into the history of SSRIs, some of the biggest-selling drugs in the history of the pharmaceutical industry.
In 1988, a new “antidepressant” was introduced by the drug company Eli Lilly. This drug was one of the first of a new range of powerful, mind-altering drugs called SSRIs (Selective Serotonin Reuptake Inhibitors). It was marketed as having few side effects, could make patients ‘better than well’ and was sold with the slogan ‘happiness in a blister pack’. The drug was called fluoxetine, and the company gave it the brand name Prozac.
Billions of dollars have since been spent on marketing Prozac and drugs in the same family of SSRIs – and much of that spend has gone on raising awareness of the experiences we call ‘depression’. For example, in the US, Eli Lilly gives a $4 million-a-year ‘educational grant’ to the National Mental Health Association’s Campaign on Clinical Depression. A big part of the marketing of these drugs has been direct-to-consumer materials that drill home the chemical imbalance theory – if you are feeling depressed, you have a chemical imbalance in your brain and this drug will fix that. Have a look at this video for Zoloft (the unbranded name of this drug is sertraline) from 2001.
Through powerful marketing campaigns, SSRIs soon became the leading kind of antidepressant. In the UK, from 1991 to 2018, the number of SSRI prescriptions went from 9 million a year to 70.9 million. And because of the huge commercial success of these pills, drug companies in the US developed child-friendly versions of antidepressant drugs, such as a liquid form of Prozac (think Calpol for happy thoughts).
In 2016, more than 338 million prescriptions were written for ‘anti-depressant’ drugs(( medications)) in the USA for every man, woman, and child in the country. Here in the UK, between 2015 and 2021 prescribing of ‘antidepressants’ to children aged 5–12 years has increased by more than 40%. Is that increase because more children’s brains are broken? The pharmaceutical industry now makes $12.5 billion each year from such pills, and this figure grows year on year. If you stop for a moment to consider these figures, you get a sense of how entrenched the chemical imbalance theory has become – we are conditioned to believe that no matter what our life circumstances, whether we are in a shitty school, working in a shitty job, are in a shitty relationship, or are depressed about the state of humanity, if we feel low or sad or anxious we have a chemical imbalance in our brains and need pills to fix it
Many of my clients question whether their ‘anti-depressants’ are working for them or making them worse. According to some of the latest studies – there is little to no evidence to show that ‘antidepressants’ are any better than a placebo for treating depression. And more recently, evidence has emerged that more than half of people trying to stop taking “antidepressants” experience withdrawal, and half of those describe the withdrawal symptoms as severe. Even the newer SSRIs can increase the risk of suicide (and homicide), with one study published in the British Medical Journal in 2016 showing that children and adolescents have a doubled risk of suicide when taking selective serotonin and serotonin-norepinephrine reuptake inhibitor drugs to combat depression. This doesn’t mean that if you or your child are taking these drugs that you should suddenly stop. But if you are questioning whether the drugs are working or perhaps you are wondering if they may be making you or your child worse, it’s really important you address this with your doctor. Be aware that – in my experience at least – some doctors may be biased in favour of the drugs (we all have biases and blind spots) and may blame something else if you or your child are feeling worse. You need to be the ultimate judge of this.
Despite the billions spent on pills, depression is quickly becoming the biggest health problem in the world, according to the World Health Organization. Compare this to the huge advances made in other areas of medicine. As medical anthropologist James Davies notes in his book Sedated: ‘If in the late 1970s a child had contracted this heart-breaking disease [leukaemia], their chances of survival would have been around 20 per cent. But if a child contracts leukaemia today, their chances of survival are around 80 per cent.’ This means outcomes have improved by over 300 per cent. Impressive rates of improvement can be found across almost every other area of medicine, apart from psychiatry, where ‘not only have clinical outcomes broadly flatlined over the last thirty years, but according to some measures they have actually got worse.’
Based on figures like these, and on the experience of many people I have worked with, it seems that our way of thinking about and treating depression and other mental health problems is not working. The chemical imbalance theory is not true. So what can we do?
The Essential Value of Critical Thinking
The first essential step we need to take as parents and grown-ups who care about children is to think critically about the field we call ‘mental health’.
I work with many parents whose children have received a psychiatric diagnosis and they are not sure if the diagnosis is accurate or not. To understand if a diagnosis is valid, we need to understand what model of truth (in philosophy this is known as our ‘epistemology’) we are using. When a child breaks their leg, a doctor can take an X-Ray to confirm whether the leg is broken, where it is broken, and the doctor can give a rough timeline for how long it will take the leg to heal. In this example, we know what the doctor says is true because they show us the X-Ray. We see the truth with our own eyes. Only extreme flat-earther types would question an X-ray that shows a broken arm.
With psychiatric diagnoses, we can’t ‘see’ depression in the same way we can ‘see’ an X-ray of a broken leg. This does not mean that the suffering associated with these terms isn’t real. Feelings of anxiety, of confusion, of despair can cause great suffering. It does mean that there is a greater level of subjectivity both in how we interpret our inner experience and how the world around us conditions us to interpret those signals.
To give a concrete example, if a teenage boy is still feeling very sad six months after his dad died, is that a normal grief response or is that Prolonged Grief Disorder, one of the new diagnoses added to the latest edition of The Diagnostic and Statistical Manual (DSM)? The DSM is one of the most influential (powerful) books in the world of mental health, the one that has done more to condition our thinking about mental health than any other. It is the bible that defines all psychiatric diagnoses. The first edition of the DSM was published in 1952. It was 145 pages long and contained 106 ‘disorders’. The latest edition of this book is the DSM V. Published in 2013, it is over 1000 pages long and contains 298 ‘disorders’, each one having subcategories that in total add up to over 600 potential diagnoses.
If we apply our critical thinking here, we might ask questions like: why has the book and the number of diagnoses within it grown so much? Is it because we are getting better at recognising ‘mental illness’? If so, why are the outcomes for mental health treatment not getting better? And who are these people deciding – on behalf of the whole world – what is a ‘normal’ response to life events and what is abnormal?
The late psychiatrist Robert Spitzer was a pivotal figure in the development and global growth of this system of psychiatric diagnoses. And even he acknowledged the subjective nature of these diagnoses, saying ‘‘There are only a handful of mental disorders in the DSM known to have a clear biological cause. These are known as the organic disorders [things like epilepsy, Alzheimer’s and Huntington’s disease].’
If there are so few diagnoses that have a clear biological cause, then how do we decide on what is a diagnosable psychiatric disorder and what isn’t? Well, you might be surprised to hear this, but new diagnoses get added to the DSM not by looking under a microscope, but via consensus and voting, In 2013, Thomas Insel, the president of the National Institute for Mental Health (NIMH), the largest funding body for mental health research globally, spoke out about the subjective nature of the DSM, saying it lacked any validity and: “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” So here you have one of the most prominent establishment psychiatrists in the United States confirming that the vast majority of DSM diagnoses are consensus-based and therefore highly subjective. James Davies came to a similar conclusion after interviewing Robert Spitzer about the creation of the DSM: “Mental disorders aren’t…waiting to be discovered, like molecules or bacteria. They are much like the constellations, which are imposed upon the night sky. Sometimes these map-makers draw patterns that make sense, but sometimes they don’t; and sometimes they make mistakes so dramatic that it’s hard to put things right again.”
The real problem is that these consensus-based ‘constellations’ become in our society powerful, viral memes, given a turbo boost by pharmaceutical companies who make profits from our attachment to these labels and the drugs prescribed for them.
Empowerment as an antidote to perverse incentives
It is of course too easy to blame Big Pharma. But there are perverse incentives baked into the whole system. A perverse incentive is one that has an unintended and undesirable result that runs contrary to the intentions of the designers of the system. The classic example of a perverse incentive is the cobra effect, named after a system, installed by the British government in India to try to reduce the number of deadly cobras by offering a bounty for every dead cobra. Although this strategy worked at first, eventually locals began to breed their own cobras for the extra income.
For a more modern perverse incentive, consider the ‘‘Childhood Trauma Test’ that went viral on Tik Tok in May 2022. The tags “trauma test” and “childhood trauma test” have to date 12.7 and 2.1 million views respectively. The company behind the test is “Better Me”, a subscription-based app that provides mental health support. Unsurprisingly, the data collected through this test (which seems to be a big hit amongst young people) is being shared with third parties like Amazon, Google, and Facebook. The perverse incentive here is in convincing you (in this case using a catchy online test) that you have a problem (childhood trauma), and then selling you the solution to the problem they have just told you you have. Of course, some people do have experiences of childhood trauma and recognising the impact of childhood trauma has been a huge step forward for mental health services in general. But the perverse incentive kicks in when companies realise they can make money by producing more cobras. i.e. convincing more people via an online test that they have childhood trauma and need treatment.
This kind of perverse incentive runs across many domains of our everyday lives. And it’s not just ‘capitalism’. I run a mental health charity called Apart of Me, and I can see the perverse incentives lurking in how we talk about and focus on the problem of childhood trauma and loss. To exist, and to raise funds, we need there to be a consistent problem that we are in the best position to fix. Similarly, as a therapist, my income (and even my identity) is to some extent based on people having a problem that I can fix. I would be a fool to say in my initial consultations: ‘I’m really not sure if I can help you or not, but trust me anyway…oh and please pay the invoices on time.’
The way I come to terms with this dilemma in my own practice is by empowering the clients I work with to tune into their own direct experience, especially into their bodies, to feel what works and what doesn’t, what feels true and what doesn’t feel true for them. I frame my work as an experiment, because every human being is different, and there are no guaranteed formulas for what works for one child or another, or one grown-up or another. An experimental attitude, along with space for both critical thinking and embodied reflection about what helps and what doesn’t – these are essential tools for us all as we navigate this post-truth world.
So, coming back to the question which many clients have: how do I know whether a mental health diagnosis is true or not? The answer will always be to a large extent subjective. Accepting the highly subjective nature of this system of psychiatric diagnoses really helps. By accepting this, we are forced back to trust our own experience. I will often say to parents: ‘You know your child better than anyone else.’ And I offer questions that can help them to think critically about the diagnosis they have received for their child, questions like: Has the diagnosis led to successful treatment of a problem? Has it helped you to understand yourself/ your child better? What other explanations are important that are excluded from this diagnosis? What uncomfortable truths might this diagnosis prevent us from seeing? How might the diagnosis get in the way of you fully understanding and relating to your child?
Seeing That Frees
As we begin to loosen the grip of dominant ways of understanding our mental health (such as the chemical imbalance myth), we can begin to open ourselves to different ways of seeing. I love the work of the late Buddhist teacher Rob Burbea, whose book is called Seeing That Frees. In this book, he explains that reality is more subjective than we might realise, and because of this, we have some freedom in how we choose to perceive reality. And, there are some ways of seeing that are more likely to free us from suffering. We should choose ways of ‘seeing that frees’.
This might seem a bit woo-woo to you. But neuroscience experiments have confirmed this to be true. When you ‘see’ something out there in the world, the image that your brain creates is composed mostly of memories and expectations stored in your visual cortex. As neuroscientist David Eagleman explains: ‘You don’t perceive objects as they are, you perceive them as you are.’ When we realise this, we can begin to unravel some of our conditioned ways of perceiving things, and choose ways of seeing that lead to less suffering. Isn’t this ultimately what we all want in the end, a world free from unnecessary suffering?
One way of seeing that I have found really helps to reduce suffering in the clients I work with is to see their ‘symptoms’ as potentially intelligent. What if our so-called ‘symptoms’, and those of our children, might be trying to communicate something vital to us? What if our psychological symptoms are unconscious attempts to heal conflicts in the world around us? In this sense, the ‘world’ means you, your family, and the wider society.
I’m sure you know the phrase ‘canary in the coalmine’. The term came from some high-risk experiments by Professor John Scott Haldane, a Scottish physiologist with a huge, bushy moustache and an interesting approach to parenting. While working at Oxford University, he wanted to find a way to stop miners dying from toxic gases. So he would lock himself in sealed chambers full of potentially lethal gas cocktails to discover their effects. On one occasion, deep underground in a mine filled with toxic gas, he had his young son Jack recite a speech from Shakespeare’s Julius Caesar until Jack’s legs buckled and he fell unconscious. Fortunately for Jack, his dad soon discovered that canaries made much better gas detectors than children. This is how canaries became what’s known as a ‘sentinel species’, warning us of danger.
I believe there is an important way of ‘seeing’ the rise in psychological distress amongst our children that can lead to more freedom from suffering. This way of seeing takes a step back and looks at the bigger picture. You see, it just doesn’t make sense to say that the global rise in psychological distress amongst our children is down to broken brains. Instead, we can choose to see our children as sentinel species. Because they haven’t yet built up strong psychological defences, they are more sensitive than grown-ups to the social pressures and toxic values of the world around them. They are canaries in the coal mine. From this perspective, the rise in psychological distress among our children warns us of impending danger and beckons us to a more beautiful world.
Right now, we humans find ourselves in a twilight zone, a space between worlds. We can no longer hold on to the old comforting truths about ourselves and the way we live. Infinite growth is not possible on a finite planet. While some will surely continue business-as-usual, there is a growing realisation that our way of living is not sustainable and that something new will have to emerge. What if instead of pathologising and medicating our children’s psychological distress, we instead receive it as a collective wake-up call. If the environment we are providing for our children is not meeting their needs, then instead of fixing our children, fixing their broken brains, we need to put all our love and energy into fixing this world in which they are growing up.
I realise this is a very big and abstract concept – fixing the world. But we can turn this into a practical tool by asking ourselves and each other simple questions. If you are involved with a child who is struggling with some issue, whether it’s eating, sleeping, schoolwork, anxiety or depression, instead of trying to ‘fix’ them, ask yourself these questions:
- What might my child’s problem be trying to communicate or heal in the world around them? (And be prepared, the ‘world’ might include you!)
- What blind spot in our family or in the world might my child’s ‘undesirable’ behaviours be shining a light on?
- How might their emotions or behaviours be an attempt to regain some power in a situation where they feel powerless?
- How can I help them express this in a healthier way? (It may be just listening to them, or finding someone else to listen to them, or helping them to write or draw it out. You know what works best for your child.)
- What’s one simple thing I can do to help improve the environment in which my child is growing?
It’s not easy to open to the possibility that our child’s ‘unwanted’ behaviours may be giving voice to an uncomfortable truth about our family or about the world. But if you want your child to heal, if you want your child to grow up in a world where they don’t feel permanently broken, then you have to be willing to hear this truth.
I’ve worked with many families where a child developed a problem because their parents were in conflict or because there were some really uncomfortable, unspoken truths, like a dad with a drinking problem or a mum who had an affair. Often, trauma gets passed down through generations, but our children provide us with an opportunity and incentive to heal this trauma. And children can develop problems because the culture of their school is toxic, with unsupported and stressed-out teachers. Whatever the uncomfortable truths might be, please remember it’s not your fault but it is your responsibility. Can you imagine how much better your family, your school and indeed the world might be if all of these unconscious communications from our children were given a space, a voice; if all that energy expended in symptoms was channelled into making positive changes in the world?
The late psychologist John Welwood said that ‘not feeling loved and then taking that to heart is the only wound there is. It cripples us, causing us to shrivel and contract.’ Thus apart from a few neurological disorders, the DSM might as well begin: “Herein we describe all the wretched ways people feel and behave when they do not know they are loved.” In the end, the most important thing for our children and for their future, for our collective future, is that our children can grow up with a feeling deep in their bones that they are loved just as they are, that they are beautiful, not broken.
Your Brain Is Not Broken
They tell you your brain is broken.
I’m here to tell you it’s not.
Your brain is not broken.
They say you have a chemical imbalance.
Whilst their balance sheet grows.
Selling you pills, to fix all your ills.
Your brain is not broken.
They give you a label,
Reducing three pounds of pink and grey flesh,
And 3.8 billion years of evolution,
Into a one-word prison.
Your brain is not broken.
They tell you you are not enough,
And then sell you the cure,
Nips, tucks, pills more and more.
Your brain is not broken.
The world is on fire,
A fire rages inside of you.
Our oceans are dying,
An ocean of sadness grows inside your heart,
Your brain is not broken,
Your brain is connected,
To your belly,
To your heart,
To my brain,
To my belly,
To my heart,
To our brains,
To our bellies.
To our hearts,
Our brains are not broken.
They are beautiful.
This post originally ran on Mad in the UK and has been reposted with permission – find the link to the original post here:
- S Timini, ‘The McDonaldization of childhood: children’s mental health in neo-liberal market cultures’, Transcultural Psychiatry, Vol 47, Iss 5, November 2010
- Sedated: How Modern Capitalism Created our Mental Health Crisis (Paperback), James Davies
- David Eagleman, The Brain: The Story of You