In mid-May of this year Jen and I broke down and gave the go-ahead to our pediatrician to attempt to find a pharmacological solution to the problem of Martin’s behavior in school and at home. (Read this to refresh your memory or get filled in.)
I balked longer than Jen did, despite the fact that many members of my family have used psychotropic drugs to solve problems. My dad, a psychiatric social worker working in state-operated out-patient mental health for most of the last 35 years, witnessed first-hand the effect psychotropics in general and anti-psychotics in particular had on the population of mentally ill people in his care. During those years, drugs enabled tens of thousands of people (including a woman who lives in my parents’ care now) to be safely moved from prison-like mental hospitals out into the community. People who once struggled to control violent or self-destructive impulses now live dramatically more free and comfortable lives among us.*
My sister Julie and I had more ambivalent experiences with drugs as children. We took ADHD drugs back in the early 80s–well before it became cool to take ADHD drugs. We both struggled in school. When we started on Ritalin, she was angrily battling to learn to read and I was constantly frustrated by my inability to manage my homework assignments and my restlessness in class.
Although our teachers and parents described some improved outcomes shortly after we started taking the drugs, neither Julie nor I experienced any dramatic long-term improvement. And, in my case anyway, the social blow-back of being the first kid in the school on spaz drugs far outweighed whatever marginal benefits to my concentration I may have received from taking them.
I wasn’t particularly worried about social blow-back for Martin. For one, he seems–at least for the moment–to be completely immune to embarrassment. And in the current climate, his acting out behaviors carry a much heavier weight of stigma than taking some drugs would. However my experiences did affect my reluctance to start Martin on a regimen of psychotropics.
In particular, I remember my ambivalence about having my brain changed. Not only did the drugs have a physiologically strange effect on me, I also just felt weird about altering my brain. How would I be able to tell what was the “real” me? Did I want to be different than I was? In the years after I started taking the drugs I often wondered how I would be different if I didn’t take them. What if I would have simply learned to cope with my disability on my own? How would I be able to tell if I didn’t need the drugs anymore?
As we were contemplating medicating him, I had some of the same concerns for Martin. What if drugging him hampered his ability to learn to regulate his behavior himself? How would we know when he didn’t need them anymore? Would he ever come to wonder how things would have been different for him if he never took the drugs?
In the end the reasons for putting him on the medication overwhelmed my reluctance. However I believe the questions I was asking are the right ones and I intend to continue to ask them and attempt to monitor them as well as I can.
* The process of deinstitutionalization that I discuss in brief above is actually quite complex and not at all unambiguously salvific. For more information you can consult your local historian of medicine or look up deinstitutionalization on wikipedia.