Dr. Thomas Barrett is a psychologist and psychoanalyst in Chicago whose work with children and adolescents includes helping them avoid or discontinue the use of psychotropic medications. In the following interview, Dr. Thomas discusses the reasons behind his philosophy.
Why and how did you become interested in the effects of medication on children?
For 20 years, I was the Director of the Hanna Perkins Center for Child Development in Cleveland, OH. The agency operated a therapeutic preschool and kindergarten, as well as an outpatient clinic. Many of the children came to us on medications, which their parents wanted reduced or alleviated. We had good rates of treating children and advancing them from therapeutic programs into public schools without medication.
When I came to Chicago in 2001, I served on the faculty of The Chicago School of Professional Psychology. A colleague was researching the effects of medication, and he shared the results with me. For a time, it was believed that a combination of medication and psychotherapy worked best, but that turned out not to be true. Time and again studies have shown that, in the long-term, medication does not perform as well as psychotherapy. Even with adults who are schizophrenic, studies show the best treatment results are not with drugs but in therapeutic communities.
What makes medication a problematic intervention?
Almost no data that shows that medication cures anything. My colleague has followed recent research comparing anti-depressants with probiotics, and probiotics are showing as strong if not better results than drugs and placebos. Placebos rank almost as high as drugs in most trials. Most psychotropic drugs have not been tested on and approved for children. Their long-term side effects are unknown. Prescribers tend to ignore that fact.
Children often get prescribed medication because teachers are concerned and recommend it to parents. When a child gets put on medications, it is often without a lot of input from that child about what it feels like. Whereas adults are always interviewed and carefully worked with about the effects of the medication, kids are not. They are left feeling vulnerable, thinking, “I am on this medication; I must be broken.” It impacts their self-esteem.
In addition, racial bias and prejudice loops into decision-making. Looking at the data nationwide, a disproportionate number of children in foster care are on medication, particularly on antipsychotics. Many of those children are African American and male. An epidemic like that can’t have anything to do with an actual need to use medications.
So, weighing the very few, if any, benefits against problematic outcomes, it seems like medicating children is unwise.
Are there any situations in which you would recommend medication?
There are those who believe kids can do better and be helped by medicine, but I am not convinced. In some cases, when medications are carefully used and monitored, they may help children gain ego capacity that enables them to make better use of treatment. Then that medication can be reduced and eliminated. But that doesn’t happen very often. Children are put on medications, and it turns into a life sentence.
I realize that what I am saying depends on the person having good opportunities for treatment, which is not always the case. But we should not just medicate people because we are not providing good treatment. We need to try to understand them. In 45 years of practice, I have never recommended medication for a child.
How should parents and clinicians think through whether or not to suggest medication?
They should think of medication as a last resort and try to find other avenues for intervention. We need to stop thinking that something organically happens in the brain that requires medication when what we are really seeing are the consequences of complex trauma, fear, aggression, or people who have had their development disrupted. Clinicians need to work with parents on other ways of handling children’s feelings and their behavioral manifestations, such as preparing children for changes so that they have the tools to succeed.