DRUGGING AWAY THE PAIN OF YOUTH

It was only when it was up on the screen that the bureaucrats gathered in
the Parliament House office really got the message. There, in an image of
an eight-year-old's brain, was proof that abuse and neglect in early years
produces lifelong damage.

The devastation was clear in the picture. The child whose brain was on show
had suffered severe maltreatment as a toddler, and that had caused
deterioration in the architecture of the brain. Everyone took a deep
breath. This was moving evidence that the body's major organ was vulnerable
to emotional, as well as physical, torment.

"They were affected by what they saw," leading child psychiatrist Louise
Newman said. The screening in the house on the hill made the hard-nosed
health boffins aware that you don't need to bash a child to blight its
future. But for all that, it barely scratched the surface of what Dr Newman
calls the "forgotten epidemic of child maltreatment".

"Very, very young children are being exposed to family breakdown,
attachment problems, abuse," she said. "God knows what that will do in the
future."

Dr Newman, who heads the child and adolescent faculty of the Royal
Australian and New Zealand College of Psychiatrists, says children's mental
problems, including depression, are, like the kids themselves, being
overlooked. "It's a travesty," she said.

Dr Newman believes the problem is so dire that pregnant women need to be
assessed for risk factors associated with poor parenting. This would allow
those at risk, and they are a large, growing number, to be helped before
the child is born.

The intervention cannot come soon enough, if the first detailed study into
the mental state of the young is any guide. The Mental Health of Young
People in Australia makes it clear that children are not only suffering
alarmingly high levels of mental disturbance, they are being prescribed
powerful drugs that are neither approved nor scientifically validated for them.

The survey found that, while 14 per cent, or more than 500,000, children
and adolescents have mental health problems, little or no treatment and
support is available. Just one in four of those with mental problems
received professional help, and help was only available to half of those
most severely affected, for whom suicide was a real threat.

The survey, led by Adelaide University psychiatrist Michael Sawyer, found a
high correlation between mental disorders, family break-up and poverty. The
children surveyed, aged between four and 17, were more likely to be
mentally disturbed if they were living in low-income, step/ blended or
sole-parent families.

The survey suggests that the most commonly diagnosed mental problem in
children, attention deficit hyperactivity disorder (ADHD), may not be a
clear-cut illness. ADHD, usually treated with powerful stimulants, is said
to affect 355,000 children.

But, as the survey says, the high prevalence must be "viewed with caution".
Many question whether ADHD is a condition at all. Melbourne child
psychiatrist George Halasz believes ADHD is partly created by drug companies.

He argues that the 24-fold increase in the prescription of stimulant
medication from 1990 to 1998 does not reflect a rise in the prevalence of
ADHD. Rather, it illustrates how market-driven health care prescribes drugs
for children as a first, instead of a last, resort.

"Once the ADHD tag is used, then it is easy to give the drugs," he said.
"The point is, of course, is that what the child has?" He is not against
all drug use. He says some children have a brain disorder that lends itself
to stimulants.

But throwing amphetamines at very young children because they seem
hyperactive was a dangerous step. "Persistent disruptive behavior is, in my
experience, like a coded signal, needing time to be unravelled," he said.

In America, the most widely used drug for ADHD, Ritalin, is prescribed to
about four million schoolchildren, many of whom are not mentally ill but
just showing normal behavioral problems.

Dexamphetamine is the main drug prescribed in Australia. Prescriptions for
it in Victoria have risen from about 1500 eight years ago to more than
35,000. It is mostly prescribed by paediatricians, often against the
instinct of child psychiatrists. There are no long-term studies of its
side-effects. Paediatricians argue that it is safe and scientifically proven.

But Dr Halasz says the drug is being used as a "chemical strait-jacket" to
contain children and produce a generation bereft of self-understanding and
the ability to cope with life's challenges. American expert Peter Breggin,
of the International Centre for the Study of Psychiatry, agrees.

"The drugging of children is a national catastrophe," he said. "ADHD is
just a list of behaviors kids have when in conflict with adults. There is
no biological basis for it." He said a recent Canadian study showed that
9per cent of children on stimulants developed psychotic symptoms.

It is not just stimulants. Anti-depressants are also given to children,
even though, as Dr Newman says, most have not undergone trials for
children, nor are they endorsed for child use by drug companies.

In America, the number of prescriptions or recommendations for the
anti-depressant Prozac for children under 12 rose 212 per cent between 1994
and 1997. In Australia, where 117,000 children are estimated to be
suffering from a depressive disorder, use is also increasing.

Perhaps most worrying of all is that powerful anti-psychotic drugs approved
for use in adults with schizophrenia are being given to children. In a
recent Melbourne case, an eight-year-old boy diagnosed with ADHD was
prescribed the anti-psychotic Risperidone at the highest adult level, as
well as Ritalin. Although no one knows what the long-term effects will be,
3000 approvals for anti-psychotics were granted between mid-1999 and
mid-2000, for the use of at least 1500 children under 13.

The other big area of depression affecting children is the darkness that
hits many new mothers. Anne Buist, director of the Austin Hospital's
mother-baby unit, is an expert on post-natal depression (PND), and says the
condition is not just hormonal.

"A lot of women think a pill will fix it, that they don't have to do
anything about it, but they do," she said. "A lot of these women have not
been well parented themselves, so have trouble parenting. But there's
little support for them out there."

Professor Buist and the Austin's head of child and adolescent mental
health, Neil Coventry, worry about the over-prescription of
anti-depressants. Dr Coventry says about 10 per cent of new mothers suffer
from PND and 4 to 8 per cent of adolescents suffer from depression.

"The dilemma is where do you draw the line between sadness and depression?"
he said. "I don't like to put labels on children."

Dr Coventry says the focus should be on prevention, but it is not. "The
problem is that too many of these kids don't get any treatment."

A spokeswoman for state Health Minister John Thwaites said the government
was aware of the problems and would return 200 of the welfare counsellors
the former government took from schools, as well as 100 nurses. About
$23million has been committed over three years to set up 21 primary mental
health teams to work with hospitals.

"We're doing a lot of work with adolescents and suicide," the spokeswoman said.

Melbourne University psychology professor Jeanette Milgrom sees
post-natally depressed women, and says evidence for PND being a biological
disease is weak. Like many experts who rail at the system privileging drugs
over psychotherapy, she believes treatment should encompass more than
medication.

"Depression is fitted into the medical model, but there is room to expand
science to take in more complex ideas of experience," she said. "It's a bit
of a cop-out to say that because you can't measure the unconscious, you
can't assess it."

There is little precision about depression. Every story is different. Some
experts talk about it like it is a biological disease, but it is as much an
artefact of being alive as a distinct medical condition. It is the biggest
determinant of disability in the world. But despite the hype of drug
companies, there is no pill to cure this ill. The magic bullets like Prozac
ease the symptoms of some sufferers, but they don't cure.

If the chemistry in the brain of a depressed child is imbalanced - and
there is no test to prove it always is - no one knows why. Nor do they know
how anti-depressants - which are thought to act by boosting the
concentration of neurotransmitters, such as serotonin, in the brain -
actually work. Biologists do not know what depression is.

As Mark Kingwell says in his book Better Living: In Pursuit of Happiness
from Plato to Prozac, we know as much about depression as the quack in
Moliere's play La Malade Imaginaire, who explained to a dubious patient
that a "sleeping potion worked because of its potent dormative (sleeping)
properties".

The majority of children cited in the mental health survey are in pain. And
it is not the pain of a headache, to be eased by a sedative, nor the
invasion of a tumor, to be revealed in an X-ray. Their brains may or may
not lack serotonin but, judging by the survey, their early lives lacked warmth.

That is what Dr Newman was getting at when she flashed the brain images of
the unfortunate eight-year-old on the screen in Canberra. She wanted the
powerful to appreciate what breaking-edge science is now revealing. As the
pioneer of mental health in children, Britain's John Bowlby, said 40 years
ago, very bad parenting - usually to do with long separation and loss and
abuse - can, and does, damage the brain. And while drugs may ease the
resulting symptoms, they won't cure them.

SANE Helpline number is 1800 688 382