Research suggests that about one-tenth of U.S. children have an impairing mental illness. About 10 million children and adolescents take antidepressants, 5 million take stimulant drugs, increasing numbers are prescribed antipsychotics, and many are taking more than one psychoactive medication. One interpretation of these facts is that, while the number of children affected is sobering, the use of medications to manage their difficulties is largely beneficial and appropriate. This view is common among those who support the “medical model” of mental illness, which characterizes mental illness as a biological dysfunction in an individual. The authors whose essays appear in No Child Left Different, a collection edited by psychologist Sharna Olfman, disagree. The need to look beyond the medical model for solutions is carefully introduced by Jane Healy, whose essay stresses the intertwining roles of nature and nurture in children’s development. The authors whose work follows offer illuminating alternative perspectives that aim to secure children’s well-being by redressing noxious cultural and political institutions and constraints.

Most of the collection’s contributors address the scope of the mental health problem, attributing the large number of distressed children to environmental and social issues that are ignored by the individual-centered medical model. Examples are toxic pollutants, which burden the poor particularly (Varda Burstyn and David Fenton); violent television, which increases aggression, desensitization, and fear (John P. Murray); a global consumer culture that sows the seeds of eating disorders (Margo D. Maine); and the pace and pressures of American life, which contribute to ADHD diagnosis and drug treatment (Lawrence Diller). Standing out among essays on this theme is the well argued and moving chapter on children’s depression by Mary Burke. The crucial concern, she says, is disruption of children’s relationships with their parents. With vivid examples, she explores the dearth of support systems for stressed parents (or other caregivers) and disturbed children. Lack of support undermines the parents’ abilities to care well for their children; insecure relationships and the children’s depression often follows. Burke argues that in this milieu, the managed care health-care system is particularly harmful. In her view, its drive for profit and efficiency effectively forces clinicians to provide simple and inexpensive medication, forgoing more time-consuming but more effective individual or family counseling. Contributors Michael Brody and Daniel Burston echo this theme in their pieces, along with deriding the influence of pharmaceutical manufacturers on prescribing practices. Risks and potential risks of the drugs themselves is a third theme of the book, addressed by several authors.

In the current environment, in which the medical model of mental illness is dominant, these alternative perspectives need and deserve emphasis. This makes No Child Left Different an important contribution. Several of the essays are outstanding. Mary Burke’s I have already mentioned. Another is Stuart G. Shanker’s piece, “The Development of Mentally Healthy Children,” in which he articulates the need to think in positive terms about development of mental health, rather than the more impoverished notion of mere absence of disease. However, a number of the essays are marred by failing to confront dominant opinions directly. This failure to specifically address well-known counterarguments—for example, on drug efficacy, or concerning non-media influences on aggression—reduces the potential impact of some of the essays. Several contributions also take on too much, again diminishing the pieces’ effectiveness.

Overall, while those well-versed in these issues may not find much new here, those seeking an introduction to alternative ways to view the problems facing America’s children–and progressive solutions to these problems–will appreciate this collection. Editor Sharna Olfman, whose series “Childhood in America” also includes the volumes Childhood Lost: How American Culture is Failing Our Kids and All Work and No Play… : How Educational Reforms Are Harming Our Preschoolers, is to be commended for making this range of views readily accessible.

©
2007 Susan Hawthorne

Susan Hawthorne, MA; doctoral candidate in Philosophy, University of Minnesota

Categories: ChildhoodDisorders, Ethics, Psychology