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American Pediatrics and the Transition from Mental Health to Illness Since the 1960s

Published online by Cambridge University Press:  07 July 2020

LAURA HIRSHBEIN
LAURA HIRSHBEIN*
Affiliation:
University of Michigan
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Abstract:

American pediatricians are now bearing the brunt of massive increases in demand for treatment of mental illness in children and adolescents, areas in which many pediatricians have not been well trained. It would be logical to encourage policy measures to increase pediatricians’ expertise in this area to improve access to care. But the expanses in demand for services are about much more than increased incidence of biologically-based illnesses. Instead, pediatricians are caught juggling between their traditional focus on health and prevention and a rapid rise in broad socially, culturally, and economically mediated distress among young people and their families. This article explores the historical context of pediatricians’ engagement with mental health and the hazards of the push toward treatment for mental illness. The historical perspective can help us develop policy more directed to broader goals of improving the mental health of our nation’s children and adolescents.

Keywords

child psychiatryreimbursementmedicationsmedical modelbehavioral pediatricschild development
Type
Critical Perspective
Information
Journal of Policy History , Volume 32 , Issue 3 , July 2020 , pp. 360 - 382
Copyright
© Cambridge University Press 2020

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Footnotes

This research was supported by a Robert Wood Johnson Investigator Award. The paper was first presented in the Ralph Hermon Major Lunch Series, University of Kansas Department of the History and Philosophy of Medicine in March 2018. Many thanks to Chris Crenner, Ryan Fagan, and the participants in the lunch series, as well as the editors and reviewers of this journal, for their helpful comments.

References

Notes

1. See White House press release, “Fact Sheet: President Obama Applauds Commitments to Raise Awareness and Increase Understanding of Mental Health at White House Conference,” 3 June 2013, https://www.whitehouse.gov/the-press-office/2013/06/03/fact-sheet-president-obama-applauds-commitments-raise-awareness-and-incr. For some history of previous White House involvement in child health, see, for example, Hulbert, Ann, Raising America: Experts, Parents, and a Century of Advice About Children (New York, 2003)Google Scholar.

2. See for example, Horwitz, Allan V., Creating Mental Illness (Chicago, 2002)Google Scholar; Herzberg, David, Happy Pills in America: From Miltown to Prozac (Baltimore, 2009)Google Scholar; Lane, Christopher, Shyness: How Normal Behavior Became a Sickness (New Haven, 2007)Google Scholar; Horwitz, Allan V. and Wakefield, Jerome C., All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders (Oxford, 2012)Google Scholar.

3. It turns out that the question has not really been asked—it has just been assumed that early treatment leads to fewer problems later. Costello, E. Jane and Maughan, Barbara, “Optimal Outcomes of Child and Adolescent Mental Illness,” Journal of Child Psychology and Psychiatry 56 (2015)CrossRefGoogle ScholarPubMed: 324–41.

4. This has particularly been the case with the diagnosis of pediatric bipolar disorder. For a critique of the concept in children, see Healy, David, Mania: A Short History of Bipolar Disorder (Baltimore, 2008)Google Scholar. For an exploration of the pharmaceutical industry’s role in promoting mental illness diagnoses, see, for example, Carlat, Daniel J., Unhinged: The Trouble with Psychiatry: A Doctor’s Revelations About a Profession in Crisis (New York, 2010)Google Scholar. For a discussion about the problems with the pharmaceutical companies from the perspective of a former editor of the DSM, see Frances, Allen, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (New York, 2013)Google Scholar.

5. See, for example, Zuckerbrot, Rachel A. et al., “Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment, and Initial Management,” Pediatrics (2007)CrossRefGoogle ScholarPubMed: e1299–e1312.

6. Copeland, William et al., “Cumulative Prevalence of Psychiatric Disorders by Young Adulthood: A Prospective Cohort Analysis from the Great Smoky Mountains Study,” Journal of the American Academy of Child & Adolescent Psychiatry 50 (2011)Google ScholarPubMed: 252–61.

7. Anderson, William S., “Acceptance of Presidency,” Pediatrics 39 (1967): 143Google Scholar; “American Academy of Pediatrics: President’s Address,” Pediatrics 40 (1967): 1046–48.

8. Gitlin, Todd, The Sixties: Years of Hope, Days of Rage (New York, 1987)Google Scholar.

9. Doroshow, Deborah Blythe, “Residential Treatment and the Invention of the Emotionally Disturbed Child in Twentieth-Century America,” Bulletin of the History of Medicine 90 (2016): 92–123CrossRefGoogle ScholarPubMed.

10. See, for example, Mintz, Steven, Huck’s Raft: A History of American Childhood (Cambridge, Mass., 2004)Google Scholar; Fass, Paula S., The End of American Childhood: A History of Parenting from Life on the Frontier to the Managed Child (Princeton, 2016)Google Scholar.

11. For the dominance of psychoanalysis in psychiatry in general during this time period, see Hale, Nathan G. Jr., The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917–1985 (Oxford, 1995)Google Scholar.

12. Schowalter, John E., “Child and Adolescent Psychiatry Comes of Age, 1944–1994,” in American Psychiatry After World War II, 1944–1994, ed. Menninger, Roy W. and Nemiah, John C. (Washington, DC, 2000)Google Scholar, 461–80.

13. Herman, Ellen, The Romance of American Psychology: Political Culture in the Age of Experts (Berkeley, 1995)Google Scholar; Capshew, James H., Psychologists on the March: Science, Practice, and Professional Identity in America, 1929–1969 (Cambridge, 1999)CrossRefGoogle Scholar.

14. American Academy of Pediatrics, 50 Years of Child Advocacy (Evanston, IL, 1980).

15. See, for example, Nelson, Waldo E., ed. Textbook of Pediatrics, 7th ed. (Philadelphia, 1959)Google Scholar.

16. Spock, Benjamin, The Common Sense Book of Baby and Child Care (New York, 1946)Google Scholar. See also Maier, Thomas, Dr. Spock: An American Life (New York, 1998)Google Scholar.

17. Prescott, Heather Monro, A Doctor of Their Own: The History of Adolescent Medicine (Cambridge, Mass., 1998)Google Scholar.

18. Haggerty, Robert J., Roghmann, Klaus J., and Pless, Ivan B., eds., Child Health and the Community (New York, 1975), 316Google Scholar. See also Pawluch, Dorothy, The New Pediatrics: A Profession in Transition (New York, 1996)Google Scholar.

19. American Academy of Pediatrics, “Pediatrics and the Psychosocial Aspects of Child and Family Health,” Pediatrics 70 (1982)Google Scholar: 126–27; Russo, Dennis C. and Varni, James W., eds., Behavioral Pediatrics: Research and Practice (New York, 1982)CrossRefGoogle Scholar.

20. Levine, Melvin D. et al., eds., Developmental-Behavioral Pediatrics (Philadelphia, 1983)Google Scholar.

21. Decker, Hannah S., The Making of DSM-III: A Diagnostic Manual’s Conquest of American Psychiatry (Oxford, 2013)Google Scholar.

22. Horwitz, Allan V. and Wakefield, Jerome C., The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (Oxford, 2007)Google Scholar.

23. Healy, David, The Creation of Psychopharmacology (Cambridge, Mass., 2002)CrossRefGoogle Scholar.

24. Mayes, Rick and Rafalovich, Adam, “Suffer the Restless Children: The Evolution of ADHD and Paediatric Stimulant Use, 1900–80,” History of Psychiatry 18 (2007)CrossRefGoogle ScholarPubMed: 435–57.

25. Diagnostic Categories committee folder, Box 42, Archives of the American Academy of Child and Adolescent Psychiatry, AACAP Headquarters, Washington, DC.

26. Esman, Aaron H., “Recent Studies in Adolescent Psychiatry,” Journal of the American Academy of Child Psychiatry 21 (1982)CrossRefGoogle ScholarPubMed: 315–17.

27. Costello, Elizabeth J.et al., “Psychiatric Disorders in Pediatric Primary Care: Prevalence and Risk Factors,” Archives of General Psychiatry 45 (1988)CrossRefGoogle ScholarPubMed: 1107–16.

28. Smith, Matthew, Hyperactive: The Controversial History of ADHD (London, 2012)Google Scholar.

29. The AACP incorporated adolescents in 1987.

30. Grob, Gerald N., From Asylum to Community: Mental Health Policy in Modern America (Princeton, 1991)Google Scholar.

31. American Academy of Pediatrics Folder 1, Box 20, Archives of the AACAP.

32. Ibid.

33. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Primary Care Version (Washington, DC, 1996)Google Scholar.

34. William B. Carey (MD, Philadelphia), “Current Controversies in Diagnosis in Behavioral Pediatrics,” Developmental and Behavioral News (Spring 1991), AAP, American Academy of Pediatrics Folder 3, Box 20, Archives of the AACAP.

35. American Academy of Pediatrics, The Classification of Child and Adolescent Mental Diagnoses in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version (Elk Grove Village, IL, 1996)Google Scholar.

36. Gray, Bradford H., “The Rise and Decline of the HMO: A Chapter in U.S. Health-Policy History,” in History and Health Policy in the United States: Putting the Past Back In, ed. Stevens, Rosemary A., Rosenberg, Charles E., and Burns, Lawton R. (New Brunswick, 2006)Google Scholar, 309–39.

37. Mechanic, David, “Mental Health Services Then and Now,” Health Affairs 26 (2007)CrossRefGoogle Scholar: 1548–50.

38. Mayes, Rick, “The Origins, Development, and Passage of Medicare’s Revolutionary Prospective Payment System,” Journal of the History of Medicine & Allied Sciences 62 (2007): 21–55CrossRefGoogle ScholarPubMed.

39. American Academy of Pediatrics, “Insurance Coverage of Mental Health and Substance Abuse Services for Children and Adolescents: A Consensus Statement,” Pediatrics 106 (2000)Google Scholar: 860–62.

40. Petrina, Stephen, “The Medicalization of Education: A Historiographic Synthesis,” History of Education Quarterly 46 (2006)CrossRefGoogle Scholar: 503–31.

41. Reese, William J., America’s Public Schools: From the Common School to “No Child Left Behind” (Baltimore, 2011)Google Scholar.

42. On the role of teachers in the spread of ADHD diagnosis and treatment, see Smith, Hyperactive.

43. On the older medical model, see Horn, Margo, Before It’s Too Late: The Child Guidance Movement in the United States, 1922–1945 (Philadelphia, 1989)Google Scholar.

44. Trent, James W. Jr., Inventing the Feeble Mind: A History of Mental Retardation in the United States (Berkeley, 1994)Google Scholar.

45. Ladd-Taylor, Molly and Umansky, Lauri, eds., “Bad” Mothers: The Politics of Blame in Twentieth-Century America (New York, 1998)Google Scholar.

46. American Academy of Pediatrics, “The New Morbidity Revisited: A Renewed Commitment to the Psychosocial Aspects of Pediatric Care,” Pediatrics 108 (2001)Google Scholar: 1227–30.

47. Voigt, Robert G. et al., eds., American Academy of Pediatrics Developmental and Behavioral Pediatrics, 2nd ed. (Itasca, IL, 2018), 2Google Scholar.

48. Carey, William B., ed. Developmental-Behavioral Pediatrics (Philadelphia, 2009)Google Scholar.

49. Dixon, Suzanne D. and Stein, Martin T., eds., Encounters with Children: Pediatric Behavior and Development, 4th ed. (Philadelphia, 2006)Google Scholar.

50. Viola Cheung, Michele L. Ledesma, and Carol C. Weitzman, “Anxiety and Mood Disorders,” in American Academy of Pediatrics Developmental and Behavioral Pediatrics, 536.

51. Healy, David, Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression (New York, 2004)Google Scholar.

52. See Apple, Rima D., Perfect Motherhood: Science and Childrearing in America (New Brunswick, 2006)Google Scholar; Hulbert, Raising America.

53. On the emergence of the consumer perspective in health care, see Hoffman, Beatrix et al., eds., Patients as Policy Actors (New Brunswick, 2011)Google Scholar; Tomes, Nancy, Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers (Chapel Hill, 2016)Google Scholar.

54. Papolos, Demitri F. and Papolos, Janice, The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder (New York, 1999; 2nd ed. 2006)Google Scholar.

55. For the parenting book that advocates Biederman’s approach, see, for example, Wozniak, Janet and McDonnell, Mary Ann, Is Your Child Bipolar? The Definitive Resource on How to Identify, Treat, and Thrive with a Bipolar Child (New York, 2008)Google Scholar.

56. Carlat, Unhinged. Ketamine, a hallucinogen that is approved for its use in anesthesia, is gaining a reputation as a possible miracle treatment for suicidal thinking. The pharmaceutical companies are driving a good deal of the enthusiasm about this drug, which also has a long history of abuse.

57. Kaplan, Stuart L., Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis (Santa Barbara, 2011)Google Scholar.

58. For a description of the kinds of interventions that lead to health-care disparities, see Link, Bruce G. and Phelan, Jo C., “Fundamental Sources of Health Inequalities,” in Policy Challenges in Modern Health Care, ed. Mechanic, David et al. (New Brunswick, 2005), 71–84Google Scholar.

59. Meredith Matone et al., “The Relationship Between Mental Health Diagnosis and Treatment with Second-Generation Antipsychotics over Time: A National Study of U.S. Medicaid-Enrolled Children,” HSR: Health Services Research 47 (2012): 1836–60.

60. https://www.cdc.gov/vitalsigns/pdf/vs-0618-suicide-H.pdf.

61. Though this research team looked at broader sociological variables, they still assumed that mood disorders were the primary mediating factor in suicide. Twenge, Jean M. et al., “Age, Period, and Cohort Trends in Mood Disorder Indicators and Suicide-Related Outcomes in a Nationally Representative Dataset, 2005–2017,” Journal of Abnormal Psychology 128 (2019)CrossRefGoogle Scholar: 185–99.

62. Benjamin N. Shain and Committee on Adolescence, “Suicide and Suicide Attempts in Adolescents,” Pediatrics 138 (2016): e2016–1420.

63. Rosemary A. Stevens, “Specialization, Specialty Organizations, and the Quality of Health Care,” in Policy Challenges in Modern Health Care, 206–20.

64. Mayes, Rick and Erkulwater, Jennifer, “Medicating Kids: Pediatric Mental Health Policy and the Tipping Point for ADHD and Stimulants,” Journal of Policy History 20 (2008)CrossRefGoogle Scholar: 309–43.

65. David Mechanic, Lynn Rogut, David Colby, and James Knickman, “Introduction,” in Policy Challenges in Modern Health Care, 1–10.

66. Gold, Claudia M., The Silenced Child: From Labels, Medications, and Quick-Fix Solutions to Listening, Growth, and Lifelong Resilience (Boston, 2016)Google Scholar.

67. For critical concerns about antidepressants, for example, see Kirsch, Irving, The Emperor’s New Drugs: Exploding the Antidepressant Myth (New York, 2010)Google Scholar.

68. For an analysis of the benefits of consumer choice in mental health, see Frank, Richard G. and Glied, Sherry A., Better But Not Well: Mental Health Policy in the United States since 1950 (Baltimore, 2006)Google ScholarPubMed.

69. Burton, Marion, “Vision of Pediatrics 2020: The AAP’s Role in Maintaining Focus and Creating the Future,” Pediatrics 126 (2010)CrossRefGoogle ScholarPubMed: 1006–7.