To Drug or Not To Drug
Judith Warner misses the real questions about medicating children.
It's a truth verging on a truism that journalism is about telling stories. But what exactly is it that narratives—good stories—do for us? Stories work because they explain important or unusual or compelling events in terms of our everyday psychology—the causal principles that we all understand by the time we are 4. A good journalist explains why the health care bill failed, for example, by telling us about the beliefs, desires, and emotions of the wavering senators.
But science isn't about applying the causal principles we know about. It's about discovering causal principles we don't know about. Psychological science, in particular, is about using evidence to find new and unexpected causal explanations for our actions and experiences. It's not about using our everyday psychological knowledge to explain what we do. When psychologists do that, we rightly accuse them of just telling us what we already know.
This is especially true when scientists are trying to explain the conditions we vaguely call "clinical" or "dysfunctional" or "pathological." After all, people aren't pathological when they are angry or frustrated or sad because of what they want or believe. They are pathological precisely when we can't explain their miseries in the normal way—when the successful author suddenly kills himself, or when the bright child with loving and concerned parents just can't read no matter how hard she tries. Clinical scientists try to use evidence to discover the less than obvious causal principles (his serotonin level was too low, she can't process language sounds) that can explain these events.
Human beings do love stories, but, fortunately, they can also appreciate the interest and fascination of scientific problem-solving. Good science journalists think like scientists. They don't just tell stories. Instead, they understand and explain how new evidence can lead to surprising and counterintuitive conclusions. And they study and evaluate the scientific journals and peer-reviewed articles—the currency of science.
Judith Warner's book illustrates the perils of preferring stories to science. We've Got Issues takes off from an unquestionably important set of events. Within the past few years more and more children have been given powerful brain-altering drugs to deal with a wide range of problems. Many of the traditional journalistic parts of Warner's book are interesting and engaging. She tells some compelling stories about desperate parents, about the absurdly dysfunctional American health care system, and about the greed of the big pharmaceutical companies. The everyday psychological explanations that underpin these stories work very well. The companies want to make a lot of money, so they manipulate the data. Poor children don't have health care, so their problems are left untreated until they become emergencies, and so on.
The book is also written as a story about Warner herself. She started out thinking, from talking to people and reading blogs and newspapers and magazines, that overambitious parents and unfeeling doctors were pressuring children to succeed at all costs and callously using drugs to help. Then she talked to more people, particularly the parents and doctors who were giving children the drugs, and she read more blogs and newspapers and magazines. She had her epiphany and changed her mind. Actually, the children had real problems, and the parents and doctors were trying to help them.
That, quite explicitly, is the main point of the book, and much of it is devoted to Warner's emotional recounting of these discussions and her reactions to them. You have to wonder a little, even from a purely journalistic perspective, about whether Warner really expected that the parents she talked to would say to her, "Yes, actually my child doesn't have real problems; I'm just medicating him because I'm an overambitious neurotic." But surely the real question is not, "Are the parents and doctors good or evil?" but "Do the drugs make the children better?"
You may be able to answer the first question with journalistic narrative, but to answer the second question you need scientific evidence. Sometimes, at least, Warner seems to think that her epiphany licenses the conclusion that we should indeed be giving children drugs for this range of psychological problems (though she's fuzzy about this). But nowhere in the book does she explain or evaluate the scientific evidence that could actually help answer this question. In fact, there are far more references to newspapers than to scientific journals, and she consistently treats an anecdote or an interview as if it has the same weight as a meta-analysis or a randomized clinical trial.
Warner's book also reflects a common confusion in popular writing about psychology. She writes as if there are just two kinds of explanations for human behavior. Either the everyday narratives are right—so that children are unhappy because their parents don't care about them, or they fail at school because they are lazy. Or else the right answer is that the children's problems are the result of "something in their brains." Warner's logic seems to be that since the parents do care about their kids, the problem must be in the children's brains and therefore drugs will fix it.