April 9, 2010

Taking Issue with Judith Warner’s WE’VE GOT ISSUES

I was predisposed to like Judith Warner’s new book, We’ve Got Issues: Children and Parents in the Age of Medication (New York: Riverhead Books, 2010). I read it and had a visceral, negative reaction. I couldn’t put my finger on what bugged me. Two weeks passed, and I still couldn’t sort out my thoughts. I sat down with the book again yesterday, and now I can explain.

Like the more than 60 families Warner interviewed in We’ve Got Issues, my family has children who have needed medication.  I, like so many of these parents, have struggled to come to terms with the implications of medicating kids for diagnoses that 30 years ago would have gone unseen, let alone untreated. In fact, they did go unseen and undiagnosed in my extended family, and the attendant wreckage and dysfunction have been profound. My mantra concerning medicating children for mental illness has evolved to this: it is far scarier to contemplate what things will be like if the meds don’t work than if they do. Hence my predisposition to read Warner’s book with a favorable eye.

We’ve Got Issues is a combination conversion narrative, memoir, and reportorial expose.  I wasn’t sure how I felt about Warner situating herself at the center of the book, but I thought I understood the strategy.  She was outing herself as a card-carrying member of the opposition, one of the judgmental parents certain that kids these days are helpless pawns. Warner started her project, originally called UNTITLED on Affluent Parents and Neurotic Kids, ready to lambaste “the whole archipelago of therapy and tutoring and labeling and medication” (7). She was prepared to delve into the “social construction of disease,” assuming that overly anxious, ambitious parents were incapable of accepting their children’s imperfections and therefore labelling less-than-perfect behaviors as pathologies.  She was set to dine out on stories about the way Big Pharma fed these anxieties, making gazillions shoveling anti-depressants and untested anti-psychotics into the mouths of babes.  Warner stepped out of her comfort zone to attend a meeting billed as “Should I Worry?” The stories she heard at this meeting in a church basement made it difficult and eventually impossible for her to continue with her stated project. Here were parents describing interactions with out-of-control children who were destined for disaster. Diagnosis, treatment, and medication were saving lives.

Warner’s conversion moment came when she encountered a sentence the left-leaning French philosopher Jean-Paul Sartre had penned: “Mental illness is the revolt that the free organism in its total entity invents in order to live in an unbearable situation.” She confessed that she’d been inhaling these kinds of ideas for decades:  “‘Theory’ was like a religion to me” (25). It was time, she decided, to grow up. How could she swallow theory whole when the concrete experience of suffering precluded the validity of the musings of Lacanians and deconstructionists and Marxists? The theorists were engaging in “foolish, inhuman, cruel” thinking, leading her to “deconsruct kids’ diagnoses by analyzing them symbolically” (27). She stopped bashing psychiatrists and started listening to families in the trenches, and she hoped that others sympathetic to left-leaning cultural criticism would join her in her new religious affiliation.  She also hoped that families living through what she was describing would find solace, validation, even community in her book.

Other reviewers have taken Warner to task for her approach. Did she, in fact, have this come-to-Jesus moment, or was the conversion merely a brilliant marketing strategy?  If Warner cared so much about evidence, why did she focus narrowly on family stories instead of digesting scientific research?  You can click hereherehere, and here for generally favorable summaries and reviews.

So, why my hesitation in giving Warner kudos? What’s holding me back, given the fierce struggles my husband and I have fought to help our families? As she set out her research methods, Warner explained that she had interviewed “psychiatrists, psychologists, parents of kids with autism, Asperger’s, ADHD, anxiety disorders, OCD, bipolar disorder, dyspraxia, dyslexia, and sensory integration issues — in short, the range of disorders that I had once dismissed as ‘fashionable maladies.’ (And that I will, from here on, refer to as ‘mental disorders,’ ‘mental health disorders,’ ‘mental health issues,’ or ‘mental illnesses’” (27-28). She makes this elision again on pages 35-37.  Since when has “dyslexia” — an umbrella term covering difficulties with decoding, fluency, and spelling written language — been considered a mental illness? And though ADD and AD/HD were, in the dark ages, referred to as “minimal brain damage,” scientists these days think of this condition as a brain difference and a learning disorder.  Dyspraxia — a neuromuscular problem — a mental illness? Come on!

It’s true that cutting edge researchers are exploring whether many of these conditions are “spectrum disorders.” That is to say, scientists wonder whether there is a genetic relationship between, for instance, ADHD, OCD, bipolar disorder, and schizophrenia.  Families with members who have any of these syndromes are more likely to have children and grandchildren and great-grandchildren who inherit variations of these syndromes. Scientists want to know if similar neurotransmitters or genetic mutations are involved. By conflating these conditions, Warner does a terrible disservice to the field of neurology and to the people — children, in particular — who are living (and living well) with “issues.”

When I returned to Warner’s book, I was struck by her description of the process by which she initially got her book contract for UNTITLED.  Her editor and publisher were so taken by her as a personality and writer that they green-lighted her idea. I am curious to know if they took a similar approach to the manuscript.  Who reviewed it?  Did no one along the way object to Warner’s approach to “mental illness?” It’s hard for me to believe that anyone working in the fields of psychology, psychiatry, neurobiology, or education wouldn’t have challenged this manuscript.

Last: by putting herself at the center of her book, Warner blurred the lines between insider and outsider.  She wanted to maintain distance and objectivity so that she could report stories that might be unfamiliar to many readers.  But she committed the cardinal sin of the outsider who wants to pass, by way of empathy, as an insider.  She made a careless, even harmful mistake that no insider, no one who actually lives with “these kids” and “these issues” would ever make. And while there is much to praise in Warner’s new book, I can’t forgive her. I hope, when the book goes to paperback, she will revisit the construction of her definition and make a few critically important changes.