Suffer the Children - Foster Care and Medication

Extract from Robert Whitaker's Anatomy of an Epidemic

If You're a Ward of the State, You Must Be Bipolar

The medicating of foster children in the United States took off in the late 1990s, and so I thought, in order to gain a perspective on this phenomenon, I would visit with Theresa Gately. She and her husband, Bill, took ninety-six foster children into their Boston home from 1996 to 2000, and thus she personally witnessed this change in how our society treats foster kids. The first children that Social Services sent them weren't medicated, but by the end, "it felt like all of them were on psych drugs," she says.

Over the course of several hours, we sat on her front porch, which looks out over a busy street in a fairly rough part of Boston, and nearly everyone who walked by waved and affectionately shouted hello, no matter what their ethnicity. Theresa Gately is a thin woman with straw blonde hair, and she has her own history as a foster child. Born in 1964, she was sexually abused by her step-father, and she turned so defiant as a teenager that she landed in a Maryland psychiatric hospital. There she was put on Thorazine and other neuroleptics, and, she said, it wasn't until she started "tonguing" the drugs - pretending to take them while nurses were watching and then spitting them out - that her head started to clear. However, she isn't "anti-medication" at all, and during a difficult time a few years back, she found an antidepressant and a mood stabiliser to be extremely helpful, and she remains on those drugs.

As a foster mother, Gately was required to follow "medical advice" and give psychiatric medications to the children who arrived on them. Most of the children were on cocktails, and it seemed to her that the drugs were primarily being used to make the children quieter and easier to manage. "One young girl, Liz, was so heavily medicated that she couldn't think at all," she recalls. "You would ask her if she wanted a pork chop and she wouldn't answer." Another was "almost mute when she came to me. The last thing you need to do is give somebody who already doesn't talk more drugs." Theresa ran through the histories of several more of her foster children, concluding that "maybe nine to eleven [of the ninety-six children] needed to have the drugs and were being helped."

She has kept track of a number of the ninety-six children, and as could be expected, many have struggled mightily as adults. Had she, I wondered, noticed a difference in the fate of those who stayed on the drug cocktails, versus those who stopped taking them?

"When I look back on the kids that stayed on the drugs and those who got off, it is the ones that are off that are the successes," she says. "Liz should never have been on the drugs. She got off the drugs and is doing great. She is a full-time student in nursing school and almost ready to graduate, and is about to get married. The thing is, if you get off the drugs, you start building these coping mechanisms. You learn internal controls. You start building these strengths. Most of these kids have had very bad stuff happen to them. But they are able to rise above their past once they are off the medications, and then they can move on. The kids who were drugged and continue to be drugged never have that opportunity to build coping skills. And because they never had that opportunity as a teenager, as an adult they don't know what to do with themselves."

Hers isn't a scientific study. But her experience does offer a peek into the toll that the medicating of foster kids is taking. Most of those who stayed on the drugs, she says, ended up "filing for disability."

Like Theresa Gately, Sam Clayborn, who is a social worker in New Rochelle, New York, can tell from personal experience what it is like to have been a foster kid in the United States. When he was born in Harlem in 1965, his mother was unable to take care of him, and by age six he was living in a residential group home. We met in his apartment in Croton-on-Hudson, and very quickly he put things into a historical context. "They weren't so hot on psychiatric diagnoses back then," he explains. "They were more into beating your ass, restraining you, and just throwing you into an empty fucking room. I'm glad I grew up when it was like that rather than what it is like today, because if I grew up now, I'd be fucking drugged up. I'd be doped out and zonked out."

For the past two decades, he and his partner Eva Dech have worked as advocates for foster children and poor youth in Westchester County. She also had a tough childhood, which included a stint in a mental hospital where she was forcibly medicated, and they see a racial aspect to this medicating of foster children. Starting around 2000, rates of black youth diagnosed with bipolar disorder soared, and based on hospital discharges, they are now said to suffer from bipolar disorder at a greater rate than whites.1 The diagnosis provides a rationale for medicating the kids, and that in turn puts yet one more burden on them, Clayborn believes.

"The Tuskegee syphilis experiments were nothing compared to this. That's mild shit compared to what they are doing to black kids today. The pharmaceutical companies and the government are fucking in cahoots, and they are doing a wicked dance with a lot of people's lives. They don't give a fuck about these kids. It's all about capitalism, and they will sacrifice all the niggers in the hood. We are damaging these kids for life, and the majority of these kids will never rebound. These kids will be destroyed and they are going to make the SSI rolls more overwhelmed."

One of the area youth that Clayborn has mentored is Jonathan Barrow, who had been splayed out on the living room floor during our conversation, half sleeping and half listening. Born in 1985 in Harlem to a mother on crack, Jonathan bounced around as a child, eventually ending up at his grandfather's home in White Plains. At age seven, he was diagnosed with ADHD and put on Ritalin. In junior high, he started becoming rebellious and got into a few fights, and that led to a diagnosis of bipolar disorder and a prescription for Depakote and Risperdal. Up until that time, Jonathan had been an active adolescent who spent most of his free time on the basketball court, but now he began spending most of his time "in his room isolated," Clayborn says. He went onto the SSI disability rolls before he turned eighteen, apparently "severely impaired" by this bipolar illness, and he remains on SSI today. "I'm doped up," Jonathan explains, still somewhat heavy-lidded from his afternoon nap. "I don't like it. It makes me sleepy and feel like a dope fiend."

At this, Clayborn rose from his chair, more agitated than ever. "This is happening to a lot of the brothers today, and once they are on the medication, it takes them away from themselves. They lose all the willpower to struggle, to change, to make something out of themselves and have success. They succumb to the chemical handcuffs of the motherfucking medications. It's medical bondage is what it is."

Not long after that interview, I attended a meeting of the Statewide Youth Advisory Council at Westborough State Hospital in Massachusetts. The council is composed of young adults who entered the mental health system before they were eighteen, and it provides advice to the Massachusetts Department of Mental Health on what it can do to help teenagers with psychiatric problems thrive as adults. In 2008, the coordinator of the council was Mathew McWade, who was first diagnosed when he was in the seventh grade, and it was he who made my visit possible.

At the meeting, I went around the table and asked everyone how they had gotten into the system. I thought I might hear stories of kids who were first put on a stimulant or an antidepressant and then moved on to a bipolar diagnosis, and while there was some of that, several men in this racially mixed group told of yet another societal route to psychiatric disability.

When Cal Jones was sixteen years old, he had gotten into a violent argument that ended with his being treated in the emergency room at Children's Hospital in Boston. There he told ER staff that he "wanted to kill the other kid," a sentiment that earned him a trip to a psychiatric facility, where he was diagnosed with bipolar illness. "They didn't run any tests," he says. "They just asked me a bunch of questions and started me on a bunch of medicines." Since then, he has been hospitalized twenty-five times. He doesn't like antipsychotics, and so he regularly stops taking them when he is discharged, preferring to smoke marijuana instead, and inevitably that leads to trouble. "I get arrested and get sent back to the (psych) hospital, and I'm like okay, it's just a business. The more patients they have, the more the doctors make. But I hate it. I can't stand it. I feel like a slave in a Nazi camp."

At least three others at the meeting told similar stories. One young man said that shortly after he graduated from high school in 2002, he got upset over a family matter and smashed the windows of his car. "I was having a bad time. They wanted to label me as mentally ill. I don't know if I am." Another explained that six months earlier, after he had committed a minor criminal act, a judge had given him the choice of going to prison or to Westborough State Hospital. "It's safer in here than in prison," he says, explaining his choice. A third member of the council said that he had been diagnosed with bipolar illness at age thirteen after "I killed somebody."

Their stories bore witness to another pathway into the mental health system for poor youth. Delinquency and crime can get them diagnosed, medicated, and routed into a mental institution. While many of the young men on the council were on heavy-duty cocktails, moving about and speaking in a sluggish manner, the one who had told of having killed somebody was now living in the community and not taking any medications. "If the state really wants to help us, it should put money into a jobs program," he says.