The Psychiatrization of Youth

Every year, millions of youth are drugged with psychotropic medications either against their will or without meaningful consent. 

Psychotropic medications are medications designed to alter the mind. These include stimulants like Adderall and antipsychotics like Zyprexa. 

Psychotropic medications can have severe short- and long-term effects. 

Sometimes, of course, there is a real mental illness and it can be helpful and empowering for youth to identify with a diagnosis and decide to take medication. 

However, there are also many times where the behavior of youth is labeled as mental illness when it might actually be an appropriate response to distressing conditions or environments. 

This happens in many different situations, including in foster care and/or psychiatric treatment facilities, in immigration detention facilities, in schools, in stressful home environments, and in juvenile justice facilities. 

Many of these settings involve adults controlling and confining youth. And others deal with youth who have experienced trauma. But all too often, the adult response is to use medication as a way to manage behavior, rather than to treat underlying causes of distress. 

This could mean that a youth could be labeled with mental illness and medicated for something that has an environmental cause. For example, a youth who is anxious because of conflict at home; a youth who is distracted because their school environment is too rigid for their needs; or a youth who is sad because they have experienced trauma and are now separated from their families. 

In all of these situations, experiencing distress would be appropriate and normal. But that doesn't mean there is mental illness.

The inappropriate labeling of distress as an illness is harmful because it can leave the underlying problems unaddressed. And because psychotropic medications can be very intrusive and damaging. 

Moreover, adults are the ones who decide how a "normal" youth should act, and what expectations youth need to meet. This leaves very little room for youth voice and autonomy. 

In other words, even if adults think that a youth's response is not "normal," young people might have a different view of the situation. From a young person's perspective, maybe their response is entirely appropriate. But the adults are typically the ones doing the labeling. 

What allows this labeling and psychiatrization to happen?

In part, it is the law. Most youths under 18 have no right to decide whether they take or refuse medication. 

But the problem runs deeper than that. It's tied to ageism and the oppression of youth in society. Ageism refers to age-based stereotypes and discrimination. And age-based discrimination against young people is everywhere in our society. 

The interests of children and young people are regularly subordinated to the interests of adults. When the interests of youth get ignored in policy, youth are disempowered. 

This disempowerment of youth fortifies the power of adults and adult-created institutions (like schools and foster care systems). Then, when youth are having a reasonable response to the distress caused by adults or adult-created institutions, rather than correcting the problem, adults label some of those behaviors as mental illnesses, which often leads to medication. 

This is how psychiatrization -- the process of diagnosing and medicating using psychiatry -- perpetuates the oppression of youth: it turns the valid feelings and actions of youth into illnesses to be medicated. It stifles resistance and agency but does so in a way that presents itself as professional and legitimate. It is a clear example of how the subordination of youth gets legitimized and institutionalized. 

So psychiatrization leads to the subordination of youth. But this process also goes the other way. 

Ageism and subordination of youth allow adults to psychiatrize and label youth, even when the behavior is not effectively treated by the medication, and even when the behavior is a normal response to maltreatment by a system or environment that causes harm. Because, as explained above, youth have few, if any, legal rights to resist psychiatrization. And they have little political power to change the adult-created conditions causing their distress. 

Then, once youth are labeled and psychiatrized, it is hard to question that diagnosis. Often, youth resistance to psychiatrization is used as more evidence that the youth suffers from a mental illness (e.g., oppositional defiant disorder (ODD)). 

In other words, coercive psychiatrization and the subordination of youth are intertwined. And there is a toxic feedback process in which coercive psychiatrization and the subordination of youth facilitate and justify each other. 

So how do we stop this cycle? 

We can begin by recognizing the importance of autonomy and bodily integrity for youth. And by recognizing the rights of youth to refuse medication in non-crisis situations. But the right to refuse is not enough. 

This is not enough because the right to refuse medication, without alternative treatment options, could leave some youth stranded in distressing situations. A solution to this problem is the requirement of fully informed consent, including alternative causal explanations for the distress, information about less intrusive treatment options, and supported decision-making for younger children. 

This is an empowerment approach that promotes youth input and could help address the social and environmental causes of youth distress. 

The empowerment approach also helps to challenge the broader subordination of youth. For adults, this means listening to youth and presuming that young people know what's best for themselves. Arguably, nobody -- including adults -- always knows what's best for themselves. But that shouldn't stop us from taking each other's views seriously in the first place and looking for alternative solutions.

Through this process, youth and adults can work together to address the social and environmental problems that cause distress. And the rights and minds of youth will be better respected and protected.