Domestic violence is a serious issue in the United States and, at its most extreme, domestic violence can result in broken families and ruin the lives of many individuals. In many cases, moreover, domestic violence can have a detrimental effect on children if they are involved. When children are involved in domestic violence they are often the recipients of the worse, often resulting in state intervention in order to secure the child’s safety until the problem is resolved. This can be challenging for children. Indeed, children who need state intervention because of domestic violence enter a system that is already overwhelmed with cases of abandonment, neglect, abuse and even mental health problems. This puts, in many cases, otherwise very healthy children into a system that deals with the rehabilitation of children with serious health issues. This, in turn, exacerbates the dilemma in terms of rehabilitation on all the children involved. In some cases, in turn, state intervention for children of domestic violence can actually result in these healthy children developing disorders such as attachment disorder, and developing distrust with their overall worldview.
Domestic violence occurs in three ways: intimate partner violence, spousal directed violence, and violence involving children [
Douglas S. Diekema (2008) suggested that children under eighteen and some elderly are the most common examples of those who lack complete rationality. However, in this paper I focus only on the former: children who lack the rational ability to take actions based on critically evaluated deliberations. Of course, the responsibility of choice for children typically falls on the parents or legal guardians of the child. However, what is best medically for a child might not always be within the morals of the patient’s guardian. Diekema (2008) offered the example of vaccines and their ideological objectors to show how sometimes states rights to intervene on behalf of a child trump parental authority. Diekema (2008) contends that the doctrine of parens patraie establishes that “the state is to act as ‘surrogate parent’ when necessary to protect the life and health of those who cannot take care of themselves, including children” [
Earlier, I identified some situations in which the state might have the rights and a duty to intervene in situations involving vulnerable children. The specific situations in which a state can intervene in cases involving children vary depending on the circumstances, but most situations are outlined by The Administration on Children, Youth and Families (ACYF) in their National Child Abuse and Neglect Data System (NCANDS), which are compiled from state and federal child protective services agencies.
First, NCANDS defines a victim as “any child for whom the state determined at least one maltreatment was substantiated or indicated” (21). The FFY 2014 data from NCANDS indicate the national number of recorded victims of abuse or neglect was 702,000 [xii]. NCANDS also provided a three-fold description of maltreatment types included in these numbers. The most common type was neglect―75 percent of victims; physical abuse― 17 percent; and sexual abuse―8 percent of victims [
Clearly, there is a great need for intervention from competent child protective agencies in the case of child abuse, neglect, and/or sexual abuse. Based on the 2014 national estimate, the types of care provided to the children represented by these statistics range from a staggering 23 percent or 147,462 receiving foster care services. Moreover, there are expenses associated with placing children in foster care in a group home, or residential treatment center [
In the academic sphere as well as society in general, behavioral health needs have become synonymous with mental disorders, which The Center for Disease Control and Prevention (2016) described as serious changes in the way children typically learn, behave, or handle their emotions, and which cause distress and problems getting through the day [
These alarming statistics should raise concern on multiple levels: First, the drugs are given to children, and even worse, the state might be the authority that is recommending them. Second, psychotropic drugs are rarely effective ways to treat the behavioral disorders displayed by children who are the victims of abuse.
So, first, it is important to understand what psychotropic drugs are and what they do. Pierre Schulz and Thierry Steimer (2000) defined psychotropic medication this way: “A psychotropic drug can be described according to the way in which it influences receptors, transporters, and enzymes, i.e., the cellular sites of its pharmacological actions” (178). Another characteristic of the drugs is that they vary in their ability to be selective. For example, Clozapine acts on several cell-membrane receptors and transporters at once; in fact, ten separate modes of action are affected, giving it the classification of a “dirty” drug [
The reality of institutionalized drug use―and some of the associated risks―can best be understood by considering primary accounts of children who have lived it. For example, ABC’s 20/20 investigation on the drugging of foster children, which was based on a two-year investigation orchestrated by the Government Accountability Office (GAO), studied the GAO’s macro level investigation focusing on foster children in Florida, Massachusetts, Michigan, Oregon, and Texas. The GAO investigation (2011) found foster children in these five states were prescribed psychotropic drugs at rates 2.7 to 4.5 times higher than were non-foster children on Medicaid in 2008. In addition, these states spent over $375 million for psychotropic prescriptions provided through fee-for- service programs to foster and non-foster children [
Interestingly, the investigative report―Generation Meds, focused on a micro-level investigation of psychotropic drugs and their side effects, based on primary accounts of youth in Child Protective Services (CPS). In the case of Brook, for example, a seven-year-old, 43-pound child who was prescribed five different psychotropic drugs for mental disorders, the child began to exhibit serious anger outbreaks and her foster parents were told to take her to a mental health clinic. What was the mental health clinic’s solution? Not surprisingly, more drugs, including the commonly prescribed anti-schizophrenic drug Seroquel. Weeks later, the medications failed to improve Brook’s violent and angry outbreaks, and her mother claimed they continued to worsen. The changes in medication continued, and reached an astonishing ten changes in just four months [
Clearly, Brook’s case shows the impact drugs can have on the previously mentioned subsystems of brain activity that are affected by psychotropic drugs. In this example, side effects resulted in rage, anger, and further confusion for the parent and child. Not only does it give example to the adverse effects these drugs can have, it provides evidence of how minimally active the foster system was in aiding the parent and child in treatment. First, the parent and child were experiencing pain, and instead of the system collaborating with all parties involved to find a solution, she was continually told to trust the system. However, the system continued to peddle seven-year-old Brook ten different medications, including one for schizophrenia, in just four months [
The American Academy of Child And Adolescent Psychiatry’s (AACAP) A Guide for Community Child Serving Agencies on Psychotropic Medications for Children and Adolescents (2012), stated that the organization is “composed of over 7,500 child and adolescent psychiatrists and other interested physicians whose members actively research, evaluate, diagnose, and treat psychiatric disorders…” [
As far as short term effects, a follow up report on the GAO investigation provided vivid primary accounts of the effects psychotropic medications have had on the foster youth. Ke’onte, an eleven-year-old who was prescribed a cocktail of drugs after his abusive foster relative, Diane Sawyer attested after interviewing Ke’onte, “…beat him with belts, switches, and extension cords-which not only left him with the physical scars on his body, but understandably, with anger and despair” [
These primary accounts reveal different examples of short-term side effects. Primarily concerning how the medication made the individual feel and subsequently act, but also the more physiological consequences like weight gain and the possible increased risk of diabetes. These reflections also give insight into the feelings and subsequent actions after removing meds from their daily ritual, including: the feel of “freedom,” feeling “in control of myself,” and even boosting one’s ability to succeed in the classroom [
I think we should apply this analysis to the children interviewed who reported and described the side effects of drugs prescribed through the foster care system. The horrifying feelings and subsequent actions described by the children can be attributed to the gap in logic that Schultz and Steimer argued that psychiatrists often operate under while prescribing. Side effects are a result of not understanding the vast network of higher brain functioning [
While it is fair to say that children in foster care may experience increased mental and behavioral issues, this doesn’t entail that their problems are different from those of other children, nor does it justify the need for giving them powerful medications. ABC’s investigative report interviewed Dr. Charles Zeanah, Director of Child and Adolescent Psychiatry at Tulane University, sheds light on the diagnostic protocol: “the general consensus is that when you’re treating young children, you always try behavioral intervention before you go to medication” [
Additionally, Dr. Jeffrey Thompson, Chief Medical Officer for Medicaid in the state of Washington, said, “Nobody gets up in the morning to overdose kids… Kids get aggressively diagnosed and sometimes we look for the easy solution, which is a pill over psychotherapy or better parenting” [
To move the discussion further into how Medicaid-sponsored medicating of foster children affects adults who grew up within it, the case of Tyrone Obasekiis illuminating. Obaseki entered the foster care system at just two months old. As an adult, he earned Bachelor’s in Sociology from Texas A&M and a Master’s in counseling from Prairie View. Obaseki is quickly attested to his “hellish” experience in an interview with Corrina Rachel (2014). Obaseki stated, “The way I felt in CPS? I felt like an animal, because every little behavior that I displayed, it was written down as if I was bi-polar or schizophrenic” [
Notably, Diekema referred to the doctrine of parenspatraie, which establishes that the state has a duty to act as a surrogate parent in order to protect the life and health of those who cannot take care of themselves. However, the preponderance of evidence I have presented suggests that the best interests of the state in securing the health and life of children, may not always be the best, and sometimes they are just the most convenient, for the state, when Diekema’s “threshold for intervention” theory is used to analyze the effectiveness of state intervention in the realm of child abuse and domestic violence.
The essay until this point has largely been concerned with how state institutions choose to treat the mental instabilities of children who’ve experienced abuse and neglect. Although the evidence suggests that it is often otherwise, the current standard for state intervention requires a guardian to act so to always make the decision most favorable to the child. However, the competing interests often complicate what is best for the child. The doctor’s interest may seem like the most logical, but a child also has an interest, and the child is the one that might be affected emotionally and physically [
Further, Diekema’s Harm Threshold, based on Feinberg’s harm principle, suggests an eight-fold set of criteria on which the state should ground their justification for state intervention. To narrow the scope, I apply only four of his criteria to this argument. These four criteria are: a) Is the harm imminent, requiring immediate action to prevent it? b) Is the intervention that has been refused of proven efficacy, and therefore, likely to prevent harm? c) Do its projected benefits outweigh its projected burdens significantly more favorably…? d) Would any other option present serious harm to the child in a way that is less intrusive to parental autonomy and more acceptable to the parents? [
Next, it is important to consider whether the treatments suggested for children of abuse have been proven effective. According to the AACAP, when a medication is considered “off-label,” the FDA has not yet approved the medication. FDA Black Box Warnings, on the other hand, indicate that the medications have been FDA approved, but require special attention and caution regarding the potentially dangerous or life-threatening side effects. Moreover, Selective Serotonin Reuptake Inhibitors (SSRIs) carry a black box warning that they may cause suicidal ideation or behavior, although the most recent review of the evidence is not conclusive that SSRIs increase suicidal behavior. Families should work in consultation with their child’s physician or other mental health professional to develop an emergency action plan, called a “safety plan” in case their child exhibits any suicidal behavior [
In discussion of the final threshold, other options should be considered before options that might present serious harm to the child. Other, less intrusive forms of treatment like therapy, communication, and a competent trustworthy guardian are available to children of abuse, but the states are often unwilling to provide the necessary resources to these children for them to obtain these less intrusive, and less harmful forms of treatment. However, holding practitioners, the FDA, pharmaceutical companies, and guardians accountable to the standards of the harm threshold might provide a reliable mechanism for addressing the problems that perpetuate children “feeling like bricks are on their head” [Generation Meds].
This plan provides better avenues for addressing the systemic and institutionalized “easy” fix that has pillaged the foster care system. Unfortunately, the current way of dealing with the overwhelming lack of competent parents has become a system that may or may not be less competent and more problematic to a child’s short-term needs, as well as long term needs. However, the system is just as vulnerable and misguided as the youth under its supervision. In his novel Saving Normal (2013), Allen Frances suggests diagnostic inflation, psychiatric fads, and the paramount promoter behind both―pharmaceutical drug marketers―as the driving factor of widespread, unjustified adoption. For example, in the late 1980s and early 1990s, SSRI anti-depressants, particularly Prozac, became a best seller and in the years following came new SSRIs like Zoloft, Paxil, and Celexa, and each showed promise for eager pharmaceutical companies [
The marketing of these easy-to-use drugs was closely tied to the marketing of what were (according to the drug companies) easy-to-make psychiatric diagnoses. Soon the SSRIs were also prescribed for panic disorder, generalized anxiety, social phobia, OCD, PTSD, eating disorders, premature ejaculation, and compulsive gambling, and as a general pick-me-up [
The same profit and marketing potential brought a new round of SSRIs or antipsychotics like Risperdal, Zyprexa, and Seroquel, and with their seemingly less problematic side effects, they were beating sales records around the country. However, Frances also attested that the schizophrenia market, to which SSRIs were originally purposed, was too narrow for the record-breaking sales. Something else must have been at play. With a 60 billion dollar-a-year advertising and promotional budget, which is double the research budget, pharmaceutical companies have capitalistically defaulted to the business of marketing, rather than focusing on the research needed for the relatively small number of patients who truly need medicine [
In recent decades, the drug companies have efficiently hijacked the medical enterprise by exerting undue influence on the decisions made by doctors, patients, scientists, journals, professional associations, consumer advocacy groups, pharmacists, insurance companies, politicians, bureaucrats, and administrators [
This army of trusted, educated and influential professionals chooses to believe the sales representatives of pharmaceutical companies and just like that they return to their profession and knowingly or not, begin marketing for the company.
Frances continued;
The best way to sell psychotropic pills is to sell psychiatric ills. Drug companies have many methods of doing this: TV and print media adverts; co-opting most physicians’ continuing medical education (often provided at the most expensive restaurants and the nicest resorts; doctors in training and medical students come cheaper―a pizza will do); bankrolling professional associations, journals, and consumer advocacy groups; invading the Internet and social networking sites [
In my estimation, pharmaceutical companies have brought profit-only driven corporations into the formerly sacred space healthcare industry. Similar to the drugs they push, the side effects of a money hungry healthcare industry have been detrimental to society. In light of this profit-driven system, Susan Cullen and Margaret Klein (2008) emphasized the importance of physicians and parents respecting a patient’s autonomy due to a patients lack of knowledge on the subject. They claimed:
When knowledge is power, ignorance is slavery. Unknown to a patient, a doctor that operates for profit only, has restricted the freedom to make meaningful choices. In this way, the doctor has discounted the patient’s ability to reason and make decisions, and in this way, treated a patient with disrespect [
Although just a thought experiment, these authors have defined the immense responsibility doctors have in their position regarding healthcare. A doctor’s unique position of power carries with it a responsibility within the medical profession for an outstandingly trustful, moral, and ethical character because their knowledge is essential to their patients’ health and well-being. Thus, because patients trust their doctors, they are vulnerable if the doctor acts contrary to their benefit. By extension, pharmaceutical companies, given their widespread reach, should call for an even more heightened sense of responsibility to patients. However, the seemingly unregulated, profit-driven privilege they operate in, has fostered an environment where money is more compelling than the ethics. The ability billions of dollars has to affect the logic and rationale of the public at large has become insurmountable to the point of exploiting a vulnerable population, the youth. Money has created a lawless territory for big pharmaceutical companies to do what they please. Ethics and morals yielding to money and greed is far from a new dynamic in the United States, but bringing the fist of justice to those who exploit children would be fitting in the case of patients who have suffered child abuse and neglect. Fining the pharmaceutical conglomerates is not the fist of justice, and is often considered a meager loss in their abundant profit. Instead, the United States must hold individuals accountable for the actions of corporations. That being said, if a CEO doesn’t know the under working of the company he is the head of, the CEO better start. These forces are too powerful for a fine, too greedy for morals, and too widespread to not be held strictly accountable for their actions.
Overall, identifying the main threat to the already overwhelmed foster care system is essential to identifying and beginning to address the various problems that have compounded the current ultra-problematic environment. In addition, we also must consider the underlying socioeconomic problem that is prohibiting the funding of treatments with proven effects. It is hard to believe that in the United States of America cannot find the funds to improve the efficiency and accountability of its own foster care and child protective services systems. Psychotropic drugs may seem to be the cheap option, but the treatments they provide have little evidence of actually improving the behavioral and emotional problems related to this population. Using psychotropic drugs as symptom based treatment is neglectful in itself. Until a child can asses, consult with doctors on their own, and learn about their behaviors and emotions with the help of competent psychologists or mental health professionals, they should not be prescribed psychotropic medications. When the psychotropic treatment is compared to more progressive treatments like therapy, the cost might be more expensive at the beginning for therapeutic treatments, but the reoccurring costs lessen with time and increase the effectiveness of treatment in the long run. Tax payers who fund the operations of institutions like child protective services should consider how the government is handling their youth and appropriating their taxes. The paradigm shift needed regarding treatments for children of abuse and neglect must change from the question “can we afford it?” to the question, “can we afford not to?” [
Robert Burke, (2016) Psychotropic Drugs: The Excessive, Yet Inconclusive Treatment for Child Victims of Domestic Violence by United States Institutions. Open Journal of Social Sciences,04,189-197. doi: 10.4236/jss.2016.45023