email page print pageAll Topic Reviews
The Creek"Who Could That Be at This Hour?"100 Things Guys Need to Know3 NBS of Julian Drew3 Willows33 Minutes47A Company of FoolsA Corner Of The UniverseA Crack In The LineA Frog ThingA Great and Terrible BeautyA Monster CallsA Monster CallsA Northern LightA Step From HeavenA Step Toward FallingA Stir of BonesA Walk in the Rain With a BrainA Wish for Wings That WorkAdam Canfield of the SlashAfterAlice MacLeod, Realist at LastAll Rivers Flow to the SeaAll SoulsAll the Bright PlacesAll the WayAll Unquiet ThingsAmerican GirlsAmong the HiddenAmong the ImpostorsAnatomy of a BoyfriendAnatomy of a MisfitAngus, Thongs and Full-Frontal SnoggingAnnie's BabyAnything Could HappenAristotle and Poetic JusticeAristotle and the Secrets of LifeArizona KidArtemis FowlAs Simple as SnowAssessment and Treatment of Childhood Problems, Second EditionAt the End of WordsAway Laughing on a Fast CamelBad Girls ClubBad RatsBang!Beating HeartBeauty QueensBecause of Winn-DixieBefore I DieBefore I FallBetween Mom and JoBeyond MagentaBig Mouth & Ugly GirlBig Rabbit's Bad MoodBlack HelicoptersBlack-eyed SuzieBlind SightBog ChildBoy Kills ManBoy ProofBoysBoys Are DogsBoys, Bears, and a Serious Pair of Hiking BootsBraceBrainstormBrave HeartsBreakfast Served AnytimeBreaking PointBronx MasqueradeBruisesBrushing Mom's HairBrutalBurnCatalystCathy's BookCathy's KeyCaveat EmptorCharlie and the Chocolate FactoryCharlie and the Great Glass ElevatorChild Insanity in England, 1845-1907Children and the Politics of SexualityChildren's RightsCity of CannibalsCity of HalvesClaiming Georgia TateClawsClay's WayConfessions of a Teenage Drama QueenConfessions of an Angry GirlContentious IssuesCoralineCountry Girl, City GirlCrispinCrossesCruise ControlCulture and Conflict in Child and Adolescent Mental HealthCut Both WaysDancing in My NuddypantsDani Bennoni: Long May He LiveDear Zoe,Define NormalDeliriumDeliverance From EvilDestination UnexpectedDirty Little SecretsDiscovering Pig MagicDivaDivergentDoing ItDown the Rabbit HoleDrawing a BlankDuck! Rabbit!Ellison the ElephantEmma Jean Lazarus Fell Out of a TreeEmpress of the WorldEscape Under the Forever SkyEvery Exquisite ThingEvery Little Thing in the WorldEverything Is FineEverything on a WaffleFacelessFacts About ADHD ChildrenFade to BlackFade to BlueFaith, Hope, and Ivy JuneFaking NormalFans of the Impossible LifeFeather BoyFile Under: 13 Suspicious IncidentsFinallyFinding H. F.FiregirlFirst CrossingFlashcards of My LifeForbiddenForest of the PygmiesFoxFreak the MightyFreaky Green EyesFree?FreewillFrictionGeektasticGentlemenGeography ClubGeorgeGeorge's Marvelous MedicineGetting Over Garrett DelaneyGhost at the WindowGirl PartsGirls Acting CattyGirls in PantsGirlsourceGLBTQGoing BovineGood GirlsGoodbye RuneGossip GirlGotta Get Some Bish Bash BoshGranny Torrelli Makes SoupGutsHamletHandbook for BoysHappy Halloween, Li'L SantaHarmlessHarry the Hypno-potamusHate ListHear Us Out!HeartbeatHeartbeatHeroHippie ChickHitler's DaughterHonor GirlHootHow to Build a HouseHumanism, What's That?Hurt Go HappyI Am Not Joey PigzaI Donít Want to be CrazyI Need You More Than I Love You and I Love You To BitsI Saw It HappenIf a Tree Falls at Lunch PeriodIf I StayIf We KissIn the Company of CraziesInvincibleIt Happened to NancyIt Was A Dark And Silly NightIt's Me!It's Perfectly NormalIt's Perfectly NormalJacob's LadderJakarta MissingJake RileyJames and the Giant PeachJennifer, Hecate, Macbeth, William McKinley, and Me, ElizabethJoey Pigza Loses ControlJoey Pigza Swallowed the KeyJokerJumping Off SwingsJumping the ScratchKeeping the MoonKeeping Your Child in MindKids Gone WildKidYogi - Yoga for ChildrenKim: Empty InsideKiss of Broken GlassKissing in AmericaKissing Ted Callahan (And Other Guys)Knocked Out by My Nunga-NungasLast CallLast DecemberLeaping BeautyLemony SnicketLess Than PerfectLiarLittle ChicagoLizard LoveLizard RadioLizzy's Do's and Don'tsLock and KeyLooking for BobowiczLooking for NormalLord of the FliesLoserLove and SexLove That DogLove, AubreyLucy in the SkyLukeís Way of LookingMadappleMade For YouMaking the RunMaking the RunMany StonesMapsMargaux with an XMary Pope Osborne's Tales from the OdysseyMichael Rosen's Sad BookMirrorMaskMolly Moon's Incredible Book of HypnotismMonsterMore Than a LabelMore Than FriendsMore Than FriendsMouse's First ValentineMy Brain Tumour AdventuresMy HeartbeatMy One Hundred AdventuresMy Perfect LifeNastybookNo Right TurnNot As Crazy As I SeemNothing But the TruthNothing PinkNow Playing: Stoner & Spaz IIOCDanielOlive My LoveOlive's OceanOliviaOlivia Saves the CircusOn the Bright Side, I'm Now the Girlfriend of a Sex GodOne Hot SecondOut of BoundsOut of the DustPandemoniumPanic at Toad HallPaper TownsPaperweightPatrolPeachesPeriod PiecesPictures of Hollis WoodsPiggyPINSPlanet JanetPlanet PregnancyPlaying a PartPretty Girl-13Prince William, Maximilian Minsky & MePrincess in LovePrincess in the SpotlightPrisoner of Night and FogPrisoners Under GlassProject Sweet LifePsychotherapy with Adolescent Girls and Young WomenPuddlejumpersPunkzillaPurgeRainbow PartyRebuttalRequiemRethinking Gender and Sexuality in ChildhoodRevolting Rhymes & Dirty BeastsRosy Cole's Memoir ExplosionSabrielSaving GraceSay YesScatSchool of FearSee You at Harry'sSexuality in AdolescenceSexyShadows on the WallShatteredShelterShooterSide Effects May VarySilence is GoldfishSimon vs. the Homo Sapiens AgendaSins of the FathersSix Impossible ThingsSkelligSmackSmall Avalanches and Other StoriesSolitaireSome Assembly RequiredSomeday This Pain Will Be Useful to YouSomeone Like YouSomething About AmericaSong for EloiseSophie Pitt-Turnbull Discovers AmericaSophie Spikey Has a Very Big ProblemSophomore SwitchSplit ScreenStartled by His Furry ShortsStone WaterStory of a GirlStuffSuffer the ChildrenSummer of the SkunksSurviving HitlerSweetheartsSymptoms of Being HumanTalkTargeting AutismTeaseTeen Angst? NaaahTeen TelevisionThat SummerThawThe 10 PM QuestionThe Absolutely True Diary of a Part-Time IndianThe Actual Real Reality of Jennifer JamesThe Amnesia ClinicThe Arctic IncidentThe Artsy Smartsy ClubThe Bear MakersThe Beast of CretaceaThe BFGThe Big BurnThe Book of JudeThe Boy Who Climbed into the MoonThe Boy Who DaredThe Boyfriend ListThe Buffalo TreeThe Carnivorous CarnivalThe Case of the Case of Mistaken IdentityThe Cemetery BoysThe Chosen OneThe Clouds AboveThe Color of AbsenceThe Crazy Things Girls Do for LoveThe Dating GameThe Day Leo Said I Hate You!The DaydreamerThe Diary of a Killer CatThe Diary of Pelly DThe Disreputable History of Frankie Landau-BanksThe Dream BearerThe Dulcimer Boy The Earth, My Butt, and Other Big Round ThingsThe EndThe Ersatz ElevatorThe Eternity CubeThe Eyes of van GoghThe Flight of a DoveThe Future of UsThe Geography of GirlhoodThe Geography of You and MeThe Ghost NetworkThe GiantessThe Great BrainThe Grim GrottoThe Heretic's DaughterThe Hookup ArtistThe Horse and His BoyThe Hostile HospitalThe Last Chance TexacoThe Last Time I DiedThe Last Time We Say GoodbyeThe Little TernThe Love Curse of the RumbaughsThe Lucky PlaceThe Memory of LightThe Men They Will BecomeThe Miseducation of Cameron PostThe Mystery of the Third LucretiaThe Naked Truth About SexThe Neil Gaiman Audio CollectionThe Opposite of InvisibleThe Order of the Poison OakThe Outcasts of 19 Schuyler PlaceThe Palace of LaughterThe PanopticonThe Penultimate PerilThe Porcupine of TruthThe PostcardThe Princess DiariesThe Rules of SurvivalThe Same Stuff as StarsThe Sands of TimeThe ScarThe Serious KissThe ShakeressThe Silent BoyThe Silly BookThe Sledding HillThe Slippery SlopeThe Snow SpeaksThe Spider and the BeeThe SpindlersThe StepsThe Story of Frog Belly Rat BoneThe Tail of Emily WindsnapThe Teenage BrainThe Thief LordThe Thing About JellyfishThe Thought that CountsThe Treasure Map of BoysThe TwitsThe UninvitedThe View from SaturdayThe Vile VillageThe Virginity ClubThe WilloughbysThe Wish HouseThe Witch of Blackbird PondThe Witch's BoyThe Wolves in the WallsThe Wolves of AndoverThen Again, Maybe I Won'tThen He Ate My Boy EntrancersThey Broke the Law-You Be the JudgeThings I Have to Tell YouThirstyThirteen Reasons WhyThis Book Is Not Good For YouThis Burns My HeartThis Full HouseTime Stops for No MouseTrue BelieverTrue BelieverTruesightTwenty Boy SummerTwistedUnder Pressure and OverwhelmedUnder the Wolf, Under the DogUnder WildwoodVery Far Away from Anywhere ElseVirgin Sex for GirlsVirgin Sex for GuysWalking on GlassWastelandWatch Me Do YogaWe're Not MonstersWelcome to the ArkWhale TalkWhat Comes AfterWhat HappenedWhat I Saw And How I LiedWhat the Birds SeeWhat Works for Bipolar KidsWhat Would Joey Do?What's Happening to My Body? Book for GirlsWhen Jeff Comes HomeWhen Nothing Matters AnymoreWhen You Reach MeWhere She WentWhere The Kissing Never StopsWho Has What?Why Are You So Sad?WildwoodWill You, Won't You?Witch ChildWith Their EyesWolf on the FoldWonderlandWorlds ApartWurst Case ScenarioYogaYoga 4 TeensYou Hear MeYou Know You Love MeYou Look Different in Real LifeYour Body Is AwesomeZane's TraceZapZazoo
Marilyn Wedge has provided an excellent resource for clinicians and parents. Her book, Suffer the Children, is a tour de force argument against the current trend in American education and psychiatry which assumes that children with behavioral difficulties will likely require medication. Throughout her argument against this trend, she provides positive support for the alternative treatment that she is recommending--strategic child-focused family therapy. This support comes by way of numerous case studies drawn from her years of clinical practice; perhaps the greatest virtue of the book is the large number of case studies that she provides for the reader.
In this review, we will highlight some of the book's features that recommend it to clinicians and concerned parents. In chapter 1, Wedge describes the current situation in child psychiatry and discusses some of the trends in family systems therapy since the 1970s. She questions the trend in child psychiatry to label emotional or social disorders as "brain diseases." She argues that medicating in many situations might appear to be a "quick fix," but often medicating a child causes unforeseen side-effects or other negative consequences.
Furthermore, Wedge argues that many so-called "disorders" with which children are diagnosed are most likely related children's family environments: "[…] instead of giving them a label or a diagnosis, I view children's symptoms--unhappiness, jumpiness, moodiness, suicidal thoughts--not as signs of a 'psychiatric disorder' but as evidence of something wrong in the family, something that I can remedy with the right interventions" (p. 2). The right intervention for Wedge is not merely to substitute talk therapy for medication; it involves working with a child's entire family and incorporating a child's teachers, friends, and others. It is a more holistic approach.
In chapter 2, Wedge illustrates how her recommended alternative framework, strategic child-focused family therapy, approaches issues in a dramatically different way. To do so, she works through a few case studies from her own practice. Among these cases is the example of a seven year old child named Paolo. Paolo was having difficulty paying attention in class and was also disruptive (p. 32). Paolo's teacher had recommended that he be evaluated for ADHD. After meeting with Paolo, Wedge determined that he did not display any signs of ADHD; however, since he had moved to the US at age 4 from the Philippines, she thought that he might be having difficulty comprehending English. After Paolo had been in an after-school program for reading comprehension and after he had been seeing his school's reading specialist, he still had difficulty in class. His teacher then suggested that he be reevaluated, this time for autism.
When Wedge observed no signs of autism, she began to be pressured to give some sort of diagnosis to Paolo: "The school counselor was pressing me for a diagnosis of ADHD, ODD (oppositional defiant disorder), or even autism" (p. 34). Wedge remained unconvinced that Paolo had any of these disorders, and so she sent him to a pediatrician. In the end it turned out that his eyesight needed to be corrected, and a pair of glasses took care of the issue. The worry with this situation was the assumption on the part of the teacher and the school counselor that there must be something wrong with Paolo that could be corrected with medication. Wedge argues that strategic child-focused family therapy provides an alternative starting point: "Working within the frame of strategic child-focused family therapy, I approached Paolo's problems without the preconception that he had a mental illness" (p. 36). Given the stigma that can surround the diagnosis of a disorder, as well as the myriad side-effects that can result from believing that one has a disorder, it seems that avoiding having such a preconception is well worth it.
At some points it is difficult to determine Wedge's general viewpoint on prescribing medication to children for behavioral difficulties. Sometimes it seems like Wedge is not completely against the use of medication for the treatment of children. Chapter 7 focuses on two cases where children were administered medication and improved somewhat. One of the cases she discusses is the case of Matt; Matt was having difficulty performing in school. His parents were resistant to having medication prescribed for their son, so Wedge began to treat his family. The parents responded somewhat well to therapy, but Matt did not improve. Finally, his parents decided to have Matt treated by a psychiatrist for ADHD with medication and discontinued family therapy; soon his performance improved in school. Unfortunately, Matt had other difficulties that arose after he began taking medication, such as weight loss and difficulty sleeping. So Wedge contends that medication in Matt's case was a mere "band-aid" which helped only his performance in school but which did not treat other problems that resulted from dysfunctions at the family level, since his family stopped participating in therapy (p. 175).
Chapter 9 is a wide-ranging chapter, dealing with issues ranging from current debates in psychiatry over classification in the forthcoming publication of the Diagnostic and Statistical Manual (DSM) by the American Psychiatric Association to issues in the history of psychiatry such as the so-called "moral treatment" of 19th century French physician Philippe Pinel. Wedge is keen to criticize the current way in which the disorders in the DSM are classified, according to what she calls "classification by [the] consensus" of DSM panelists (p. 205). She contrasts this method of classification with one that would classify according to biological causes. However, it's not clear that this is entirely fair to the DSM panelists. After all, it is not mere consensus of a group of panelists that determines whether a disorder will be included or not; instead, for a given disorder there is a cluster of symptoms which are determined, and then the diagnostic criteria for that disorder are tested to determine their validity and predictive power. While Wedge is certainly correct to draw her reader's attention to the fact that the vast majority of so-called "mental" disorders are not classified according to some biological cause(s), she has not done justice to the process of classification that the DSM panelists actually undergo (and are currently undergoing as the DSM 5 is being finalized).
Wedge's book has much more of worth for practicing clinicians and for parents than we have discussed. Her argument encourages an overall caution in medicating children for behavioral difficulties. The force of her argument suggests that psychiatrists and family care physicians should be much more hesitant to prescribe medication than many currently are.
© 2012 by Shannon M. Bernard-Adams and Marcus P. Adams
Shannon M. Bernard-Adams, M.A. is a community mental health therapist in Pittsburgh, PA. Marcus P. Adams is a Ph.D. candidate in the department of History & Philosophy of Science at the University of Pittsburgh.