This week's pairing brings together two members who cover the politics of parenthood, from different angles. Joanne Bamberger—a writer, recovering attorney, and political analyst known around the blogosphere as PunditMom!—asks New York Times contributor and author Judith Warner five questions about her new nonfiction book, just out from Penguin. In the exchange that follows, Judith offers a frank assessment of her own thinking and writing process, reminding us that where we start is often not, nor should it be, where we end. (And do keep an eye out for Joanne’s book about the growing political involvement, Mothers of Intention, to be published by Bright Sky Press in 2010!). -Deborah Siegel
1. Your new book is titled We've Got Issues: Children and Parents in the Age of Medication. As someone who has spent many years writing the Domestic Disturbances column at the New York Times, where did the idea for this book come from? Was there anything that came up in your research for your last book, Perfect Madness : Motherhood in the Age of Anxiety, that steered you in the direction of this topic?
I think it was more my life at the time that I was writing Perfect Madness
that gave me ideas for the book. I saw all these parents running to all sorts of therapies that sounded crazy to me. I heard of all these kids being diagnosed with all kinds of problems. It seemed, at the preschool, that every other day some child was being "evaluated" by the on-site OT (occupational therapist, for the uninitiated). It was very hard for me to believe that all these children really had anything wrong with them. And when I heard of older children taking medication, it was an utterly foreign idea for me.
Given that I had been completely focused, in that period, on parental anxiety and "hyperparenting" and competition and perfectionism, it was sort of a natural leap to think the things I was seeing around me were related to that phenomenon. Unfortunately, that's a link that people commonly make today as well. What I didn't understand, because the subject was too new and foreign to me and I was not as compassionate as I should have been, was that, if some parents seemed to be rushing around like mad to appointments and evaluations and the like, it was because they were scared. Because something was wrong and they didn't know what to do about it. You know, there were lots of criticisms of Perfect Madness
, but the ones that truly stuck in my mind and made me think were those when someone—and these were face to face criticisms by someone I knew—suggested that I could have been more empathetic to parents. Whether it was Ellen Galinksy reminding me that parents try to do their best, however misguidedly, or a Bethesda friend letting me know how offensive it was to read of peanut allergy treated as a metaphor for the social ills of our time (her own son had nearly died in her arms from anaphlyatic shock after ingesting some peanut butter), these criticisms sank in. Over time, I came to truly understand them and to see the way to do something about them.
2. We all know that writing a book is a major undertaking, especially when it involves years of research. What was the biggest obstacle you had to overcome in writing this book?
I had to overcome the fact that my initial idea was just plain bad. I sold this book too easily, based on a conversation with my then-editor and a five-page letter. I thought at the time that I'd won the jackpot: a new contract without months and months of work! But there are good reasons for writing full-length book proposals—they do give you a chance to test out some of your ideas and see if they hold together. I realized, as I started trying to write my book, that the center didn't hold. I had a tapestry of belief, numbers, and quotes lifted from the press, but none of that added up to a real edifice for building an intellectually honest book. As I tried to make the idea work, I felt more and more like I was sinking into quicksand. I couldn't prove that children really were being overdiagnosed and overmedicated. And I really couldn't prove that lazy parents were stuffing their kids full of meds to make them perform better. The facts just weren't there.
3. Based on what you learned during the writing process for We've Got Issues, how do you think the current debate surrounding health care in this country will impact the needs of families with children who have been diagnosed with mental health conditions like autism, ADHD, and bipolar disorder?
The health care debate never made it to the point of discussing exactly what health insurance would have to cover (except in the case of not covering abortion, of course). What I would certainly hope to see is a requirement that health insurance plans cover mental health treatment, and that that coverage be as generous as what's offered for other health claims. (If they provide mental health coverage, companies now do have to make sure that coverage is on par with the rest of what they offer, but they're not required to offer mental health coverage.) I would really hope to see insurance companies reimbursing pediatricians for providing mental health care—as very often this is the only care for mental health issues a child will get—and also reimburse them for longer visits with parents in which they can discuss all the aspects of a child's life and care, and time spent coordinating care with parents and other mental health specialists. There is a terrible shortage of children's mental health specialists in this country—only 7,000 child psychiatrists nationwide, with most concentrated in urban areas. Whether or not this would be part of health reform, it would be a very good idea for the government to offer students incentives to specialize in children's mental health.
4. I know you've been working on this book for several years. When you started out on this topic—of whether we as a country are over-diagnosing and over-medicating our children—did you have a view of where the research would take you? If so, did that view change as you worked on your research and synthesized the information you discovered, and how did that impact the writing process?
As I said, once I started working, I quickly saw that I was in trouble. I contacted doctors whom I'd seen quoted in the media saying things that I thought were in line with my ideas and found out that (with one or two very vocal exceptions) they didn't actually agree with me. They didn't agree that disorders like ADHD weren't real or that parents were rushing to medicate or that the medications were parent palliatives that didn't actually work. I interviewed a doctor who had chaired an American Psychological Association task force on overdiagnosis and overmedication and found out that he thought the real problem in our country was underdiagnosis. He said, however much he disagreed with the too-frequent use of medication, he did not believe that perfectly "normal" kids were being diagnosed with psychiatric issues. More and more and more I saw that the scientific literature didn't back up my views. And when I started talking to parents about their experiences, I encountered a reality that was entirely at odds with my initial conception of the book. These were parents who were dealing with very serious, sometimes devastating problems with their children. They tended to try every possible alternative to medication before reluctantly making the choice to give pills a try. And when they did that, it was because they felt they had gotten to a point where the benefits outweighed the risks. Often, they were desperate.
5. I'm sure many other writers at She Writes are writing books on difficult and complicated subjects like the one you tackled in We've Got Issues. What advice would you have for those writers who might find themselves getting sidetracked during the research process? And, if you realize you've moved your project in a direction you're not sure it should be going, how do you get yourself back on track?
My problem really, rather than being one of having been sidetracked (I was sidetracked often writing Perfect Madness
; I worked in the Georgetown University library and just couldn't resist reading everything I could get my hands on, especially if it concerned the post-war period in America we can now so fascinatedly witness in Mad Men), was one of having been wrong. I think simply selling a book off a long and thoughtful proposal would keep most writers from ending up in this situation. In the end, I'm really glad that it happened. It made for a more fascinating journey, and also one that people can relate to. I've been told repeatedly since the book came out that readers start the book thinking the exact same way I did when I began, and then when they follow along with my trajectory, their minds are changed as well. This is immensely gratifying. Horrible though writing this book often was, I am very, very glad now that things worked out the way that they did.