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One of the problems is that doctors, seeing the impossibility of hospitalizing patients (especially adolescents), tend to hand out drugs like candy hoping that will do something to control the patient. Many of these drugs should really be used only under close supervision, but that’s not possible.

Adolescents present a particular problem because that is often the time when the serious mental disorders suddenly appear (schizophrenia, etc.) and yet while there were once entire hospitals that specialized in caring for and attempting to treat adolescent patients (California had a gem of a hospital for this purpose, prior to deinstitutionalization) there is really nothing doctors can do now except order a brief (3-day) committment when the child gets suicidal or violent - and give them drugs. I had a friend whose manic-depressive son went through years of brief committments and finally, a few hours after the last one, did manage to kill himself. The family, in the meanwhile, had virtually lived in the emergency room or at the police station; they were completely destroyed, the parents divorced, and the other children in the family, who had never had decent childhoods themselves because everything was invested in caring for their older brother, were left bitter and alienated.

So in the case of your friend, a long term comittment at an adolescent facility might have helped her, because perhaps she really was more than a spoiled brat; or if she really was just a spoiled brat, this would have given everybody time to sort it out. Sometimes adolescents react better if they are out of a particular family environment. But handing out drugs is about all psychiatrists can do right now.

My objection is to givnig drugs for the minor (and, in my opinion, non-existent) disorders such as “ADD” and other mysterious “learning disorders,” which really are often just disciplinary or behavioral problems or at worst, developmental problems that would probably resolve themselves in a few years, especially with young children. In fact, giving them drugs probably interferes with their development and makes the problem worse.

So I agree that it’s true that sometimes parents who have created an uncontrollable and hostile child simply through poor upbringing are looking to drugs for a magical cure for the monster they have created. But at other times, there is a genuinely serious problem that may be exacerbated by poor parenting but is something that goes way beyond that and might be controllable by drugs - but certainly needs more comprehensive treatment than just the occasional handful of pills in an unsupervised environment.

Medications are not all bad. I have seen people whose lives were utterly tormented by paranoid hallucinations suddenly experience peace when the right combination of anti-psychotics was found. But this needs supervision, either in a full-time residential facility for the more fragile cases, or in some more open setting where there is still regular monitoring. When people are having an “episode,” they’re not pretending: they really do think they’re being stalked by monsters or that somebody is “listening to their brain waves” through their fillings, and they’re genuinely terrified and are not going to go for help voluntarily.