How closely does a writer’s work mimic her life experiences? It’s a perennial question made all the more irresistible as it pertains to Lena Dunham, the 26-year-old creator of one of TV’s most talked-about shows, and her recently-revealed history of Obsessive-Compulsive Disorder.
In the first season of HBO’s Girls, Dunham stirred up debate by, among other things, repeatedly revealing her less-than-perfect body while playing the show’s main character, Hannah Horvath. What got people talking as the second season progressed, though, was how serious the show seemed to be getting, especially with its depiction of Hannah coping with a resurgence of her OCD symptoms.
Critics, fans, mental illness activists and patients have largely praised the Girls’ depiction of OCD, which they’ve hailed as convincing and nuanced, but agonizing to watch. One hollywood.com writer and self-described former OCD patient called it “some of the darkest, most difficult material with which Girls has wrestled to date,” lauding the show for avoiding the temptation to turn OCD into a mere joke.
The fact that Dunham revealed in a March cover story for Rolling Stone that she’s struggled with OCD since childhood – and taken medication for it on and off – gave the topic more buzz. (I discussed what she revealed-and what she didn’t-here).
In a HBO behind-the-scenes look at one of the episodes, Dunham disclosed a little more about the connection between her experience and the show’s representation of Hannah’s OCD – though she didn’t go into specifics.
For those looking for a more direct comparison, here’s a look about what Dunham has said about her own experiences with OCD symptoms and treatment – and how they compare to Hannah’s.
Part of the cringe-inducing delight of watching Girls is hearing Hannah say things and do things she knows she shouldn’t. And part of what’s refreshing about Dunham herself are her irreverent, indecorous comments and self-revelations, whether on Twitter, New Yorker essays, or interviews.
So I was especially curious to hear what Dunham had to say about her obsessive-compulsive disorder and medication use in a just-released Rolling Stone cover story. Especially since it was titled Girl on Top: How Lena Dunham Turned a Life of Anxiety, Bad Sex, and Countless Psychiatric Meds into the Funniest Show on TV.
We keep asking ourselves “how?” and “why?” And, with authorities still trying to piece together evidence, the public has to make do with limited – and often incorrect – information.
First came reports that the shooter, Adam Lanza, might have Asperger’s. To my knowledge, no authoritative source has yet confirmed Lanza had a formal diagnosis of that or any other emotional, behavioral or developmental condition.
But that lack of evidence – as well as expert consensus that Asperger’s was extremely unlike to have triggered a shooting rampage – didn’t stop an army of commentators from weighing in.
Now, comes the speculation about whether Lanza might have a history of taking mood or behavior-altering medication.
Don’t get me wrong, here. I’m not blaming journalists, bloggers, pundits, Twitter users, and the general public from wondering if Lanza might be taking psychiatric meds.
In fact, it’s one of the first questions that came to my mind – even before I heard the reports of his possible Asperger’s.
Many children with autism spectrum disorders (ASD) take psychotropic medications to treat associated symptoms of their conditions, such as irritability and anxiety. Usage has increased in recent years, and some recent studies have questioned the evidence base supporting the drugs’ effectiveness in young people with ASD.
A new study, published in a supplement to the November issue of Pediatrics, suggests that coexisting psychiatric conditions and problem behaviors might account for much of that prescribing.
The study, which examined children and teens ages 2 and 17 with autism spectrum disorders, found that 80 percent of children with a comorbid psychiatric condition were taking medication, compared to just 15 percent without any psychiatric comorbidity.
Depending on the condition in question, those with a comorbid disorder were between 5 and 17 times more likely to be taking a psychotropic medication as those without the additional disorder.
The study included 2853 children enrolled in a registry run by the Autism Treatment Network, a consortium of 17 academic medical centers in the United States and Canada that is associated with the advocacy group Autism Speaks.
The registry used DSM-IV-TR criteria and the Autism Diagnostic Observation Schedule to diagnose autistic disorder, Asperger syndrome, or pervasive developmental disorder not otherwise specified. It relied on parent reports for information about comorbid psychiatric diagnoses and medication use.
Some metaanalyses have questioned the effectiveness of treating ASD with psychiatric medications, though they have not always taken psychiatric comorbidity into account. Comorbidity is very common in autism spectrum disorders, with studies finding that between 70% and 95% percent qualify for at least one additional psychiatric diagnosis. Other researchers, however, have said these high rates partly reflect overlapping symptoms and problems with diagnostic criteria.
The Pediatrics study didn’t collect information about why the children and teens had been prescribed medication – that is, whether the meds were to treat the comorbid condition, symptoms of the ASD, or both.
However, it found that current psychotropic use was also correlated with high scores on the Child Behavior Checklist, a measure of overall problem behavior. That …
This weekend a mother published a New York Times column about how her son came to be diagnosed with ADHD and became a member of the ballooning “Ritalin Generation.”
“Just a little medication,” the teacher told the boy’s mother, “could really turn things around” for the boy, who was having trouble focusing on class worksheets and lining up quietly for transitions between classes.
When the mother firmly responded that she and her husband weren’t going to medicate their son, the teacher backtracked, sounding mock-horrified.
She wasn’t explicitly suggesting medication, she said. The law prohibited such a thing. She just didn’t want him to fall through the cracks – and thus was was merely suggesting the boy’s parents have him evaluated by a psychologist.
The boy was evaluated, and sure enough, he ended up on Ritalin for a short-time, though he quit it on his own a year later, matured out of his former inattentiveness, and eventually ended up a well-adjusted, school-loving honor-roll student – and medication-free.
Such stories are commonly invoked as cautionary tales about the alleged over-diagnosis of ADHD and other behavior disorders and over-prescribing of drugs like Ritalin to keep children’s behavior in check. Teachers recommending meds for disruptive students often feature prominently. In fact, the debate over school involvement in medicating disruptive children showed up as early as the early 1970s.
With all the attention on the misuse of psychiatric drugs, I think it’s worth taking a look at how the increased scrutiny affects people who have a diagnosis and a legitimate prescription.
I don’t mean to suggest that just because someone has been diagnosed and a doctor has seen fit to prescribe her medication that she necessarily needs the meds – or even that she “should” be on them. Plenty of people have unjustified diagnoses and unneeded prescriptions.
But for those who do benefit from treatment, you’ve got to wonder how all the media attention affects their experience.
In a recent post, I explored the question of whether meds can help reduce bullying behavior in kids with psychiatric conditions, since they are more likely to bully peers than kids without such problems.
But research shows that kids with psychiatric problems are also more likely to be bullied – and that those who are bullied are at elevated risk of suffering from psychiatric disorders later on.
In my own research for my book on young adults who grew up taking psychiatric meds, I was struck that almost everyone I interviewed reported having been bullied during childhood or adolescence (some also reported bullying other kids).
So how does taking psychiatric meds affect the likelihood of kids being bullied? Do the drugs enhance kids’ self-esteem and behavior so that they’re less likely to be picked on? Or do kids get teased because they take meds?
In recent years, there has been a huge increase in the prescribing of psychiatric medication to treat aggression in children.
Specifically, atypical antipsychotic and mood stabilizing drugs, originally developed for schizophrenia and bipolar disorder in adults, are now routinely prescribed to treat the aggression that occurs in a variety of childhood psychiatric disorders.
Prescriptions for atypical antipsychotics increased sixfold between 1993 and 2002, and the majority were prescribed to treat non-psychotic aggression, according to a task force that recently published guidelines on how to treat aggression in kids.
But these drugs carry the risk of serious side effects, notably severe weight gain and metabolic changes that can lead to Type 2 diabetes. Critics, including many in the medical community, have said they are over-prescribed.
At the same time, we’re in the midst of a collective national hand-wringing over how to reduce childhood bullying. Might drugs that curb aggression be the answer?
What are the issues involved in taking stimulant medications for ADHD from early elementary school onward? And what happens when someone who has done this decides to quit the drugs in college – only to find her motivation and academic capabilities diminish without the meds, and to suffer a crisis of identity and mood problems upon resuming them?
Two recent guest posts from a reader raised these questions and prompted ample discussion and comments from readers. In those posts, I let the young woman in question speak for herself. Now, I’d like to highlight some of the larger issues her story illustrates.
I’m going to continue to do that, because there are many more topics I want to discuss (please feel free, as always, to make suggestions in the comments section if there are particular subjects you’d like me to write about).
However, if you’d like to read an account of what got me interested in this subject in the first place, you might want to check out the excerpt from my new book, Dosed: The Medication Generation Grows Up, which is over at Salon.com.