Should Clinicians Medicate against Structural Violence? Potential Iatrogenic Risks and the Need for Social Interventions

Abstract

This paper examines how a child psychiatrist might approach treatment of aggression in foster care youth. We argue that a multimodal approach is best. Physicians should weigh not only the iatrogenic risks of off-label antipsychotic medications but also the possible consequences of failing to treat complicating social factors at hand. Advocates must address structural violence and failures of imagination in their efforts to improve mental health equity among vulnerable youth. CaseJordan threw himself down on Dr. Eitel's couch. He stared into the distance with a scowl on his face. Anger and frustration emanated from him-he was in no mood to talk. Jordan had once again gotten into a fight at school resulting in a five-day expulsion. Although the police had been called, thanks to the school's misconduct policy, an official arrest had not been made with the understanding that the school would handle the situation. Nevertheless, this was no victory for Jordan. "He knew exactly how to piss me off!" Jordan yelled at Dr. Eitel, "He did it on purpose. He was trying to push me over the edge because he knew this was my last shot!" A string of muttered expletives followed. The principal had warned him that one more misdemeanor would meet criteria for permanent expulsion from the school. Following his five-day expulsion, Jordan would have to attend a committee meeting to determine whether he would be allowed to remain at St. Joseph's Academy. Dr. Eitel felt bad for Jordan-she knew that he had been trying hard to stay out of trouble. He was making an effort, but it just was not good enough. Jordan's demeanor changed to one of resignation and defeat. "Whatever, I heard the alternative school makes you wear jumpsuits. It'd be nice, like wearing pajamas all day," he joked.Jordan had not been dealt an easy hand in life. At the age of eight he had been placed in the foster care system and was presently in his third foster home. His current foster family seemed to take a greater interest in Jordan than his prior placements, but Dr. Eitel could sense that even their patience was running thin. They had worked hard to get Jordan placed in this school and Jordan knew that his poor behavior had disappointed them.