Curbs on Violence Research:
Impeding Science or Preventing the Next Tuskegee?

Paper from the Violence Research Session at the 1999 APHA Annual Meeting

The Coalition Against the Violence Initiative by ELLEN ISAACS, MD

The New York chapter of the Coalition Against the Violence Initiative
(CAVI), a group of health professionals and community activists, was begun
18 months ago in response to the publication of a study by NYSPI, and a
similar one at Mt. Sinai Hospital, in major psychiatric journals. The NYSPI
study involved indirectly measuring the serotonin levels in the blood of 34
six to ten year old boys to look for a correlate with aggression. The boys,
who had no medical or legal history themselves, were chosen because they
were the younger brothers of boys known to the Probation Dept, which gave
their names to the researchers. Only minority boys were included in the
experiment. The children were kept fasting for 18 hours, were given a high
dose of oral fenfluramine (which is known to cause microanatomical brain
damage in animals) to stimulate serotonin release, and had blood drawn from
an intravenous line in place for six hours.

The fallacies in this study are many. On what basis could these children
even be said to display aggression or be likely to do so? All that can
really be said is that black and Latin teens are much more likely to end up
in the hands of the justice system than their middle-class white
counterparts. How could a scientist possibly attempt to correlate the level
of a neurotransmitter at one point in time with complex behavior in the
present or future? How can one draw conclusions even about serotonin levels
when there are no control groups? There were no boys who were subjected to
the stress of the experiment and not given fenfluramine and no group of
children said not to be prone to aggression.

Although this particular research project is over, the ideas and practices
it represents are ongoing at NYSPI and at many institutions around the
country. The psychiatrists at NYSPI subscribe to the view, now widely held
in the psychiatric community, that about 8 million children out of the 50
million in the US are mentally ill and in need of treatment at some point
in childhood. The most common diagnoses are Attention Deficit Hyperactivity
Disorder(ADHD), Oppositional Defiant Disorder(ODD), Conduct Disorder(CD),
anxiety and depression. Indeed it is controversial whether ADHD exists at
all, being so vaguely defined as inattention and restlessness. And the
conduct disorders involve behavior which almost every child demonstrates at
one time or another, especially if under stress, such as grabbing other
children's things, irritability, resistance to adult authority. Moreover,
the NYSPI doctors believe that nearly all so-called mental disorders are
biological in nature and thus subject to a biological cure. When we met
with them, they told us that in their child mental health clinics, any
problem than remains unresolved after four weeks, is treated with drugs.
That means treatment with Ritalin, Prozac or its congeners, and perhaps
more potent drugs like Depakote, often for many years. This year, the Child
Psychiatry Department has opened clinics in 9 schools around the hospital,
in the poor back and Latin community of Washington Heights. We worry that
many children will be labeled, put on long term medication and/or be made
the subject of drug experiments of no benefit to themselves.

We in CAVI have some disagreements about the definition and treatment of
mental illness, but we are united in our opposition to reclassifying human
responses to adverse social conditions as medical diseases and subjecting
ever larger numbers of people, especially children, to mind-altering drugs.
It is also evident that the victims of the medicalization are largely poor,
black, and Latin. Our strategies to oppose this bad science have included
extensive writing and leafletting in the area around Columbia-Presbyterian,
where the present and potential research subjects live. We have also had
quite a few spirited demonstrations at NYPSI and at locations where they
are speakers. When possible, we have registered for meetings and confronted
them during the question period. We held a large forum on the issue at
Riverside Church, in which the NYSPI scientists refused to participate, and
we have circulated a petition to the State Research Review Board. We are
currently continuing our opposition to the exoneration of Columbia by the
Office of Protection From Research Risks, despite the clear violation of of
consent guidelines and rules prohibiting the use of normal children as
research subjects. We have had some success in generating exposes in NY
newspapers. Most importantly we are continually seeking to broaden our ties
with the community and have published a parent guide if their children are
approached as subjects.

We have formulated 5 demands as the basis of our program:

No more research be done on childhood behavior which does not fully
consider the environment and is not part of a program to better the
socioeconomic conditions of the child.

No studies be done on children which do not include subjects of all ethnic
and socioeconomic groups.

No studies be done on children which do not fit the criteria of minimal
risk or without fully informed and non-coerced consent, and without
community review.

Researchers, such as Pine, Wasserman, and Halperin, who have not adhered to
the above principles, must be banned from further research on children.

Mayor Giuliani and Chancellor Crew must reveal how and why the names of
children known to the Probation Dept. and the Special Education Dept. were
given to NYSPI, and they must desist from releasing the names of any
children in the future.

There is a national trend, of which this research is but a small part, to
attribute behavior to biological or genetic cause, especially behavior
which is not desirable to those in power. This is not a new phenomenon, but
a resurgence of old ideas which many thought or hoped were dead. During
slavery, slaves who ran away were diagnosed with a mental illness called
"drapetomania." For the first half of this century, the eugenicists in this
country proposed that poverty, feeble-mindedness, and crime were genetic,
and on the basis of this so-called science, sterilization laws and
immigration quotas were imposed. In the late 1960s, following widespread
urban rebellions, a collaboration between the Justice Dept and the NIMH
began which funded hundreds of projects aimed to predict who might become
violent and study methods of behavior control. Perhaps the most notorious
of these proposals came from three neurosurgeons from Mass General who
declared that urban rebels acted violently because of abnormalities in
their temporal lobes, for which psychosurgery was said to be the cure. The
Nazis used such "science" to justify genocide of Jews and other minorities
and their political opponents. The legitimization of biodeterministic
theories in medical and academic institutions, when married to the
propaganda of the fascist state, allowed millions of Germans to be won to
the idea of aiding or abetting mass murder. We should not forget that it
was doctors, psychiatrists to be specific, who first carried out Nazi
policies as they selected deformed, retarded or mentally ill people for
extermination.

In the early 1990s, the NIMH, with the support of the CDC and the Justice
Dept., proposed that research again be increased into the biological causes
of violence, and this so-called Violence Initiative became, for a time, the
most heavily funded NIMH project. Many pharmaceutical companies and private
foundations have also funded such research.

But let us look at the real sources of the violence which we see around us
-- behavior which results in wide spread death or injury. In a four week
period this summer, the NYC police shot and killed 5 people, including a
mentally ill man holding a hammer and a young, unarmed man who hadn't paid
his taxi fare. In NY, 6 people have died of encephalitis and 4 from E Coli
contaminated water because the Health Dept. budget was cut so drastically
in this decade that insect and water control measures are no longer
effectively implemented. Meanwhile, American bombers bomb Iraq daily,
killing a steady stream of civilians, not to mention the estimated half
million children who have died because of US sanctions. Over the past few
decades, our government has been responsible for the death of untold
thousands in Vietnam and Central America. However, no scientists are
investigating the brains of the police or the military or the politicians
for violent tendencies, for these perpetrators are merely carrying out
public policy.

However, we are supposed to be frightened of young children and teenagers
who live in urban ghettos. Despite the fact that violent crime amongst
youth has decreased 39% since 1993, we are said to be in an unprecedented
era of youth violence. The massive publicity around the recent school
shootings has created a climate of alarm and fear which is being used to
justify the increased presence of mental health and police in the schools.
But I believe it is obvious to all of us that children's behavior is highly
influenced by the environment in which they find themselves. A young child
in a poor neighborhood, in dilapidated housing, whose parents may not be
steadily employed, who may not be well nourished, have enough books to read
or a place to study, who encounters hostile police on the street and in his
school, who is in a class of 30 children in a crumbling building is
justified in being unhappy with his nvironment. But a young child does not
sit and analyze the situation and join our Coalition -- he or she expresses
that dissatisfaction in childish ways. He may not pay attention, she may
talk too much, he may not do his homework, she may not cooperate well with
other children or the teacher. In our current environment, that child will
likely be referred by the teacher for "evaluation" and intervention, which
is very likely to result in the child being labeled as ill with depression
or Conduct Disorder or ADHD and placed on Ritalin or Prozac. It is
noteworthy that the majority of children involved in the recent school
shootings were already on Ritalin or Prozac (or a related drug).

Why is the medicating of children happening today with greater and greater
frequency? Clearly it is easier and less expensive to give out pills than
to attempt to fix the myriad of problems that afflict poor youngsters. It
is also more expedient to blame defects in children for their problems than
to address flaws in children's environments. And it is true that the drug
companies are making millions of dollars from this vast new market and that
the psychiatrists at NYSPI and all other institutions are heavily supported
by the drug companies. But I believe that the most important reason behind
drugging millions of children is to control them, and the powerful have
more and more need for this control because there is more and more for
children, especially poor and minority children and their families, to be
angry about.

The globalization of the world economy, with jobs and factories galloping
around the world with ever increasing speed in search of the lowest wages
and production costs, has forever changed the status of American workers.
They are now just another cog in this planetary machine, competing with
workers in much less developed countries, which explains why the wage gap
between the rich and poor is widening in America and even the middle class
must struggle to get by, as documented by recent articles in the NY Times.
Despite claims of the "strong economy," most middle and low income people
are working longer and longer hours for less, while others have only
minimum wage, part time work. Fewer and fewer have health insurance or
enough savings to retire. Although the US is still the greatest military
power in the world, it is also the biggest debtor nation in the world and
desperate to maintain access to cheap sources of raw materials, especially
oil. Thus a continued series of wars to control resources in the Middle
East, Eastern Europe, and South and Central America is to be expected, with
the possibility of escalation to nuclear war always present.

People respond to deteriorations in their conditions of life or the
threat of war in which they don't believe by fighting back, be it through
strikes, demonstrations, or rebellions or just individual resistance. From
the point of view of those in power, there are time tested remedies to
quell such disturbances or the potential for them. One is racism, to
convince people that their problems are the fault of another racial,
ethnic, or national group and not the fault of the system under which they
live. Another is to convince people that their problems are their own
fault, their own inability to make it in a complex world, because they are
too stupid or lazy or incompetent.

The present wave of medicalization of social problems is a major tactic in
this effort to deceive us about the source of our problems. We can see the
reason behind the spate of books and articles claiming that "bad genes"
lead us to be addicts or thrill seekers or unintelligent or criminal.
Recently, an op-ed piece in the NY Times by Alvin Poussaint argued that
"extreme racism" should be declared a mental illness rather that a
reflection of the racism in society. The research at NYSPI and other
institutions that looks for the causes of violence and aggression and crime
in the defective brains of young children is part of the same process. But
it is even more sinister, because these doctors propose not only to
diagnose but to drug large numbers of children for years to come, to rob
them of their energy and sense of well-being and label them as defective.
This is truly genocide against our children, genocide against the poor and
black and Latin children of Washington Heights. If we allow this trend to
continue, we are facing the spectre of a society where the poor and the
rebellious may be the victims of social control through massive
pharmaceutical intervention, all in the name of biomedical progress.

.
Updated November 13, 1999.
kpomeran@gwu.edu