It's Insanity Writ Large

February 22, 2007, 9:10 pm
Why Rebecca Died

Tags: child abuse, psychiatric medications

If you haven’t been reading the Boston newspapers, then you’ve missed the awful details in the story of 4-year-old Rebecca Riley, who on Dec. 13 was found on a pile of clothes in her home in Hull, Mass., wearing a pink diaper and a pair of gold earrings, her lungs filled with fluid. She’d died of a drug overdose – murdered by her parents, local prosecutors claim, who had purposefully administered excessive doses of her bipolar and attention-deficit disorder medications in order to keep her calm and quiet.

Though I would like, on the one hand, to spare you the miserable details of Rebecca’s life – a life filled with abuse and neglect and incompetence and the worst sort of failure and cowardice on the part of almost every key adult present – I feel it’s important to share them. For if you’re at all like me, then reading about Rebecca, whose story was outlined in The New York Times last week, filled you not only with sadness, outrage and pity, but also with anxiety.

The anxiety came, perhaps, because like millions of other American parents, you have a child who is taking one or more psychiatric medications. Or maybe it’s not your child, but your sister’s child or your best friend’s child, or the child who lives across the street and is so sweet and lovely that you can’t believe – you say, shaking your head as you close your front door – that he or she is “on drugs.”

It’s such a scary thing, this business of medicating children. Especially when the medications are being prescribed for off-label use, or are being given to very young children, or are being taken as part of a multidrug “cocktail,” as is the trend among kids with multiple behavioral and emotional ills. It was the case with Rebecca, who according to state police reports was taking 750 milligrams a day of the antiseizure drug Depakote, 200 milligrams a day of the antipsychotic Seroquel, and .35 milligrams a day of clonidine, a blood pressure drug that is also used as a sedative. She went on her medications at age 2.

It’s so easy, if you’re a parent of a child who takes psychiatric medications, to feel vaguely like a criminal, or like you’re lazy or irresponsible, a dupe of the drug companies, or a standard-bearer for a sick society, as a mother in California put it to me this week, as she discussed her inner struggles over the decision to medicate her son for attention-deficit hyperactivity disorder. “It’s like ‘One Flew Over the Cuckoo’s Nest,’” she said.

It’s easy to read Rebecca’s death as a cautionary tale for all parents who might even consider medicating their kids. The Times certainly did, headlining its story, “Charges in the Death of a Girl, 4, Raise Issue of Giving Psychiatric Drugs to Children.” But giving it this reading doesn’t actually do justice to her story. And this interpretation could – if all the fear, anger and despair that the story raises were allowed to rage beyond reason – lead to worse, rather than better, care for some children.

So it’s worth taking a detailed look at what actually happened to Rebecca:

She came from a home that was rife with abuse. In 2005, her father, Michael Riley, had been accused of assaulting his wife Carolyn’s 13-year-old daughter from a previous relationship. He was later banned from the house by restraining order after allegedly choking Rebecca’s 11-year-old brother – but he had returned prior to Rebecca’s death. Complaints of abuse and neglect had been filed over the years against Carolyn Riley as well; on one visit, a social worker found her seemingly drugged and unable to care for her children.

Carolyn ran through Rebecca’s prescriptions for clonidine – ostensibly prescribed to help her sleep and make her less aggressive – at an alarming rate; she would tell Rebecca’s psychiatrist, Kayoko Kifuji, of Tufts-New England Medical Center, that she’d lost the pills, or ruined them with spilled water. And Kifuji kept writing prescription after prescription – despite an alarmed call from a pharmacist at Walgreen’s and reports from a school nurse that Rebecca was like a “floppy doll” when she arrived at school in the morning.

Family members watched Rebecca wander the house dazed and sick in the days before her death. Afterward, her uncle claimed that he told Michael Riley, “If you won’t bring her to the hospital, then I’ll beat you so that the ambulance will come and take both of you,” according to an affidavit described in a newspaper account.

In other words, Rebecca’s world was a nonstop horror show. It began with her parents, ran right on through her extended family (“What are people supposed to do, stop living?” her grandma scolded a Boston Globe reporter, when the news got out that Rebecca’s parents had gone bowling and attended a high school reunion in the days just after their daughter’s death), and was allowed to continue – without, it seems, more than biochemical interference – in her psychiatrist’s office.

From all of this, it’s fair to raise questions about the stranglehold that the focus on brain chemistry has on certain members of the mental health establishment. It’s fair to raise questions about psychiatric diagnoses in very young children and draconian drug treatments. But we should avoid generalizing from what appears to be a case of patent domestic abuse – where the weapon of choice happened to be pharmaceuticals – to a widespread condemnation of parents and doctors who treat children with psychiatric drugs.

Rebecca Riley was not killed by biological psychiatry or AstraZeneca or the Massachusetts Department of Social Services or parents like you or me who may or may not be medicating our children but are, indisputably, part of a culture in which doing so is now the norm.

She was killed by abuse, neglect and abandonment.