Letters: The Questions Raised by a Son’s Death

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Re "Diagnosis: Human," by Ted Gup (Op-Ed, April 3), about the death of his son from a mix of alcohol and drugs:

Mr. Gup poignantly highlights the potentially fatal consequences of colluding with "a system that devalues talk therapy." A study found that the percentage of visits to psychiatrists involving psychotherapy was less than 30 percent. Furthermore, insurance companies aggressively move to control costs by preferentially reimbursing and supporting drug therapy over the more time-consuming talk therapy.

These trends have not evolved overnight and will take time and effort to reverse. Medication, when correctly prescribed, can be lifesaving for many individuals. Psychotherapy, while more labor-intensive and costly in the short run, can also have profound and enduring therapeutic effects.

Clearly we are living at a time in which cost control is a major and legitimate consideration for the delivery of health care. Mr. Gup highlights the less conspicuous but heartbreaking cost of a system that devalues talk therapy.

LARRY S. SANDBERG
New York, April 3, 2013

The writer is a clinical associate professor of psychiatry at Weill Cornell Medical Center.

To the Editor:

As a pediatrician, I wish to respond to the suggestion that the prescribing of stimulant medications — in this case Adderall — may have contributed to the death of Ted Gup's son David. It is possible that David turned to alcohol and drugs as a way to deal with personal challenges that were not adequately addressed — either by medication or through therapy. It is not uncommon for children and young adults to turn to drugs for relief when they feel overcome with the negative consequences of attention deficit disorder — poor grades, social difficulties and diminished self-esteem. Depression and anxiety are often associated with inadequately managed attention deficit.

Mr. Gup suggests that the prescribing of stimulant medications represents an embrace of misguided marketing and a culture of performance enhancement. The intent of medications such as Adderall is to ameliorate the pervasive, compromising impact of inattentiveness and distractibility, and to enable a child to reach (not exceed) his or her innate potential.

While many parents and their children celebrate the benefits of judicious use of these medications, we must recognize that they must be but one element in the overall management of these children.

Ultimately, may our mourning David's loss inspire all health care providers to commit to prescribing all medications with discretion and vigilance.

THOMAS N. FROMSON
West Hartford, Conn., April 3, 2013

To the Editor:

Ted Gup expresses what I have felt every day in the almost three years since my 21-year-old daughter died after a ski accident. Life asks so many parents to bear what is unbearable. An awful strength allows me to continue working, writing and looking after my students, husband and sons.

It is inexplicable, really, that parents of dead children carry on, but I do it without expecting or wanting closure. Grief is not a treatable disease; it opens a window to the dead.

KATHERINE SWETT
New York, April 3, 2013

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