Ben Polis thinks America has a drug problem.

When evaluating that statement, there's two things you should know about Ben Polis: He's talking about the kind of drugs doctors legally prescribe, and he has an outside perspective, since he's Australian.

He's one of a steady stream of specialists, doctors, and patients passing through Pittsburgh this month to talk about whether we are over-diagnosing children with mental illnesses, and then giving them too much medication.

It all started with the release of an extensive study at the beginning of June that concluded that half of all Americans will have a mental illness at some point in their lives and, perhaps even more startling, that three-fourths of these illnesses start before age 24. The study's authors said that most mental illnesses go untreated -- suggesting that more people need to be diagnosed.

One of the study's authors was here for last week's International Conference on Bipolar Disease, which mapped bipolar illness in the brain and in genes. The weekend before, experts gathered for a symposium entitled Drugging Our Children at Point Park University.

The symposium's thesis -- overdiagnosis and overmedication -- questions the idea that mental illness is something physically wrong with the brain that can be fixed with a pill, a theory called the medical model of mental illness, which has been gaining strength in medicine. Some say that the medical model has lessened the stigma that has been attached to mental illness for centuries, while others argue it is a convenient way for pharmaceutical companies to describe problems that can be helped, in some cases, only by drugs.

Polis might represent both sides of the debate. He was a terror when he was young; he beat a child in his class with a broomstick, exposed his genitalia to his kindergarten class, and downed a power line with a spear gun.

He was diagnosed with ADHD when he was 12, and was immediately put on Ritalin. But he was still out of control.

He eventually learned to manage his behavior and seek out situations that would help him deal with ADHD. He completed college and now travels and lectures internationally. He thinks that although medication is the best way to treat ADHD, it does not solve it.

Yes, it helped him, but on the other hand, "In America, every single person I speak to thinks they've got some sort of mental disorder," he said.

Defining normal

That's precisely what is bothering Dr. Sharna Olfman, an associate professor of psychology at Point Park University, and editor of numerous books, including an anthology to be released in December. She uses the example of Anne of Green Gables, the red-haired, rebellious character in books for adolescents, to illustrate her point.

If Anne were a real person alive today, Olfman argues, her jubilant moods, deep sadness (she talks about being "in the depths of despair") and impulsivity would be reinterpreted today as manic and depressive episodes.

She'd be prescribed medication, and the Anne that readers know and love, Olfman contends, would vanish, or at least change. A child whose daydreaming is considered a problem but does not perform well can be hurt by being medicated, she says.

"We're too quick to diagnose kids, or judge kids as having a psychiatric disturbance when they're marching to the beat of a different drummer," she said.

Unlike adults, children have moods and feelings that help them grow, she said. While she's quick to say that in extreme circumstances, medication is necessary, it should be the treatment of last resort.

"Children have an increasingly small role to fit into," said Dr. Lawrence Diller, a developmental pediatrician who has written two books about drug treatment of children and who spoke at the Point Park symposium. "It's getting harder and harder to be normal."

Diller sees 8-year-olds who come in complaining they can't focus, or are feeling down, when years ago, they wouldn't be so open with their feelings. He thinks it's time to focus on changing an environment that makes kids feel more anxious because of demands on their performance.

Mental illness on an X-ray

But this kind of thinking can seriously undermine the medical model that has helped countless children and adults, some doctors say.

A trained professional is adept at using the Diagnostic and Stastical Manual of Mental Disorders, the psychiatric profession's bible, to diagnose and treat mental illnesses, said Dr. William Cohen, professor of pediatrics and psychiatry at the University of Pittsburgh school of medicine. There are standard criteria for diagnosing an illness, including consulting with the school and family members about a child's illness. A diagnosis cannot aptly be made without those criteria.

"If anything, we need to be sure that this person is being evaluated by a professional who knows what the standards are," he said.

In Allegheny County, such evaluations have resulted in an increase in diagnosed psychiatric disorders in children. According to the state Department of School Health, in 1997, there were 2,436 children in County schools with psychiatric illnesses, or 1.15 percent. The number climbed to 2,718, or 1.32 percent in 1999, and 3,221 or 1.59 percent in 2001.

Nationally, the number of children on psychotropic medications more than doubled between 1987 and 1996.

Seeing those numbers makes you wonder: are there just a lot of "bad" doctors out there prescribing medications, or is the range of mental health problems in kids just now being discovered?

Balance

Most likely, it's a little bit of both, doctors say.

Medications might seem like an easy fix for parents who have their hands full dealing with a child who isn't performing well at school or doesn't get along well with others.

But while medications, if prescribed wisely, can make positive changes, some doctors say that advertisements and a general discussion about drugs in public might have some parents carried away.

Some are starting to blame that lack of balance on the pharmaceutical industry. And this is a problem that is mostly American.

In Australia, for example, drug companies are not allowed to advertise their products to the public. In England, antidepressants are strongly discouraged for use in children.

"I see women's magazines that are advertising medication for the [women's] children -- that's just wrong," said Polis, the Australian with ADHD. Within two months of his visit to the United States, he was contacted by a drug company that wanted to sponsor his lecture tour. He declined.

The pediatrician Diller contends that the drug industry has framed any childhood mental illness as a brain problem, reducing all solutions to one form of psychotropic drug or another.

"If I had my druthers, drug companies would not be able to advertise to the public," said Cohen, the Pitt pediatrics professor. "It drives parents to demand these drugs."

In the past year, warnings about the potential negative effects of a type of antidepressants on children, studies suggesting that therapy is better than medication for kids with obsessive-compulsive disorder, and suggestions that therapy might work better than drugs for mildly depressed children, may have tempered parents' drive for drugs.

But all in all, parents should realize that raising children is hard work, said Dr. Mary Burke, an assistant clinical professor of child and adolescent psychiatry at the University of California, San Francisco, and that it's a combination of environment, family influences, and in some cases, medication that produces the healthiest children.

A shy child might develop an anxiety disorder in one environment and not another. So it's important to provide this child with a healthy environment before resorting to medication, and supporting the many facets of this child's personality.

"It's about recognizing strengths that a child brings," Burke said.

While Burke, like other doctors, prescribes antidepressants and other medications to children, she urges restraint in categorizing kids with one disorder or another.

"In 2004, 2.4 percent of all American kids were on antidepressants," she said. "We don't know if that was a helpful thing."