An English teacher learns how to deal with medicated students

By Nancy Schnog
Sunday, September 19, 2010

Here's a scene that 20 years teaching English never quite prepared me for.

It's 10:00 a.m., the end of a short break between classes on a bright fall morning. My 11th-graders trickle into literature class, chatting while finishing off peanut butter bars and sugar donuts.

In marches a perfectly likable young person who announces to all within earshot: "Good morning, Ms. Schnog. Oh, I can't study today. I didn't take my meds."

"Ummm," I utter, before falling mute. What now? Give a mini-lesson on Benjamin Franklin and the power of the will? Introduce Mary Baker Eddy's concept of mind over matter? Grin neutrally or disapprovingly? Ignore this altogether and launch my lesson on Emily Dickinson?

Uncertain how to proceed, I intone something half-baked, sprinkled with cheery uplift. "Of course you can." Pause and stammer. "Drugs don't control us." The less-than-three-minute exchange trails off into an apologetic retreat, as I mumble about my fear of side effects and my wish that we lived in simpler times.

There it was: the "teachable moment," an occasion to bring this student to a powerful insight about educational responsibility. And I was making a mess of it.

So over the summer I decided to do what I tell my students to do when they confront a perplexing question: research it. I realized that though I prefer to let the school nurse or the students' doctors handle "meds," medication talk is surfacing more frequently in the classroom. If teachers are going to deal with it -- rather than avoid or squash these exchanges -- we need solutions.

I started with Judith Warner's recent book, "We've Got Issues: Parents and Children in the Age of Medication," which explores the complicated matter of parents' decisions to medicate their children. (I knew some of this complexity personally, having once been told to give my child Ritalin.) Warner shows how parents are buffeted between pro-medication advice and anti-medication warnings. The book helped me accept that, no matter one's own preferences -- mine used to tend toward the anti-medication end of the spectrum -- medical interventions into learning are here to stay.

After reading Warner, I sought the expertise of Nancy Rappaport, a child-and-adolescent psychiatrist and professor at Harvard Medical School. She said she sees more educators, in both private and public schools, being asked to manage the "emotional and diagnostic world of kids." For most of them, it's uncharted territory that can include uncomfortable moments -- like the ones I had experienced. "When a student announces, 'I can't study today because I didn't take my meds,' she's checkmating the teacher, who was most likely never trained to discuss this issue," Rappaport explained.

She made clear that students deserve privacy and that it's not the place of teachers to get involved with -- or make judgments about -- individual medical challenges. But that doesn't mean teachers can't do anything. They can respect boundaries and still foster discussions about "the art of self-care." Sleep, nutrition, exercise, relaxation -- none of this should be outside their scope.

Yet those conversations are typically the first to be edged out by the long shadow of "instructional minutes." When some teachers must spend every moment preparing students for standardized exams, it's hard to imagine them detouring into a serious discussion about a good night's sleep and three square meals a day. Additionally, while some teachers feel comfortable talking with students about life outside the classroom, others do not. I have no problem cutting short my Dickinson lesson to address my students' school-inflicted frustrations, but with a test scheduled for Friday, I might decide to skip that talk.

Rappaport understands this. But, she says, teachers and administrators need to confront today's medical realities and make time for them in the curriculum. Conversations with students will flow more readily, she believes, as teachers learn more about psychotropic drugs and their side effects and grasp more fully the biases that they may have regarding these treatments. "We all have our assumptions and reflexive responses to medications," she stressed. "What is truly important for teachers is that they are familiar enough with major mental health issues -- mood, depression, fatigue, focus -- so they can better serve as gatekeepers, directing students to the resources they need."

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