Katie Gibson, “Disappearing Structure”

Though psychotropic medications have been prescribed to youth in American child welfare systems without state oversight since the late-60s, only in the last ten years has media coverage, research and policy advocacy shed light on the disproportionate rates of use in this population and persuasively framed them as problematic. In 2011, federal authorities mandated that states must create systems of oversight and monitoring to ensure the safe, ethical, and effective use of psychotropic drugs with these youths. This dissertation explores the ethics and effects of the forms of professional vision that are exercised and enforced in Illinois’s attempts to regulate and monitor psychotropic medication use. Founded in 1998, Illinois’s consent program is nationally considered the “gold standard” for oversight. This study sets aside the question of the capacity of psychotropic drugs to alter the emotions and behaviors of the youth who consume them to investigate what else drugs—and the psychiatric ethics and authority that come with them—do in and to the child welfare system. Rather than treat drugs only as a particular kind of problem or solution, I conceptualize drugs as institutional agents that influence the thoughts and behaviors not only of the children to whom they are prescribed but of the professionals and caregivers who prescribe, suggest and monitor them. This 16-month ethnographic study analyzed (a) state protocols and regulatory practices surrounding appropriate psychotropic medication use, (b) the interpretation and enactment of these protocols in clinical settings, and (c) how these processes influence each other. The analysis explores the ethical imperatives and expert modalities that are involved in determining the effects of medications in everyday practice, as well as how medications (and the accountability mechanisms that come with them) influence the way people interpret and represent youths’ behaviors and psychologies.