Michelle Pratt shuffles to the witness stand in a crowded Los Angeles Criminal Courtroom. Her beaten down and weary appearance cannot mask a once attractive personae. The prosecutor asks her if she understands the serious nature of the charges being brought against her. “Yes,” she replies emotionlessly. He then inquires if she understands that by testifying, she is waiving her constitutional right of protection from self-incrimination. “I don’t care,” she mumbles, glancing at the jury.

“Does that mean 'Yes?’” the prosecutor asks, and when she nods he asks his opening question: “How and when did you first become aware of your son’s problems, Mrs. Pratt?” She gazes blankly out over some familiar faces among the courtroom spectators. “Mrs. Pratt, please answer the question.”

“What did you say?” she asks. Slowly and methodically the prosecutor repeats the question. “Right,” she says,” how and when? I’m not too sure, but it seems like a long time ago when the school first contacted me,” and via her testimony, the story unfolds. . .

* * *

Aaron Pratt, a sweet, happy eight-year-old boy, sits in his first grade classroom, innocently daydreaming, as his classmates engage in a writing activity. His teacher calls his name to re-direct him to the assignment. Aaron looks up at her, pauses, then lowers his gaze to the paper on his desk, and begins to work. Later that evening, the teacher calls the Pratt home to express concern about Aaron’s “diminishing attention span.” She suggests that he be looked at by a physician.

The next day, Dr. Decker, Aaron’s pediatrician, examines him in the presence of Michelle and Richard, Aaron’s father. When finished, he asks Aaron to wait in the reception area so he can speak privately to the Pratts. “He’s healthy,” Decker assures them, “but I sense he can probably use some help focusing. This is consistent with what his teacher says,” he goes on, referring to a report he holds. “There are attention-deficit issues that should be addressed, and a little Ritalin would probably help.”

Michelle is alarmed. “But he’s never had any problems before. He’s not hyperactive.” Decker concurs, and explains that Aaron exhibits the “inattentive” type of ADD, and that medication will help him concentrate. Richard, a high-powered corporate type, enthusiastically agrees, having expressed concern in the past about Aaron’s less-than-stellar school performance. He also frequently compares Aaron’s level of functioning to that of his two children from a previous marriage who are both high academic achievers. Michelle leaves the doctor’s office troubled. Richard is pleased.

Several days later in school, Aaron waits on a long line of children outside the nurse’s office, where she dispenses an array of medications to them. Back in the classroom, he is unusually fidgety, and his teacher has to reprimand him for disturbing the child seated next to him. On the play yard, he even becomes aggressive, pushing a classmate who falls to the ground and starts to cry.

After a telephone call from school regarding Aaron’s behavior, the Pratts are back in Dr. Decker’s office. Decker tells them that Aaron’s changed behavior must be a side effect of the Ritalin which, “effects different children in different ways.” When Michelle suggests he stop taking it, Richard disagrees. The doctor concurs, and prescribes Clonodine, a tranquilizer, which he says will counteract Aaron’s “irritability.” Again, Michelle is concerned.

At home and at school Aaron becomes lethargic. At his birthday party, he shows no excitement, even while opening gifts. He stares blankly at the TV screen when watching cartoons on a Saturday morning. At a public library, while Aaron sits forlornly in a story-telling group, Michelle peruses a “Physicians Desk Reference” and discovers that a possible side effect of Clonodine is depression. Without telling her husband, she stops giving him the drug before school in the morning, but continues the Ritalin.

Unable to reach Michelle at home, the school nurse calls Richard at work, and informs him that his son’s behavior has become aggressive again, especially in the mornings, but he seems to calm down later in the day after she administers his lunchtime doses of Ritalin and Clonodine. “Who’s responsible for his morning medications?” she asks.

“My wife,” he replies.

“Has she been giving them to him?”

“Of course,” Richard assures her. Somewhat skeptical, the nurse reminds him that failure to medicate Aaron could be construed as child abuse, and that a report to the Department of Child and Family Services might have to be filed which could trigger an investigation. At home that night, Richard questions Michelle. Her answers are evasive, but when he presses her, she admits to having discontinued the Clonodine. A violent screaming match ensues and Michelle breaks down in tears. The result is that Richard begins administering the drugs each morning.

A year passes, and the Pratts are called to school for a conference. Seated at a long table with them is formidable array of school personnel including Aaron’s teacher, principal, school nurse, a special education administrator and the school psychologist. A recommendation is made by the psychologist that Aaron be placed in a special class for children with learning disabilities. When Michelle questions the recommendation, Richard tells her not to meddle with “professionals.” The meeting concludes with the principal assuring her that the class is not filled with behavior problems.

Several days later, Aaron cowers in the corner of his new classroom. There are ten students present, nine if whom are boys. The teacher tries to control them. Before lunch, she marches the class to the nurse’s office, where nearly every child is given medications. Aaron takes his Ritalin and Clonodine. Back in class, he is depressed and anxious.

Over the next several months, Aaron becomes increasingly withdrawn. When Richard asks him to play catch one day, he shakes his head no. “Come on,” his father says, “liven up” but Aaron’s affect remains blank. In the bedroom that evening, Richard comments on his son’s demeanor, “He such wet mop lately.” It’s then that Michelle tells him that she received a call from the school psychologist recommending that Aaron see a child psychiatrist.

“Well, why haven’t you taken him?” he asks.

“Because I think it’s the medications that are causing his mood, and that a psychiatrist wouldn’t do any good.”

“Since when did you become a doctor?” he snaps. Michelle doesn’t answer. When he inquires about exactly when she received the call, and she responds “about a month ago” Richard explodes. “You’re ruining Aaron’s life by not listening to the experts. You are the worst mother that ever lived!” A screaming match ensues, while in the bedroom next door, Aaron stares blankly at the pounding wall.

Richard makes an appointment with Dr. Allen, a child psychiatrist, who meets with Aaron several times. Finally he calls the Pratts in for a final consultation. “According to our testing,” he says,” along with the school reports and Dr. Decker’s observations it’s clear that Aaron is clinically depressed, and I’m recommending that we place him on regimen of Paxil, an anti-depressant. It should help."

“Does that mean he can stop taking the other drugs?” Michelle asks.

“I’d strongly recommend against that,” Allen replies, indicating that this cocktail should work, as long as it is closely monitored. Visibly upset, Michelle begins wringing her hands. When Allen asks if she is okay and she shakes her head no, he advises her to seek help and hands her the card of a colleague, a psychiatrist named Dr. Falk. At the conclusion of the meeting, Richard asks Michelle to wait outside so he could speak to the doctor privately. Somewhat reluctantly she leaves, and it is then that Richard informs Allen that he has filed for divorce and that he and Michelle are in a custody dispute.

Several days later, Michelle meets with Dr. Falk. After a brief conversation in which she tells him that she feels both depressed and anxious, he writes out prescriptions for Luvox, an anti-depressant, and Xanax, an anti-anxiety drug. “I’m not comfortable with this,” she says. “Can’t we just talk things out?”

“There’s really nothing more to say,” he answers. “You need help, and that’s what medications are for. Just take the pills as directed and make an appointment to see me in a few weeks.”

Back in school, Aaron’s behavior has again shifted. He is loud and disruptive in the classroom. Out on the play yard, he screams and engages in physically aggressive behavior. At lunch, he bangs his fists on the table, and when another child complains, he pushes his lunch tray, dumping food all over him. A fight ensues, and it is broken up by a teacher aide who escorts Aaron to the principal’s office.

Another meeting takes place with school officials where again, Aaron’s emotional state is discussed. The principal suggests that his erratic behavior could necessitate his transfer to an “E.D.” class.

“E.D?” Michelle asks.

“Emotionally disturbed,” he explains.

“My son is not disturbed!” Michelle shouts out “It’s you people that are destroying him!” and she storms out of the room. Richard apologizes for his wife’s behavior, explaining that they are separated. He also does not fail to mention and that she is undergoing psychiatric treatment. When the discussion turns back to Aaron, Richard, as an aside, says that his two children from his previous marriage are “completely normal, and perhaps Aaron’s behavior has some kind of hereditary basis stemming from his wife’s side of the family.”

“The source of these issues is hard to pin down,” remarks the school psychologist. She then goes on to suggest that perhaps Aaron should return to Dr. Allen for a “medication adjustment.” Richard nods in agreement and leaves the conference room, passing a distraught Michelle waiting in the hallway.

“I’ll see you in court,” he hisses to her, and coldly walks away.

Several days later, Richard meets privately with Dr. Allen. “Where’s your wife?” he asks.

“She refuses to come to see you anymore,” Richard explains. “In fact, she hardly leaves the house.”

“I’m sorry to hear that,” Allen responds, and the discussion turns to Aaron. “According to his current school reports and my most recent evaluations, his behavior and mood swings are possible indications of a bi-polar disorder. I think we’ll start him on a regimen of Lithium and Haldol. Along with the other medications, this new cocktail should settle him down.”

Several months go by, and the Pratts are in a family courtroom sitting before a judge. Michelle, Aaron, and her divorce lawyer are at one table; Richard and his attorney at another. Behind Richard’s table sit the school psychologist, the principal, and the nurse ‹ witnesses for Richard in this custody hearing. Michelle eyes them apprehensively as she strokes Aaron’s hair.

When Michelle takes the stand, Richard’s attorney asks her why she should be granted custody. She answers that she is a good mother and that she loves her son. The attorney counters by asking, “Would a good mother suddenly stop giving her child prescribed medications without first consulting with a doctor?” When Michelle does not respond, he presses on. “Would a good mother attack educators at a meeting called to help her son?” Still Michelle is silent. When the lawyer points toward the school officials and indicates that he intends to call them as witnesses to attest to her “instability” and “irresponsible” behavior, Michelle shoots back.

“These people don’t understand Aaron,” she responds. “The school, the psychiatrists, they do nothing for him. Their answer to all of his problems is more medication. He’s on five different medications now. Five! And each one has serious side effects. They’re not treating him anymore; they’re treating the side effects!”

“Are you taking any medication, Mrs. Pratt?” the lawyer continues, ignoring her response. Michelle’s attorney objects, claiming the question is irrelevant. The judge overrules, stating that Mrs. Pratt’s mental condition is highly relevant in determining custodial competency. Michelle testifies that she is being treated for depression and anxiety with Luvox and Xanax. Upon hearing that, the lawyer concludes that Mrs. Pratt is incompetent, and based upon her past actions and current emotional state she should be considered a “danger” to Aaron. Custody, therefore, should be granted to Aaron’s father.

Michelle breaks down crying, and rushes off the witness stand and back to the table to wrap her arms around Aaron. Meanwhile her attorney objects: “Your honor, as you can see, my client is distressed, and calling her a ‘danger’ is a prejudicial and insensitive characterization.”

“If I were you counsel,” the judge responds curtly, “I’d advise my client to return to the witness stand.” But when the attorney quietly so advises her, Michelle shakes her head no.

The judge then sternly admonishes her himself: “Mrs. Pratt, you have not been dismissed. I suggest you get back on the stand immediately.” But she ignores his warning as well, while continuing to cradle Aaron. Sensing an advantage, Richard’s attorney informs the judge that he has no more questions for Mrs. Pratt, and is prepared to call witnesses. “That won’t be necessary, counsel,” the judge responds. “I’ve seen enough,” and he instructs the court officer to take Aaron into the hall so that he can render his verdict. Reluctantly, Michelle lets Aaron go.

After the door to the courtroom swings closed, the judge grants full custody to Richard. Michelle is granted weekend visitation privileges, with the stipulation that she continues treatment for herself and, without fail, administer Aaron his medications. Any violation of these orders, he warns, could result in court-supervised visitations or even a total loss of visitation privileges. Michelle is stunned, but when she starts to speak out, her attorney quickly quiets her.

Days later, back in her psychiatrist’s office, Michelle speaks to Falk about how much more severe her depression has become as a result of the court verdict. “I think I’m losing my mind,” she confesses. “I feel like killing myself.”

“We’ll take care of that,” Falk says, writing out a new prescription and handing it to her.

“It’s still Luvox,” she says.

“Yes, but we’ve increased the dosage,” he answers.

“Sometimes I feel like this medication makes my problems worse,” she goes on. “I get so afraid.”

“Then just take more Xanax,” he responds nonchalantly, looking down at his watch, indicating that the session is over.

The following Friday, Michelle pulls into the driveway of Richard’s house to pick up Aaron for her first weekend visitation. She honks the horn, and Richard and Aaron come out the front door. Exiting the car, she rushes to her son, wrapping her arms around him, kissing him warmly on the face. Aaron’s affect is flat, zombie-like. Michelle is alarmed. “Make sure he’s back by Sunday afternoon at four,” Richard barks. “And don’t forget to give him these.” He hands her several small plastic Baggies with pills inside. Each bag is marked with the time and day the medications are to be administered. “And don’t try to pull anything,” he threatens, “or you’ll wind up back in court.”

The next morning, Aaron and Michelle are seated in the small kitchen of her rented apartment. On the table is a glass of water and a bag of Aaron’s pills. “What’s wrong, honey?” she asks her son, who is visibly melancholy. His eyes are half closed and crusty, his lips parched and dry. He doesn’t answer. “Come on Aaron, please. Talk to me. What’s bothering you?”

Finally he responds to her coaxing. “I don’t feel good, mom. I wish I could be happy like other kids.”

She puts her arms around him. “Are you eating okay?” she asks. “You look a little thin,” and he tells her that he doesn’t have much of an appetite.

“I throw up a lot mom, and my eyes hurt sometimes. I get headaches too. Bad ones. I don’t feel good.”

As he lapses back into silence, Michelle looks down at the pills. Suddenly she stands up, walks to the bathroom, and flushes all the medications down the toilet, including her own. When she returns, she says, “How would you like to go on a little trip? Up to the mountains. Just you and me.” Hurriedly, she packs a few bags, loads them into the trunk of the car and drives away with Aaron. Later that afternoon, Michelle’s car pulls into a motel parking lot in the mountain town of Lake Arrowhead, California.

The following evening, Sunday at six o’clock, Richard calls his lawyer and tells him that Aaron and his ex-wife have not yet returned. His lawyer advises him to wait a few more hours and then call the police. “Be sure to file a missing persons report,” he says “and tell them you want her charged with kidnapping.”

When Aaron awakes on Monday morning, he is uncharacteristically animated, nervous, jumpy, talkative, and eager to go out on the rowboat trip that Michelle has promised. “Come on,” he urges her, as she lingers in bed, wiping the sleep from her eyes.

“Boy, you sure are excited,” she remarks happily. “You sound wonderful! Just like you used to.”

“Let’s go, mom. Let’s go!”

While Michelle washes up in the bathroom, Aaron gazes out the bedroom window. Suddenly he shouts out excitedly, “Wow, did you see that!”

“What?” She calls back from the bathroom.

“Stars!” he says. “So many stars, shooting everywhere.”

“It’s the daytime Aaron, there are no stars.” He continues looking out the window, his face aglow with fascination.

After a quick breakfast, Michelle rents a boat a heads out toward the middle of the lake. It is a clear, cool, hushed mountain morning. Sitting in the middle seat, facing the stern, she rows methodically. Aaron, at the bow of the boat, behind her, peers straight ahead. “Aaron,” she softly says, peering up at the surrounding mountains, “look how beautiful this is.” He raises up his eyes, and then slowly lowers his gaze into the icy water. He is transfixed.

“Stars, mom,” he says. “There are stars in the water. I can touch them, mom. I really can.”

“Of course you can my love, my little star,” she answers tenderly while continuing to row. Aaron reaches over, further and further, until his hand skims the water. Seconds pass, and suddenly there is a splash. Michelle wheels around, and sees that her son is gone. Wild, wide-eyed, she screams out, “Aaron, AARON!!!” and plunges into the cold lake.

Later that day, Michelle stands on the shoreline, crying and shivering as she huddles under a blanket in the frigid dusk. Police cars and emergency vehicles are arrayed about her, their lights flashing. Out on the distant waters, several search boats ply the lake with grappling hooks. . .

* * *

Her testimony nearing its end, Michelle is exhausted. “Mrs. Pratt,” the prosecutor says, “Just a few more questions.” She looks at him. “Why did you stop giving Aaron his medications?”

“I wanted to help him. I wanted him back. The way he was. Happy. A child again”.

“Mrs. Pratt, are you familiar with the term Sudden Withdrawal Syndrome?”

“Yes.”

“Were you aware of that term PRIOR to your son’s death?”

“No.”

“You testified that you were previously warned by your husband and by school officials not to take Aaron off his medications. Is that correct?”

“Yes. But I never thought there was any danger.”

“You knew, of course, that Aaron was on five extremely powerful drugs at the time you left for Lake Arrowhead?”

“Yes, and it scared me.”

“Did it also scare you that sudden withdrawal from drugs such as these might have devastating side effects, among which could be psychotic episodes causing hallucinations, hallucinations such as seeing stars?” Tears well up in her eyes. “Did THAT scare you, Mrs. Pratt?” he presses on, raising his voice. Michelle does not respond. “Did you even THINK about the possible consequences?”

“I KILLED HIM!” she suddenly cries out. “I love him so much, and I killed him! Oh my God, I’m sorry. I’m so sorry.” And as she lowers her head onto her arms and sobs, the prosecutor closes with,” No further questions, your honor.”

The verdict was quick, a forgone conclusion: guilty of involuntary manslaughter. Days later, at sentencing, the courtroom is again crowded. When the judge begins to speak, Michelle and her attorney rise. He asks if she has any last words to say, and when she sadly shakes her head no, he begins: “There is no punishment I can level that would approach the suffering you will have to endure for the rest of your life, Mrs. Pratt. Although I’ve decided against sending you to prison, you will be placed on ten years probation, the first five of which are to be served in a halfway house. In addition, you’ll be required to undergo psychiatric treatment and counseling. This court will closely monitor your progress. I sense that you were a good mother, Mrs. Pratt, who cared deeply about Aaron. But in no way does that excuse you from what you’ve done. As I said, you must live with the terrible consequences of your action and, in essence, you’ll be locked away in a cruel prison of your own making.”

The judge pauses and then raises his gaze from Michelle, fixing his eyes on the crowded courtroom. “It would be remiss of me to close these proceedings without also addressing the system, a system that appears to have gone too far in seeking quick fixes for our children by medicating them. Although there’s little doubt in my mind that the prudent use of drugs in helping children function in both school and society is beneficial, patience and understanding in dealing with children’s problems must also be elements in that process. The lack of those elements on the part of far too many educators, health care providers and parents is an unfortunate sign of our times, and is leading toward a virtual medication epidemic. And until this system is corrected, I foresee tragic scenes such as will repeat themselves for years to come. Unfortunately this court cannot pass sentence on a system, although I believe it would be appropriate to do so. And why? Because I fear that in far too many cases, most of which we will never hear of, we are medicating our children to death.”

The courtroom is silent. The judge turns his gaze back to a devastated Michelle Pratt, and fixes on her. He then slowly rises. All rise with him as he turns and quietly exits the court.

Dr. Karlitz may be contacted at: karlitz@earthlink.net