Such tragedies are unspeakable.  Yet speak of them we must, for they are cautionary tales.  In the case of Rebecca Riley, there is no doubt plenty of blame to go around.  Whether or not the parents in fact "poisoned" their daughter (and that is for the justice system to decide), it seems evident from the information presently available that there was much amiss in the child's home environment.  If Rebecca's short life was like that of all too many children here in Massachusetts and throughout the country, she experienced some measure of abuse and neglect from her caregivers, who may additionally have been violent with one another (or other partners) and struggled with substance abuse and/or mental illness.  Thus, instead of being raised in a consistently stable and nurturing environment, Rebecca probably occupied a painful and confusing maelstrom.  It is little wonder that she manifested emotional and behavioral difficulties.

Unfortunately, the mistreatment that seemingly marked her home life was to be coupled with mistreatment of a different sort--by the psychiatric profession.  Despite the environmental and intrafamilial stressors that no doubt caused Rebecca to act out in any number of ways, the psychiatrist who "treated" her somehow saw fit to diagnose this child who was presumably barely out of diapers with a major mental illness, bipolar disorder.  Having established such pathology (at least within the narrow, biologically-biased confines of his or her mind), the doctor then chose to subject Rebecca to a powerful and, in retrospect, dangerous cocktail of psychotropic medications--some or all of which was prescribed off-label.  It is difficult to imagine a more negligent and incompetent level of care.  A suspension, if not an indictment, should be forthcoming.

But what of the psychiatric establishment at large, which increasingly overlooks or minimizes the role of environment in the development of dysfunction and dis-ease in favor of purely biological factors that can ostensibly be treated with medication?  What of the pharmaceutical companies, and their sales representatives, which encourage such points of view and increasingly promote the off-label use of their products, such as the medication that Rebecca was on?  What of the health insurance companies, which generally prefer the cost efficiency of pharmacotherapy versus psychotherapy and support such treatment?  What of Congress and the Food and Drug Administration, which have permitted lobbyists for the pharmaceutical and insurance industry to have undue influence over public policy and to help create a system of care that values the profits of a few to the health of the many?  What of the Bush Administration, which pays lip service to the needs of children and families but fails to adequately fund more essential programs and services (instead spending hundreds of billions of dollars on the war in Iraq)?  What of all these others who, in one way or another, were complicit in the death of Rebecca Riley?  Why don't they have to answer for this tragedy?