When I graduated from my child psychiatry fellowship training in 2018, I felt qualified to provide quality mental healthcare to children. I had trained at a nationally recognized program and successfully passed my board certification exam.
And then I learned about the fenfluramine study.
Not during my formal training or as part of board certification prep. I learned about it the way I’ve learned most of what I know about psychiatry’s racist history—on my own, through resources well outside of my profession.
I first saw it referenced in Ibram X. Kendi’s landmark book Stamped from the Beginning, which cited Harriet Washington’s Medical Apartheid, where I read about it in greater depth.
I felt ashamed that as a prescriber of psychotropic medication for children, I had not been required to learn about it, much less take responsibility for it.
What Happened
In the mid-1990s, child mental health researchers at top New York institutions injected grade-school boys with fenfluramine, also known as the diet drug “fen-fen,” a substance that was later banned by the Food and Drug Administration, due to its links to valvular heart disease and pulmonary hypertension.
The boys were all Black or Hispanic by design: Eligible participants were required to be African American or Hispanic because they were deemed to be at higher risk for developing disruptive behaviors. They fasted for 18 hours and had a catheter in their arm for six hours while being injected with a drug later pulled from the market.
The study explored whether serotonin levels were correlated with other possible indicators of risk status, such as adverse rearing practices, antisocial family environments, parental or sibling aggression, or increasing displays of aggressive behavior.
The families received less than $200 for the procedures, and their risk was minimized in the informed consent paperwork. The recruitment letter told parents that researchers wanted to learn “what keeps children out of trouble”—the opposite of what they were actually studying.
Prominent contemporaries, like Harvard child psychiatrist Alvin Poussaint, described the recruitment letter as “sugarcoated” and “misleading.”
These nontherapeutic experiments were conducted on 34 boys, between the ages of 6 and 10, who were younger brothers of convicted delinquents. The researchers breached the confidentiality of juvenile court records to identify the boys.
In December 1997, Disability Advocates lodged an official complaint against the study on behalf of the children and families affected.
The controversy was covered extensively in the press. Mark Schoofs’ 1998 Village Voice investigation contended that the researchers had deliberately obscured the study’s true purpose from parents.
The NIMH investigated and found no wrongdoing. The researchers and institutions denied wrongdoing and were never sanctioned. Their findings were published in top journals.
The World These Boys Were Living In
One of the most alarming aspects of this study for me is that the researchers were focused on studying the violence risk of these children while perpetrating a form of violence against them (through the nontherapeutic administration of fenfluramine and the extrajudicial use of their brothers’ court records).
Another is that they were not interested in assessing the structural sources of violence, like poverty and racism, criminalizing and traumatizing Black and Latinx youth like them nationwide.
All of this was happening during the era of the Exonerated Five, five children wrongfully convicted and later acquitted of sexually assaulting a White woman in Central Park.
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This was the height of the War on Drugs, when racialized myths of superpredators were being leveraged to justify tough-on-crime approaches that disproportionately policed and incarcerated the communities these boys came from.
Instead of interrogating structural violence, researchers searched for biological markers in Black boys’ bodies.
Where was the desire to protect them?
This Is the Pattern, Not the Aberration
It was, perhaps, muted by the mental health profession’s broader historical pattern of pathologizing racially minoritized people’s survival and resistance to racial violence.
For drapetomania—or runaway slave syndrome–during slavery, the recommended treatment was whipping. During the Civil Rights Movement, psychiatrists labeled Black men championing their human rights with a “protest psychosis” diagnosis.
In both cases, more humane alternatives—like abolishing slavery or ending apartheid—were disregarded. Psychiatrists squarely located pathology in the minds and bodies of those who struggled against oppression, even though their resistance ultimately secured broader civil rights.
More recently, disruptive behavior diagnoses, like oppositional defiant disorder, have been overdiagnosed in Black, Latine, and Indigenous children. Practice parameters do not require providers to account for the structural racism these children face.
The fenfluramine study perpetuates this legacy: the normalization of racial oppression, the pathologizing of resistance, and behavioral control as intervention rather than advocacy against racial violence.
The study used dangerous drugs, relied on scientific racism about the heritability of “violence,” and treated marginalized kids as expendable research subjects, infringing upon ethical standards of consent, safety, and respect.
The study cannot be separated from the broader history of forced medical experimentation on Black and Brown bodies. The Tuskegee Study of Untreated Syphilis in the Negro Male (1932-1972) is often held up as the most disturbing exemplar of this legacy. The fenfluramine study, which transpired only a few decades ago—and was directed at children–is part of a broader arc that also includes forced sterilizations on tens of thousands of racially minoritized women.
Why This Matters Now
To prescribe psychotropic drugs to children safely, I was trained to check certain labs, verify the medical history, and follow established guidelines regarding dosing, side effects, and discontinuation. Medication management was upheld as objective, protocol, and neat.
Nowhere was I trained to prescribe with critique: to analyze how psychiatry can function as social control under the banner of care.
This is especially true for kids in settings where freedom is curtailed: juvenile detention, foster care, group homes, and inpatient psychiatric facilities. The most vulnerable children are often the most medicated. And they are often racially minoritized.
That I—a board-certified child psychiatrist with a specific focus on racism and antiracism in healthcare—did not learn about it during my fellowship training raises serious concerns. What’s missing from psychiatric training is as important as what’s taught.
I am disappointed that child psychiatry has not reckoned with this research abuse nor offered any atonement.
This study should be taught to all child psychiatrists. The institutions that conducted this research, whose researchers built distinguished academic careers, should be held accountable.
The critique came from outside the profession—from public advocacy groups, legal advocates, and community members who organized and spoke out.
Silence in the face of this history teaches its repetition.
It is time for our profession to stop being quiet.