The Digital Orphanage
Parentis ex machina
Almost every week, I see a child arriving in the ER under police escort or parental surrender. The story is always essentially the same: violence at home, an outburst at school, a threat made online. The chief complaint reads, “psychiatric evaluation.” The parents say they cannot control their child. The school says it cannot have him back. And so the problem is delivered to the only institution that legally cannot refuse it.
The ER was meant for children with illness or injury, not for those who simply have no one left to manage them. It is the worst possible surrogate parent. Unlike the home, the daycare, or the school, the ER is cold, clinical, and entirely without relationship. I can try to be warm, to speak gently, to show patience; I have children of my own. But to the child before me I am not a father, teacher, or protector. I am masked stranger in a uniform, the embodiment of every needle they have ever feared. I am not a trusted adult. I am the jailer. The child is brought to me explicitly for me to control because no one else can or will, and I am not permitted to refuse him. And when words fail, that needle is all I have left to do it.
I am compelled to participate in this heartbreaking act, even though I know that what these children really need is not haloperidol but a parent. But moms and dads cannot be dispensed from Pyxis machines. They cannot be tubed up from the central pharmacy. I cannot phone one in to Walmart.
Almost all of these children have parents, but not parenting. Their mothers and fathers are present in the biological sense but absent in the moral one, absorbed in lives still organized around their own desires rather than the absolute, all-consuming attention that raising a child requires. Their own lives remain their primary focus, and in that vacuum the screen becomes a de facto parent. These children are pacified not by the steady soothing of a parent but by the rapid, ever-changing stimulation of the algorithm, which offers attention without judgment and novelty without limit. It never says no. It never pushes back. It teaches them that desire is met instantly and that the world exists to accommodate their impulses. And when reality refuses to work that way, the child unravels in precisely the manner the system has taught him to, and then is brought to us.
The Screen
Every day, I see toddlers holding iPads like pacifiers, the flickering glow soothing them where a mother’s gaze once did. Parents sit beside them scrolling their own devices, each captive to a different feed. The child learns early that attention can be summoned on demand, but only from machines. Patience, restraint, and empathy, the virtues once taught by relationship, no longer have an opportunity to form.
When that illusion breaks, the child does not rage against the screen. He rages against the real world, which moves too slowly, answers too inconsistently, and demands too much effort. What we diagnose as attention-deficit disorder is often nothing more than the predictable reaction of a brain reared by the internet and now maladapted to life in reality.
Pediatric psychiatry has responded to this crisis not by questioning its cause but by naming its consequences.
The chronically overstimulated are labeled ADHD. The defiant are called oppositional. The isolated are said to have depression. Each diagnosis creates the illusion of understanding and the promise of a cure. It is easier to prescribe a stimulant than to confront a parent.
The child becomes the patient, and the parent becomes the victim of a mysterious disorder beyond his or her control. We turn social failure into medical pathology and congratulate ourselves for our compassion. We feel bad for the parent, burdened with a sick child. What constitutes good parenting no longer means correcting the child’s bad behavior but instead means faithfully attending medical appointments and giving psychoactive medications every morning.
The Parents
The vast majority of these parents are not cruel or neglectful. They are exhausted, anxious, and digitally addicted in their own right. I do not blame them. They are doing what they were taught to do. We live in a society that no longer believes in anything beyond personal fulfillment. The old moral frameworks that once demanded sacrifice for the sake of the next generation have collapsed. Parenthood has been reframed not as a duty to the future but as a path to self-actualization. Children are expected to give meaning to their parents’ lives rather than to receive formation from them. When fulfillment is the goal and not the byproduct, the hard work of shaping a child’s character loses its urgency. Why endure the daily frustrations of discipline and correction when the culture insists that the point of parenthood is not the future but the parent’s own experience of it?
A society that believes in nothing beyond the self cannot produce parents capable of the supreme sacrifice that good parenting requires. It is unsurprising that so many turn to screens, schools, and finally the ER to manage what they were never prepared, encouraged, or taught to bear. The individual parent falters because the culture has already surrendered.
These parents live in the same attention economy that devoured their children, but with one crucial difference: they remember, dimly, what it was like to live without it. Their children do not. For them, silence is terrifying, boredom intolerable, and the absence of stimulation a form of withdrawal.
These children are not broken. They are perfectly adapted to the world we built for them, a world of endless distraction and absent consequence. The tragedy is not that they are sick, but that they are normal.
The Technopharmaceutical Complex
The modern child is both consumer and commodity. Big Tech creates dependence, and Big Pharma monetizes it.
One trains the brain to expect constant novelty; the other sells chemical focus to survive it. We call this “treatment,” though it is closer to market correction. The same culture that destroys attention then offers to rent it back to you at a monthly cost.
The incentives align perfectly. Tech companies profit from overstimulation, and pharmaceutical companies profit from the behavioral fallout. Each sector insists that it is meeting a need, and in a sense it is. But it is a need they helped manufacture. No one asks why every year produces a new cohort of children who cannot sit still, cannot focus, cannot tolerate boredom, and cannot obey even mild authority. We treat the symptoms as though they appeared spontaneously, unrelated to the media diet we feed them from infancy.
Stimulants and sedatives have become the two pillars of childhood. One is given in the morning to induce focus for school. The other is given at night to counteract the first. The child oscillates between chemically sharpened compliance and chemically induced sleep. This is considered success. If the dosage needs to increase, that too is considered success. It is framed as progress because the chart shows improvement, even if the child’s mind does not.
What was once moral failure, such as impulsivity, defiance, or gluttony, has become a subscription model. The digital economy rewards what medicine pathologizes. Between them, they have built a system that calls weakness compassion and sells it by the dose. A child who cannot sit still becomes a revenue stream. A teenager who cannot tolerate silence becomes a market opportunity. A generation that cannot endure discomfort becomes an annuity.
None of these children ever seem to get better. They do not graduate out of their diagnoses. Rather, they accumulate more of them. Their medication lists grow longer. Their sense of agency grows smaller. They enter adulthood already convinced that their own minds are defective and that stability comes only in twelve-hour, extended-release increments, manufactured in a laboratory.
The ER
All of this eventually returns to my doorway. The ER absorbs the consequences of every failed institution, every abdicated responsibility, every cultural lesson that taught a child to expect the world to obey him. By the time they reach me, the damage is already done. There is no medication I can prescribe to reverse a childhood spent in front of a screen, no order set that can create discipline or conscience, no psychiatric admission that can teach patience or empathy. I cannot summon the family, the school, the church, or the community they never had. Most of these children are not orphans, but their loneliness is indistinguishable from orphanhood.
Yet I am the only party in this entire chain who is not permitted to say no.
I cannot refuse the patient. I cannot refuse the problem. I cannot refuse the cycle. I am legally required to participate, even when participation means little more than documenting the same story, admitting the same child, and watching the same pattern repeat.
I perform the ritual because the system demands the ritual, not because it heals. I know that the inpatient stay will not help. I know that the child will not emerge transformed. I know that there will be another tantrum, another outburst, another threat of suicide, each one triggering the same cascade of liability-driven responses that bring him back to me. The cycle is self-perpetuating. The enormous attention given to each crisis does not extinguish the behavior. It reinforces it.
The hopelessness comes not from the chaos of the moment but from the certainty of its return. I stabilize the child in front of me while already seeing the adult he will become. I see the impulsivity hardened into violence, the entitlement calcified into rage, the lack of discipline evolving into danger. One day, I will restrain and sedate that adult not because he is frightened and lost, but because he has truly hurt someone. I see the arc before he does. I see the future before he can imagine it.
The tragedy is that none of this was inevitable. It was taught.
And still the child is brought back to me, again and again, because I am the only one who cannot refuse him. The ER was never meant to raise a generation, yet it has become the last refuge of children abandoned not by parents, but by the culture that shaped them. Until that culture changes, we will remain its digital orphanage, caring for the lonely under fluorescent lights while their phones glow beside them, waiting for someone to finally look up.