Recently I attended a reception at the Austen Riggs Center in Stockbridge, MA for the new medical director. Austen Riggs is an inpatient psychiatric hospital where intensive psychotherapy remains the core of treatment( thought certainly medication is used as well.) At the reception I met the new Erikson scholar, an art historian who is writing a biography of a woman, one of the first patients at Riggs, who shortly after her stay went on to become a world famous violinist. We spoke about the connection between mental illness and creativity. We wondered what this woman's fate might have been had she lived today when she most surely would have been medicated.
In the last chapter of my new book Keeping Your Child in Mind: Overcoming Defiance, Tantrums, and Other Everyday Behavior Problems by Seeing the World through Your Child's Eyes I discuss the problems associated with the exponential rise in prescribing of psychiatric medication for children. While I am not against medication per se, I have a number of concerns about what I consider to be an over-reliance on medication to treat complex problems. Not only are there side effects and unknown effects on the developing brain, but medication is often the focus of treatment to the exclusion of important family issues. Significant events in a child's life may go unaddressed. Usually a child does not have an opportunity to talk about what it means to him to be taking a pill to manage his behavior.
Following this conversation at Riggs it occurred to me that I should add yet another concern- potential loss of creative talent.
Several weeks ago there was an op ed in the New York Times: “Words Failed, Then Saved Me, “ that offers a beautiful example of turning a biological vulnerability into an adaptive asset. The author, Philip Schultz, now a Pulitzer Prize winning poet, struggled terribly as a child with what is today recognized as dyslexia. Schultz describes how his mother would read his favorite comics over and over again with the hope that this would help him to make sense of words. I wonder if this kind of tolerance and patience gave Schultz the space to, as he says, “invent a new way of reading” that was adapted to his particular form of dyslexia.
Schultz describes not only his academic struggles but also how he was kicked out of one school for hitting other children when they called him "stupid.' I wonder if he had been child today, he might have been described as "impulsive" and "distracted," classic symptoms of what now is called "ADHD." He might have been diagnosed and medicated. Had his symptoms been medicated away, he might not have invented his new way of reading, a method he now uses to teach others with similar difficulties to write fiction and poetry. He might not have become poet, much less win the Pulitzer Prize.
As a behavioral pediatrician, I often hear parents ask if there “something wrong" with their child. I help them to reframe the question, asking instead “what is his experience of the world, and how can we help him to make sense of and manage that unique experience?” I have seen kids who were "explosive" and "inflexible" as very young children. They were easily overwhelmed by a variety of sensory experiences. But in the setting of an understanding and supportive environment, they have gone on to be talented actors, musicians and artists.
Supporting children in this way involves investment of time and energy from parents, teachers, and clinicians. In our culture treatment of a child with "behavior problems" usually focuses on resolution of symptoms, often with medication, rather than understanding the meaning of behavior. Medication may more quickly control a child's symptoms. But at what cost?