Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Tuesday, March 15, 2016

The Problem with Biological Psychiatry: A Mother's View

In my forthcoming book (May 3) The Silenced Child, I offer evidence, based on stories from my pediatric practice integrated with contemporary developmental science, that the disease model of biological psychiatry may interfere in a child's development if we fail to protect time to listen to what a child's behavior is communicating. Recently I came upon a powerful blog post eloquently articulating exactly this idea, but told from the perspective of a mother who herself was a psychiatric patient as a child. 

The author, Faith Rhyne, wrote the post in the wake of the viral blog post I am Adam Lanza's Mother that followed the Newtown shootings. She tells her own story, offering alternatives to the disease model of mental illness, that she views as highly destructive. 

First she writes of her own struggles as a child:

"At age 12, I sat in a room with my mother, in an office that I didn’t want to be in, and listened to her discuss with a doctor what might be “wrong” with me.  She was concerned and she had every right to be. In fact, she had a responsibility to be and, as a mother, she had an instinct to be. I was her child and I was struggling. I was angry, violent, suicidal, sullen, and rude."

She identifies how in this type of evaluation, the nuanced details of a child's struggles may not be heard:

"I don’t know if they told those doctors that I had just watched our family land be cleared and developed or that I was terrified of my math teacher or that, the year before, I had gone to Catholic school for a year, where an 8th grader had kissed me on the bus."

She fully acknowledges that she was suffering, but that the suffering was in no way alleviated by the notion that there was something "wrong" with her brain:

"My family spent many thousands of dollars trying to help me and, as it turned out, the help hurt me more.  Further, the idea that I had something out-of-whack in my brain drove an invisible wedge between me and the rest of my family, who spoke in measured tones and who would glance at me furtively, wondering if I was about to explode."

She echoes the work of Stanley Greenspan, who identified the intimate connection between our sensory and affective experience, when she writes:

"It wasn’t until 20 years later that I learned that the way I process information affects how I feel and that not everybody’s brain works like mine...For some, the world is a loud and clumsy place, full of laughter that isn’t understood and a deep observant sadness. For others, clothes hurt and school is a nightmare. The lights buzz. The cafeteria stinks. The kids are mean and the teachers are uninspiring. For some, it is all very confusing and hard to keep up with. The frustration alone brings tears and anger."

She highlights the complexity of the genetic aspect of emotional struggles when she sees similar qualities in her own children. Not only do they seem to share these traits with her, but when she observes their struggles it provokes painful memories of her own childhood. She speaks from a place of deep empathy for both parent and child:

"No parent wants to see their child struggle. I am the mother of children sometimes remind me a bit of myself as a kid, kids who are bright and sensitive, who feel things deeply and who sometimes aren’t easy to comfort when they have simply had enough. I understand how it feels to not know what to do, to see that your child is struggling and to find that efforts to “make it better” seem to cause more upset."

She calls attention to the need for families to: 

"find skilled and conscientious supporters to help empower their children to be confident in the worth of their differences and to find self-determined ways to navigate challenges."

And to take time to listen to what the child's behavior is communicating:

"Often, children don’t know how to articulate what they need.  However, they will try to tell you. Sometimes, when children “act out,” they are trying to tell you."

She captures the painful sense of betrayal that accompanies being told that there is something wrong with your brain:

"What does it feel like when the people you most need to believe in the strength of your future and the sincerity of your struggle sit down and inform you that there is something imbalanced in your brain and that it means you’ll probably always struggle and that it means, also, that people may be scared of you, because they don’t understand."

She articulates how the very effort to decrease stigma by equating mental and physical illness actually worsens stigma:

"The idea of mental illness creates and sustains stigma, by informing us that people who struggle with their humanity in ways outside of the acceptable range of normality are inherently flawed."

Finally she seems to channel the ideas of pediatrician and psychoanalyst D.W.Winnicott when she describes how the disease model may obstruct healthy development by interfering in a parent's ability to see the child's "true self:"

"When the professionals teach mothers to see their children as ill, both mother and child are harmed in that they lose something essential to the parent-child relationship, which is the ability to see their children clearly, with compassion, love and a commitment to their brightest possible futures."

My major divergence from Ms. Rhyne lies in the fact that that while she appears to have joined the "anti-psychiatry" movement, I do not see this problem as the "fault" of psychiatry alone. Rather, as I also articulate in my new book, I see a complex set of cultural forces that have come together in a society that is in many ways prejudice against children. A range of professionals who care for children, including psychiatrists, pediatricians, occupational therapists, educators, and many others, must join together with parents to overcome this prejudice. We must recognize the value and necessity of protecting time and space to listen to these youngest voices. In doing so we support their healthy development, and with that our future.


1 comment:

  1. I recently came across some characters in the Biblical story of Job that I didn't know about known as "Job's Counselors." They told Job that if bad things were happening to him it must be because he was not pious enough - the exact opposite of the truth. Not just psychiatrists but psychologists and social worker therapists as well have become analogous - if you're upset, angry, or unhappy with the way the world is treating you, then therefore there must be something wrong with YOU!

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