Think of the Parents, or Think of the Children?

If you've ever dropped by Respectful Insolence, you've probably read the many posts on autism "cures" - in quotes because a child surviving them is a miracle.

Reading the New York Times article on the child deemed "psychopathic" (Damning word, and not an official diagnosis), along with the posts on Respectful Insolence, I've been thinking about children with mental disorder diagnoses and their families, notably the emphasis on parents.

We emphasize parents in the following ways:

1. Their kid's behavior is the parents' fault (Ask a child therapist about this one - their answer can be quite interesting).

2. Their kid's behavior is the kid's fault and most certainly not the parents' - typically applied to kids 12 and older, though sometimes as young as 8. I guess when you hit a certain age, the damage that was inflicted on you when you were younger is no longer relevant.

Subset of 1 and 2 - Oh those poor parents. Even if a kid is unruly due to the parents, we secretly feel bad for those parents because who wants to live with a juvenile delinquent. 2 is obvious.

The kids with diagnoses topic is complicated. I've heard several anecdotes on parents being threatened with a call to CPS for failing to put their kids on drugs for AD/HD - this is problematic because parents often don't realize teachers can't "diagnose" anyone (This is illegal), and pediatricians are often stuck doing AD/HD evaluations and writing prescriptions for stimulants because child psychiatrists aren't common in many parts of the US. I love our pediatrician, but I'm not trusting anyone with minimal neurology and psychiatric education to prescribe psychotropic medication for long-term use for my kid. Give me a referral? Sure. Making that diagnosis? Generally not qualified.

To make things more nasty, school systems will attempt to get out of paying for occupational therapy for kids, even though refusal to provide that as part of IEP is against the law. They'll also fail to tell parents that they can select a private psychologist to evaluate their child instead of the school psychologist, and the school system has to pay for it. Also against the law. And in the case of AD/HD, IQ tests are required for a diagnosis despite the lack of correlation between IQ and AD/HD - IQ tests take a long time to administer and a long time to score, which equals more money than anyone would like to spend.

Even more fun, special education teachers - who are often wonderful - have large classes and at times minimal psych training. This situation is not their fault, but it does affect the quality of education kids get.

It isn't surprising how much we support parents, at least compared to kids. (This is where the autism thoughts come in). At least in my neck of the woods, there are bi-weekly support groups for parents of kids with mental health diagnoses, case managers to help parents get resources for their kids, parenting classes, more support groups. There are national ads featuring happy parents of kids diagnosed with autism, who have received generous support via donations and grant money from viewers like you. Which are incredibly important.

There are no AA, NA, DBSA, survivors of suicide, or any other sort of recovery group for kids, at least where I live. Teens are welcome to join these groups in my area, but they sometimes feel uncomfortable - it's hard to relate to a person who is sober for the first time in twenty years when you haven't even lived that long. There are Al-anon groups, of course - perhaps this post should be more about how there is a lot of support for everyone who isn't "the problem person." For another day, I guess.

I think we forget that kids with mental disorder diagnoses become adults with mental disorder diagnoses. It's got to be a shock to come into adult mental health services with folks going, "Recovery, recovery!" - or even a "I know you're perfectly capable of doing this but I don't trust you to do it, so I'll do it until you buck up" - when we don't really talk to kids about what it means to be in recovery.

We may imply it, but I'm not sure if we ever explicitly say, "Look kid, you're going to grow up someday. You're going to be expected to act a certain way, to get along with everyone else. No one can blame it on your parents once you hit 18, especially you. You can minimize or even eliminate the torment you're experiencing right now. Life doesn't have to suck." Or something along those lines that's in terms the kid can understand.

Just my observation. I'm thinking the peer support movement needs to get more involved in this stuff, for starters. A lot of adults with a diagnosis were a lot of kids with a diagnosis.

To sum up: parents, get a lawyer; mental health workers, talk to kids about moving on with their lives.

Personality, Meet My Friend Shovel

There are a few recent articles floating around on psychopathy (aka Antisocial Personality Disorder in the DSM) in young children, the catalyst being in the New York Times featuring a violent nine year old who couldn't stand his younger brother. While that may sound like many nine year olds, the article describes behavior that is beyond the realm of what one would consider healthy to the individual and his family.

The article, as well as the comments, raised a few questions in my mind. One was on the treatment/research project the parents admitted the kid into. This program utilized behavioral modification, which works quite well for changing distressing behaviors for many issues (smoking, overeating, potty training) when implemented properly. However, it doesn't seem to work all that great for a lot of adults with an Antisocial personality diagnosis - if you really think about it, rewarding "good" behavior probably won't work all that great with these folks unless you're giving them a million bucks per incidence of "goodness" - so I wondered why on earth they would try such a thing on kids who supposedly face the same challenges.

Second, I have heard enough stories on PTSD issues being diagnosed as Antisocial - PTSD being induced by actions that are so horrific I once had to leave in the middle of a lecture to go throw up in the bathroom because the idea of doing such a thing to a child makes me want to hunt down people and make their lives miserable. Can't imagine how the person who manages that brand of psychological hell minute by minute feels. (On the bright side, I've run into quite a few success stories on good therapy and emotional support resulting in a complete 180 in terms of empathy and sense of meaning)

The notion of personality makes my head hurt a bit. I once asked a teacher, a trained psychoanalyst, for a definition of personality. He gave me a similar answer to what I've read and received by others: Personality is more or a less a person's view of the world and how they interact with it, and the bulk of it is formed in early childhood. I told him I didn't care for something that implies permanence, but he said that people can certainly improve to points where less-than-helpful personality traits are rarely an issue, but it's never ultimately different.

I'm not sure how I feel about this idea, which is pretty common in the mental health realm as well as with the general public. Nothing seems all that permanent, atleast on this earth (afterlife, who knows). My skin is showing a fine line or two, my hairdresser recently said I have three gray hairs (she refused to pluck them, to my frustration), my shoe size went up by a half after pregnancy, I'm constantly shedding skin cells. The box elder trees that came with our yard continue to grow, my next door neighbor has a new dog, pop music seems to get more intolerable by the year, and our country has gone from significant patriotism to a severe distrust of more or less everyone in charge. Life is one of those things that is in constant flux - bodies, culture, nature. I really can't figure out why in the heck people are so stuck on the idea that personality is permanent when nothing else is.

I do have a theory. I suspect the roots of the notion that personality is permanent is in the idea of mind/body dualism - basically the mind (personality, behaviors) is a separate entity to the body. This idea mostly came out of the thought that the mind = the soul. Seeing as that psychology is of the more recent fields to come out of philosophy (per ancient Western philosophers, thought more or less boiled down to mathematics or philosophy - including religion), it's unsurprising that it continues to include the idea of a permanent personality.

Besides the idea of how free will ties into the mind (I mean, if the mind = the soul and the soul is what we are born with and the soul is God-given, why in the heck are we to blame for some of our suckier aspects? Why would we even bother trying to change if change is futile? Why is it that therapy and life experience can significantly change our views of the world? Um, aren't we supposed to be responsible for our actions? Oh, and what about a possible translation for soul in Hebrew being "to breathe?"), it makes me think of Traumatic Brain Injury (TBI) and personality changes.

Personality, meet my friend shovel. If I took a shovel to your head enough times without managing to kill you, you could very well end up with a number of mental health challenges - including a change in personality. We have a diagnosis for this phenomenon in the DSM. One could argue that TBI is permanent, but then again, the nature of an individual's TBI is not. Early intervention for TBI can provide significant improvement in the challenges folks with TBI manage, and some may experience little issue after treatment depending on just how hard I hit you with that shovel and a myriad of things we plain don't know about the brain. Additionally, TBI challenges can grow worse without intervention. And people diagnosed with TBI are human like everyone else and have many of the same experiences as every other person on the planet, which will affect their perceptions of the world as they age.

Don't get me wrong, I have no problem with souls. I just don't think it has anything to do with brains, atleast for our intents and purposes in this universe.

We know the brain changes. We also know how ingrained behaviors, whether we're born with them or they're conditioned or a mix, are an utter bitch to change. Doable, but painful. Despite our knowledge that the brain changes, we can't seem to predict what treatment is going to work with what person at this point in time. It doesn't mean we should assume behavior that fails to serve someone can't be improved or even eliminated just because we don't know how to help the person sitting in the chair across from us.

So shove it, deterministic naysayers. You may think I'm being an optimistic grad student who will wise up by the end of my first clinic day, but I am one of many who one would think wouldn't be optimistic for anyone diagnosed with something psych-related. Multiple suicides in the family. Mental health outside of "normal" severely stigmatized by both father's and mother's families. Mom diagnosed with out-of-control Schizophrenia (which gets harder for her to deal with by the year) when I was three; Dad doing the depression, alcohol, sobriety, alcohol, sobriety, AA, depression, therapy, AA, depression.

But now a tortoise-paced ascent into some level of happiness.

Me from suicidal, angry elementary school kid to happy kid to suicidal and angry to determined to depressed to a weird cycle of who knows what to hypomania to mellowness to more depression.

But now feeling good about things, even with past dissociation and self-injury and avoidance of people.

Then there are the testimonials of Clifford Beers, Mary Ellen Copeland's mother, Kay Redfield Jameson, Carrie Fischer, Marsha Linehan, Ken Steele, and many others. And most dear to me, all of the wonderful coworkers and individuals I have served who identify as those with psych diagnoses - including personality - who have experienced change, better or worse at times.

Rather than assume people with Antisocial personality diagnoses are screwed forever, or assuming many have it at all, or assuming it manifests in incredibly young children, maybe we should carefully work with these folks with a nudge towards recovery. And, ya know, show some empathy (Do unto others). It's tough, and at times senseless, to judge how far one can go in life.