In my last column for the Huffington Post, I wrote about the stigma surrounding childhood psychiatric disorders. My article focused on the need for acceptance, understanding, and humility to help those who are suffering feel safe reaching out for treatment. In writing about the stigma surrounding child mental illness, I also made reference to my late father, who spoke passionately and intelligently about how the ideas and knowledge we carry in mind can unnecessarily limit us or help us fulfill our potential. What I did not write about is the use of psychiatric medications -- so I was surprised by some of the comments on the article, particularly those from readers who've objected to the idea that childhood psychiatric disorders are real and require treatment.
In the fight against childhood cancer, everyone is on the same side -- the side of doing more research, finding better cures and saving lives. In the fight against childhood psychiatric disorders, there is no such unity -- as the comment sections of even the most uncontroversial articles demonstrate. Some commentators feel that autism doesn't exist, or if it does exist, it shouldn't be considered a psychiatric disorder (implying that being in that category is demeaning). Others feel psychiatric medications are over-prescribed, that diet causes ADHD, or that pharmaceutical companies are engaged in a conspiracy whereby they "create disorders" in order to profit on the pain of children and families who don't know where else to turn. All of these myths -- expressed so frequently in abusive and judgmental language -- preclude both civilized debate and progress in the field of child and adolescent psychiatry. We generally ignore the fact that over 10 years ago Surgeon General David Satcher conducted a historic first mental health report and informed us that most kids with psychiatric disorders are never given any treatment.
And what happens as a result? As a clinician on the forefront, I see it stopping families from seeking treatment for childhood psychiatric problems, and those who finally do seek help are often demoralized and afraid. I've heard countless mothers say: "I don't want anyone to know my son has ADHD. Teachers will brand him. Parents won't want their kids to play with him." And the question parents constantly ask me is this: "How can my child get treatment without being humiliated in the process?" Kids and their families deserve so much better.
There are of course many important and complicated issues in child mental health. We're only beginning to understand healthy brain development and what happens in the brain when psychiatric disorders emerge -- yet in the last five years we've made extraordinary leaps forward. We've begun identifying children's symptoms earlier and treating their conditions more effectively.
Psychopharmacology is also an important piece of the puzzle. While most children with mental health disorders don't need medication, many benefit from medication when it's properly prescribed, following an accurate diagnosis, under the right individual circumstances. Research and clinical experience demonstrate this -- which is why we continue to use medications, usually in combination with specific, effective types of therapies, to help children overcome distress and dysfunction. We do the best we can, in good faith, because we don't want our kids to suffer; we want our kids to thrive.
So all of us, but especially readers who are engaged with the issues in child mental health, should practice restraint and open-mindedness. Try not to lash out. Don't fall into the trap of thinking you (or I) have all the answers, and keep in mind that scientists and clinicians are working tirelessly to understand childhood psychiatric disorders, and to improve how we diagnose and treat them. In the meantime, we take the best science we have and use it to give children treatment and care that may enable them to overcome their symptoms and fulfill their potential.
I truly hate to sound preachy, but here's the thing: If you're concerned about the current state of child and adolescent psychiatry -- or if you have doubts about the future of the field, the use of medications, and so on -- you can take your concerns and make them the reason to get involved in a positive way.
The issues in child and adolescent psychiatry are often divisive, but at the end of the day, I think we all want what's best for our kids, and we can meet each other on the same side -- the side that fights stigma and advocates more research to discover better treatments.
Every day, I meet families from vastly different backgrounds, and they remind me that this kind of cooperation, collaboration and compassion is possible and essential. It just takes heart and a lot of work.
Harold S. Koplewicz, M.D. is a leading child and adolescent psychiatrist and the president of the Child Mind Institute.
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