When I was young and just thinking about what I would like to do for my career, my father urged me to become a doctor. He was a Polish immigrant and Holocaust survivor, and in our Jewish household, where there was always a lot of passionate talking and shouting, I remember often feeling frustrated by his insistence that I go into medicine. I loved political science back then, and so I told my father, who'd graduated from law school in Warsaw in 1936, that perhaps I'd like to be a lawyer. He was surprised at this. "Why would you do that?" he asked, like so many Jewish immigrants of his generation, he was keenly aware of which skill sets were transferable across cultures and language barriers. Medicine, he thought, was something I could practice in any part of the world. He said I needed skills I could "carry" in my mind and use anywhere. If you're going to lose everything, he said, all you've got is what's in your head.
My father worried about what I carried in mind partly because he'd survived 14 concentration camps and then arrived in America penniless and unable to speak English in 1949. While his message resonated with me from that vantage point, near the end of college I gained a deeper understanding of what carrying something in mind could mean. I'd realized that my primary interest was human behavior, not politics, and as I began making plans to pursue psychiatry in medical school, I was becoming increasingly sensitive to the fact that what we carry in our minds is in fact everything: In life, we want good health, security, love and the ability to fulfill our potential; but untreated mental illness can rob us of all these things, beginning in childhood.
During my nearly 30-year career as a child and adolescent psychiatrist, I've seen how young lives can be dramatically transformed, for better or worse, as a result of complex developmental changes in the brain. Children's lives can veer off course due to the maladaptive coping and biological processes that underlie psychiatric disorders; and their lives can be improved with effective treatment and support. The problem is that we've long had the wrong response to childhood psychiatric disorders. Our first response has been denial; many people don't want to believe that children can have mental health disorders such as autism and ADHD. And our second response has been to appoint blame, or to say that bad parenting, offensive TV, over-medicating or something else can explain psychiatric problems.
We've unfortunately had trouble accepting that childhood psychiatric disorders are real, highly prevalent (1 in 5 children and teens struggle with a diagnosable disorder), and have biological and genetic causes as well as environmental triggers. In addition, feelings of shame and the fear of society's judgment prevent millions of children and teens from getting treatment -- care that could arm them with the skills to effectively cope with their day-to-day experiences, build self-confidence and self-esteem, and develop satisfying relationships with family, friends and others. The truth is that we can give kids tools to lead healthier lives -- and we can save lives, as we've done in the fights against childhood cancer and diabetes, if we can find common ground and work together to help kids heal.
My father's message about what we carry in the mind is really relevant here, too, because to truly help our kids fulfill their potential we must not only expand the provision and availability of mental health care, but also change how we think and talk about childhood psychiatric disorders. While most parents would say they're opposed to stigma and discrimination, almost any child with a psychiatric disorder can tell the story of how a peer or adult offered cruelty instead of empathy, judgment instead of care. And many parents of children with psychiatric disorders say they felt shame instead of acceptance, loneliness instead of support, before their children were diagnosed and treated.
If we embrace the reality of childhood psychiatric disorders and then refuse to judge and blame each other for them, we will be far more successful in reducing the suffering of kids and families, improving prevention efforts, and removing the barriers to treatment.
Finally, there is the gift humility, which we should insist on offering one another, because no one is invulnerable to psychiatric illness; it can be found across all races, ethnicities and income levels. It's real -- and it's common -- but also very treatable.
Harold S. Koplewicz, M.D. is a leading child and adolescent psychiatrist and the president of the Child Mind Institute.
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Too often family members want to blame everything on "Johnny's bi-polar disorder'. And Johnny wants us to believe he can't help it when he steals or assaults. "It's because I'm bi-polar.", he'll say almost proudly. We use low-dose meds to help with impulsiveness and aggression. But our primary focus is to change the family "dance" - i.e., the old patterns of behaviors...of acting and reacting...that have resulted in this dilemna. Oh, and we try to focus a lot on Diet. Thanks for the article.
I do not view positing a "stigma" as changing how we think and talk. I am offended by its appearance, no matter who directs it, nor at whom or what.
My first and most lasting experience with that term is very familiar to the author. He recounts some of his history, he is intimately aware. My second, the Women's Movement refuting its association with rape affect my usage deeply: They would not comply with it, I do not.
Yes, we must change how we talk, that others do.
Harold A. Maio, retired mental health editor