Shirah Vollmer MD

The Musings of Dr. Vollmer

How Does Child Psychiatry Ruin Lives?

Posted by Dr. Vollmer on March 8, 2016

Psychiatrists want to help people. Child Psychiatrists want to help children and their families. Many times there are remarkable and heart-warming stories of intelligent guidance and warmth which saves children and families from lives of suffering and despair. This is a story of the opposite. A story, so scary to me, that I feel compelled to write about it as a cautionary tale. To preëmpt my critics, let me start by saying there are many sides to a story and cause and effect cannot be determined. I float in a world of theories and ideas which prove serious consideration resulting in different approaches to treatment. I do not work in a world of certainty or clear scientific evidence. With that in mind, let me tell you the fictionalized story of Joey, age 25, Caucasian, who grew up in a middle class area of San Diego. Joey is the youngest of four children. His three older siblings, by his report were “easy” and he was “difficult”, or so his mother told him. At 6, his mother took him to an academic medical center, trying to figure out why he was “so difficult.” Academic child psychiatrists diagnosed him with “atypical autism” and off he went, at age 6 on a continual journey of psychotropic medications including Straterra, Wellbutrin, and stimulants. Joey reports that being on these medications not only did not help him, but made him feel defective and disabled. Despite those negative feelings Joey got into a good college and did well, until he hit a disappointment, a break-up of a loving relationship, and by his account this triggered his childhood feelings of being seen as “disturbed” and so he, although never having used addictive drugs before, spiraled down into the world of heroin and cocaine. Yes, all of that could have happened without a mental health diagnosis, without being misunderstood as a child with a mental illness, as opposed to a child with a bad temper. Yes, all of that could have happened secondary to parents who felt inadequate to raise him and made him feel very inferior to his three older siblings, even if they had never sought a psychiatric evaluation and treatment. My point, however, is to illustrate that in this fictional tale, it is plausible that the medical team made Joey’s life worse.

What would have happened, I wonder, if the child psychiatrist had said that Joey is a wonderful kid, outlining his strengths, who needs help with anger management? What would have happened if the child psychiatrist would have guided this family towards a more positive parenting model where Joey was seen as a child who could go on to great things, as opposed to seeing Joey as a person who would forever be disabled and crippled by his limitations? Joey’s story, with all of the uncertainties associated with it, makes me cry. I cry because whether this applies to Joey or other adults out there, growing up with a label that suggests they are limited in their abilities, when in fact, they have enormous potential, I feel the tragedy of what our profession has done to their lives. Yes, I have diagnosed many children as autistic, but my bar is low, as it should be. The label, and I understand it gets very needed services, has the hazard of diminishing the self-empowerment of that child. It has the potential to take a capable person, perhaps with some rough edges, and make them feel small and helpless. Children, and adults, need understanding to flourish in this complicated and demanding world. Psychiatric labels oftentimes limits that understanding and that alone can have dire consequences. Add to that the journey of psychotropic medications which flows from that diagnosis, leads to an identity confusion that can cripple the budding adult. Joey was not crippled by his biology, I suspect, but he was crippled by his psychiatric journey. Tragic, unnecessary.  and it has to stop.

7 Responses to “How Does Child Psychiatry Ruin Lives?”

  1. Shelly said

    Imagine the parents, for a moment. They are at their wits end. The school calls them all the time, telling them to get Joey under control or take him out of school. Joey is a terror at home, he throws tantrums everywhere he goes–in the supermarket, in the park, in line at the movies. He has no play dates because nobody wants to play with him. They can’t take him to church with them, so they can’t go. They become isolated in their community. They can’t leave him with a babysitter. They bring him to doctors, social workers, psychologists–you name it. They need and want help. Don’t you think they did everything right? Don’t you think they tried? Why do you say that they needed a “more positive parenting model?” Why blame the parents? Why always put the onus on them? It’s always easy for someone who takes drugs or is on alcohol to blame the parental unit. What kid doesn’t? You and I do! Everyone does. It’s easier to do that than take responsibility for our own actions. I know you blame people in your own profession, but you also blame the parents.

    • Shelly said

      In addition, you don’t make your patients take responsibility for their own actions. They should.

      • Hmm..this is not an issue of blame, but rather an issue of how do we understand “difficult children”. I agree that a minority have biological issues which makes “good parenting” very difficult because their biology limits their ability to make good decisions for themselves. However, far more children have challenging behaviors which can be made better by more consistent and loving parenting. When the child grows up then he does need to take responsibility. The point of this post however is that labeling children with mental health issues can create a negative downward spiral which can be prevented by a more positive approach to the issues. Again, having said that, certain children should be labeled,because it helps with understanding and developing a treatment plan, but in my opinion, far too many are added into the basket of mental illness causing harm to these children. Thanks, as always.

  2. Ashana M said

    The message that he is “defective” comes from his mother. He was the “difficult” one. He experienced being the broken child every minute of his life. You can’t blame psychiatrists for that, but they colluded with it.

    • Yep. Thanks.

    • Shelly said

      Wait, what? Why does the message that he is “defective” come from the mother? Do you mean in this fictional narrative, or in general? Why not from the father? In general, it is the mother who is the “tiger” and who protects the child from harm, and is the last person who wants to label the child.

      • Ashana M said

        Yes, in this fictional vignette. The father wasn’t mentioned. I have no idea what he was thinking. Dr. Vollmer mentioned the mother identifying the child as being the difficult one. In a family where the real problems are too painful to identify, it is not unusual for the fallout from that problem in the behaviour of the child to attract attention. The child then usually feels like the source of all of the problems in the family, when that is not the case. The child just doesn’t have the resources to develop in a healthy way. It’s a little like noticing the cough (a symptom), but never acknowledging the TB. Some mothers protect their children. Some don’t. But the label brings with it the meaning it has for the people interacting with that label. It has no particular meaning on its own. Some people feel someone finally cares when they are diagnosed, because at last someone has taken note of the problem and tried to help. Some feel defective. It depends on the relational context and the attitudes other people have about that label.

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