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.