AB: My fellow blogger David Keith and I began a conversation today that I want to share. After we talked about the shaky state of our Union, I relayed a session that I had with a family doctor student in my office yesterday. The case she presented got me thinking–again–about where we’re at as a society.
As part of my family therapy teaching, family practice doctors-in-training spend time with me in my office, sitting in on therapy sessions, and presenting their own cases for discussion.
Yesterday, Dr. B, one of my family doc students–a lovely, bright, and thoughtful woman, brought up a case from her office that puzzled her. Her patient, a young mother, had just given birth to a baby, and her older child, a six-year old daughter, had begun demonstrating behavior that troubled this young mother. Her older daughter’s behavior included loud, sustained yelling, according to the physician. I asked Dr. B if she had seen this child: She said her patient, the mother, brought her in for one visit. Apparently in this office visit, this six-year old seemed like a precocious child, well-behaved and charming. As far as I know, no school problems were reported.
This older child had been adopted shortly after birth by the patient, who was only nineteen at the time. The birth mother of this child apparently gave the child up for adoption due to substance abuse and some unspecified “mental illness”. The child, newborn, and mother lived with the mother’s mother, who had a professional degree in one of the health sciences. Dr. B said both mother and grandmother were strong, competent women who appeared to be rather no-nonsense type of people.
Dr. B’s patient, the mother of the newborn, had been emailing her about getting psychiatric care for her six-year old child. The mother was worried that there was “something wrong with her” and in fact, had taken her to a psychiatrist when the child was five years old. This clinic psychiatrist had prescribed a powerful anti-psychotic drug, Risperdal, for this five-year old. According to the mother, the child was “better” at first, and then resumed her “disruptive” behavior.
I repeat: This psychiatrist had prescribed a powerful anti-psychotic medicine for a five-year old child. And believe it or not, this is not unusual.
I had to stop our conversation at this moment, paused, and put my head in my hands. Not to sound too dramatic, but I felt a wave of despair pass through me. Not just despair for this family, but despair for our culture.
I pulled myself together and we continued talking. I reminded Dr. B that any “mental health” issues in a small child belong to the “mental health” of the family, and that’s where we need to look. I speculated that, since this child was adopted, with a birth mother who had an array of emotional/psychological issues, this young mother may worry about “genetic predisposition”. In addition, since it appeared that both mother and grandmother in this case were strong, no-nonsense women, they might have difficulty with the normal craziness of children. In fact, Dr. B said this six-year old seemed advanced for her years. A little grown-up.
Dr. B and I enjoyed a satisfying conversation which seemed to open up some possibilities for her to explore next time when she sees her patient. Dr. B–like most my family doc students–is intelligent, curious, and open-minded. My students generally appear to benefit from our sessions, where we have the time to explore cases from a broader relationship perspective. This dynamic approach typically introduces complexity to the presenting problem.
But what about the practice of prescribing anti-psychotic medications–or anti-depressants, or any of the other strong drugs that are now widely used on our kids?
How can a society–including its psychiatric professionals–have gotten so dumb? (These quick fixes apply to a lesser extent in medicine, where doctors in clinics often have only fifteen minutes for a patient visit). What does this say about us?
I found myself thinking about the recent American election of a know-nothing president, someone who doesn’t read, doesn’t question and shows no curiosity. And this Reality TV star’s absurd, simplistic self-assurance apparently appeals to many people. It’s frightening to think that, as a culture, we seem to have lost the art of wonder and the willingness to tolerate complexity and ambiguity.
In many professions now, so-called “quality measurement” is the dominant language, reducing, quantifying, and eventually, side-lining the importance of human interaction. This can not be good for us as living, breathing, multi-dimensional beings. And much of our social media orientation supports the simplistic explanation, the quick fix, the single-minded truth.
So, as we enter this new historical period, for the U.S. and the world, let us remember to value complexity in all human understanding. America knows how to do that. We have been the premier innovators in the fields of art, music, science, education, technology. The list goes on and on. No real growth–personal, social, cultural, economic, political, artistic–is possible without understanding and embracing divergent thinking. To ignore complexity in ourselves, our relationships and our world is to do so at our own peril.
