I'll Never Be The Same

Clinicians who consider themselves experts miss the diagnosis the vast majority of the time. Parents are often inappropriately blamed for their children’s problems because of misinterpretations of the research data. Patients are being told extraordinary stories that trauma has damaged their brains. Treatments that work are being ignored by clinicians. In short, we cannot depend solely on professionals to get the right information to patients. I have personally trained hundreds of clinicians, written dozens of articles, and given dozens more professional lectures, and while I have enjoyed baby steps of progress, I know the impacts are small, and I am ready to leave that career behind. Jeremy was fourteen years old. From the ages of five through eleven his stepfather physically abused him. After six different medications from doctors and weekly psychotherapy counseling with a psychologist for another two years, his problems were not getting better. In fact, they had been getting worse. The school tolerated his spats, sulking, and disobedience until he vaguely threatened to burn the school down, at which point the school expelled him. The defiance and outbursts were frequent at home, too.

Army Of One

He would leave home for hours without telling his father where he went. Jeremy was referred to my clinic, and after four months of the right treatment his symptoms markedly improved and he was back in school for the first time in three years. This outcome was enormously satisfying to Jeremy’s father, to the therapist who treated him, and to me. I think I always felt the best way to disseminate information was to get it directly into the hands of consumers. Let’s see where this takes us. Because there are so many people to thank, it is impossible to list all of them. I am also grateful to the National Institute of Mental Health, which funded most of my studies, and the anonymous grant reviewers who found some merit in them. I owe a debt of gratitude to my agent, Jill Marsal, who guided me through this process and gave me good counsel. She made many suggestions to make my meanings clearer and soften my tone. Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference is an old saying that suggests wisdom is hard to acquire. When many children and adolescents have been through severely stressful, traumatic experiences in their life, they are changed and they are frustrated, and parents recognize it. Parents want to know how their children have changed and how to help them.

Written In The Stars

Some changes are obvious. Some changes are mysterious. Some changes are hidden from view. As a parent, it is up to you now, but you have little idea what to do. No other disorder in psychiatry has such a sudden, bewildering, and terrifying onset. Not only the youths, but also the parents and other family members must deal with the wreckage. There are many new questions to consider. What are the signs and symptoms? What is the right diagnosis? What does the future hold? How to find good help? First, parents must recalibrate their expectations. Life is harder, permanently. It is as though suddenly a judge has handed down a sentence stating, You must live a different life now. The new task for survivors and their loved ones, as well as what must be done sometimes to survive, is to try to understand the new normal. I’ll never be the same.

The Big Picture

I mean I used to be happy and a positive person, and now I’m never happy. Compare this to an example of another type of sudden change in life. Nearly all of us have had the experience of using a computer or a smartphone and then, after using one of these devices for months, one day the screen suddenly looks different than it looked yesterday. Some commands for touching or clicking have been moved to different locations on the screen and cannot be found. Perhaps the background colors and physical appearance of the layout have changed, too. The typical reaction of users is bitter frustration at the software developers who made these changes without our permission. The anger is softened considerably, however, because we are also confident that eventually we will find the commands that have been moved, and we will get used to the new layout. As with scratches and bruises on the skin and bad memories that fade with time, they think things will pop back to normal. But when weeks pass and then months pass and things have not popped back to normal, there is often an indescribable sense of loss of control. The anger and frustration increase with time rather than fade. It cannot be overstated how frightening this can feel when you realize you have lost control of your own mind and body. Throughout the healing process, it usually will be up to parents to make sure the questions about problems get answered correctly. It is up to parents now because most clinicians do not know what they are doing. Parents need to accept this reality as surely as death and taxes. Most clinicians do not know what they are doing due to a variety of reasons. One reason is that they are poorly trained. Another is that the profession of mental health is inherently complicated and messy. Another is that clinicians make a lot of their treatment decisions based on their personal beliefs instead of research data. The names and details have been changed to protect their privacy. The case of Lisa is a good case to begin with because it illustrates the important point that far too often it takes far too long for children to get diagnosed and get the help they need. Actually, the mother and father felt the choice was more or less made for them because Lisa’s grandfather was extremely frail. They thought an evacuation would cause more harm to him than toughing it out at home through a hurricane.