Should I Be Worried?

Pick the questionnaire that is appropriate for the age of your children. She had been crossing a street in her neighborhood when a car sped toward her. She could not see the car because cars parked on the curb blocked her view. She bounced off the grill of the car and landed about forty feet away in the neighbor’s front yard. She broke a leg and had extensive soft tissue bruises. Now that the bone was healing and her massive bruising had disappeared, it appeared that she would make a full physical recovery. The pediatrician felt this little girl was enormously lucky. The mother, however, had asked him a pointed question one day in his office. The mother told the pediatrician that now the girl was afraid to cross the street. In fact, she seemed terrified. Should I be worried? My impression of this pediatrician was that he was excellent. This particular pediatrician struck me as relatively more sensitive to the psychological issues of his patients.

Left In The Dark

The fact that he was posing this question to me at all was a sign of his recognition of psychological issues. In addition, that a mother apparently felt she could trust him well enough to impose her agenda in the 6.4 minutes allotted to an average pediatric visit suggested to me that he might be more attuned to psychological problems than the usual doctor. I was almost sure that was why he was bringing up this story in front of his fellow pediatricians. Instead, this pediatrician reported that he had told the mother not to worry. He went on, saying to the mother how being scared of crossing a street after getting struck by a car was just normal caution following a bad experience. The pediatrician then asked me, Should I have been worried? Was the girl’s fear of crossing the street just a bit of healthy caution learned from experience? His reasoning was that if children suffered any harm from past experiences, such as being hit by a car while crossing a street, then their fear of similar situations, such as crossing any street, is logical and appropriate. In other words, it is not a symptom. What this reasoning fails to acknowledge is that caution is normal for children when crossing busy streets, but terror is not. Fear is not developmentally normal for everyday situations. Fear is almost always abnormal. The experience of almost losing her life had been burned into her mind.

Welcome To The Good Times

A stunning research study by Andrew Miele, a student at Marywood University in Scranton, Pennsylvania, and his professor, psychologist Edward O’Brien, captured the massive incompetence of mental health experts. Even more disappointing is that Miele and O’Brien found hardly any change when they revisited one of the sites ten years later. Maybe the Miele and O’Brien study was just a freak occurrence, you may think. But the pattern of missed diagnoses is so easy to find that I believe the Miele and O’Brien study is the norm, not a freak occurrence. To avoid any bias in how they studied the patients, the researchers then selected forty patients at random from the inpatient population over a period of six months. They live in a foreign world, which we can pass through only with great effort and an experienced guide. Parents and their children do not have time to wait for training programs to get better. Etiological event is required. That is, life events had to happen before the symptoms could appear in the patients. Furthermore, researchers have learned that many, if not most, children who have experienced a traumatic event have experienced more than one traumatic event. For example, in a community representative sample of 1,420 children, 37 percent had been exposed to more than one traumatic event.3 To be thorough, clinicians must take the time and go through a menu of all possible types of traumatic events.

Straight Into Darkness

Next, in order to make sure the symptoms are due to the traumatic events, clinicians must determine whether the symptoms were present before the events or they arose after the events. This process also poses unique technical challenges. These processes take time, precious time, and most clinicians will cut corners on this in order to save time. Liam avoided the topic and did not volunteer this information to the psychologist because he did not want to think about those experiences. The psychologist avoided the topic as well and did not ask about traumas. Luckily, the psychologist referred Liam to a psychiatrist for possible medications, and the psychiatrist conducted a thorough review of the boy’s trauma history and discovered that he had experienced many frightening events since he was a toddler, including times when he witnessed his mother being beaten by boyfriends and passed out from drugs. Another patient showed avoidance in a different manner. Rose was raped at the age of thirteen by a stranger in a parking lot. Rose avoided talking to her parents about her symptoms because it was too painful and embarrassing. In order to avoid the memories of the beating that kept barging into her mind, she would stay busy to distract herself. She would never stay home where it was quiet and boring and the memories could overwhelm her. Jade had shown many clues of her symptoms, but her mother avoided putting the clues together. There had been multiple obvious clues, such as pulling out her hair, begging her mother not to leave her with her uncle, and so on. It is not entirely clear why Jade’s mother did not react to the clues, but it was likely due, at least in part, to her own avoidance. Her mother may have wanted to avoid the difficult topic of trauma and thought that if she asked about trauma it would upset Jade, or herself, or both. Memories of trauma feel like things to be avoided. This avoidance makes it more difficult to conduct a good assessment. The tricky job of doctors is to solicit descriptions of events that patients would like to forget.