Essential Questions for Concerned Parents
In March, in a new initiative for Mad in America, I launched the Concerned Parents’ Project. This initiative grew out of the idea that there may be parents out there who are confused and bewildered by the mixed messages on what it is to have normal and healthy childhood experiences.
New parents are bombarded by pathologizing language, encouraged to question their child’s demeanour and compare it to an idealised ‘norm’. To help parents navigate in the midst of this uncertainty, I created a set of thirty-one questions and answers, designed to encourage parents to embark on a journey of self-education.
A summary of all thirty-one questions can be found below with links to the full responses. I hope that, taken together, these questions paint a picture of the sorts of things that a concerned parent might want to pay attention to when it comes to his or her child’s emotional well-being and mental health challenges.
The questions posed asked a lot of parents, including the invitation to examine family dynamics, research alternatives to the current pill model, and think deeply about their child’s circumstances and what might be contributing to his or her distress. If you are a parent, I hope you accepted those invitations!
Our next effort as part of the Concerned Parents’ Project is to provide you with video interviews with experts from around the world, where we’ll focus on specific issues of importance to you. The speaker list is not yet finalized and we’d love to get suggestions from you about possible speakers. Please email us with your suggestions and, if you can, please provide contact information for the people you recommend.
We hope to grow the Concerned Parents’ Project and the Parents Resources section of Mad in America over the coming year. Lots more to come, so do stay tuned!
Do not rush to some simple answer—for instance, that your child has a so-called mental disorder—when you know that life is more complicated, nuanced, and mysterious than that.
We are being trained to look at just about everything as problematic so that we can be sold chemical solutions and other “expert” solutions to that problem.
His or her ways of being may create difficulties, and those difficulties certainly must be addressed, but there is no reason to treat your child’s unique ways of being as suddenly surprising.
Step one is to recognize that you are being pressured. If someone in a position of power or a supposed expert provides you with exactly one explanation of what is going on—the mental disorder explanation—and you know that there must be multiple ways to conceptualize what’s going on, you should appreciate that their “one explanation” amounts to implicit pressure on you to believe a certain thing, to react in a certain way, and to grant the powers that be a certain permission.
Let’s paint the following too-simple but useful picture. There are seven ways to look at what’s going on. The first is that nothing dramatic is going on and that there is no problem at all. The second is that this is a momentary aberration or transitional phase. The third is that something is “broken” in a medical or biological sense, the underlying premise of the mental disorder paradigm. The fourth is that it’s a matter of circumstance, say that he or she is being bullied in school. The fifth is that it’s a matter of original personality, like being born with lots of energy, which is now translating itself into restlessness and fidgeting. The sixth is that it’s a matter of formed personality, like becoming less confident over time because of school failures. The seventh is that it’s a result of family dynamics, like living with an abusive parent. To repeat, this is a too-simple picture. But it’s a useful one, in part because it’s a reminder that you may be causing or contributing to your child’s distress.
Some problems are mountains and some problems are molehills and most problems are somewhere in between. That your two-year-old grabs toys from other children isn’t a catastrophic problem. That your adolescent is relying on heroin is another matter entirely. That your child’s grades aren’t stellar isn’t a catastrophic problem, even though it may feel that way as you think about his or her future. That he or she is seriously self-harming is another matter entirely. You do not want to hold all problems as of equal moment and of equal weight.
If the claim that a supposed expert makes is at odds with what you know to be true about your child, be careful about overriding your intuition and replacing it with someone else’s too-quick opinion.
In the moment—right now—what you may want is that your child stop bouncing off the walls, throwing tantrums, hating school, playing so many video games, not listening, or acting so morose. Maybe you want him or her to be less curt, less weird, more helpful, less sullen, less defiant, a better student, more responsible, or less annoying. All of that is what you want from your child. But what do you want for your child? That turns out to be a very hard question to answer because it involves us in significant contradictions. Do we want what we want or what our child wants? And even if our wants are congruent, how do we help our child get there?
Your child is organizing and reorganizing his or her inner world and that constant inner constructing amounts to real and sometimes significant change. Should you construe that new attitude or behavior as a “symptom” or as a change? Why the former and not the latter? Your child’s circumstances may have changed and your child’s inner reality may have changed. Mustn’t all that be factored in as you try to figure out what’s going on?
Take time to consider the link between stress and distress in your child’s life. Childhood, adolescence, and young adulthood are anything but stress-free. To be holding some romantic or idyllic notion of the ease of childhood flies in the face of reality. Isn’t it possible that stress, and not a putative “mental disorder,” is causing your child’s sleep problems, bed-wetting, tantrums, irritability, forgetfulness, underperformance, sadness or other so-called “symptom”? Doesn’t that seem logical and even likely?
If family dynamics are contributing to your child’s difficulties, isn’t that a very different lens through which to view your child’s troubles than the “mental disorder” lens?
Trauma and abuse produce distress. If your child comes home from summer camp and seems not to be his or her usual self, doesn’t it make sense to check in with him or her to see if something abusive or traumatic occurred at camp?
Mean people, aggressive people, bullying people: they do harm. Presume that if such a person is in your child’s life, that contact is negatively affecting your child and may amount to a complete explanation of your child’s difficulties.
If you are highly anxious and vigilant and your child becomes highly anxious and vigilant, your child certainly has a problem. But what’s your part in the equation?
If the problems your child is having are being caused by someone in the family, that is a clarion call to action. If you won’t protect him or her, who will?
Are you in the habit of checking in with your child so as to understand what he or she is thinking and feeling?
Have you checked in with the people in your circle and your community: your mate, your other children, your parents, and anyone else who knows your child well? What are their thoughts about what’s going on?
If our child breaks an arm, we have no doubt that something needing attention has happened. But which feelings, moods, attitudes and behaviors require similar attention?
What child wouldn’t grow sadder or angrier if he or she felt that what he or she got from a parent wasn’t love but criticism or even revulsion?
Educate yourself about alternate visions that reject the idea that because you have a certain experience, say of anxiety, you have a “mental disorder” and must take “medication” for that so-called mental disorder.
What if your child’s school difficulties have to do with poor eyesight or poor hearing? What if his or her lethargy, pain complaints, or sleeplessness are symptoms of a medical condition?
Let’s say that your teenager is getting poor grades, doesn’t have friends, is morose, describes life as meaningless, and experiences great social anxiety. Will you aim for help for one of these, say by searching out a tutor to help with his math difficulties or a psychotherapist for his social anxiety, will you presume that these are all connected under the banner of “difficult teenage years” and press for peer counseling or a coping skills workshop, or will you go down the road of psychiatry, which will lead to a mental disorder diagnosis and chemicals?
So-called mental disorders are not “diagnosed” based on causes that can be tested for (or even articulated) but are instead “diagnosed” according to what are called symptom pictures. This is a highly questionable practice. For example, what is the logic in calling defiance a “symptom of the mental disorder of oppositional defiant disorder”? Why isn’t it just defiance?
The profit motive is a powerful motive in human affairs. Pharmaceutical companies make huge profits by supplying powerful chemicals called psychiatric medications that are touted as safely and effectively treating things called mental disorders. If you are merely in despair, they have no way to make a profit from you. If that despair is given the medical-sounding name clinical depression, then they can provide a medical-seeming pill called an antidepressant. However, pharmaceutical companies aren’t the only ones with a vested interest in the mental disorder paradigm.
Imagine asking your surgeon, “Why are you planning to cut me open?” and getting no answer. Or getting the answer, “Because it’s a surgical issue.” Or getting the answer, “Because of your symptom picture.” Since the leap made by mental health professionals from observed behavior to a mental disorder diagnosis is a labeling leap and not a medical leap or a scientific leap, the answers they provide will likely cause you to shake your head. Make sure that the rationale for this whole business makes sense to you.
Even if you assume that the psychiatric chemicals given to children work, which is a highly debatable assumption, that they work is not the only criteria by which to judge whether or not a chemical should be taken. Vast amounts of Scotch may work to help you forget that you hate your life but that doesn’t make alcoholism an excellent treatment for despair. When it comes to the psychiatric chemicals that may be prescribed to your child, as important to answer as “Do they work?” are “Do they make sense?” and “Are they a good idea?”
How can you know what’s making your child despondent before you do a little investigating? Do you feel sanguine that turning your child over to a mental health professional who only knows to go down the first route is everything that you can or should do? Doesn’t it make good sense to try to arrive at thoughtful answers to the thirty-one questions I’m posing this month? It is holding the bar too high to suppose that you will become some sort of expert in these matters since frankly, no one is. But I know that you agree that exploring additional avenues makes sense.
If you’ve tried to help your child in some way, whether via a traditional psychiatric intervention or via something else, the next question to address is whether your child is getting better, whether the situation remains unchanged, or whether your child’s situation has worsened. It seems as if this should be easy to gauge but in fact, it isn’t really that easy.
Let’s say that your child has been extremely sad, has been diagnosed with a so-called mental disorder and put on so-called psychiatric medication, and is now quite worse, deeper in despair, and talking about suicide more often. How should you think about this moment? Your child’s mental health provider is likely to promote the idea that your child either needs a different dose of the antidepressant he or she is taking, a different antidepressant, or an additional antidepressant. What he or she is unlikely to suggest is that your child’s worsening is a direct result of taking these particular powerful chemicals, many of which are known to increase despair and thoughts of suicide. Given that your child’s helper is unlikely to provide this information, you would naturally feel pressured to go along with his or her suggestion regarding a change in meds. But now that you know that the chemicals themselves might be causing the deterioration, what should you do?
You have your own life, your own needs, and your own challenges. If parenting is demoralizing you or depleting you, you need your own self-care and support. You may be caught in a vortex of difficulty, trying to deal not only with one child but with his or her siblings, with your mate, with your parents—and then there are all of your social and existential needs, your need for friends, meaning, and all the rest. Life lived this way is like a hurricane. It is a fair question and not a selfish question to ask, “What do I need?” Unless you ask that question and arrive at some satisfactory answers, you may be jeopardizing your physical health and your emotional wellbeing and coming to the table of life as a weakened version of yourself.
We’ve tackled thirty-one questions this month. Answering them will help you look at what’s going on in your child’s life from a much broader perspective, one that takes into account the many pitfalls of the mental disorder paradigm and that includes the significant alternatives available to you. I think that trying to answer these thirty-one questions is a thing that you ought to do.
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.