Welcome to Childhood Made Crazy, an interview series that takes a critical look at the current “mental disorders of childhood” model. This series is comprised of interviews with practitioners, parents, and other children’s advocates as well as pieces that investigate fundamental questions in the mental health field.
In this interview, Dr Eric Maisel (EM) chats with integrative psychiatrist Henry Emmons MD (HE). This interview first appeared on Psychology Today.
Henry Emmons is a psychiatrist who integrates mind-body and natural therapies, mindfulness and Buddhist teachings, and compassion and insight into his clinical work. Henry developed the Resilience Training Program, which is currently offered at the Penny George Institute for Health and Healing. This program is based upon the ideas developed in his books, The Chemistry of Joy and The Chemistry of Calm.
EM: How would you suggest a parent think about being told that his or her child meets the criteria for a mental disorder or a mental illness diagnosis?
HE: Bear in mind that psychiatric diagnosis is based upon descriptions of symptoms and behaviors and is to this day rather subjective and limited. It tells us very little about root causes, potential solutions or ultimate prognosis. In some ways, receiving a formal diagnosis simply confirms what you already know as a parent—that your child is suffering, and that it is to such a degree that it is in some way impacting his or her ability to function.
There are only so many ways that mental or emotional suffering are manifest, and those variations are not always helpfully addressed in the DSM categories. Some people, for example, become more energized, even agitated, when under stress. Others might withdraw or lose energy. Those two patterns may result in completely different diagnoses, yet could simply represent different ways of reacting to the same underlying stressor.
An accurate diagnosis should put us in the right ballpark of what to do for relief, but should not become a label that somehow adheres to a person for the rest of their lives. In my practice, I find it more important to try to understand what is driving the problem, and what has gone awry in one’s innate self-righting capacity, i.e. their resilience, so that effective solutions can be found.
EM: How would you suggest a parent think about being told that his or her child ought to go on one or more than one psychiatric medication for his or her diagnosed mental disorder or mental illness?
HE: In most instances, I view psychiatric medications as one of many potential tools, intended to support someone temporarily until they have found other means of keeping themselves healthy. There are some conditions that may require long-term treatment, but I do not believe in telling someone at a young age that “You will need to be on medication for the rest of your life.”
Many people today are wary of psychiatric medications, and with good reason. Yet there are times when they can be helpful if used wisely, such as in acute depression or panic anxiety. My advice is to work with a prescriber who has a healthy caution when it comes to medication. Here are some considerations I would try to keep in mind before agreeing to use medication:
If the situation is not too acute, have other means of supporting brain chemistry been tried first? Examples are diet, exercise and nutritional supplements. You can refer to The Chemistry of Joy for alternatives to depression, or The Chemistry of Calm for anxiety.
How long is the medication going to be used? In my view, most psychiatric medications become harder to come off after long-term use, which I consider to be anything beyond a year or so. That timeframe is just a week or two with some anxiety and sleep drugs, like Ativan, Xanax or Ambien.
Is the starting dose low? This is important for anyone, but especially children, because so many of the potential problems from medications are avoided if the dose is kept as low as possible right from the start.
Are we really treating the right thing? The medications most commonly used in children are stimulants and antidepressants. They are much less safe if used in the wrong condition. ADHD, for example, is easily misdiagnosed when the problem is really a variant of bipolar disorder or anxiety. Over time, the stimulants are likely to make both of those conditions worse.
EM: What if a parent has a child who is taking psychiatric drugs and the child appears to be having adverse effects to those drugs or whose situation appears to worsening? What would you suggest the parent do?
HE: In many respects, the first 2-3 weeks of treatment with a medication are the most important, and you should have open access to the prescriber during that time. Most side effects are mild and get better within the first couple of weeks. For example, mild nausea or headaches can occur with any medication when first starting them, and are usually not a cause for concern. Here are some more concerning things to watch for:
Most importantly, watch that the mood is not getting worse. For some people, the serotonin antidepressants (SSRIs) are agitating. Usually, this results in not sleeping as well or feeling restless or moody. In extreme cases, though, it can lead to self-injury (e.g. cutting) or even suicidal thinking. These should be addressed immediately, and if they are new behaviors be sure that due consideration is given to the medication being the cause.
Three common side effects of the SSRIs are tiredness, poor focus and weight gain. Obviously these can present problems for young people. Sometimes they will improve with time, but occasionally the dose needs to be adjusted, so let the prescriber know about them. Be careful if the suggestion is to add another medication to counter the side effects of the first one. That approach often ends up causing more harm than good.
Sometimes side effects look like the original problem. For example, sleeping too much or too little might look like depression or anxiety, but may really be caused by the medication. Also, a flat, disinterested mood might be confused with depression, but is a common side effect when the dose of an antidepressant is too high.
EM: What sort of work does your organization do?
HE: My organization, Partners in Resilience, uses lifestyle medicine, integrative mental health and mindfulness practices to help in the recovery and prevention of depression and anxiety. Our goal is to foster resilience across the lifespan. We have designed resilience programs for teens and adults, and we are developing one for children.
In our teen program, we incorporate yoga, natural medicines and mindfulness therapies in a group setting to provide the mental and emotional skills that can help restore a teen’s health. As part of that program, we also meet with parents to teach ways that they can help support their child’s resilience skills.
EM: You’ve written The Chemistry of Joy, The Chemistry of Calm, and The Chemistry of Joy Workbook. What might parents get from those books that might help them?
HE: In The Chemistry of Joy, (and the Workbook) I present a comprehensive, user-friendly, self-directed program to move out of depression. In The Chemistry of Calm, I do that for anxiety.
All of my books focus on restoring resilience, which I consider to be foundational for good mental health. I developed a resilience model that addresses the whole person—body, mind, heart and soul—because “mental health” is really about every aspect of what it means to be human. I believe that modern psychiatry’s focus on brain chemistry (addressed almost entirely by medication) is far too limited to be of real value for most people. I think that is even truer for children and teens. They are still so close to their natural resilience that sometimes it takes only minor shifts in lifestyle, thinking patterns or emotional skills to make a huge difference in the course of their lives.
I help the reader determine what measures to take, not based on diagnosis, but on underlying patterns. Then you can choose the best diet and nutritional supplements to support healthy brain chemistry for your particular needs. I also incorporate the wisdom of the East, with a focus on mindfulness skills. Those practices can help one go beyond recovery from illness and move toward transformation of the patterns and habits that contributed to the problem in the first place.
The goal of treatment, in my view, should not stop at recovery of one’s previous level of function. It should help the sufferer to become greater somehow: more resilient, better connected, more aware and enlivened.
To learn more about this series of interviews please visit http://ericmaisel.com/interview-series/