Monday, December 5, 2022

Comments by Claudia Gold, MD

Showing 9 of 9 comments.

  • Hi Steve

    I agree with you in that often a child’s behavior is both a healthy adaptation to a problematic situation and an effort to communicate distress. The problem is when we pathologize the behavior and call it an “illness.” I am not a psychiatrist but I am not sure how my medical background disqualifies me from understanding the interplay of biology and environment.

  • Hi Liz I find your comment to be very thought-provoking. There are two reasons why I choose not to use the term “anti-psychiatry” to describe myself and my work. The first, as I allude to in this piece, is that from my perspective as a pediatrician, I see the problem of the silenced child as extending well beyond the field of psychiatry. The lack of paid parental leave, the increased academic demands of early childhood education, the complexities of the health insurance industry that place demands on the time of primary care clinicians and take away from opportunity for listening are just some of the cultural forces that contribute to what I refer to, drawing on the work of Elizabeth Young-Breuhl, as prejudice against children.The second is that, as you point out, I want these views to be heard by a broad audience. I think that identifying yourself as “anti-psychiatry” provokes members of this discipline, that wields a good deal of power in our society, to defensively shut down and not listen. In an ideal world, where we offered a holding environment to support children and families starting in infancy, we would not use psychiatric medication at all. But in the real world, as it exists today, there are as you identify “emergency situations” such as the child in foster care who will be removed from their fourth placement if their violent behavior is not brought under control, where medication has a role to play. I do look with hope to they day when we as a society take note of the explosion of science showing how the brain grows in relationships, value parents and children and by supporting healthy development from the start, and so do not have such dire situations. That long term, perhaps lofty goal is what motivates me to write my blog posts and my books.

  • Hi wtime I appreciate your point. You will not find anything in this article, or in my book, that is “anti-medication.” In my book I do acknowledge that there are circumstances where medication can make children available for other forms of intervention. The point is that our current system of care does not protect time to listen to the story but rather jumps to find something “wrong” with a child.

  • Hi Harper

    I often feel hopeful when I read articles and comments on MIA. But then I read things like this piece from NPR This piece is about how the son of the person who wrote I am Adam Lanza’s Mother. At the age of 16 was diagnosed with juvenile bipolar disorder. He says in the piece: “After Dr. Papolos diagnosed Walton with childhood bipolar disorder, everything got better.”I got the correct diagnosis. I got put on the right medication.” The article holds their story out as a model of good care. is such a long way to go before there is an understanding of how the illness model of biological psychiatry is itself stigmatizing. I wonder what things will look like for this boy 5-10 years from now.

  • Hi Steve

    I agree that listening to parents and helping them to support their children can be empowering. I find your idea interesting that resisting “blaming parents” is a way of perpetuating the medical model of disease that places the problem squarely in the child. Is it really better for a child to be given the sense that he has a diseased brain? When put in such stark terms it seems obvious that the answer is a firm “no.” This contrast highlights the way the child does not have a voice. As you point out, not only does this approach silence children it also disempowers parents.

  • Hi all
    Thank you for all of these comments. First of all I absolutely agree that there is reason for grave concern about the medical model of illness as applied to mental health care, and the reification of DSM “disorders” that are nothing but collections of behaviors or “symptoms” that tend to go together.

    This post was inspired by my reaction to the mother in the film who says that being against screening is “absurd.” I thought that from her perspective as a person who is suffering in emotional pain, to say I’m against screening seems harsh and even cruel.

    That is why I framed the post by describing screening as an effort to identify individuals who are suffering in emotional pain. I well recognize that in our current system of health care- and I do say this in the post- screening most often leads not to meaningful help but to medication.

    Screening in its most broad definition, that in the ideal world has nothing to do with diagnosing disorders but rather identifying and helping people with emotional suffering, would not be wrong. It is only wrong, and again I do say this in the post, in a system of care that does not protect space and time for listening, and instead labels people with disease.

  • I very much appreciate this interesting discussion. In my view, whether we call it trauma or maltreatment or attachment problems, in order to make sense of or in other words find meaning in experience, we need to know the developmental and relational context. We need to know the story. This requires time and space for listening, which are severely lacking both in our culture and our mental health care system. Thus clinicians simply name problem behavior as a “disorder” and aim to eliminate the behavior. But research has shown that discovery of meaning is the path to healthy emotional development. This is the thesis of my forthcoming book “The Silenced Child” (Da Capo spring 2016)