It is easy to empathize with suffering we can see: a child who lost hair in chemotherapy, for instance. The suffering of a child with psychiatric issues is far less obvious. Many children and teens with emotional problems keep their pain secret. Others express their feelings in risky or offensive ways. Due largely to stigma–fear, shame and misunderstanding about mental health disorders–the majority never receive clinical care.
Debunking myths about child mental health is critical to getting more children the help and understanding they deserve.
MYTH 1: A child with a psychiatric disorder is damaged for life.
A mental health condition is by no means an indication of a child’s potential for future happiness and fulfillment. The most important thing to remember here is that early intervention can be very effective at preventing chronic, debilitating conditions. If parents and teachers recognize the early signs of a psychiatric disorder — whether it’s ADHD or depression or anxiety — and get a child treatment, she has a much better chance of eliminating, or effectively managing, symptoms that would otherwise interfere with relationships and her ability to succeed at school and at work.
MYTH 2: Psychiatric problems result from personal weakness.
It can be difficult to separate the symptoms of a child’s psychiatric disorder — impulsive behavior, aggressiveness or extreme shyness, for example — from a child’s character. But a mental health disorder is an illness, just like diabetes or leukemia is not a personality type. By way of example, anorexic girls are often blamed for starving themselves, but the obsessive fears and distorted body image that drive their behavior have genetic and biological bases. We can’t expect children and teens to have the tools to overcome anorexia (or any other psychiatric disorder) on their own, but they can absolutely recover with the help of their parents, clinicians and a carefully individualized treatment plan.
MYTH 3: Psychiatric disorders result from bad parenting.
While a child’s home environment and relationships with his parents can exacerbate a psychiatric disorder, these things don’t cause a disorder. Anxiety, depression and learning disorders — indeed, the full range of mental health conditions — often have biological causes. Parenting isn’t to blame. But parents play a central role in a child’s recovery. They provide support and care that is crucial to their child’s treatment plan and future development.
MYTH 4: A child can manage a psychiatric disorder through willpower.
The key word here is disorder. A disorder is not mild anxiety or a dip in mood. It is severe distress and dysfunction that can affect all areas of a child’s life. A heartbreaking number of parents resist mental health services for their children because they fear the stigma attached to diagnoses or see psychiatrists as pill-pushers. This is incredibly sad because kids don’t have the skills and life experience to manage a condition as overwhelming as depression, anxiety or ADHD. They can benefit profoundly from the right treatment plan, which usually includes a type of behavioral therapy, and have their health and happiness restored.
MYTH 5: Therapy for kids is a waste of time.
Treatment for child mental health disorders isn’t old-fashioned talk therapy. Today’s best evidence-based treatment programs for children and teens use a cognitive-behavioral model: therapy that focuses on changing thoughts, feeling and behaviors that are causing them serious problems. This is solution-driven therapy, and it’s a key component of some of the most exciting and innovative new treatments plans for kids. Research has shown that there’s a “window of opportunity” — the first few years during which symptoms of mental health disorders appear — when treatment interventions are most successful. This means that early identification followed by therapeutic interventions can give kids the tools they need to decrease, or effectively manage, their symptoms before they experience the stigma and negative effects of a fully developed psychiatric disorder.
MYTH 6: Children are overmedicated.
Since so many public voices (many without authority or clinical experience) have questioned or decried the use of medications in the treatment of childhood psychiatric disorders, many people believe that psychiatrists simply prescribe medication to every child they see. The truth, however, is that good psychiatrists use enormous care when deciding whether and how to start a child on a treatment plan that includes medication — usually along with behavioral therapy. Medication is not the norm. Approximately 20 percent of children and teens in America have psychiatric issues at any one time; only five percent of them take medication. We never doubt whether a child with diabetes or a seizure disorder should get medication; we should take psychiatric illness just as seriously. The larger problem is that millions of children who suffer from serious psychiatric problems never receive any help.
MYTH 7: Children grow out of mental health problems.
Children are less likely to “grow out” of psychiatric disorders than they are to “grow into” more debilitating conditions. Most mental health problems left untreated in childhood become more difficult to treat in adulthood. Since we know that most psychiatric disorders emerge before a child’s 14th birthday, we should have huge incentive to screen young people for emotional and behavioral problems. We can then coordinate interventions while a child’s brain is most responsive to change, and treatment is more likely to be successful. Left untreated, disorders often lead to substance abuse, difficulties with relationships and work, and brushes with the law.
Harold S. Koplewicz, M.D.
President, The Child Mind Institute
Director, Nathan S. Kline Institute for Psychiatric Research
The opinions expressed herein are solely my own as a child and adolescent psychiatrist and public health advocate.
Health and social services are facing a new challenge, as many illicit drug users get older and face chronic health problems and a reduced quality of life. That is one of the key findings of research published in the September issue of the Journal of Advanced Nursing.
UK researchers interviewed eleven people aged 49 to 61 in contact with voluntary sector drug treatment services.
“This exploratory study, together with our wider research, suggest that older people who continue to use problematic or illegal drugs are emerging as an important, but relatively under-researched, international population” says lead author Brenda Roe, Professor of Health Research at Edge Hill University, UK.
“They are a vulnerable group, as their continued drug use, addiction and life experiences result in impaired health, chronic conditions, particular health needs and poorer quality of life. Despite this, services for older drug addicts are not widely available or accessed in the UK.”
Figures from the USA suggest that the number of people over 50 seeking help for drug or alcohol problems will have risen from 1.7 million in 2000 to 4.4 million by 2020. And the European Monitoring Centre for Drugs and Drug Addiction estimates that the number of people aged 65 and over requiring treatment in Europe will double over the same period.
The nine men and two women who took part in the study had an average age of 57. All were currently single and their homes ranged from a caravan, hostel or care home to social housing.
Key findings from the study — by the Evidence-based Practice Research Centre at Edge Hill University and the Centre for Public Health at Liverpool John Moores University –included:
- Most started taking drugs as adolescents or young adults, often citing recreational use, experimenting or being part of the hippy era. Child abuse and the death of a parent were also mentioned.
- Some started taking drugs late in life due to stressful life events like divorce or death. Meeting a drug using partner was another trigger. One man started taking drugs later in life to shock his drug taking partner into stopping and ended up developing a drug habit himself.
- First drug use varied from magic mushrooms, LSD, amphetamines and cannabis to heroin and methadone. Alcohol and smoking often featured alongside drug use.
- Some increased their drug use over time, while others had periods when they tried to reduce or even abstain from drugs. All but two of the participants were taking methadone, either as maintenance or as part of a reduction strategy in order to give up drugs.
- A number of the participants said they were trying to use drugs responsibly and it was felt that their age and the influence of drug treatment services were factors in this. They also appeared more aware of the need to maintain their personal safety, based on previous experiences.
- Most recognized that their drug use was having detrimental and cumulative effects on their health, as they had developed a range of chronic and life-threatening conditions that required hospitalization and ongoing treatment.
- Physical health conditions included: circulatory problems such as deep vein thrombosis, injection site ulcers, stroke, respiratory problems, pneumonia, diabetes, hepatitis and liver cirrhosis. Malnutrition, weight loss and obesity also featured, as did accidental injuries due to falls and drug overdoses.
- Common mental health problems included memory loss, paranoia and changed mood states, with anxiety or anger also featuring.
- All wished they hadn’t started taking drugs and would advise young people not to. A few were keen to give up, but others felt it was too hard. One man described his drug use as “disgusting and squalid” while another said that the older he got the worse his drug use got and that it was a “crazy” situation.
- All were single or divorced and drug use was a common factor in relationship breakdowns. Most lived alone, with three relying on careers who were also drug users. Pets were often important for some, providing companionship as well as a sense of responsibility and structure to their day.
- Drug use was often associated with chaotic lifestyles and relationships and some reported periods of imprisonment.
- Participants were positive about the support they received from voluntary drug services, but had mixed experiences of primary and hospital care. Some felt stigmatized by healthcare professionals, while others received compassion and acknowledgement of their drug use.
“Our population is aging and the people who started using drugs in the sixties are now reaching retirement age,” says Professor Roe.
“It is clear that further research is needed to enable health and social care professionals to develop appropriate services for this increasingly vulnerable group. We also feel that older drug users could play a key role in educating younger people about the dangers of drug use.”
This story was originally published at ScienceDaily: http://www.sciencedaily.com/releases/2010/09/100909074009.htm
People react to ideas they find offensive by reasserting familiar structures of meaning.
The human mind is always searching for meaning in the world. It’s one of the reasons we love stories so much: they give meaning to what might otherwise be random events.
From stories emerge characters, context, hopes and dreams, morals even. Using simple structures, stories can communicate complex ideas about the author’s view of the world and how it works, often without the reader’s knowledge.
And when stories embody values in which we don’t believe, we tend to reject them. But, according to a new study published in the journal Personality and Social Psychology Bulletin, it goes further than just rejection, psychologically we push back against the challenge, reasserting our own familiar structures of meaning.
In their research Proulx et al. (2010) used two stories that illustrate divergent views of the world to explore how people react to offensive ideas.
The Tortoise and the Hare
The first story was Aesop’s fable The Tortoise and the Hare. I’m sure you know it (if not, it’s here) so I’ll cut straight to one of its morals: if you keep plugging away at something, like the tortoise, you’ll eventually get there, even if you’re obviously outmatched by those around you.
Another interpretation is that the hare loses the race because he is overconfident. Either way, both the hare and tortoise get what they deserve based on how they behave. This is the way we like to think the world works: if you put in the effort, you’ll get the reward. If not, you won’t. The lazy, overconfident hare always loses, right?
An Imperial Message
Quite a different moral comes from the second piece the researchers used: a (very) short story by Franz Kafka called ‘An Imperial Message’. In this story a herald, sent out by the Emperor, is trying to deliver an important message to you. But although he is strong and determined, no matter how hard he tries, he will never deliver it (you can read the full story here).
Contrary to Aesop’s fable, Kafka is reminding us that effort, diligence and enthusiasm are often not rewarded. Sometimes it doesn’t matter if we do or say the right things, we won’t get what we want.
In many ways Kafka’s story is just as true as Aesop’s fable, but it is a much less palatable truth. Aesop’s fable seems to make sense to us while Kafka’s story doesn’t, it feels empty and absurd. Consequently we’d much rather hold on to Aesop’s fable than we would Kafka’s depressing tale.
These two stories were used by Proulx et al. to test how people reacted firstly to a safe, reassuring story and, secondly, to a story that contains a threat to most people’s view of the world. They thought that in response to Kafka’s story people would be unconsciously motivated to reaffirm the things in which they do believe. In their first experiment the researchers used measures of participant’s cultural identity to test this affirmation.
Twenty-six participants were given Aesop’s advert for hard work and another 26 were given Kafka’s more pessimistic tale. As predicted participants who read Kafka’s story perceived it as a threat to the way they viewed the world. They reacted to this threat by affirming their cultural identities more strongly than those who had read Aesop’s fable, which didn’t challenge their world-view.
In other words the participants in this study were pushing back against Kafka’s story by reaffirming their cultural identity.
In two more studies Proulx et al. addressed a couple of criticisms of their first study: that participants might have found Kafka’s story (1) too unfair and (2) too unfamiliar. So, in a second study they used a description of a Monty Python sketch which participants weren’t told was supposed to be a joke. In the third study they used Magritte’s famous absurdist painting of a bowler-hatted gentleman with a big green apple in front of his face.
The idea of using absurdist stimuli like Monty Python and the Magritte painting is that, like Kafka’s short story, they challenge our settled perceptions of the world.
The research backed up this idea. Both Python and Magritte produced the same counter-reaction in people, leading them to restate values in which they believed. Similar but non-absurd stimuli didn’t have the same effect.
Instead of using cultural identity, though, the researchers measured notions of justice and need for structure. Participants reacted to the meaning threat implicit in Python by handing out a larger notional punishment to a lawbreaker. Here the threat of the absurd caused participants to re-affirm their belief in justice.
In the third study participants reacted to the meaning threat of the Magritte painting by expressing a greater need for structure. They were suddenly craving meaning; something, anything that makes sense, instead of this bowler-hatted man with an apple in front of his face.
What this research underlines is that we push back against threats to our world-views by reasserting structures of meaning with which we are comfortable.
The researchers measured cultural identities, ideas of justice and a generalized yearning for meaning, but they probably would have found the same results in many other areas, such as politics, religion or any other strongly held set of beliefs.
When there’s a challenge to our established world-view, whether from the absurd, the unexpected, the unpalatable, the confusing or the unknown, we experience a psychological force pushing back, trying to re-assert the things we feel are safe, comfortable and familiar. That’s a shame because stories like Kafka’s contain truths we’d do well to heed.
This article was originally published at: PsyBlog http://www.spring.org.uk/
Study Shows About 48% of Americans Take at Least 1 Prescription Drug
Prescription drug use in the U.S. has been rising steadily in the past decade and the trend shows no signs of slowing, the CDC says in a new report.
The study, published in the CDC’s National Center for Health Statistics Data Brief No. 42, says the percentage of Americans who took at least one prescription drug rose from 43.5% in 1999-2000 to 48.3% in the 2007-2008 period.
The use of two or more drugs increased from 25.4% to 31.2% over the same decade, and the use of five or more prescription medications jumped from 6.3% to 10.7%.
The report also says that in the 2007-2008 period:
- One of every five children and nine out of 10 older Americans reported using at least one prescription drug in the month prior to being surveyed.
- 22.4% of kids up to age 11 used at least one prescription drug.
- 29.9% of young people 12-19 used at least one prescription drug.
- 48.3% of people between 20 and 59 used at least one prescription medication.
- 88.4% of Americans age 60 and over used at least one prescription drug, more than 76% used two or more prescription drugs in the past month, and 37% used five or more.
People without health insurance or a regular place to go for medical problems had less prescription drug use compared to those with such benefits.
Age and Gender Are Key
The report notes that prescription drug use increased with age, that women were more likely to use such medications than men, 53.3% to 43.2%, and the non-Hispanic white population had the highest prescription drug use at 54.3%, compared to 42% of black non-Hispanics and 33.9% of Mexican-Americans.
The CDC also says that:
- People with a regular place for health care were 2.7 times as likely to have used prescription drugs in the past month compared to those without the benefit.
- People with health insurance were about twice as likely to have used at least one prescription medication in the past month as those without health insurance.
- People with prescription drug benefits in their health insurance plans were 22% more likely to use prescription medications than those who did not have that benefit.
Most Common Prescribed Drugs
According to the 2007-2008 data, the most commonly used drugs were:
- Bronchodilators for children up to age 11.
- Central nervous system stimulants for youths 12-19.
- Antidepressants for people 20-59.
- Cholesterol lowering drugs for adults 60 and older.
- Among kids under age 6, penicillin antibiotics were the most frequently use prescription drugs.
The report says diuretics and beta-blockers were commonly used in adults and older Americans, with such medications used most often to treat heart problems and high blood pressure.
Article originally reported on WebMd:
National Center for Health Statistics: “NCHS Data Brief No. 42, September 2010.”