Sunday, October 01, 2006

Help Me If You Can...

[posted by dinah]

So my children have both told me that if your parents get divorced you have to go to therapy for a year. Just an observation, I suppose, but they've both come to that conclusion independently. "Maybe", I commented, "it's more about the parents than the kids." Since they present it as a matter-of-fact observation-- maybe putting the child into therapy lessens the parent's guilt over the divorce, gives them the sense that they are somehow rectifying the wrong, counter-acting the damage. Of course, my kids might just be wrong, or missing information about their classmates' distressing symptoms, or maybe at their school, when your parents get divorced, you go to therapy for a year.

This made me think of the time a friend told me that her neighbor's father had died of suicide. "Don't you think she should have therapy for this?" my friend asked. Now that's a hard one; we psychiatrists mostly avoid making treatment recommendations on people we've never met and there is no right answer here. There might be lots of reasons for friend's neighbor to go into therapy: maybe she's inherited her father's mental illness, maybe she's having symptoms of her own psychiatric disorder, perhaps she's remained unduly distraught over the suicide (I'll swing by the issue here of how much distress over such a thing is Too Much distress), or maybe the aftermath of the event has interfered with her own ability to love or to work or to get the most out of life. At any rate, the presumed patient wasn't seeking care. I was left to mutter "probably."

There are some events that everyone reacts to and individual responses vary. As the psychiatrist in the matter, I've simply left it that if you show up at my door saying you're distressed, that's good enough for me. Sometimes I offer reassurance that a response is normal, but never do I kick a patient out and I don't go knocking on doors in search of those who could benefit from care (---not that that's a bad idea, there's a lot of undiagnosed mental illness out there causing misery & dysfunction, perhaps for another post). People seem to vary in their ability to cope with trauma as well as their openness to asking for & getting help. Therapy helps people cope with trauma, it offers some relief through venting and sharing, and empathy (or sympathy?) and understanding, of course. But it doesn't undo trauma, it doesn't excavate all the scars, and not every person who has muddled through a difficult time needs, wants, or even benefits from psychiatric care. Sometimes a good friend (or a Camel) will do, sometimes throwing oneself into activity helps, and of course, sometimes psychiatric treatment is invaluable.

So I wonder how all those kids feel about their year of therapy.