Wednesday, September 14, 2011

Why I Am Happy That I Am Not a Child Psychiatrist

My hat goes off to kiddy shrinks.  It's a tough field, full of issues we don't see in adult psychiatry.  

Our comment section often buzzes with talk about the over-diagnosis of bipolar disorder in children and the ethics of giving psychotropic medications to children.  The Shrink Rappers never comment on these things.  Why?  Because we don't treat children.  I have no idea if the children being treated are mis-diagnosed, over-diagnosed, wrongly-diagnosed, or if the increase in treatment represents a good thing---- perhaps children who would have suffered terribly now are feeling better due to the option of medications.  I've certainly had adult patients tell me their children were treated with medications, the children have often eventually stopped the medications and emerged as productive adults.  Would they have outgrown their issues anyway.  Or did the treatment they received switch them from a bad place to a good place and enable them to carry on in a more adaptive way?  Ugh, my crystal ball is on back-order at Amazon!  

Why I'm Happy I'm Not A Child Psychiatrist:

  • Two extra years of training (and being on overnight call)
  • No extra pay.
  • "Normal" or "well" children often display behaviors that look a lot like those of "ill" children.  Ever witnessed a temper tantrum? 
  • Children often can't verbalize their feelings and they are inferred from behaviors. 
  • Children are often subjected to the treatment, with all it's options for distress-- whether it be that therapy displaces soccer or that Risperdal causes sluggishness-- without the same open dialogue and choice that adults get.
  • Children are often treated based on the distress of other people.
  • Some illnesses in children are defined by the arbitrary standards of societal expectations.  There would be fewer hyperactive children if we didn't expect boys to sit still for long periods of time.
  • It's very hard to differentiate a "phase" that will be outgrown from "pathology."  This is especially true in teenagers where some angst and rebellion are part of some people's journey.
  • There are times when treatment is based on the reports of others (such as parents) and there is no guarantee that such reports are accurate or that the parent's expectations are reasonable/realistic, and parents can be quite demanding about the need for treatment and medications.
  • It can be difficult dealing with the troubled parents of troubled children.
  • Expanding on that, parents sometimes get angry and remove their children from treatment if it is suggested that they are part of the problem.
  • I don't like treating people who don't want help and children are sometimes in treatment at the request of their parents, schools, or other agencies.  True for adults as well, but not in my office.