Medications, etc.

Mon Sep 10 13:54:13 CDT 2007

Here's another one -- I go to a presentation by a psychiatrist who is
presenting topic at a local hospital about working with children. The
Dr. is talking about school phobia and the best and most useful
medications to prescribe for the condition.

All I can think of is one of my younger teen clients who hates going to
school, and has played sick, due to the fact that he his being horribly
bullied by two kids at school. I ask the dr. if he aware that some kids
might have really good reasons to fear going to school -- such as being
hurt by a bully or otherwise threatened with harm. His face and body
language expresses clear surprise and he says, "Oh, I hadn't thought of
that."

And I think he really meant  it!!!

Karen Carnabucci, MSS, LCSW, TEP
Companions In Healing

Lake House Health &  Learning Center
932 Lake Ave.
Racine, WI 53403

(262) 633-2645
karen at companionsinhealing.com <mailto:karen at companionsinhealing.com> 

www.lakehousecenter.com <http://www.lakehousecenter.com/> 
www.companionsinhealing.com <http://www.companionsinhealing.com/> 

________________________________

From: list-bounces at grouptalkweb.org
[mailto:list-bounces at grouptalkweb.org] On Behalf Of PATRICIA DESERT
Sent: Sunday, September 09, 2007 2:38 PM
To: GrouptalkNewAddress
Subject: Re: sociatry91007

One most recent specific.  A former client of mine called me for some
advice about his 12 yr old son who recently began having close to panic
attacks when anticipating attending school.  He needs his dad to
accompany him at this point and his dad does.

This boy has a bar mitzvah coming up next month, his dear friend who is
also his sister just left for Israel, the school he's in just began a
new policy of bell ringing to signal end of class and the new 2-minutes
requirement required to get to next class, and some other stressors that
I can't remember right this minute.  The psychiatrist who spoke to the
father on the phone about this boy immediately wanted to put him on
medication.  

I like to think this psychiatrist is the exception.  P.

----- Original Message ----- 

	From: HV Psychodrama <mailto:hvpi at hvc.rr.com>  
	To: Adam Blatner <mailto:adam at blatner.com>  
	Cc: list at grouptalkweb.org 
	Sent: Sunday, September 09, 2007 12:39 PM
	Subject: Re: sociatry91007

	dear Adam/ You want specifics and I do not have the energy to
write 
	them....you are welcome to call me and we can have a
conversation...but I 
	suspect that anyone working in the trenches these days, as you
once referred 
	to my work, could come up with many examples of kids being
diagnosed with 
	all sorts of disorders rather than look at the problems  as
being indicative 
	of the disorders of society.Or take the PhD psychologist who had
his 
	daughter put on Ritalin because she was daydreamy and not
getting straight 
	As in school. She was 7.
	  The director of a local child day treatment said to me that
when children 
	get diagnoses bipolar, often the parental reaction is that
because the 
	disease is biological there is nothing they, the parents, need
to do, it is 
	the child's problem, no need for the family to be in treatment,
etc.

	----- Original Message ----- 
	From: "Adam Blatner" <adam at blatner.com>
	To: "HV Psychodrama" <hvpi at hvc.rr.com>
	Cc: <list at grouptalkweb.org>
	Sent: Sunday, September 09, 2007 1:17 PM
	Subject: sociatry91007

	> Dear Rebecca and all, reviewing your response, feeling much in
resonance!
	>    1. "The Politics of Therapy" and "Radical Therapy" -- Much
of this was 
	> before the many writings on oppression were publicized.
	>     However, I find very few examples of people subjected to
involuntary 
	> treatment today--- especially inappropriately. Yet there are
occasional 
	> cases and it makes one think. I'm interested especially in
what you all 
	> observe---specific issues in our practices. There was also a 
	> romanticization of schizophrenia as not being abnormal, out of
control, 
	> but more a response to crazy family and society. I think this
has been 
	> largely deconstructed. Admittedly, communications mixed
messages (e.g., 
	> the classical "double bind") and other family stress can make
any mental 
	> illness worse, but that's far from being a cause.
	>
	>    2. Just read in the New Yorker a story of a bright music
critic who was 
	> relieved to recognize that the diagnosis of Asperger's
Syndrome made sense 
	> of much that was bewildering in his life, and it also helped
his caring 
	> family. Yet he also notes that such folks have a website for
being 
	> considered just different, and many would not give up their
condition even 
	> if it could be "cured"---and there is (by the way) not the
slightest hint 
	> of a cure known or offered.
	>
	>    3. "Revolution not Adjustment." On the dramatherapy
listserve a 
	> re-discussion of the shifts in Gay, Lesbian, now linked to
Trans-gendered, 
	> bisexual, and questioning in their advocacy identity... and a
case of the 
	> proper way to address a 5 year old child who is very possibly
a little boy 
	> fascinated with and half into being a little girl...  I noted
we have not 
	> only the social definition problems, but also the question of
the "rights 
	> of parents"-- and how far those should be recognized.
	>
	>   4. Rebecca says, "we are still labeling and treating people
for 
	> disorders that arise from asking them to adapt and adjust to
unfair 
	> situations that need to be changed.
	>      AB: I am becoming concerned for personal responsibility
being an 
	> issue here. Most people don't get mentally ill or become
criminal from 
	> hard situations. I'm all for social action, and all for trying
to remedy 
	> such situations, but there are also some folks who would
excuse 
	> maladaptive behavior, or try to treat it by offering excuses
to the 
	> addicted, the antisocial... what about that?
	>
	>   5. It would be helpful to offer three or four examples of
people who are 
	> being medicated inappropriately. Also, there's a related
problem of 
	> psychological "fascism." ... It is still much easier to give a
person a 
	> pill then to help them look at how to make social changes.
	>       ab Help them look at... is the key phrase. I've found
that a great 
	> many people, perhaps the majority, passionately resist
consciousness, 
	> reflectiveness, thinking about thinking. This is so
guilt-producing, and 
	> for many, so demanding, that it would be like strapping them
down and 
	> pouring acid down their throats. No way do they want to look
at anything 
	> about the situation, much less the seemingly overwhelming "how
to make 
	> social changes."  Hey, I find it hard to get healthy,
thoughtful people to 
	> think such thoughts! Especially the how, the specifics.
	>
	>   6. RW It is much easier to look at an individual's
emotional/psychiatric 
	> problem as being rooted in biology or poor upbringing then it
is to look 
	> at it being rooted in societal ills.
	>        AB  what if it's 50-50? What if the causation is mixed,
rather than 
	> either-or. And rooted in .. okay, then what. How to
effectively diagnose a 
	> societal ill that can and should be addressed? What can we say
that hasn't 
	> already been said many times?
	>        (Are our readers aware of the movement to promote
social and 
	> emotional learning in the classroom? How many are active in
becoming 
	> informed about their own local school curriculum, the various
school board 
	> advocates for each position, the politics in promoting people
whose 
	> position fits our own, the activity of supplying these
politicians with 
	> professional information that would support their position,
and a score of 
	> other political adjunctive tasks. A major problem with
politics is that it 
	> requires a major investment in time and energy.)
	>
	>   7.  RW It asks less of us middle class practitioners, makes
us less 
	> uncomfortable...it demands nothing other than we give some one
an hour of 
	> paid time and/or a prescription.
	>          AB Also, that's all many patients want, all they can
afford to 
	> pay for under the present health care system. Otherwise, we'd
have to 
	> spend a great deal of free time doing social work unpaid ...
	>        And even if they can pay, they don't want more, so
there's the 
	> mixed challenge of "educating" them and "overcoming their
resistances" and 
	> wondering if that's ethical... etc.
	>          Sure, there are a few patients who appreciate a more
holistic 
	> approach... but let's all remember the others, too..
	>
	> 8. RW   It is also much easier to think of a person's problems
as theirs, 
	> rather than the communities' ...that is one of the wonderful
things about 
	> psychodrama in that it looks outside the individual. But
interest in group 
	> therapy and family therapy is on the wane and individual
therapy is now 
	> mostly solution focused short term work geared to helping the
individual 
	> solve the personal problem du jour.
	>          ab: good point about fashions in therapy also adapt
to 
	> socio-economic stresses. With the squeeze of the middle class
and a major 
	> 4-fold escalation of fees charged by most professionals in
last 30 years, 
	> "therapy" no longer is a benign procedure. Legal fines for
misdemeanors 
	> are less than the cost of brief therapy!
	>
	>  9. Although I do think the discovery of the SRI medications
has been a 
	> real and true godsend for many, many people, I can attest
(through my work 
	> in the hospital) how they are being used/misused to treat
depressions 
	> caused by situations that you or I or most adults would not
put up with, 
	> in fact we would run from as fast as we could . So we use meds
to help 
	> young people tolerate living in such situations.
	>          AB: The question is whether such situations are even
being 
	> clearly and correctly diagnosed: Are the families informed,
and are social 
	> services optimal? Even then, there are interesting social
policy 
	> questions, collective ethical questions, as to how much can we
force 
	> people to do this or that. Is it better to do what 35 years
ago was called 
	> a "parent-ectomy," removing kids from their nuclear (and
pathogenic) 
	> families? Where are the funds, who has the willingness even to
offer 
	> really therapeutic milieux for foster kids? And so forth.
	>       (Also, what about when the diagnosis of family causation
of mental 
	> illness was itself untrue?---see good book titled "Madness on
the Couch" 
	> about the heyday of psychoanalysis and the pressures put on
parents of 
	> autistic kids, for example. The presumption that therapists
know best may 
	> itself be very mistaken!!)
	>
	>    9. RW  Why are not we, as therapists, educators, community
people 
	> agitating for the political and social change that would
improve our 
	> clients/students/friends lives WITHOUT medicine.
	>      AB: For starters, we need to pick a single, specific
issue; identify 
	> what exactly needs to be done; identify then how to proceed to
follow this 
	> goal; and prioritize. There's also the "squeeze" of the middle
class 
	> financially that leaves little surplus energy for
participating even in 
	> ASGPP, much less community politics. (This squeeze has to do
with the rich 
	> growing richer, the growth of China and the cost of oil,
Thomas Friedman's 
	> book, "The Earth is Flat," and thousands of other factors.)
	>
	>    10. RW I get tired of going into work and being asked to
use 
	> psychodrama to help children with their anger...which means
teaching them 
	> not to explode but to ask/talk nicely....when talking nicely
has not 
	> worked for them; when they are asking "nicely" of addicted
parents or 
	> parents who have to work two jobs to pay the rent or parents
who are 
	> keeping them inside the apartment all the time because there
is too much 
	> danger on the streets...etc, etc... And we give the children
medicine to 
	> 'calm them down." Isn't this what the Russians were accused of
doing to 
	> dissenters?  I am ranting. Obviously I do know that for some
of the kids 
	> with whom I work medicine is making the difference between
allowing them 
	> normal lives and living in  a residence among other disturbed
kids.
	>       AB: Yeah, and who can afford to maintain such
residences? Often 
	> these "therapeutic" environments are staffed by young and
not-so-young, 
	> not-so-educated people who can't get better jobs, and who are
themselves 
	> inclined to engage in petty and authoritarian power struggles
with the 
	> kids! Yikes!
	>
	>   11. RW But you get the point...I think Anath is correct
about helping 
	> people learn to tolerate some level of
despair/depression/anger as long as 
	> it doesn't cause the level of inaction that won't lead to
change.
	>         AB: I agree that we need a level of what I call
"creative 
	> discontent" that includes political and economic awareness, in
contrast to 
	> complacency. We need to ask awkward questions. Forgive me for
pushing for 
	> specifics, but that's the way I think more effectively. Too
many 
	> generalizations gets me feeling, well, despair.
	>           Warmly, Adam 

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