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Wednesday 26 March 2014

Child mental health issues 'missed' - Adults can be wary of asking about mental health problems particularly in boys - Courtesy of the BBC Website - March 25th 2014

Child mental health issues 'missed'
 Adults can be wary of asking about mental health problems

Thousands of young people may be "slipping through the net" because adults do not spot the warning signs of mental health problems, experts warn.

MindEd, a new website, backed by groups including the Royal College of Paediatrics and Child Health, is being launched to raise awareness.

A survey of 2,100 adults found a third were unsure of signs of depression in children.

More than 850,000 children in the UK have a mental health problem.

The survey, carried out on behalf of the child and adolescent mental health groups behind MindEd, also found half of those questioned would be worried about saying anything if they did suspect there was a problem, for fear of being mistaken.
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Two-thirds would back extra government investment in children's mental health services to equip professionals with the skills to identify and treat these children earlier.
'Still a stigma'

Writing in a Scrubbing Up for the BBC News website, Dr Raphael Kelvin, child psychiatrist and clinical lead for the MindEd programme, said the survey also looked at other ways of helping children.
Teacher in classroom Teachers and others working with children, will be able to get advice about signs of a problem

"When we polled the public on the issue, 69% said they supported the notion that every school should have a dedicated member of staff on site for children to approach about mental health and well-being issues."

The MindEd website, funded by the Department of Health, is aimed at helping adults who work with children, including teachers, sports coaches and social workers, to spot the signs of a potential problem.

Dr Kelvin added: "Half of all diagnosable mental health conditions start before the age of 14 and 75% by the age of 21, so identifying children at the earliest opportunity is crucial in setting them on the best path in life.

"Investing in early intervention is crucial - not doing so comes at a high price for those battling a mental health condition, and also costs the economy vast sums of money in lost education, training, jobs, and often, through crime."
'Not confident'

He said: "It's clear from these results that there's still stigma attached to mental health with 51% of adults admitting fear of approaching the issue.

"It's also clear that many adults are not confident in being able to spot the signs of ill mental health in children and many are turning to other adults - family, friends and teachers - for help and advice.

"So it's vital that people know what to look out for so they can address the issue before it worsens and that's where MindEd can help."

Care Minister Norman Lamb said: "Spotting the signs of mental health problems early in children and young people is essential to prevent problems from escalating and continuing into adulthood.

"That's why we have invested £3m in MindEd - so that people working with children, from teachers to dinner ladies and sports coaches to Scouts leaders, can recognise when a child needs help and make sure they get it."

Sunday 9 March 2014

POEM - Parental Perspective on Psychiatry - by Dave Traxson - March 2014

Parental Perspective Poem on Psychiatry

My child is not disordered and ill

But is developing and growing still,

So in the dualism of our body and mind

Why do you give only drugs or their kind.

If you do believe in his human being

Then you would hear what I am seeing.

He is unique, fun and caring

But sometimes can be scaring,

And is better letting off steam.

So your arrogance makes me scream.

Let him be ........

The adult see ......

A future free

Of you ......

And me.

Dr Thomas Insell - Director of the NIMH who stopped them using DSM-5 as a research tool due to its lack of scientific validity - "Blazing Trails in Brain Science" By BENEDICT CAREY FEB. 3, 2014 - Courtesy of The New York Times

Blazing Trails in Brain Science


Dr. Thomas R. Insel is the longest-serving director of the National Institute of Mental Health since its founder left.


BETHESDA, Md. — The police arrived at the house just after breakfast, dressed in full riot gear, and set up a perimeter at the front and back. Not long after, animal rights marchers began filling the street: scores of people, young and old, yelling accusations of murder and abuse, invoking Hitler, as neighbors stepped out onto their porches and stared.

It was 1997, in Decatur, Ga. The demonstrators had clashed with the police that week, at the Yerkes National Primate Research Center at nearby Emory University, but this time, they were paying a personal call — on the house of the center’s director, inside with his wife and two teenage children.

“I think it affected the three of them more than it did me, honestly,” said Dr. Thomas R. Insel, shaking his head at the memory. “But the university insisted on moving all of us to a safe place for a few days, to an ‘undisclosed location.’
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Related Coverage

    interactive Interactive Feature: Profiles in ScienceFEB. 16, 2012

“I’ll say this. I learned that if you’re going to take a stand, you’re going to make some people really angry — so you’d better believe in what you’re doing, and believe it completely.”
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Mental Disorders as Brain Disorders

    Dr. Thomas R. Insel on understanding mental illness by way of brain research.
        max volume

For the past 11 years, Dr. Insel, a 62-year-old brain scientist, has run an equally contentious but far more influential outfit: the National Institute of Mental Health, the world’s leading backer of behavioral health research.

The job comes with risk as well as power. Patient groups and scientists continually question the agency’s priorities, and politicians occasionally snipe at its decisions. Two previous directors resigned in the wake of inflammatory statements (one on marijuana laws, one comparing urban neighborhoods to jungles), and another stepped down after repeatedly objecting to White House decisions.

Dr. Insel has not merely survived; he is the longest-serving director since Dr. Robert H. Felix, the agency’s founder, retired almost a half-century ago. His tenure stretches over three presidencies and, more important, coincides with a top-down overhaul in the substance and direction of behavioral science.

The extent of this remodeling is not widely understood outside scientific circles nor universally appreciated within them. But in recent months, its author has begun to reveal his instincts publicly, in blog posts and speeches. Last summer, he questioned whether people with schizophrenia should remain indefinitely on antipsychotic medications — a shot at accepted medical wisdom.

A few months earlier, he had called out psychiatry’s diagnostic encyclopedia, the D.S.M.-5, as “not scientifically valid,” weeks before a new edition was released. Psychiatrists were not happy, and they told him so. Days later, he issued a statement saying that the manual was the best “currently available,” if imperfect.

For anyone with a psychiatric diagnosis, or a family member with one, Dr. Insel’s long, twisting career and the convictions it has fostered provide a guided tour through behavior science: where it has been, where it’s going and why.

The story is neither predictable nor probable, at least by the standards of Washington officialdom. It is less a tale of perseverance than one of restless curiosity — of ascending the trail by straying off it, repeatedly and without approval.

The Young Doctor

The first time he walked away was from premedical studies.

Dr. H. Herman Insel, an eye surgeon in Dayton, Ohio, and his wife, Ruth, a social worker, were determined that all four of their boys get a medical education, and the first three went fairly smoothly. The last one out of the house, the Eagle Scout who collected insects and snakes and filled the basement with aquariums, was ahead of the program, if anything.

At the age of 15, Tom Insel had entered the prestigious six-year B.A.-M.D. program at Boston University. But two years in, the boy wanted out. He decided it was time to step off the treadmill and see the world.

“My father didn’t want me going anywhere, and I was too young to be drafted for Vietnam,” Dr. Insel said in a recent interview at his office here. “I told him, ‘O.K., so how about I go to Hanoi? They could use some help there.’ ”

The two reached a compromise, and the son spent six months backpacking around the world, stopping to work in a tuberculosis clinic in Hong Kong and at a mission hospital in Bihar, India. The experiences brought him full circle, back to medicine and to Boston, where he completed the M.D. program in 1974. “I was sure I was going to be a doctor of global health or tropical medicine in some underdeveloped country,” he said.

Instead, he found an untamed world closer to home: psychiatry, which in the 1970s was ruled by a cabal of Freudian theorists and lacked a scientific infrastructure. After a graduate course at Stanford, followed by an internship and residency in psychiatry, he landed a position in the mental health institute’s in-house research branch, known as the intramural program.

There he embarked on another kind of walkabout, this time studying the effect of an early antidepressant drug in people with obsessive-compulsive disorder. In a series of studies, he and a senior colleague, Dr. Dennis Murphy, showed that the drug soothed people’s symptoms within weeks, much faster than standard psychotherapy.

The results had the opposite effect on many old-school psychiatrists. “Obsessive-compulsive neurosis,” as it was known then, was a specialty of Freudian analysts, and here was some upstart barely out of school saying he’d discovered a better, faster form of treatment.

He wasn’t yet 30 years old. “I don’t think it helped that I still looked like I was 17,” Dr. Insel said.
Dr. Insel's tenure at the agency, which backs behavioral health research, has coincided with an overhaul of the substance and direction of the field. Credit Lexey Swall for The New York Times

The pendulum has swung so far toward drug therapy in recent years that it is hard to recapture how disruptive those 1980s studies were. Dr. Insel’s work and that of many others, testing the effect of new medications, would turn the field away from long-term talking cures and increasingly toward medication and short-term behavior therapies rooted in the same kind of randomized, controlled trials conducted in other fields of medicine. (Today, psychiatrists often treat O.C.D. with short-term cognitive therapy, complemented by antidepressant medication.)

Any young investigator at the forefront of such a shift was bound to feel a professional updraft, and Dr. Insel was soon fielding offers from universities trying to build a psychiatric research department.

At an age when most young scientists are scrambling for a foothold, a mentor and a viable project, his path was all but set. He and his wife, Deborah, a writer, had two young children and every reason to grab for longer-term stability.

Instead, they passed. Again, Dr. Insel abandoned course in midstride, taking a year’s sabbatical to study basic neuroscience.

“I just wanted to try something else,” he said. “I got bored, that’s really what it was.”

The Biology of Love

He also lost his job.

In 1985, returning to the mental health institute after his year away, he began studying tiny mouselike rodents called voles in an effort to understand the biology of attachment. This project was a long way from O.C.D., and to many others in the field, it seemed like the brain-science equivalent of backpacking to Hanoi.

“No one told me at the time that it was pointless to try to reduce a complex social behavior like pair bonding to neural biology, so I didn’t know any better,” Dr. Insel said. “I just assumed we could do it and started looking for the best model.”

He settled on voles for a good reason. One species, the prairie vole, is monogamous; it forms long-term pair bonds after mating. Another, the montane vole, is polygamous; it mates and moves on. The two species are closely related, so the difference in their behavior might be rooted in some discrete neural process that could be isolated, Dr. Insel argued.

In a series of studies in the late 1980s and early 1990s, his team showed just that: Injections of a protein called vasopressin induced monogamous bonding in male prairie voles even when the animals didn’t mate. Likewise, blocking the action of the protein prevented the post-mating bond that usually formed. Injections of the hormone oxytocin prompted similar bonding instincts in female prairie voles.

In a paper published in the journal Nature in 1993, Dr. Insel’s group reported that vasopressin is “both necessary and sufficient for selective aggression and partner preference formation, two critical features of pair bonding in the monogamous prairie vole.”

The paper was widely reported, and again put the mental health institute in the vanguard of a new area of research. But the agency was changing emphasis, phasing out its research into social behaviors. Dr. Michael Brownstein, the scientific director at the time, politely instructed his young research star to find another project — or another job. (The two are now good friends.)

He chose Door No. 2, and it took all of three months. Emory University was looking to replace the director of the Yerkes primate center, who was about to retire, and Dr. Insel was at the top of their list. He had already run a lab, as chief of the neurobiology division of the mental health institute, and his work with voles would diversify Yerkes’s portfolio, which then was focused on studying H.I.V. in primates.

He packed up his family and his voles, and moved south. “Acclaimed Researcher to Head Yerkes Center,” read the headline in The Atlanta Journal-Constitution on Aug. 20, 1994, the day the hiring was announced. “All I know is I had to go out and buy my first tie,” is how Dr. Insel tells it.

He quickly expanded rodent research at the center and also deepened his own work on the biology of attachment, with the help of an Emory postdoctoral student, Larry Young, who has since extended the research on his own. The work with voles effectively scotched the assumption that a complex behavior could not be reduced to brain biology. Oxytocin and vasopressin are now a focus of intense interest as possible modulators of social behaviors in other species, though the effects of such proteins are still a matter of debate.

His necktie came in handy at Yerkes. Between the march on his home in Decatur and other crises, the “psychiatrist who became a bench scientist,” as he has described himself, took on yet another role: He became a public official.

The "chemical imbalance" myth by Chris Kresser

 CLICK ON LINK FOR FULL ARTICLE: http://chriskresser.com/the-chemical-imbalance-myth

The "chemical imbalance" mythby Chris Kresser

“A theory that is wrong is considered preferable to admitting our ignorance.” – Elliot Vallenstein, Ph.D.

The idea that depression and other mental health conditions are caused by an imbalance of chemicals in the brain is so deeply ingrained in our psyche that it seems almost sacrilegious to question it.

Direct-to-consumer-advertising (DCTA) campaigns, which have expanded the size of the antidepressant market (Donohue et al., 2004), revolve around the claim that SSRIs (the most popular class of antidepressants) alleviate depression by correcting a deficiency of serotonin in the brain.

For example, Pfizer’s television advertisement for Zoloft states that “depression is a serious medical condition that may be due to a chemical imbalance”, and that “Zoloft works to correct this imbalance.”

Other SSRI advertising campaigns make similar claims. The Effexor website even has a slick video explaining that “research suggests an important link between depression and an imbalance in some of the brain’s chemical messengers. Two neurotransmitters believed to be involved in depression are serotonin and norepinephrine.” The video goes on to explain that Effexor works by increasing serotonin levels in the synapse, which is “believed to relieve symptoms of depression over time.”

These days serotonin is widely promoted as the way to achieve just about every personality trait that is desirable, including self-confidence, creativity, emotional resilience, success, achievement, sociability and high energy. And the converse is also true. Low serotonin levels have been implicated in almost every undesirable mental state and behavioral pattern, such as depression, aggressiveness, suicide, stress, lack of self-confidence, failure, low impulse control, binge eating and other forms of substance abuse.

In fact, the idea that low levels of serotonin cause depression has become so widespread that it’s not uncommon to hear people speak of the need to “boost their serotonin levels” through exercise, herbal supplements or even sexual activity. The “chemical imbalance” theory is so well established that it is now part of the popular lexicon.

It is, after all, a neat theory. It takes a complex and heterogeneous condition (depression) and boils it down to a simple imbalance of two to three neurotransmitters (out of more than 100 that have been identified), which, as it happens, can be “corrected” by long-term drug treatment. This clear and easy-to-follow theory is the driving force behind the $12 billion worth of antidepressant drugs sold each year.

However, there is one (rather large) problem with this theory: there is absolutely no evidence to support it. Recent reviews of the research have demonstrated no link between depression, or any other mental disorder, and an imbalance of chemicals in the brain (Lacasse & Leo, 2005; (Valenstein, 1998).

The ineffectiveness of antidepressant drugs when compared to placebo cast even more doubt on the “chemical imbalance” theory. (See my recent articles Placebos as effective as antidepressants and A closer look at the evidence for more on this.)

Folks, at this point you might want to grab a cup of tea. It’s going to take a while to explain the history of this theory, why it is flawed, and how continues to persist in light of the complete lack of evidence to support it. I will try to be as concise as possible, but there’s a lot of material to cover and a lot of propaganda I need to disabuse you of.

Ready? Let’s start with a bit of history.
The history of the “chemical imbalance” theory

The first antidepressant, iproniazid, was discovered by accident in 1952 after it was observed that some tubercular patients became euphoric when treated with this drug. A bacteriologist named Albert Zeller found that iproniazid was effective in inhibiting the enzyme monoamine oxydase. As its name implies, monoamine oxydase plays an essential role in inactivating monoamines such as epinephrine and norepinephrine. Thus, iproniazid raised levels of epinephrine and norepinephrine which in turn led to stimulation of the sympathetic nervous system – an effect thought to be responsible for the antidepressant action of the drug.

At around the same time, an extract from the plant Rauwolfia serpentina was introduced into western psychiatry. This extract had been used medicinally in India for more than a thousand years and was thought to have a calming effect useful to quite babies, treat insomnia, high blood pressure, insanity and much more. In 1953 chemists at Ciba, a pharmaceutical company, isolated the active compound from this herb and called it reserpine.

In 1955 researchers at the National Institutes of Health reported that reserpine reduces the levels of serotonin in the brains of animals. It was later established that all three of the major biogenic amines in the brain, norepinephrine, serotonin, and dopamine, were all decreased by reserpine (again, in animals).

In animal studies conducted at around the same time, it was found that animals administered reserpine showed a short period of increased excitement and motor activity, followed by a prolonged period of inactivity. The animals often had a hunched posture and an immobility that was thought to resemble catatonia (Valenstein, 1998). Since reserpine lowered levels of serotonin, norepinephrine and dopamine, and caused the effects observed in animals, it was concluded that depression was a result of low levels of biogenic amines. Hence, the “chemical imbalance” theory is born.

However, it was later found that reserpine only rarely produces a true clinical depression. Despite high doses and many months of treatment with reserpine, only 6 percent of the patients developed symptoms even suggestive of depression. In addition, an examination of these 6 percent of patients revealed that all of them had a previous history of depression. (Mendels & Frazer, 1974) There were even reports from a few studies that reserpine could have an antidepressant effect (in spite of reducing levels of serotonin, norepinephrine and dopanmine).

As it turns out, that is only the tip of the iceberg when it comes to revealing the inadequacies of the “chemical imbalance” theory.
The fatal flaws of “chemical imbalance” theory

As Elliot Valenstein Ph.D., Professor Emeritus of psychology and neuroscience at Michigan University, points out in his seminal book Blaming the Brain, “Contrary to what is often claimed, no biochemical, anatomical or functional signs have been found that reliably distinguish the brains of mental patients.” (p. 125)

In his book, Valenstein clearly and systematically dismantles the chemical imbalance theory:

    Reducing levels of norepinephrine, serotonin and dopamine does not actually produce depression in humans, even though it appeared to do so in animals.
    The theory cannot explain why there are drugs that alleviate depression despite the fact that they have little or no effect on either serotonin or norepinephrine.
    Drugs that raise serotonin and norepinephrine levels, such as amphetamine and cocaine, do not alleviate depression.
    No one has explained why it takes a relatively long time before antidepressant drugs produce any elevation of mood. Antidepressants produce their maximum elevation of serotonin and norepinephrine in only a day or two, but it often takes several weeks before any improvement in mood occurs.
    Although some depressed patients have low levels of serotonin and norepinephrine, the majority do not. Estimates vary, but a reasonable average from several studies indicates that only about 25 percent of depressed patients actually have low levels of these metabolites.
    Some depressed patients actually have abnormally high levels of serotonin and norepinephrine, and some patients with no history of depression at all have low levels of these amines.
    Although there have been claims that depression may be caused by excessive levels of monoamine oxydase (the enzyme that breaks down serotonin and norepinephrine), this is only true in some depressed patients and not in others.
    Antidepressants produce a number of different effects other than increasing norepinephrine and serotonin activity that have not been accounted for when considering their activity on depression.

Another problem is that it is not now possible to measure serotonin and norepinephrine in the brains of patients. Estimates of brain neurotransmitters can only be inferred by measuring the biogenic amine breakdown products (metabolites) in the urine and cerebrospinal fluid. The assumption underlying this measurement is that the level of biogenic amine metabolites in the urine and cerebrospinal fluid reflects the amount of neurotransmitters in the brain. However, less than one-half of the serotonin and norepinephrine metabolites in the urine or cerebrospinal fluid come from the brain. The other half come from various organs in the body. Thus, there are serious problems with what is actually being measured.

Finally, there is not a single peer-reviewed article that can be accurately cited to support claims of serotonin deficiency in any mental disorder, while there are many articles that present counterevidence. Furthermore, the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not list serotonin as the cause of any mental disorder. The American Psychiatric Press Textbook of Clinical Psychiatry addresses serotonin deficiency as an unconfirmed hypothesis, stating “Additional experience has not confirmed the monoamine depletion hypothesis” (Lacasse & Leo, 2005).

When all of this evidence is taken in full, it should be abundantly clear that depression is not caused by a chemical imbalance.

But, as Valenstein shrewdly observes, “there are few rewards waiting for the person who claims that “the emperor is really nude” or who claims that we really do not know what causes depression or why an antidepressant sometimes helps to relieve this condition.”
How have we been fooled?

There are several reasons the idea that mental disorders are caused by a chemical imbalance has become so widespread (and none of them have anything to do with the actual scientific evidence, as we have seen).

It is known that people suffering from mental disorders and especially their families prefer a diagnosis of “physical disease” because it does not convey the stigma and blame commonly associated with “psychological problems”. A “physical disease” may suggest a more optimistic prognosis, and mental patients are often more amenable to drug treatment when they are told they have a physical disease.

Patients are highly susceptible to Direct-to-Consumer-Advertising (DCTA). It has been reported that patients are now presenting to their doctors with a self-described “chemical imbalance” (Kramer, 2002). This is important because studies show that patients who are convinced they are suffering from a neurotransmitter defect are likely to request a prescription for antidepressants, and may be skeptical of physicians who suggest other interventions such as cognitive behavioral therapy (DeRubeis et al., 2005). It has also been shown that anxious and depressed patients “are probably more susceptible to the controlling influence of advertisements (Hollon MF, 2004).

The benefit of the chemical imbalance theory for insurance companies and the pharmaceutical industry is primarily economic. Medical insurers are primarily concerned with cost, and they want to discourage treatments (such as psychotherapy) that may involve many contact hours and considerable expense. Their control over payment schedules enables insurance companies to shift treatment toward drugs and away from psychotherapy.

The motivation of the pharmaceutical companies should be fairly obvious. As mentioned previously, the market for antidepressant drugs is now $12 billion. All publicly traded for-profit companies are required by law to increase the value of their investor’s stock. Perhaps it goes without saying, but it is a simple fact that pharmaceutical companies will do anything they legally (and sometimes illegally) can to maximize revenues.

Studies have shown that the advertisements placed by drug companies in professional journals or distributed directly to physicians are often exaggerated or misleading and do not accurately reflect scientific evidence (Lacasse & Leo, 2005). While physicians deny they are being influenced, it has been shown repeatedly that their prescription preferences are heavily affected by promotional material from drug companies (Moynihan, 2003). Research also suggests that doctors exposed to company reps are more likely to favor drugs over non-drug therapy, and more likely to prescribe expensive medications when equally effective but less costly ones are available (Lexchin, 1989). Some studies have even shown an association between the dose and response: in other words, the more contact between doctors and sales reps the more doctors latch on to the “commercial” messages as opposed to the “scientific” view of a product’s value (Wazana, 2000).

The motivation of psychiatrists to accept the chemical imbalance theory is somewhat more subtle. Starting around 1930, psychiatrists became increasingly aware of growing competition from nonmedical therapists such as psychologists, social workers and counselors. Because of this, psychiatrists have been attracted to physical treatments like drugs and electroshock therapy that differentiate them from nonmedical practitioners. Psychiatry may be the least respected medical specialty (U.S. General Accounting Office report). Many Americans rejected Fruedian talk therapy as quackery, and the whole field of psychiatry lacks the quality of research (randomized, placebo-controlled, double-blind experiments) that serves as the gold-standard in other branches of medicine.

Dr. Colin Ross, a psychiatrist, describes it this way:

“I also saw how badly biological psychiatrists want to be regarded as doctors and accepted by the rest of the medical profession. In their desire to be accepted as real clinical scientists, these psychiatrists were building far too dogmatic an edifice… pushing their certainty far beyond what the data could support.”

Of course there are also many “benefits” to going along with the conventional “chemical imbalance” theory, such as free dinners, symphony tickets, and trips to the Caribbean; consultancy fees, honoraria and stock options from the pharmaceutical companies; and a much larger, growing private practice as the $20 billion spent by drug companies on advertising brings patients to the office. Psychiatrists are just human, like the rest of us, and not many of them can resist all of these benefits.

In sum, the idea that depression is caused by a chemical imbalance is a myth. Pharmaceutical ads for antidepressants assert that depression is a physical diseases because that serves as a natural and easy segue to promoting drug treatment. There may well be biological factors which predispose some individuals toward depression, but predisposition is not a cause. The theory that mental disorders are physical diseases ignores the relevance of psychosocial factors and implies by omission that such factors are of little importance.

Stay tuned for future articles on the psychosocial factors of depression, the loss of sadness as a normal response to life, and the branding of new psychological conditions as a means of increasing drug sales.
Recommended resources

    Blaming the Brain, by Elliot Valenstein Ph.D.
    Rethinking Psychiatric Drugs, by Grace Jackson M.D.
    America Fooled: The truth about antidepressants, antipsychotics and how we’ve been deceived, by Timothy Scott Ph.D.
    The Loss of Sadness, by Alan Horwitz and Jerome Wakefield
    The Myth of the Chemical Cure, by Joanna Moncrieff

Monday 3 March 2014

ALTERNATIVES TO PSYCHOTROPICS FOR CHILDREN -"The One-On-One Program: A Remarkable Alternative to the Psychiatric Drugging of Our Youth." By Jeffrey Rubin - Courtesy of the dxsummit.org website

The One-On-One Program: A Remarkable Alternative to the Psychiatric Drugging of Our Youth
Jeffrey Rubin       February 27, 2014   

Today, when parents express a concern about their youth’s behavior, mood or attention span to a physician, typically within a matter of minutes this expressed concern is translated into a mental illness conceptualization using the DSM.  The parents are then sent on their way, prescription in hand.

For those of us who believe that there is something seriously wrong with this DSM medical model approach, the question that naturally arises is, what’s the alternative?  In an earlier DxSummit post I provided an alternative that would replace the DSM’s pathologizing of individuals with a more scientific approach of classifying expressed concerns. But once we finish with the classifying, what alternative to the psychiatric drugging of our youth can we offer?  Counseling and psychotherapy are often the main proposed alternatives mentioned. Although helpful for many cases, my post today puts forth a vision for an alternative when something more is required.
The One-On-One Program

The best way to introduce the One-On-One Program is with two brief parables.  They will help to give the reader an intuitive understanding of how the program can address some of the most challenging concerns that many parents and community members face on a daily basis. 
The Parable of Tony

Our tale begins when Tony is 12-years old. One day Tony’s mother, Nora, busy at work, is called by the police.  Apparently Tony, just outside of the neighborhood afterschool center, was being teased by the other kids as being a baby.

 “Baby, baby!” they taunted him over and over again. 

When he chased after them, they ran inside the center, shut the glass door behind them, and while holding the door shut, they continued to taunt him through the door.

 “Baby, baby!” image1

“Let me in!” Tony cried!  “Let me in!”

“Tony is a baby!  Tony is a baby!”

At this point, Tony picked up a rock and smashed the glass door.

When Nora and Tony get home from the police station, she starts hollering.  “You know I have to work until six, Tony!  Now the afterschool center says you’re not permitted to return!  From now on, after school you’re to go straight home!  If you get into trouble, I’ll beat the living daylights out of you!”

A few weeks go by and then once again Nora gets a call from the police.  This time a gang in the neighborhood had enlisted Tony to be a lookout while they slipped into homes and stole anything that looked valuable.  Tony explained afterwards that the gang members agreed to stop doing mean things to him if he cooperated with them.

Although threatened by a judge that another offense would lead to a stay at a juvenile detention center, Tony claimed that he thought that would be cool.  Nora began to feel helpless.

When the school counselor called to report that Tony was having trouble at school, she asked him what she could do under the circumstances.

“Isn’t there someone from your family who can watch him after school lets out?” he asked.

“To get a job, I had to move here,” she replied.  “My family lives hundreds of miles away.  I can’t afford to hire someone to work with him one-on-one every day after school.”

“We have a program at our high school called the One-On-One Program,” said the counselor. “I can find a high school student who could help you out.  You’d have to pay him something based on a sliding scale basis.  For your income bracket it would cost you about the same amount that you paid for the afterschool center that Tony got thrown out of.”

“That’d be great!” Nora replied.

Nick, 17-years old, began to meet Tony every day after school at his high school.  They began with a mile walk.  Then together, both worked on their homework for a half hour.  Nick used the rest of the time he spent after school with Tony to find some skill that he could help Tony develop.

What a difference this plan made!  Nick found the way Tony looked up to him very rewarding and he got a great satisfaction knowing he was helping.  The mile walk each day did Tony and Nick’s health a world of good.  By doing his homework each day, Tony’s grades improved.  His teacher also reported that the afterschool attention he was getting clearly improved his conduct in the classroom.  He was no longer wildly driven to get her attention and he was far less likely to blow up in anger.

For talent development, Tony showed an interest in chess, so both boys began to play every day after school and his mother bought a book to help improve their game.

image2As helpful as the plan was for Nick and Tony, perhaps helped most of all was Nora.  The stress from getting called at work by the police department completely went away.

Tony now got home a full forty minutes after her.  During that time, Nora closed her eyes, and often fell asleep for a half hour.  By the time Tony got home, Nora had enough time to get supper on the stove.  When Tony would join her in the kitchen to tell her how his day had gone, she enjoyed the interaction, whereas before she felt drained and found she quickly became annoyed.

“The plan restored me to sanity!” she often would tell her friends.  “I have so much more patience with Tony!” she cried when her own mother called one day to ask how things were going.

The next school year, Nick went away to college, so Nora was concerned about finding someone to replace him.  But Tony heard that his junior high had started an afterschool chess club.  He wanted to give it a try.

To his delight, Tony found that after a whole year of playing chess with Nick five times a week, he had become pretty good. He was able to beat several of the players, and most of the other players were about at his skill level.  Even the best players respected Tony’s skills because he knew enough to make it a challenge to win.

Best of all, several of the players began to call Tony to play chess on the weekend or to go to a movie with a few of the other guys.  Soon, he had, for the first time in his life, some real friends.
Parable Discussion

For some, once a week counseling can make a significant difference.  But in some cases, children see a counselor once a week and then go home to parents who are so stressed out at work that they frequently lose their temper.  The resulting angry parent-youth interactions may very well offset any gains that may occur during counseling.

Other children have parents working two jobs to make ends meet. When these children go home after school they rarely find needed one-on-one time.  Some of these children then seek closeness with street gangs who can provide daily close human contact, but at the expense of criminal behaviors.

In addition to the acting out type of problem that is characterized in the parable of Tony, there is another type of problem that professionals sometimes come to realize requires something more than what they can currently provide in a weekly hour session.
The Parable of June

June is 11- years old and wearing a cute pink dress. She has been brought to see Dr. Goleman, a psychologist in his mid-forties.  Wearing gold rim glasses, and a white collared shirt, Dr. Goleman is leaning forward on his desk, clearly very concerned.  

“Do you know why your mother asked me to meet with you, June?” Dr. Goleman asks.

“I’ve been awfully sad, and she hates it when I cry out that I hate myself,” June replies.  “I can’t help it.”

“Wow!  Do you know why you are feeling so blue?”

“I’m terribly lonely.”

“Lonely?  Hmmm.  You go to school where there’re lots of kids your own age.  You could go to the afterschool program where you don’t have to be lonely.  Your mother told me that you refuse to go there.  What’s up with that?”

“At school and at the afterschool center I feel lonelier than when I’m alone.  The kids make fun of me there and when a teacher tells the other kids to include me I can tell they wish they weren’t stuck playing with me.”

“I see,” replies Dr. Goleman.  “Sometimes, June, it feels lonelier when you are with people than when you’re alone.  Do you also feel lonely when you are alone?”

“Terribly.”  Tears begin to form in June’s eyes.

“I can see that you are feeling sad now,” says Dr. Goleman softly.

“I get like this a lot.”

“Are there any times when you don’t feel lonely?”

“Yeah, when my cousin Marissa comes for a visit.  She’s a few years older than me, but she really likes talking to me.  And I play the flute and she plays the piano, so we play duets together, and we love being together.  It’s just that she lives up in Rochester and so I only see her once every month or two.”