LOSING OUR SANITY
FROM CRADLE TO COUCHby Dr Tana Dineen, eminent Canadian psychologist and best-selling
authorFROM SWORD & TROWEL 2003 No 3
May was Mental Health Month across North America and with it came the
usual warnings of a plethora of psychiatric maladies waiting to beset us. But this year,
children - even infants who can’t even hold their heads up - are being targeted.
As a society, we’re already sensitized to Attention Deficit Hyperactive Disorder
in school-age children, a childhood obesity epidemic, adolescent eating disorders, suicidal
teens, and traumatized casualties of bullying.
We’ve come to accept the statistic that mental illness strikes one in eight
adolescents. But it seems this is only the tip of a mental illness iceberg. Our babies and
toddlers are also apparently suffering from disorders as adult-sounding as clinical
depression and post-traumatic stress disorder. Alarm bells are being sounded. These
children need immediate treatment the experts say. And, if we don’t give it to them, there
will be ‘serious consequences down the line’ - more serious episodes, emotional pain,
chronic disabilities and an increased risk of suicide. Up to now, the problem confronting
clinicians has been that of identifying these disorders in those too young to talk or who, as
the American Psychiatric Association puts it, ‘do not yet possess the emotional
development or the self-awareness to define and communicate their depression to adults’.
But experts now believe that they have solved the problem. Don’t worry about
getting the child to talk; rely solely on clinical ‘instinct’ (which seems strangely close to
mind-reading) and some symptom checklists created for the occasion.
As they watch children at play, clinicians look for something called anhedonia, a
psychobabble word not to be found in dictionaries, which means the lack of ability to
experience pleasure. According to Joan Luby, an assistant professor of child psychiatry at
the Washington School of Medicine in St Louis, Missouri, this is one of the clear indicators
of depression in preschoolers. If a child is not, in the psychiatrist’s view, experiencing
pleasure, he or she is depressed. Anhedonia is ‘unique to those who were depressed’ they
say; an obvious case of circular thinking since it was also the way they were diagnosed as
depressed.
Others, such as Michael S Scheeringa, assistant professor in the Department of
Psychiatry and Neurology at Tulane Medical School in New Orleans, have lowered the bar
on another disorder once reserved for adults. He believes that children as young as infants
can suffer not only from depression but even from post-traumatic stress disorder. Alicia
Lieberman, director of the Child Trauma Research Project at San Francisco General
Hospital, agrees, citing PTSD as a cause of something she calls ‘post-traumatic play’.
Mental health workers have fallen victim to the notion that they have the uncanny
ability to detect mental illness in infants just by looking at them and imagining what they
are thinking. Depressed babies, according to Alice Sterling Honig, professor emeritus of
child development at Syracuse University, ‘look listless, with dull eyes, as if they gave up
looking for their special person’. Babies as young as four months, she believes, show ‘signs
of stress seen in much older people’.
The infancy advocacy group Zero to Three offers a handbook for psychiatrists
and psychologists to strengthen their position and support their practice. With the awkward
title: Diagnostic Classification of Mental Health and Development Disorders of
Infancy and Early Childhood, it lists all possible (and imaginable) diagnoses and
their symptoms. Modelled on the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, it treats infants and children as miniature adults prone to
the same types of disorders identifiable in their moms and dads.
Are any of these opinions and assessments reliable? Or are they just
another sign of a mental-health industry that wants to expand its influence and prosperity?
With each month and year that passes, the confidence of child experts in their
ability to diagnose grows as does their list of publications which fosters the impression that
they really do know what they’re doing. Yet it all hangs on something akin to mind-reading,
guessing and proselytizing.
Who knows whether a ‘listless look’ indicates depressive thinking or just a full
stomach or a gas pain? Or whether anhedonia is something that toddlers feel or adults
imagine? Or whether frequent night wakings in infants are a sleep disorder or just an
exhausting parental nuisance?
Perhaps the answer can be found in the nature of the treatment, one that relies
heavily on medications. A recent survey of paediatricians, by Carol Rosen of Case Western
State University, finds that 75 per cent of them prescribe sleeping medication for young
children although such practice is not approved. And, although drugs such as Prozac have
not been approved for infants and young children - which means there is no evidence that
they are safe in the long term - tiny dosages mixed with pabulum are being readily
prescribed. Possibly, all this is just a marketing tool to create infant mental illness as a
niche, a new area in which to claim expertise. Or maybe there is a motive less sinister but
all the more disturbing because of its naive benevolence. Accustomed as they are to seeing
each and every aspect of life as a ‘mental health issue’, these practitioners may truly believe
that helping infants handle the challenges of life ‘will pay off down the line’.
My concern is that they’re teaching all of us, parents and children alike, that
psychological experts are needed from birth to death, that drugs are a way of handling life’s
ups and downs, and that growing up in this world involves learning to see through
psychologically tinted glasses.
From the Ottawa Citizen, May 24, 2003, for which Dr Dineen is a regular
columnist.
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