Thanks for this, I've linked to it, as I have been writing about my grief without medication(an active purposeful tapering)re: my daughter and my father being killed. I totally agree with not medicating away grief, and by not doing so it really does promote healthy healing, where you can honestly move on with your life, as hard as it seems.

Glad I live and work in a country where we wouldn't instantly reach for the script pad (most of us anyway) and the rating scales are usually kept in the drawer longer too. Our public and private medical system allow for lengthy assessments and colleagues who rush children and family through are rare in child psychiatry and psychology and generic child mental health clinics (though the pressure is on with less generous reimbursement for longer interviews in paediatrics). Grief and family dynamics are the first and foremost things most of us look for. I'm not saying this as a jibe at another nation at all and don't want anyone to take offence, but the more I read websites like FS it is clear that the USA needs to follow the rest of the developed world and get universal health care - and forget the "socialised medicine" bogey - stats show health care is much cheaper in other developed countries despite being more available. Perhaps managed care profits and time consuming paperwork gobble up much of the funds? Quite simply Philip you and your compatriots deserve better and hopefully Obama can deliver despite the financial crisis obstacles.

That's capital "R" resistance to doing this hard work. Which brings us to clinical competence. Which is to say we're fucked.

A clinician has to be able to perceive resistance in order to facilitate engagement with the inaccessible material.

And that calls for familiarity with all the Freudian texts they shredded. Whoopsies. But hows that CBT working for y'all?

These are not stupid parents. There is no cognitive error to correct. They were resisting what they know, and they expressed resistance in their exchange of glances when the treater asked the money question.

Clueless parents would not have exchanged uneasy glances, for them the question would not be loaded.

I'm so old I remember when they trained behavioral specialists to pick up on that sort of thing.

That exchange between the couple raises a question. The clinician asked it, and unburdened them from facing alone what they were ignoring and afraid to deal with, something painful they wished would go away or maybe wasn't true. That is human nature. It holds.

No matter how much we try to decontextualize, or how many brain disorders and psychoactive drugs anxious parents can recite by rote, somebody has to find the courage to point to what's in front of their noses.

We found one? O frabjous day!

Word to all of that. I've seen the same thing in some recent behavior which seems to be easing up.

Rapid change hurts, regardless of the age, but perhaps ESPECIALLY when you're not old enough to know how to process it and accept it. Too many questions, not enough answers and a lot of kids internalize it and think it was somehow their fault.

Great points made in that op-ed.

Good post. This is a crucial point for us nowadays. In the OLD days, psychiatrists were trained, and practiced, a certain way: they took a COMPLETE "psychosocial history," or "psychiatric history." Straight out of "Kaplan and Sadock" ("Synopsis of Psychiatry," now with another author or two, but still the basics). You get the psych history BEFORE starting ANY treatment. You will almost ALWAYS discover relevant info, such as this adopted child issue. Obviously, with children, you ask the parents.
With whom do you live? (you will discover lots here).
How do you pay your bills? (who eans money, who gets disability, about to be evicted, etc.).
History: pregnancy, delivery, and developmental milestones: anoxia at birth? infections with high fever in infancy or early childhood? any head injuries in childhood? etc.
Educ/Occup: highest grade completed, ever skipped or advanced any grades? Behavioral or discipline problems? Ever talk to any kind of counselor in school days?

Et cetera.

In the DSM, you should NOT dx when there are other question marks, such as: a 5 year old kid has had a disruptive life in the past year, such as absent mother. Absolutely not.

But if you read a Biederman kiddie-bipolar study, the study says absolutely NOTHING about psychosocial assessment. Instead, if you have any symptoms, they declare you bipolar. The kids get "better" because they start getting more attention, both from parents and the study staff. Everyone starts to get juiced with hope.

But usually, the problem is ineffective parenting. That is the epidemic.

Like the woman in NYC who ran the ad that got a lot of media coverage - looking for a nanny, and declaring that she was not warm to her kids, and did not want to hear advise from anyone - obviously, this woman does not regard her kids as precious. Or the woman in the news recently who made her 10 year old and 12 year old GIRLS get out of the car, and find their own way home, because mom was inconvenienced by their fighting or whatever.

THESE are the kids who are getting dragged into the offices of head-shrinkers everywhere. And diagnosed with dx du jour, and getting whatver med is currently under patent.

Thank you Philip.

"....underlying psychological issues (as opposed to psychiatric ones) when...."

I never thought that we would have to make this distinction.
I believe that before the time that psychiatry has been the first choice to any emotional problem things got so mixed up that what was common knowledge - psychosomatic and other words were used in everyday conversations - has lost it's way.
When an idea is not defended it disappears.

I think patients are sent so many mixed messages. We're told we have diseases, messed up brain chemistry. So, when I believed that message then I had no reason to work on issues like grief. How could grief be the problem, when I had a disease?

My psychiatrist's focus was on finding the right medication or pushing ECT to treat my "disease." Why would I need to work on issues when it was my brain that needed fixing? Once, I stopped focusing on "disease," I felt like I had some control over my future. For the first time in a really long time I realized I could in fact be well.

I don't remember at what decade of the 20 century people stopped using black clothes for a period to indicate mourning.

One word: duh! What Ms. Gold pointed out is so obvious that it shouldn't even have been considered newsworthy. The fact that it was indicates just how detached from reality too many "mental health" professionals and organizations have become.