November 2023: Medical Elitism

Someone goes to their GP complaining about chest pains, and the GP refers the person for tests. They might get an ECG, a chest x-ray and an ultrasound. If the patient asks during the tests what the technician is seeing, they will probably be told that the tech is not allowed to comment because it has to go through the doctor. And then when the tests and done and get interpreted, who gets the results? You’d think it would be the human being who owns the body that is being tested. But, NO! The results go to the doctor first.

It seems very reasonable to suggest that the patient should be the first person to see test results about their own body. Doctors will argue that the patient cannot properly interpret the result. What could be more of an elitist position? Of course, the patient may not properly understand, and THEN they can ask their doctor (or Dr. Google, or a friend) for assistance. We humans do this all the time – seek out information and clarification for things we don’t completely understand. But it feels very paternalistic to have a system where the doctor sees your results and decides what and when to share with you. It’s your body.

Years ago I attended a conference of psychiatric survivors (individuals who have lived through the horrors of psychiatric treatment) and the keynote speaker suggested that we should do away with prescriptions. As much as I pride myself on being good at “thinking outside the box” I have to admit my initial reaction was that this was TOO radical. I even thought the speaker was just being provocative by making crazy suggestions. But afterwards I thought about his arguments and they made great sense. We have the ability to research drugs (including their side effects and interactions with other drugs). We get to pick the recreational drugs (including alcohol) that we consume. A big part of our research might be asking our doctors for information and guidance. But at the end of the day, it’s worth considering that it ought to be up to us to decide whether we want to take a certain drug.

There’s a line between support/guidance/caring, and control, and it may be that our society has allowed the medical profession to cross over that line.

October 2023: A Parable

Years ago, someone shared this parable with me and I reflect on it all the time.

There was a remote village in Japan that was very traditional and conservative. A teenage girl fell pregnant, and it was a huge scandal. The people of the community confronted the girl and demanded to know who the father was. She identified a highly respected and admired elder. The townspeople were shocked because this man was held in such high esteem, and they angrily marched to his home demanding an explanation. They confronted the man and said “this young girl says that you are the father of her baby”. The man calmly said “is that so?”. Outraged, the townspeople drove the elder from his home and into exile.

Some years later, the girl, who was now a mother, was struggling with her conscience. She broke down and tearfully admitted that she panicked when confronted and, wanting to protect her teenage boyfriend, had accused the first person who came to her mind, which was the elder. Now she identified the father, and asked forgiveness from the townspeople.

The townspeople were horrified and ashamed at how they had treated the elder, and they journeyed to the new village where he was living in exile. They finally found him and they said “the girl admitted that you were not the father”. The man calmly said “is that so?”
Other peoples’ truths do not define us. We can always stand calmly in our own truth and our own integrity.

September 2023: “Eating Disorders” and Train Wrecks

It’s pretty widely known that I do not believe in psychiatric diagnoses and do not believe the people I work with have “disorders” because they might be facing some challenges in their lives. We ALL face challenges and setting up a system where there is a “normal” benchmark and anyone who deviates from it has an unseen and unidentifiable “mental illness” is, in my opinion, not only ridiculous but also very dangerous on a social and political level.

I work with many adolescents and one place this really gets to me is when teenagers are manifesting their lack of control and other issues by refusing to eat or only eating selectively. In a world where teenagers so often feel powerless, it makes perfect sense that they would try to exercise control over one of the very few areas they can – eating. If a teenager manifests their conflicts by staying in their room, they don’t have “staying in their room disorder”. If they manifest their conflict in sleep difficulties, they don’t have a “sleep disorder” and if they manifest their conflict in eating they don’t have a “sleep disorder”.

If a young person were in a train wreck as a small child and struggled with eating because of residual damage to their digestive system, we would not say they have an “eating disorder”. When young people have developmental trauma we can’t see it from outside like we often can with physical injuries, but it is just as real. When a young person manifests their trauma and lack of control around eating, why is that a “disorder”?

As always, the language itself doesn’t matter. What does matter is the message to a young human being, based on nothing, that there is something “wrong” with them – that they have an inherent flaw (their “disorder”). Hopefully we are moving towards a world where we can describe whatever someone is or isn’t doing or feeling without the need to label it as pathology.

August 2023: Children’s Self-Efficacy and Anxiety

I work with a lot of young adults (14-23) and have always dealt with their ambivalence and fears about becoming adults. Of course, for these young people this is what they are dealing with at this stage of life, so not surprisingly it is constantly in their thoughts.

Younger children are not yet at the point of facing an imminent transition to adulthood, but I am increasingly struck by this being a source of anxiety even for young children.
It seems to me that children deal with the construct of “adulthood” much the same as adults deal with the concept of mortality. We may go years without consciously thinking about death, but the knowledge that our lives are finite is in the background of many (most?) decisions we make (eg -if I don’t go to Egypt this year will I ever get another chance, or if I spend that money now will I have enough for retirement?).

Probably from as young as 3 or 4 children have an understanding that they will not always be children. It might still be 10 or more years away, but they know adulthood is inevitably lurking. What are the implications for parenting? To seize opportunities to empower our children and help them develop a strong sense of self-efficacy. Almost whenever we are unsure about whether or not our child can do something, it’s an opportunity to empower them by believing they can do it.

Children define their abilities and limitations based on their parents. We wouldn’t ask a 6 month old to get dressed by themselves, but might ask a 3 year old, and part of that message for the 3 year old is that we believe they have the ability to get dressed (or we wouldn’t have asked them to do it). In that context having the expectation that your child can do something is more important than whether they actually do it.

Self-efficacy is defined as “an individual’s belief in their capacity to act in the ways necessary to reach specific goals.” If we can teach children that they can believe in their abilities and that they can handle whatever comes there way, it will go a long way towards reducing anxiety.