Electronic Spring 2021 | Issue 46
President's Message - PREVENTION
By: Susan Scherer, MD
If I ruled the world, I would look way upstream and try to stop the hurts that lead to people’s illness. In the latter part of my career, I think of what I’d like for my patients, and I find that I wish they were not patients.
Most of the patients I see are in residential care or foster or adoptive families. They’ve suffered awful things and will have to live with those damages using whatever workarounds they can for as long as they live. Reading about all their psychiatric hospitalizations and placement changes is pretty heartbreaking. But what hurts most is to see the back story, the history of their parents and grandparents whose lives were just as hard.
So, I ask myself, how can we help keep these children safe? But that quickly goes to How can we keep these children from becoming parents too soon when they are hurt and never fully “grow up” to whatever their full potential might be.
Sex education: Are children learning about their bodies and how to take care of them? Have they seen models of attuned and nurturing parenting? Their own lives have shown them that bodies and emotions are unimportant, perhaps just so many inconveniences. Bodies and emotions are things for grown people to trample on, to exert authority.
Generation after generation grows up learning that they don’t matter, and they might as well do whatever they want since they won’t live past 20 or so. Why plan? Let’s get something - own something that people will admire - have a baby. Or get a gun.
A 14-year-old boy I saw last week was pleased to have taken a gun from his retired-alderman neighbor’s garage. This is the third gun he has stolen. Adoptive mom found it under the sofa. The second gun he took to school. That didn’t go well - he was not allowed to return. He has taken and sold diamond rings, phones, lots of things. He just needs something.
An 18-year-old boy I met last month has three children. I asked him how often he sees them. He looked sharply at me, defensively, and said, “as often as I want.” There are three different moms. He doesn’t and can’t support any of them, and the girls are not interested in him parenting the little ones (one is going on three years old).
A 16-year-old girl I met is pregnant and homeless, or rather she is “couch surfing.” Her problem is that wherever she finds shelter, her mother shows up. Mother is also homeless. Mom steals from the home where they’ve been allowed to stay, and they both then get kicked out. Mom is a drug addict.
One place where I work has a sign that says, “Safety is Treatment.” And we also know that “Housing is Healing.”
I’m so glad that some families will soon be getting government relief money. Poverty is horrible. It kills.
Carl Bell, MD, gave a talk at UIC in the late ’80s about the harm caused by witnessing violence. He gave us shocking statistics about the number of kids coming to his clinic (Community Mental Health Council, closed in 2013 due to loss of funding) who had seen a person murdered. He talked about how that experience impacts development and expectations. When a teenager sees a 19-year-old murdered or hears of a friend or cousin murdered, he absorbs the impression that he too will die by that age. With such a foreshortened future, school becomes irrelevant.
Dr. Bell had a great interest in the prevention of fetal alcohol syndrome. He had discovered that choline supplementation during pregnancy can mitigate the effects of alcohol on the fetus. This is spectacular news since women do not typically know they are pregnant until a month or two into the first trimester or later, after they may have used alcohol. During the Annual APA meeting of 2019, we talked about creating an educational campaign to reduce alcohol use during pregnancy and to make choline available, especially in poor communities. I told him I wanted this to be my “presidential initiative,” and he kindly agreed to collaborate. Tragically Dr. Bell died a few months later.
We psychiatrists talk about all the good ways to increase access to much needed mental health services and how important this will be in the post-pandemic world.
Telehealth, collaborative care, insurance practices whose goal is to help people get help, rather than prevent it, re-opening of community mental health centers, more hospital beds for acute psychiatric illness and detox, more residential facilities in-state so kids who can’t safely manage living in the community will be able to live in a therapeutic milieu close enough to home to have family therapy, school-based health clinics, crisis hotlines, education of law-enforcement to be sensitive to people with mental illness and substance use disorders, access to psychotropic medications, anti-drug and alcohol abuse campaigns, these are all needed.
But we psychiatrists are at the apex of the pyramid of services. We’re such a tiny part of the world of mental health care. Let’s have a closer look at the base of the pyramid and dig down below.
What can we do to:
- provide food and housing
- provide vocational education and job coaching
- model kindness
- stop bullying, fighting, stealing, school suspensions, and expulsions
- identify racist ideas
- stop racism
- stop anti-Semitism
- stop anti-immigrantism
- stop war
- stop unplanned pregnancies
- stop gun violence
How can we educate everyone that holding a baby, talking to the baby, picking up a child who’s crying, reading to a child, loving a child – all of these help the child grow strong and confident, rather than cause weakness.
How can we educate future parents that domestic violence and corporal punishment teach kids to do the same? For that matter, sexual abuse also leads to more of the same.
Kindness is the key. That’s all I really know.
Best wishes to all.
Susan Scherer, MD