March 29-April 4

The week's best posts, covering everything from breaking the rules to sexual communication.

Mental Health Is More Than Mental Illness

Why psychiatry needs to broaden its training and focus

According to the American Academy of Child and Adolescent Psychiatry (AACAP), a child psychiatrist is “a physician who specializes in the diagnosis and the treatment of disorders of thinking, feeling, and/or behavior affecting children, adolescents, and their families.” True enough, but there is something missing in this definition, namely being an expert not only in how to help when things are going wrong, but how to encourage children and families really to be truly well. 

Science is telling us over and over again that mental health and mental illness live on a continuum rather than being separate categories. In line with this insight, research also is teaching us that activities related to wellness (things like exercise, good relationships, and nutrition) can really help those who struggle with psychiatric disorders, in addition to helping those who don’t meet criteria for a disorder but are trying to optimize mental functioning.

To many, this all might seem pretty obvious. Unfortunately, however, such a perspective has been slow to permeate the identity and training of clinically oriented mental health specialties like psychiatry and clinical psychology. Most experts in depression, for example, do not study happiness; and doctors trained in how to help people who have experienced trauma and abuse often read little on what things parents can do to help children thrive.

Such an exclusive focus is slowly beginning to change. There is an expanding field of positive psychology that is attracting educators, practitioners, and researchers, led by people such as Martin Seligman at the University of Pennsylvania. In psychiatry, former American Psychiatric Association Dr. Dilip Jeste promoted the importance of “positive psychiatry” during his tenure. In child psychiatry, new approaches like the Vermont Family Based Approach, which was developed by Dr. Jim Hudziak, puts family wellness and health promotion front and center in both assessments and treatment planning.

These efforts may help our field move forward and give our clinicians the tools to help individuals and families beyond the two things we know best, namely traditional psychotherapy and medication treatment. 

At this month’s annual meeting of psychiatrists who run residency and fellowship programs across the country to train new psychiatrists and child psychiatrists, I presented an outline for a new course on child wellness that all of our incoming fellows will receive. Topics include things like happiness, positive parenting, even love. The presentation was very well received, with many people finding it remarkable that it has taken us so long to get here. While we took some teasing from our colleagues who would like everything to be directly about brain science, we can take it. After all, when was the last time you heard someone look back about the successes and regrets of their life and lament about their dopamine receptor 4 gene?

@copyright by David Rettew, MD

Image courtesy of John Churchman and www.brickhousestudios.com

David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.

Follow him at @PediPsych and like PediPsych on Facebook.