As the Halloween season approaches, I have again been reminded of the frequent concerns many parents have who are considering using medication as part of the treatment plan for their child’s emotional-behavioral problems.
Specifically, the dilemma that I and many other clinicians repeatedly hear from parents is that they want their child’s symptoms improved without changing the child’s personality and, more to the point, they don’t want their child to turn into a “zombie.”
I’m always a little saddened when I hear this concern, not because it isn’t a legitimate one but because the implication behind the statement is that I, as the treating doctor, would be just fine with having my patient acting like zombie. I say to myself—has my beloved field of psychiatry really earned such suspicion or has One Flew Over the Cuckoo’s Nest just had too many reruns? In all honesty, I have never met nor heard of a doctor who would see a dull, listless child and declare that treatment a success. Sadly, however, I have to admit that between insulin coma, refrigerator mothers, and endless hospital stays in the past that perhaps I need to earn the family’s trust, despite many the many positive steps that psychiatry has also led.
So…to counter such worries, I now quite specifically say to parents and children that “zombification is not an acceptable outcome for me either.” Very often, this statement brings a smile and a fair amount of relief. I have found that there is real value is saying quite explicitly to parents and to children that I am not interested in continuing medications that cause side effects or that don’t work, and that those interested in making zombies will have no trouble finding costumes at Halloween.
Once that easy question is out of the way, the more difficult one right around the corner is whether or not it is actually possible to treat symptoms without touching personality at all. One of the main conclusions of my book Child Temperament: New Thinking About the Boundary Between Traits and Disorder is that psychiatric symptoms and disorders are often quite intertwined with personality or temperament traits. This means, for example, that being able to surgically excise “impulsivity” without altering “spontaneity” might be a challenge in treating a child with ADHD. One the other hand, it is also not uncommon to hear upon a successful treatment of something like depression or an anxiety disorder that the parents feel like they have their kid “back,” once the symptoms that have clouded a child’s inner nature have been removed.
Unfortunately, we don’t have nearly enough research data to help answer this critical question. One study of adults showed that personality change was detectable with medication treatment, but quite interestingly, it was also present in the group treated with psychotherapy. This finding with personality at first may seem startling, but then, isn’t that what psychotherapy was supposed to do in the first place? Furthermore, despite all of the terms we have conveniently made for ourselves (temperament, personality, symptoms, personality disorders), they all have to eventually reside in that single brain that we all have.
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.