Welcome to Childhood Made Crazy, an interview series that takes a critical look at the current “mental disorders of childhood” model. This series is comprised of interviews with practitioners, parents, and other children’s advocates as well as pieces that investigate fundamental questions in the mental health field. Visit the following page to learn more about the series, to see which interviews are coming, and to learn about the topics under discussion:
Tabita Green is an author, speaker, and community organizer. Her popular blog explores the intersection of simple living, health, and social change. After three years of research into mental health and resilience for her book, Her Lost Year: A Story of Hope and a Vision for Optimizing Children’s Mental Health, she believes humanity’s future health and happiness depends on the creation of resilient, sustainable communities and a society focused on equality, justice, and dignity for all people.
EM: How would you suggest a parent think about being told that his or her child meets the criteria for a mental disorder or a mental illness diagnosis?
TG: Start by considering the motivation behind the mental illness diagnosis. Is it to understand how best to help your child? Is it required for health insurance? Or is it maybe needed for special services at school? In all these cases, it may be valid for a practitioner to think about your child's distress or behavioral problems in these clinical terms.
In general, though, I do not think it is helpful for a child to be labeled with a mental illness diagnosis. First of all, they are often not accurate and quite situational. Further, a mental health diagnosis stigmatizes and defines a young person, sometimes to the point of no return. It also completely ignores the underlying environmental factors that are playing into the situation.
A more effective approach (borrowed from ADHD expert Dr. Jeff Sosne) is to have the child express specific problems with specific situations. A child that meets the criteria for ADHD might say, "I have trouble focusing when I have to sit down and read in a classroom full of students." This also allows children to embrace their strengths, because they are not defined by a diagnosis.
EM: How would you suggest a parent think about being told that his or her child ought to go on one or more than one psychiatric medication for his or her diagnosed mental disorder or mental illness?
TG: In my experience, psychiatric medications are offered as a first, rather than last, resort. My young teen daughter saw a therapist exactly once before they recommended that we "kickstart" her treatment with an antidepressant. This led to a year of hospitalizations, polypharmacy (the use of multiple drugs by a single patient), and extreme weight gain. My husband and I went along with it because we wanted to trust the professionals.
However, we didn't know then that the pharmaceutical companies peddle these drugs to physicians on an ongoing basis. We also didn't know that about half of all continuing education for physicians is sponsored by drug companies. And we definitely didn't know that most of the psychiatric drugs given to children are not widely tested on children and often not even approved for use in children. (Doctors can still legally prescribe "off-label.")
As such, I think it is the parents' responsibility to advocate for their children. Ensure that all other avenues have been explored first (diet, exercise, sleep, wilderness therapy, adjustments at home/school, yoga, family therapy, etc.) as they are available. Medicating children for behavioral and emotional problems should be a last resort and done carefully with close monitoring and a full understanding of possible side effects, both short-term and long-term.
EM: What if a parent currently has a child in treatment for a mental disorder? How should he or she monitor the treatment regimen and/or communicate with mental health professionals involved?
TG: You know your child best. End of story. You are the best monitor of your child's progress or decline. And you must pay attention, because these are potent drugs.
Know that a psychiatric medication is not a cure. At best, it provides relief for symptoms of mental distress for some finite period of time. At worst, it doesn't provide any relief, but results in scary side effect such as facial tics, hallucinations, and suicidal ideation.
One of the biggest struggles for me and my husband was that there was never an exit strategy. When we asked our daughter's psychiatrist about it, he shrugged and said that she would probably have to be on drugs the rest of her life. That is not very encouraging, nor conducive to healing.
Medication may mask symptoms, but it doesn't help heal the underlying trauma or malnutrition or unsuitable school environment or whatever the real problems may be. In a way, medication allows us to not have to deal with the underlying problems.
If you are not comfortable with the idea of your child taking psychiatric medications, talk to your child's psychiatrist about it. It will be an uphill battle, because prescribing and monitoring medication is often the only way psychiatrists make money. You may need to find a new team of mental health professionals who know how to work with children and families without relying on medication. Don't give up. You are your child's best advocate.
EM: What if a parent has a child who is taking psychiatric drugs and the child appears to be having adverse effects to those drugs or whose situation appears to worsening? What would you suggest the parent do?
TG: Document the adverse effects (when they started, any significant details) and contact your child's prescribing physician with this list in hand. If they are anything like the psychiatrists we encountered, they will deny that the side effects are caused by the medication. Instead, they may consider a new diagnosis and prescribe even more medication to deal with the new symptoms.
Hold your ground. Remember, you know your child best. We insisted again and again that our daughter's severe side effects (hallucinations, suicidal ideation, complete inability to focus, etc.) were caused by the medication. We were repeatedly told that these were new symptoms presenting as the illness unfolded and sent home with new prescriptions to treat them. But these practitioners had never met our child before she was medicated. They never knew funny, smart, confident Rebecka. We knew—and we fought hard to get that child back. (And succeeded!)
Remember, medication should help your child feel better and function in the real world. If it doesn't do that, then what's the point?
TG: Oh boy, where to start!? In my book, I divide these "alternative treatment options" into the following categories:
1) Taking care of physical needs
2) Mindful awareness, belonging, and being part of something bigger
3) Beyond talk therapy: Family therapy, the Maudsley approach, and DBT
In the interest of space, I will not go into detail on all of these, but I would like to highlight a few different options:
The first is to get your child to move—regularly, every day. If you have a depressed child, this will take some work. You may have to move with your child (which will make you feel better too!). For an added bonus, take your exercise to the woods or some other natural space. Humans need to be in nature often. And now it is scientifically proven to improve mental health.
In addition to daily movement, make sure that your child eats real food—and stays away from foods they can't tolerate. (For more on this, please read What's Eating Your Child by Kelly Dorfman.) And make sure that your child is getting enough sleep. Sleep deprivation often gets mistaken for ADHD. Avoid screens two hours before bedtime to improve your child's chances of falling asleep.
If all physical needs are met and your child is still struggling, consider teaching them mindfulness techniques such as sitting meditation or yoga. It doesn't take much to achieve therapeutic results. I taught the Yoga Calm curriculum in an after-school program last spring, and one of the biggest troublemakers (hate those labels!) in the school was almost completely regulated at the end of each class.
If you have even the slightest hunch that something at home (parental discord, loss of a loved one, pressure to perform, etc.) might be at the heart of your child's distress, please find a qualified family therapist to work with your family. It made all the difference for our family. Marilyn Wedge, a family therapist, claims she's never worked with a family where the actual problem was with the child—it was a problem with the family system. There are so many options for treating your child's mental distress—and optimizing children's mental health. Find what works for your family.
EM: What would you like to say to a parent whose child is in difficulty and who would like to put her trust in the current mental health system?
TG: Know that the mental health system is flawed and driven by capitalist motivations—the maximization of wealth. This doesn't mean that there aren't plenty of effective, caring providers within the system. Do your research and try to find practitioners who share your values. They are out there! If it's a crisis situation, you may not have much choice but to contact the local psychiatric hospital. This is only for stabilization, and it's not the end of the world if it comes to that. But make sure that you have a high-quality outpatient team that you can return to after the stabilization period.
EM: As a parent yourself of a child who received a mental disorder diagnosis, what do you wish you had known at the beginning of that process that you know now?
TG: Ha-ha, I wrote a whole book about it <smile>.
EM: As a parent yourself of a child who was placed on psychiatric medication, what do you wish you had known at the beginning of that process that you know now?
TG: I wish I'd known more about the industry behind the medication, the corruption, and the lack of evidence that this medication is effective in the long-term. I wish I'd known more about side effects and what to look for. I wish I'd known there were other options with time and patience. I wish I'd known recovery was possible, only without the distraction of medication side effects.
EM: Can you tell us a little bit about your journey, and your child’s journey, in the mental health system?
TG: It all started when my daughter, Rebecka, was 13 years old. She expressed feelings of depression and also lost a significant amount of weight. She had friends with anorexia, so it was easy to jump to the conclusion that she had an eating disorder.
Her pediatrician prescribed an antidepressant, which didn't feel right in my gut, but we wanted to trust the professionals. A couple of months and a medication switch later (to Prozac), she started hallucinating and became suicidal. Her pediatrician threw her hands up and recommended we find a psychiatrist (easier said than done).
Before Rebecka even had her first appointment with an outpatient psychiatrist, she had a frightening experience with her hallucinations that prompted us to admit her to a psychiatric hospital. We were at a loss as to how things could go downhill so quickly.
During the ensuing year, she was hospitalized eight times and prescribed a variety of antidepressants, antipsychotics, and anti-anxiety medications—all the while losing her ability to function in the real world.
Fortunately, a friend lent us a copy of Robert Whitaker's book, Anatomy of an Epidemic, which gave us confidence to ask the attending psychiatrist (she was hospitalized at the time) to stop all medications. He agreed. This was the turning point toward recovery.
I describe this journey in detail in my book, Her Lost Year, for anybody who is interested in learning more about this experience and how our daughter, once off medication, was able to heal.
EM: You’ve written Her Lost Year: A Story of Hope and a Vision for Optimizing Children's Mental Health. What might parents get from that book that might help them?
TG: As you can imagine from the title, the most important thing I want parents to get from the book is hope. Without hope, there is no healing—no recovery. The system doesn't offer a whole lot of hope, so as parents, we must find it elsewhere.
The hope comes from knowing that "mental illness" is not a brain disease. There is no evidence that a chemical imbalance in the brain causes mental distress. With that myth out of the way, we can start to get to the bottom of what's really going on.
Sure, your child may have experienced significant trauma that has altered the composition of their brain. But the brain is plastic—it changes throughout our lives. Exercise improves it. So does proper nutrition. So do mindfulness practices. We know that resilience trumps trauma. And we know that resilience can be learned.
As I mentioned above, I provide a lot of resources and approaches for building resilience and optimizing children's mental health. I want parents to think about mental health as something desirable—something we work on, just as we work on optimizing our physical health. Mental health isn't something taboo or stigmatized—it's the ultimate state of being.
Finally, I hope that parents can take a step back and realize that there are many factors in our society that contribute to children's mental health. By advocating for social change, we can help our children—and all children—have the possibility of good mental health. This gets a bit political, but that is the uncomfortable truth—politics and economics matter in mental health outcomes. And we don't talk about this enough. I'm working to change that.
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