eric
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Welcome to Childhood Made Crazy: Deconstructing the Mental Disorders of Childhood. This series is comprised of interviews with practitioners, parents, and other children’s advocates as well as pieces that investigate fundamental questions like “What exactly is a mental disorder?” and “Is a mental disorder diagnosis a real diagnosis or a kind of labelling?”

Gail A. Hornstein is Professor of Psychology at Mount Holyoke College (Massachusetts, USA). Her research and writing focus on the contemporary history and practices of psychology, psychiatry, and psychoanalysis, and her articles and opinion pieces have appeared in many scholarly and popular publications. She is the author of two books – To Redeem One Person is to Redeem the World: The Life of Frieda Fromm-Reichmann, and Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness – and her Bibliography of First-Person Narratives of Madness in English, now in its 5th edition with more than 1,000 titles, is used internationally by educators, clinicians, and peer organizations. Professor Hornstein is actively involved in training and research to expand the Hearing Voices Network in the United States, and she speaks widely about mental health issues across the US, UK, and Europe. More information is at: www.gailhornstein.com

EM: How might a parent help a child who is experiencing emotional difficulties, in addition, or as an alternative to, trying to access medication or psychotherapy?

GH: The place to start is by really listening to your child. Avoid judgment, at least initially, and believe whatever he or she is telling you. You don’t have to agree with what’s being said, and you needn’t contribute, financially or otherwise, to doing or not doing something that your child says they want. But non-judgmental attentiveness – trying to draw out how it really feels from his or her perspective – is crucial to a trusting relationship. Whether or not we happen to understand other people, they always have good reasons for how they think and feel and act. Even if you can’t agree with or even make sense of these reasons, they’re still important to try to understand. One of the fastest ways to block off communication with someone is to say that their behavior “doesn’t make sense” or is “crazy” or “senseless.” If you start from the opposite assumption – that a person’s actions and feelings and ways of thinking always make sense to them – it becomes possible to create a path toward empathy and understanding.

About 10 years ago, I visited a peer-support group for people who experience the kind of intense suspicion that gets diagnosed as “paranoid schizophrenia.” These people had all sorts of beliefs about the world that I found strange or hard to believe – that the water in their neighborhood was being poisoned, or somebody was trying to spy on them through their computer, or the numbers on their bank account contained coded messages. Even though their ideas were strange, and the group members all had different ones, I was struck by how skillfully they were able to help each other. Instead of challenging the content of what someone was saying – about the spying or the computer or whatever – they focused on the person’s anxiety or fear. So rather than saying, “Don’t be silly, the water is fine,” they said: “It must be so upsetting not to be able to drink from the tap and to feel that something as basic and necessary in your life as water could be being poisoned.”

Listening to the group, I learned how much worse it could make an already-distressed person if the feelings they risked revealing weren’t trusted or believed. And usually, the person wasn’t actually looking for agreement; they were looking for empathy and appreciation of how horrible things felt to them. (Of course, with the changes in technology that have occurred over the past decade, and our much greater awareness of cyber-stalking and hacking and identity theft and the poisoning of the water in Flint, Michigan, etc., those “crazy” and “unbelievable” things people said in that meeting don’t seem so strange now.)

It might be hard to get your child to believe that you do really want to know how he or she feels, especially if there’s already a lot of mistrust between you. But even if what he or she is saying doesn’t make much sense to you, taking it seriously can often be the crucial first step in finding assistance that will actually be helpful. As each of us knows from our own experience, someone can want to be useful but what they do might nevertheless feel un-helpful to the person on the receiving end. Of course, people can have poor judgment or be in denial about their own behavior, but it still doesn’t work simply to impose a solution and try to force them to follow it.

Even people who don’t seem capable of having very much insight into their own feelings and actions – because they’re too young or too inarticulate or too upset – can often be surprisingly astute if given a chance to express themselves to someone who is calm, non-judgmental, and genuinely interested. People often know what would actually be helpful to them at a given moment even when they are very distressed, and it’s worth inquiring into what they think would work in case it’s something you can reasonably accomplish.

And even someone who is silent or uncommunicative or agitated or is saying things that seem like nonsense isn’t always going to be like that. One of the biggest misunderstandings that people have about emotional or psychiatric problems is assuming that they are fixed or static states, in other words, that once diagnosed, a person is depressed or hyperactive or paranoid or anxious all the time because that’s just how he is. In fact, there’s a huge amount of variability, for different people and even for the same person at different times. So the best way to help someone is to listen to what they actually need right then, and see if it’s feasible to provide at least some of it under the circumstances.

EM: Isn’t it dangerous or wrong to do what someone “not in their right mind” wants? Won’t “colluding” with their irrational thinking make them worse?

GH: Actually, in most situations, the answer is no. You don’t have to agree with the content of someone’s thoughts, what they are actually saying (“the teacher hates me”). But instead of focusing on that, you can focus instead on how difficult they are finding the situation that faces them. After you have created some basis for trust, and the person feels seen and heard, then you might be able to move toward a gentle questioning of the evidence that seems to be supporting the person’s belief itself. In other words, instead of starting out with a dismissal, like “That’s silly, your teacher doesn’t hate you, how could you even say that?” you might try: “If that’s how it feels, no wonder you don’t want to go to school. It must be really hard to have to keep doing it every day. Can you tell me about what happened that makes you feel that she hates you? Maybe there’s something we can do about it.” Saying these words won’t magically get your child to open up to you, but saying them often enough, and then really listening, will help you to chart a course of action that is more likely to work for both of you.

Once you have a clearer sense of what your child is actually experiencing, you can brainstorm ideas – with teachers or school administrators or your partner or the child him/herself – about what might be done to improve the situation. Of course, sometimes it’s simply necessary to adhere to school policy, regardless of anyone’s feelings. Children are subject to all kinds of rules and standards, and are allowed a far narrower range of acceptable behavior than is typically imposed on adults. But sometimes it’s the teachers or school administrators who are the ones who need to be challenged. So long as a child isn’t violent or abusive, it’s a parent’s right to stand up for them against arbitrary or unfair treatment. In addition to whatever practical benefits might result, your child will trust and respect you more for joining forces instead of siding with the authorities against them.

At the same time, it’s also a parent’s responsibility to make clear the limits that constrain a particular range of choices. Children are required by law to be educated up through at least age 16 in the United States. Unless you can afford to hire a personal tutor or are prepared to homeschool them, your children must attend a school in your area. Allowing them to think that this is negotiable is counter-productive and likely to have destructive consequences. But if changing to a different school might solve a key problem and this is something that is feasible, it makes sense to try to make it happen.

Of course, if your child is an adult, you have much less influence and control, unless you are the legal guardian. This means that listening to what he/she says about what helps and what doesn’t is even more important. Again, you don’t have to agree with what is being said or even think it makes any sense, but it’s still essential to try to understand the other person’s perspective in order to have any insight into why they are doing whatever it is.

For example, one of the people at that support group for paranoia I visited said she had started to worry about her water being poisoned. Someone else suggested drinking only bottled water that she purchased herself until the situation could be sorted out. Of course, doing this wouldn’t solve the problem of why she had this fear in the first place, but it was a helpful temporary solution and made the woman feel less alone and frightened. Isolation fuels people’s private craziness; connection to others can offer reassurance, reality testing, and less need for anomalous behavior.

Without question, it’s hard to withhold judgment if a person you love is doing something you consider destructive. But if there’s one thing I’ve learned in 40 years of teaching, research, and writing about mental health, and talking at length to hundreds of people who’ve been through seriously distressed or disturbing states, it’s that people are usually doing the best they can with the challenges that confront them. What looks destructive to you might feel life-saving to them. The clearest example of this is cutting or other forms of self-harm, which can horrify family and mental health professionals but which sometimes, paradoxically, can be a coping strategy that helps to keep the person alive. Transforming emotional pain into physical injury can make it seem more manageable, or enable the person to get assistance more readily. Again, even in situations like these, where it seems so hard to understand the motivations for someone’s actions, seeking out opportunities to talk with them about their feelings – even their desperation – can be hugely helpful in finding a way out of the anguish.

EM: If a person has emotional difficulties or gets a psychiatric diagnosis as a child, does that mean they will have problems as an adult?

GH: Definitely not. But there is still so much stigma about mental illness in our society that people who recover tend not to talk about it. They’re not like proud breast cancer survivors wearing pink ribbons and joining public celebrations; they’re more like gay people of the 1950s, hoping to remain hidden. We all suffer the consequences of not seeing how many of the people we encounter every day – colleagues, neighbors, the guy who delivers the mail – have suffered through debilitating emotional problems that are now behind them. We don’t see the many inspiring examples of people who “conquered” mental illness the way others have triumphed over cancer or fought their way back from stroke or heart attack. So we underestimate how often childhood problems are resolved and how many adults are living normal lives despite earlier difficulties.

And in the meantime, while a person is still suffering, it’s absolutely essential to be hopeful and to believe that change is possible, no matter how poor the odds. The self-fulfilling prophecy has powerful effects on human psychology, and it’s practically impossible to recover from a psychiatric condition if the person doesn’t first believe that this is even possible. Conveying to a child – of any age – that he/she should just resign themselves to accepting whatever level of impairment or disability or difficulty they are currently experiencing is both incorrect and potentially destructive. Carrying hope – even when a person can’t carry it for themselves – can be the single most important thing that you can do to help. And learning about the wide range of alternatives that exist – like the ones discussed in this series – can be life-changing, both for you and for your child.

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Visit the following page to learn more about the series, to see which interviews are coming, and to learn about the topics under discussion. You’ll also find links to 115 interviews I recently conducted with a roster of international experts in the critical psychology, critical psychiatry, and anti-psychiatry ranks.

Visit here: http://ericmaisel.com/interview-series/

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Rethinking Mental Health

How Can Parents Help?

An interview with Gail Hornstein

Three Parents Speak

Interviews with Wendy Shackley, Laurie Goldstein and Suzanne Beachy