Sick burn(out.)

16 09 2013

So often, the only way you get what you need in this field is to kind of be a pain in the ass. No one wants to, but you have to. Lots of people don’t check their voicemail. Or they don’t answer their phone. Or check their email. They might not even go here.

So you have to be “proactive.” That’s the nice way of saying “stalker.” It’s fine, no charges have ever stuck. But it’s the way things get done.

I’ve even been guilty of it. Sometimes phone calls slip through the cracks, as much as I pride myself on actually responding to those who reach out. I love getting surprised “oh, thanks forgetting back to me!”s. And it happens routinely. I’m always astonished when other service providers actually answer their phones and I don’t get to use my pre-rehearsed voicemail message. “Hello? Oh, oh my god. Yes, hi. Why was I calling again…” I would be more coherent if I ran into Ryan Murphy on the subway and he asked me to originate the role of the singing sex educating social worker on Glee.

Not that I’ve considered that. Anyway.

You need to stay on top of people. When I get a new referral, the first thing I do is call the new client. Then I call the referral source. Then I email the referral source, copying her supervisor and my supervisor. Then I call the referral source’s supervisor. And of course I write all this up.

When I started here, I would’ve thought this was obnoxious. But it’s a matter of course. People are busy, and you need to remind them that you’re waiting and that you’re invested.

Sometimes, though, people aren’t prepared to deal with it.

Again, I’m guilty myself. I got annoyed recently when a guidance counselor called me. The first call didn’t bother me. I was in a meeting, and called her back within a half hour. I left a voicemail, as she didn’t answer. She happened to call back when I had stepped away to pick something up at the printer, and I called her back within two minutes. “Oh, finally!”

Hmm…all right. Do not appreciate your tone, lady. Though I get how it is when it’s your emergency.

But then…later that same day…

I had referred a family for a mental health evaluation, and hopefully, follow up services, for the teenage son. The hospital wouldn’t admit him, but he had a pretty serious history of violence and self harm. The mother told me a very believable story of phone tag with the mental health agency’s intake worker, explaining why the appointment hadn’t been scheduled yet. The mother got through to her once, but the intake worker said she was too busy and would call later in the day. Then three days want by. It was so believable as I’d been involved in a similar delightful game.

I wasn’t “it,” but I called back anyway. Proactive, remember?

“Hi, this is SJ from Anonymous Agency, I referred this child last month and just wanted to follow up and see if his intake was scheduled.”


SJ: “Hello?”
Worker: “I’m looking, give me a minute!”

Oh, ok. Normal functioning adults ask others to hold, but you’re doing your own thing. Cool. Follow your heart.

“Ok, I left you three voicemails!”

You left one, and I returned it, twice.

“I called the mom, but her phone was disconnected.”

Weird, she always answers for me. And I remember when clients have working phones.

She then started aggressively telling me the phone number she called for this mother. She told me my phone number. Halfway through her barking out the family’s address, I realized we had gotten off track. I wasn’t calling to question her outreach efforts. I was calling to make sure this family got the services they need.

She didn’t take that statement in the spirit it was intended.

“Well their referral is closed for the next three months. Send them somewhere else, I don’t know.”

I seem like a real sarcastic asshole, I know. And often I am. But not to clients, and not unprovoked.

There is no reason to talk to people like that. What cause do people have to answer the phone ready for a fight?

People love to talk about how busy, or stressed, they are. One of my most important lessons of adulthood has been–who cares? You’re not special. Everyone is busy, everyone is stressed. Very few people you speak to are sitting at their desks, feet up, luxuriating in a lack of paperwork.

I can deal with some rudeness. I write snarky blog entries and bitch to my coworkers. But if she’s talking to me like this, why wouldn’t she be talking to clients the same way?

That’s why my supervisor called her supervisor. It might sound like juvenile tattling, but we absolutely cannot let these things slide. If people are this miserable, they need to move on. Work at Starbucks and passive aggressively fuck up latte orders if you really hate the world that much. Don’t put yourself in a position where a child is denied needed mental health treatment because you’re too grumpy to do your job and engage with people.

Burnout and frustration happen. We have to learn to keep them in check. This wasn’t my first experience with a service provider like this. I hope maybe it can be the last, though.

We do have to do better, because kids are awesome.

19 12 2012

Last week, I had every intention of posting a new blog on Monday. I was planning for it to be something fun and lighthearted, since my last one was a bit heavy. Then on Friday, as I was standing on line for cheesecake at the agency Christmas party, a little pissed off that we were expected to return to the office for an hour afterwards, a coworker looked up from his phone to say, “They’re saying it’s at least twenty dead now.”

There are a lot of ways I thought I could approach this.

I could get into the need for a serious overhaul of mental health services in this country. However you feel about the author of “I Am Adam Lanza’s Mother”  and the general narcissism/martyrdom of mommy-blogging, (yeah, who am I to judge?) she’s right. And of course, we don’t need mental health services so us normies can be safe, we need it because the mentally ill are human beings who deserve treatment. Anyway.

I could also talk about gun control. My boyfriend’s a police officer, and there’s a gun in our home. This makes me somewhat qualified to say that anyone who thinks that a gun could be safely kept in a kindergarten classroom and that a teacher would have been able to stop this with returned fire is an idiot who shouldn’t be allowed to own a water pistol. Honestly. Peanut butter is too dangerous in our classrooms, but an M4 would be just fine? Not to mention that it’s hard enough to find good teachers when they aren’t also required to be sharpshooters.

OK, maybe I do have a few things to say about that one. But it’s all been said plenty.

I could talk about why interviewing children who’ve just been through unimaginable trauma, then defending it as “allowing them to share their story” instead of “trying to be the first ones to get the story with no regard for ethics or the well being of six year olds” is bullshit and wrong.

I could mention the sick opportunists blaming this on lack of prayer in school or comparing this massacre to abortion. But then I would have to think about them.

I also thought about writing about this woman and the other teachers there. People who are often criticized for not “getting it,” because they’re young or don’t have their own kids or are just doing it for their big fat paycheck. It’s hard to imagine that you could care about someone else’s children that much, but everyone I know who works with kids understands it completely.

Then I thought what would be best would be remembering why we care about these kids so much. How even when they drive us crazy, they are sweet and innocent and make us laugh. How the worst day can be brightened by a visit from a child. To remember who we’re protecting when we talk about all of the changes to be made and work to be done.

SJ: “Did your teacher tell you she called me?”
8 y/o: “Yes.”
SJ: “What did you think about that?”
8 y/o: “Busted.”
Ha! We call that insight.

6 y/o: “Did you bring play-doh? It helps me with my anger.”
Well, look at you.

9 y/o: “I have a concern. My dad snores. I can hear it through the wall, it’s ridiculous.”
I love the confidence it took to bring this up during a safety conference.

SJ: “Let’s talk about what you love about your family.”
7 y/o: “We have a fish.”
The fish’s name is Crunchy, it is pretty great.

6 y/o: “Hey SJ? When you’re done talking to my mom maybe you can come give me a hug?”
Oh…ok, that sounds lovely. It’s nice that we can schedule these things.

11 y/o: “My school said you were looking for my report card. Did they tell you it was beautiful?!”
It was beautiful.

SJ: “Are you excited for winter break?”
5 y/o: “Yeah, I’m ready.”
SJ: “What are you going to do?”
5 y/o: “Party.”
I bet!

7 y/o: “Don’t worry mom, I’ll help you take care of him. Hear that, baby? It’s you and me!”
This was said to his mother’s protruding belly, as she cried over her boyfriend having left the family.

4 y/o: “Hi SJ! This is my snowsuit. Wanna hold hands?”
Yeah, why not?

Everyone I know was devastated and overwhelmed with grief and feelings of powerlessness as they watched this play out. Some of us can help in concrete ways, but sometimes it feels like all you can do is bear witness by overloading on horrific news. We know this isn’t for the best, but it might feel like all there is. We can also bear witness by remembering, honoring, and protecting everything that’s wonderful about childhood. The reaction of so many people was to want to hug the children in their lives closer. It applies to us too.

Letting someone else talk for once–is there a diagnosis for that?

21 05 2012

I don’t only make people think, laugh, cry, or angrily comment/tweet at me. Sometimes I inspire a frustrated blog post. Our friend RealityTx is back with a dose of mental health reality. Listen closely to your substitute blogger, she’ll be reporting on your behavior to me when I return. 

Stop Diagnosing Already!

Hello, this is RealityTx here with a new dose of reality about mental health and wellness. Let me preface this by saying that I am a licensed provider in NY. In other words, I’ve been trained for this. I went to grad school for three years, did a 700 hour internship in school and did 3000 hours (yes, 3K) of clinical work post-grad plus took an exam to get my license. Ok, now that’s out of the way, I can talk about what’s been bugging me lately. SocialJerk recently wrote a post about not diagnosing fictional characters and inspired me to write about something that’s been festering within.

One of the things that annoys me about technology is the rapid access to information (and misinformation). Thanks to the internet and many other forms of technology (which I do love very much) random people think they are qualified to diagnose others. Guess what, if you haven’t gone to school for it, chances are you’ve no clue of what you’re saying.

So here is a list of things that go into diagnosing a mental health disorder (and NO, reading the DSM does not qualify you to diagnose either.) And if you don’t know what the DSM is, stop diagnosing ASAP!

  1. A recent physical with all the works. Why? We in the diagnosing field of mental health (therapists, counselors, social workers, psychiatrists, psychologists, etc.) have to figure out where symptoms are coming from. Maybe someone is woozy because they drank cold medicine and later drank. Or a child who has low blood sugar ate too much candy and is now bouncing off the walls (commonly diagnosed as ADD or ADHD).
  2. Now that I’ve mentioned symptoms, here’s another tip: don’t diagnose based on one thing. Bouncing off the walls (aka a symptom) isn’t only a sign of ADHD. Being forgetful isn’t a sign of Alzheimer’s or Dementia. Several criteria are used to determine whether or not someone has a particular disorder. After a physical (see #1), practitioners look at the symptoms (ie what is happening), the time frame (how long have the symptoms been present), the lifestyle (what’s happening in the person’s life), the age (stage of development) and level of functioning (how is the person doing in all environments). See why it’s so hard?
  3. Age is important! In mental health, age isn’t just a number. There is a reason why there are several theories of development. Freud wasn’t the only one with developmental stages (Piaget and many others). Check out books on developmental theories and you’ll see what I mean. A child, teen, adult and older adult can have different reactions to the same thing. Everyone has specific body chemistry at various stages as well as different lifestyles.
  4. Emotions are not mental health disorders people. Being happy does NOT mean a person is manic. Being sad is NOT the same as being depressed. If you’ve seen commercials about depression medication on television, some of the more recognizable symptoms are mentioned – no longer doing what interests you, frequently isolating from others, etc. But, being sad because you didn’t get a job isn’t the same as being depressed. Depression (yet another disorder that regular Joe Schmoes misdiagnose) is an on-going diagnosis that isn’t treated easily. Therapy, medication and constant work all go into treating an individual with a diagnosis. Normal is relative to each individual and all people have different kinds of normal.
  5. Medication isn’t magic. A mental health disorder is a serious thing. It disrupts your life and interrupts your level of functioning. A disorder can keep you from doing well in school, at work and/or at home. In short, it can stop a person from being the best that he or she can be. Yes, medication helps with chemical imbalances in the body, but it doesn’t automatically solve other lifestyle issues that come from having a diagnosis.
  6. Diagnoses come in several flavors – mild, moderate, severe and profound. They come in degrees. How bad do the symptoms affect the person’s day-to-day life? How often do the symptoms appear? How long is a person symptomatic during an episode? A diagnosis does not allow the person to control the symptoms alone – on-going therapy and medication and lifestyle changes help an individual manage his or her symptoms.
  7. Medication isn’t the only option. I believe in medication as a last resort. If therapy and lifestyle changes aren’t enough to reduce the frequency of the symptoms then medication can be explored starting off with the lowest dosage.

Please note that even with all of this going on, there is much more to diagnosing. So please, if you’re not a professional in the field, don’t diagnose. However, if you do see something out of the ordinary in a person’s behavior, seek professional help. Go through your doctor, school social worker or guidance department or through your insurance or employee assistance program. There are many practitioners out there. Make sure to use your best judgment to ensure that you’re loved one gets the proper diagnosis. Ok spiel over. You can now return to your regularly scheduled programming.

Can we stop diagnosing fictional characters with Asperger’s?

23 04 2012

One of my more important takeaways from show choir social work school was that we need to start looking at mental health more similarly to the way we look at physical health. Not that we’re doing such a bang-up job with physical health, but the stigma that surrounds mental illness just isn’t there. Someone might not want to talk about having cancer, but they’re generally not ashamed of it. Before making a judgment of someone with a mental health issue, I try to replace that in my mind with a physical one. Would my reaction be different if that were the case? If yes, rethink. (Also, shut up.)

We always want more mental health awareness and openness. People have issues, and they shouldn’t be hidden. People talk about chronic physical disorders (though, I admit, my former supervisor could have kept her irritable bowel syndrome to herself) so it’s great that people are more aware of mental health issues and the effects they have.

Except that idiots now know what these things are.

Mental illness is talked about much more, but not necessarily always in a meaningful way. It’s part of our everyday vocabulary, because everyone’s aunt has seen an episode of Oprah about someone with a personality disorder, a 20/20 featuring a child with an attachment disorder, or a Law & Order about a detective’s bipolar family members.

This leads to us hearing things like the following:

  • “I swear, Mila Kunis looked anorexic. Gross.”

First of all, you do not speak ill of Ms. Kunis. Second of all, I knooow. Eating disorders, they are the ickiest! A body weight less than 85% of what’s expected for her height, probably accompanied by amenorrhea…wait, you don’t really think that this actress, or that bitch in your Spanish class, has a disorder, and therefore needs help. Somehow, cutting down someone else’s body type makes you feel better about yourself.

How is that not in the DSM?

  • “I’m just really depressed today.”

No. You’re sad because you’re human, the weather is a bit gross, and your job has been really boring lately. Now it”s tomorrow, and you feel better!  You don’t suffer from depression, and you should be happy about that.

  • “That little boy is so ADD.”

You can’t be ADD. You have ADD. And he’s eight years old and in a Barnes and Noble, what did you expect? A diagnosis of ADD actually requires a bit of interaction with a professional, not six minutes of observing a child knock over a book display.

  • “One minute she’s fine, the next she’s yelling at me. She is actually bipolar, I’m not kidding.”

But she’s not. She’s your mom, and sometimes you piss her off and sometimes you don’t. It’s a human relationship, not a disorder.

  • “Can I have some Purel? I know, I need to stop being so OCD.”

Again, you are not OCD, you have OCD. Except you don’t. You just like the smell of rubbing alcohol and don’t like the idea of colds.

  • “I was just thinking of everything I had to do and I had a panic attack. It’s fine now.”
I’m glad you’re fine, but you didn’t have a panic attack. A panic attack is when you think you’re dying of a heart attack and you go to the hospital. What you’re describing is a moment of feeling overwhelmed, that was remedied by writing up a to-do list.

When every mood swing is bipolar, every urge to alphabetize your boyfriend’s DVDs is obsessive compulsive (they just look better that way!) these terms lose their meaning. “Oh, your kid is autistic? Yeah, I think my nephew is a little autistic.” Not far from this is, “It’s not such a big deal! I was depressed in high school and I didn’t try to kill myself!” “My daughter had a little of that oppositional-defiance, but I just wacked it out of her.”

If you can discipline something out of your child, it’s not a mental illness. If a jog and a viewing of Bridesmaids brightens your mood and gets you on with your day, it’s not a major depressive episode. This is something to be grateful for, not defensive of. Not everyone has a little OCD in them. Your desire to drop ten pounds to look super hot over spring break in college may have been misguided, but it probably wasn’t a six week episode of anorexia nervosa. Mental illness is everywhere. But when we act like it’s actually everywhere, in everybody and in every action, we take away what it means, and we take away the legitimate struggle.

Part of having these terms in our lexicon is understanding how serious they are, and what they really mean. That many of these terms we throw around lightly are actually meant to refer to a lifetime disorder that requires constant management. It’s not something you diagnose yourself with one day, then get over the next.

I blame the internet.

Why Mental Health is Bad for My…Mental Health

12 04 2012

When ACS refers a case to us, there are certain things they want done. (Most often, these are things we don’t do. But that’s for another blog…) A lot of times, it’s counseling for domestic violence, sexual abuse, or substance use. These don’t apply to everyone. But one thing is constant. Everyone in the family–parents, kids, household pets–should have a psychiatric evaluation.

I’m rarely against an evaluation. It can’t hurt, right? Well, I guess anything can hurt, but the professional would have to be a real idiot. Surely there aren’t any of those. I think our kids are overdiagnosed and too often prescribed serious psychiatric meds but evaluations…why not?

There are a few problems, of course. Some parents don’t agree with them, some kids think it means I think they’re crazy. The number one obstacle, though?

Where the fuck are they supposed to get this done?

With the health care debate raging in this backwards ass country, I keep hearing about these “free clinics” that one supposedly trips over on any stroll through the ghetto low-income side of town. They’re doing free well-child visits and tossing out birth control like Gobstoppers at Willy Wonka’s factory.

Unfortunately, they don’t exist. Most of those “free clinics” actually charge Medicaid. You can get urgent care, not ongoing treatment.

This is also true for mental health clinics. In my first months on this job, I thought they were a myth, like Sasquatch, or the G train. But they’re out there. They’re just hard to find. It’s especially hard to find one that takes your insurance. Sure, everyone has Medicaid, but most people also have supplemental insurance. This place takes straight Medicaid, not Health First. This place only takes blah blahdiddy blah…

Most unfortunately, we don’t have mental health staff here at anonymous agency. We’re social workers and case workers, but no doctors. I can do family counseling, play therapy, which is all good stuff, but I can’t prescribe Ritalin. No matter how much I may try. This means that we have to refer out.

Until recently, we had a connection with a nearby mental health clinic. They came by when they felt like it to collect our referrals, and our clients were able to get appointments within a couple of months. To be honest, I thought they did supbpar work. But we had to take what we could get.

That relationship was terminated for some reason that hasn’t been explained to any of us because we’re not important. Now, we’re back to the old referral process.

Agency names have been changed for my amusement.

I call Shining Time Mental Health Station to refer a nine year old girl and a thirteen year old boy. Their mother is also to be evaluated, but I don’t mention that at first, as I don’t want to seem greedy. No one answers, so I leave a message. I do this fourteen days in a row, while also leaving messages at Miss Kitty Fantastico Memorial Mental Health Center and St. Mungo’s Center for Nonmagical Mental Maladies. No one will answer me, and I start to take it personally. I leave decoy messages, telling the intake worker that she’s won a sweepstakes and needs to call me immediately, or saying that I’m holding her puppy hostage. Nothing. That woman does not care about her imaginary millions, or her puppy.

At some point, I give up on St. Mungo’s, because they don’t take this family’s supplemental insurance. Miss Kitty Fantastico is no longer seeing children. That leaves me with one in their area. Oh god.

Finally a coworker sees me sobbing into the phone, and mentions that she has a contact at Shining Time, who might help. I get my hopes up (always a mistake) and call. Of course, this person is a domestic violence specialist only. Could you encourage their dad to stop by and rough up the mom? OK, in that case I can’t help you. Let me transfer you to our intake worker.


Next, I try the child study center at St. Anastasia Beaverhausen Hospital. I call their general intake number, and am given the option to press one for the diabetes program, two for women’s health, three for dental, all the way to nine for foot problems, but no child study center.I start cursing into the phone, hoping that this will cause them to connect me with a real person (it works with FedEx) but all this gets me is some looks from my coworkers.  I hit zero for all other calls, and am told that my call is very important to them, but there are six other callers ahead of me. After an hour, I begin to doubt the importance of my call. Someone answers. I ask for the child study center. She transfers me to the foot center. I ask for the child study center. Foot lady transfers me back to the lady who transferred me to her. I finally get the child study center after three more rounds, only to be told that they aren’t accepting new clients for five months. Can’t I put my kids’ names down now, that way in five months they can have an appointment? No, it doesn’t work that way, because we say so. Oh.

While I’m chasing my tail, there are children who need help and aren’t getting it. Counseling, play and art therapy, are crucially important to their well being, and I do that. But when there are things like PTSD, ADHD, bipolar disorder, or a family history of schizophrenia going on, they need to see a doctor.

People in need can always walk into the ER. We always hear this from people who don’t want to pay for our frivolous health care, and it’s true. They can walk in, sit down, and wait for hours. Wait, and wait, and wait. Often they choose to leave. Generally, if they aren’t actively suicidal, they don’t get to stay. I once got frustrated enough that I asked a mobile crisis worker if I should wait to call back when my (pregnant, schizophrenic, drug abusing, cutting, but not presently suicidal) client was setting herself on fire.

In retrospect, that was too far. This is not how we get what we want.

If a client is admitted, they’re often transferred to a different hospital, particularly if they’re a child. Depending on insurance, this can take forever. Not literally, but just about. There’s a sort of time suspending limbo you enter when you walk into an ER.

One of my teen girls who had attempted suicide more than once wound up being sent to a notoriously unpleasant (to say the least ) psych hospital in Brooklyn. They had an available bed and would accept her despite not having insurance. Her mother was afraid to send her there, and didn’t want her to be two and a half hours away, but she did it because she had no other choice.

I don’t think I need to point out the irony that the mental health system in the Bronx has driven me a bit insane. I’m glad I get to absorb this frustration for the parents I work with, honestly, because I can’t imagine that they could do this on their own while also worrying about everything else going on in their lives. But it’s infuriating to see how difficult it is to get someone help. Are they a danger to themselves or others? Yes, but not enough of a danger. Come back when something tragic happens, so we can all blame the parents for not having done enough.

We are tragically failing our people in need when the only way to get (temporary, kinda-ok) treatment is to be brought in slitting your wrists.

I wish I could end this by offering a solution. All I can say is that we need more, and we need better. Prevention is almost always the answer, says the preventive worker. Maybe if some of those earlier evaluations and mental health treatment could happen, we’d be taking fewer trips to the ER.

But what do I know.

Don’t read this, it’s just a cry for help!

6 10 2011

Recently, at a family party, I was talking with someone whose friend was training to work at a suicide hotline. (This is the normal turn for family parties. Right?) Another guest didn’t care too much for the idea.

“That’s for people who don’t really mean it. I know people who wanted to kill themselves, and they’re dead. If you’re calling the hotline, it’s just a cry for help.”

It’s one of those clichés we’ve all heard. “It’s a cry for help” or “He’s only doing it for attention.” Somehow, these two concepts have been conflated in a dangerous fashion. We all know that if someone, say a two year old, is doing something for attention, say, throwing a tantrum, we should ignore it and go get a margarita.

A “cry for help” is not the same thing wanting attention. It’s a recognition that there is something very wrong going on with someone, something that they can’t handle on their own. It’s a way of reaching out for support and intervention. Some people are able to do this in a constructive way, by calling a hotline or going into the hospital. Plenty of people aren’t able to do this, due to their mental health, cognitive abilities, or other reasons.

So they “act out.” We see it with kids all the time. They’re angry about their parents divorce, so they start skipping school. They’re traumatized from being abused, so they start using drugs. Some people are depressed, and untreated, so they start hurting themselves.

Cutting seems to be the fashionable “cry for help” these days. I’m never one to buy into that hysteria that you see featured on the Today show or Dr. Phil about the latest teen trends–you know, they’re all blowing each other in the school cafeteria and having “pill parties.” I don’t know how they even have time for their pregnancy pacts and school shootings!

But self-mutilation does seem to have caught on. My younger cousins keep my finger on the pulse of all things emo, and it has become something of a rite of passage. Not something that people do all the time. But lots of them seem to have tried it. Everyone has moments of feeling depressed, misunderstood, or crazy in high school. Emo kids strive to have as many of those moments as possible, so it kind of makes sense.

I remember first hearing about “cutting” when I was about 13. It was on an episode of 7th Heaven. (I admit to that, because I feel that I’m in a safe space here.) It was one of those “special episodes,” where one of the eighteen kids brings home a new best friend, who serves only to teach a lesson, and is then never heard from again. They discover that she’s cutting herself, talk about the warning signs (“I should’ve known! She was wearing long sleeves out of season, keeping to herself more, and seemed moody!” Who talks like that?) and send her on her way. I thought it was weird, until I read an article in 17 magazine. (Again, we’re not judging.)

Like all kids at that age, I had my times of feeling down and like things would never get better. An idea that otherwise would never have crossed my mind did, and I cut my finger. I found that it hurt, I still felt down, and I didn’t care for the sight of blood. So that was that.

This has now become a concern due to all the media attention given to teen suicides. Obviously the attention is not to blame for making kids feel bullied or depressed. But is it possible that it’s planting an idea, a more effective cry for help?

Honestly, I don’t know. But I am pretty confident that the answer isn’t going after the media for paying attention to these deaths, or their friends for memorializing them. We should probably be playing closer attention to those early warning signs, so that when the kids finally get that attention they’re looking for, it isn’t too late.

A girl I’ve written about in the past, Angelica, was a cutter. Her mother and I twice brought her to the emergency room, for this and other troubling behaviors. Both times, the doctors told us that this was “attention-seeking behavior” and generally wasn’t serious. I explained, as not hysterically as I could, that I understood this, but did that matter when she was slashing up her arms for some unknown reason?

Apparently it didn’t. Until things escalated and she was hospitalized, where the truth about her rape and abuse came out.

Just because it’s a cliché doesn’t mean it’s entirely wrong. It would seem that a lot of people who attempt suicide don’t really want to die. (A rather popular first thought, upon jumping off the Golden Gate Bridge seems to be, “I wish I hadn’t jumped off this bridge.”) They want help. Obviously this doesn’t mean we should let them jump. “But SJ, it’s just a cry for help! Responding to it will only feed their desire for attention!”

Maybe. Maybe not. But if in their quest for attention they’re going to be crushed and swept away in the waves, or accidentally hit an artery and bleed to death as Bullet for my Valentine (thanks emo cousins!) plays in the background, does it really matter? Where does this idea that we should wait for a genuine desire to die come from? We accept the need to early intervention in seemingly everything else (I mean, not in the sense that we should insure for it, but as a concept) but not for depression.

Wanting help, and even wanting attention, are not bad things. We need to stop acting as though they are.

I don’t even think I have bootstraps

29 09 2011

I was a sociology major as an undergrad. It made sense to me, as I knew I was going into social work. I stand by that major, though I’ve heard many people disparage it as an easy way to get through college. Hint: everything’s easy if you don’t do any work.

Learning about society and how we function together as a unit to avoid killing and eating each other (it’s possible I just read Hunger Games) has been very helpful to me as a social worker. One professor in particular made a major impression on me, and made me think about some things that inform my practice in a different way.

This professor was old. Really old. He told us stories about growing up during the Depression. And of course, he had way more energy than any of the 20 year olds in the room. He talked about how people should work long past 65 now, because we live so much longer. He told us about his trips to South America, climbing mountains and hiking in rainforests with native people.

You’d think a tough guy like this would be pretty into that whole “pull yourself up by your bootstraps” mentality. (I don’t really know what that means. My boots have a fashionable and convenient side zipper.)

But he was the first person I heard say, “Some people are born on third base and grow up thinking they hit a triple.” Lots of those people were in the room, so it was a pretty cool moment.

I think we’re all familiar with this attitude when it comes to financial issues. People who think they’ve worked so hard to get where they are, and maybe they have, but who fail to recognize how lucky they were. To have parents who supported them, to have been able to go to college, to not have had to drop out to care for a sick relative.

My professor was fascinated with what he described as the American ideal–pushing through adversity. Not admitting weakness. Not admitting defeat. He told us a story about a time he almost died giving a lecture, because he decided to ignore severe abdominal pain until his appendix ruptured. The man running the event he was speaking at talked to my professor’s wife, after he had been rushed to the hospital. “Your husband’s quite a guy,” he said with admiration.

“You think so?” said his wife. “Well, I think he’s an asshole.”

I want to be friends with her.

I have to deal with this attitude from parents, teachers, and other workers all the time. Many parents have told me that they understand that their child has a mental illness. However, that is no excuse for poor behavior!

Well, it kind of is. Not that we should let it go. But you have to adjust your expectations. If we’re not going to do that, then what does a diagnosis even mean? You have ADHD, you have bipolar disorder, you have PTSD, but we’re going to act like you don’t. Hmm…

These parents always tell me that their children know right from wrong. I’m sure that they do. But the voices in their head don’t seem to. And when your brain is rushing so fast that you don’t have a minute to slow down and take in and process new information, you’re bound to make some bad decisions. We have kids evaluated and diagnosed when they’re struggling with these things so they can get treatment, so adults in their lives can be a little more patient, and so those same adults can learn what’s effective with this child’s unique ways of thinking and behaving. And yet it’s so hard to let go of the idea that clinging to those same expectations, and resisting medication and other treatments, is somehow superior.

I remember talking with a fellow student back in college, who had an IEP in high school and was entitled to extra test time. However, he was embarrassed and always refused to take it. The other girl we were talking to said, “I’m proud of you for not taking the extra time!”

1. You’re not his mom.
2. Why? Because he jeopardized his academic career for the sake of appearances? Because failing in the face of unfair standards is better than passing, if it means admitting you need help?
3. Why are you still talking. She doesn’t even go here! (Anyone? Come on.)

“If we admit that something is wrong, then we’re coddling him!” You’re right. You there, in the wheelchair! Up, now! If we give in to this desire to be pushed around everywhere, she’s never going to get up and walk.

Of course that’s ridiculous. But we say things like that all the time. To people with disabilities we can’t see, to people with histories we don’t know. They’re doing this incredibly destructive, unproductive thing. Why don’t they just stop it? I don’t know. Why don’t we work together? Simply saying, “Stop. Get yourself together. Do things this way” doesn’t make you a purveyor of tough love.

It makes you, in the words of my dear professor’s wife, an asshole.

Did you forget to take your meds?

17 02 2011

The kids I work with are nuts. I think we all know that is said with affection. At times I get concerned, but for the most part, they’re a hoot and a half. If you can’t be crazy at age eight, when can you?

Not everyone shares my view of childhood.

I got a referral for a six year old the other day. Presenting problem? “Child plays around and is very silly.”

It’s high time for this lad to settle down. That mortgage is not going to pay off itself.

I’m sure there’s something there. It’s distressing his mother. But what was recommended for this child? The all-powerful psych eval.

I have one eight year old waiting on a psych eval. Family court is insisting. What behavior is she getting up to? She stopped doing homework and her grades dropped. Then her mother beat her with a belt. (Hence the ACS case.) The kid had just been diagnosed with diabetes over the summer. Her life changed. To make up for it, she got tons of attention from her family and friends. By the time school started, the attention had faded, but the diabetes was still there. She acted out.

But we need a psych eval. Even though the kid’s mother doesn’t really want it. Even though the kid is doing much better.

I’m not against medication. My cousin was prescribed Ritalin for ADHD, right when everyone was saying that it was incredibly overprescribed, and that those kids were just being kids.

I saw what Ritalin did for this kid. He didn’t turn into a zombie. It allowed him to be himself. He was still energetic and hard to keep up with, but he was able to channel this into his love and talent for sports. He was no longer angry at everyone and frustrated with himself. It made a huge, positive impact on his life, and our family.

That being said–not all of my kids need medication. And yet I’m being told that they do. ADHD isn’t even enough anymore.

I was working with a seven year old recently, who had what everyone thought was a pretty clear case of ADHD. He was bright, but doing poorly in school because he couldn’t concentrate or sit still. He was delightful in counseling, but required constant one on one attention. He got up to do the running man at random moments. (I admit, I never wanted that one to end.)

His mother was against a psych eval. She felt that he would be drugged and his personality changed. In this case, I felt the evaluation was really necessary. As did my supervisor, and the kid’s teachers and doctor. The mother and I talked about it at length. We went over her concerns, and her right ask questions. She finally felt comfortable with it.

Also, she couldn’t take another homework session interrupted by this boy’s need to express himself through 80s dance moves.

They were on three waiting lists for months. Mental health services in the Bronx are frighteningly hard to come by. Finally, though, the kid was in.

After three meetings, this seven year old had been diagnosed as bipolar and sent home with a free sample of Abilify.

Who doesn’t love samples?!  The little packets, so fun.

Being a responsible, loving mother with an internet connection, this woman did a little Googling. Reading the fine print for any medication will terrify you, no matter what. WebMD convinced me that taking more than one Tylenol causes internal bleeding, asphyxiation, talking in tongues, and the ability to fly.

Abilify, though, is serious business. For bipolar disorder, it’s only approved in ages ten and up.

Not to mention that the psychiatrist met this child three times. A grand total of 135 minutes. Her first thought was a label like bipolar, and a powerful antipsychotic? The mother’s very legitimate concerns were brushed aside. Just try the medication, keep an eye on him, he’ll be fine.

Ultimately, mom couldn’t go through with it. She returned the samples, and discontinued mental health services.

And I supported what she did.

Again, I’m not anti-medication. But I think we can all agree that not everyone is bipolar. A third of the kids I work with have had a doctor or counselor speculate that they might be bipolar. About the same number are on psychiatric medications.

I would think that this is a nationwide issue, but I recently spoke with a nurse in a lovely, wealthy suburban community. She was shocked to hear that a sixteen year old she knew was diagnosed with bipolar disorder. “They try not to put a label like that out there until age 18, because the kids are changing so much.”


She couldn’t believe what I was telling her about my experiences. Apparently, likelihood of serious mental illness decreases as tax bracket increases. Curious.

People should be open to medication. They should not be ashamed to admit to having a mental illness. But why the disparity? Why is the future of a child of affluent parents in an impressive zip code so important that he can’t be saddled with a serious diagnosis, while my kids and their parents, many of whom are rather young and rather not-white, are told to just be good and take their meds?

Stories like this seven year old’s are exactly what people are afraid of when the idea of a psych eval is raised. It drives people away from mental heath treatment that their children may really need.

It’s hard as a social worker to question the opinion of a doctor. Who the hell do we think we are?

We are the ultimate advocates for our clients. And for our kids’ right to be nutty kids.