The depression story of a leading psychiatrist helps shape their treatment of young people

    Abdulaziz Sobh

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    When Mike Shooter was in medical school, he suffered the first of what he calls "thunderous depressions." More often. Shooter's efforts to cope with these experiences have made him acutely aware of what young people with mental health problems endure and forged his career as a leading child psychiatrist in England. He was the first specialist to be elected president of the Royal College of Psychiatrists, a position he held between 2002 and 2005. He recently published "Growing Pains", which is based on 40 years of work with young people. The book explains why it is imperative to differentiate between depression and the common but often intense difficulties faced by some children. He recently spoke with The Washington Post about these issues. This transcript was edited for clarity and duration.

    Q: Do you think young people are more vulnerable to mental illness now?

    A: Research suggests that the United Kingdom is the least happy place to raise a child in the Western world; The United States cannot be far behind. Some of this could be attributed to the effect of poverty. But not all: frantic competition, in school, in the struggle for work, in relationships between groups, means that many children are left out of the competition and feel they have failed. Or they are so insecure about their own value that they sit around all night searching for "likes" on social networks instead of the right friends.

    But not all is bad news. Currently, there is a lot of research on resilience: what allows some children to cope, while others do not. I know from experience that there is one thing that can make a difference: a relationship with an adult close enough to them, that supports them, listens to their anguish and treats them as something valuable. That person could be a relative, a friend of the family, a teacher or, dare I say it, a child psychiatrist.

    Q: What is the difference between depression and sadness?

    A: Depression is a formal psychiatric diagnosis with recognizable symptoms, well-researched treatments, and a predictable outcome. Sadness is a normal reaction to sad circumstances, or a floating mood typical of teenagers.

    The danger is that the kind of anguish that I describe if it ever comes to the clinic, will be crushed into a psychiatric category that does not guarantee or be discarded as a problem for which the psychiatrist has no answer. The children in "Growing Pains" have not been able to get help because they have not met the formal criteria, which reinforces their sense of failure. These children need help, as we call them, sad or depressed.

    Q: Is there a danger in labeling a disorder?

    A: Labeling can be very dangerous. In the best of cases, it can fossilize a child's image and the way they are seen and managed by those around them. At worst, it can ruin their lives.

    Once they contacted me about two young girls, both 14 years old, both labeled. The first received a diagnosis of depression from his general practitioner and underwent treatment with antidepressants. When I saw her, she told me that she did not feel loved in her family, that her only friend had died in a traffic accident and that her grandmother, her only confidant, had died. Desperate to find a way out of her pain, she had decided to join them by committing suicide, swallowing the tablets that had been prescribed for her. What she needed was the opportunity to talk about her unhappiness.

    The second girl was labeled as a personality disorder: anxious about everything, always blaming herself, sleeping badly, unable to make friends. This is how it is, said the adults, nothing can be done about it. Actually, she almost certainly had fallen into a clinical depression that could have responded to the treatment, but it was not recognized. After an argument with girls at school, she disappeared and was found dead two days later. They asked me to make the pain work with those left behind: vital for them, but too late to save the daughter.

    Q: What better way, then, to support a vulnerable child?

    A: The most useful is a relationship that can keep the child in confidence as we work together to try to change things.

    Trust must be earned. Some children feel safer talking in the privacy of a clinic. Some are so young and so frightened that they are beyond words and need special techniques to discover the cause of their anguish. Many will need to be seen in their own patch, at home, at school, where they feel most comfortable. It may require negotiation with adults to ensure the necessary space, and unless the child needs an immediate rescue of the damage, it will take time.

    Once trust is established, we must work together to develop the child's self-confidence so that he can explore new ways of thinking about himself and the world. In other words, it must be an empowering relationship that looks for the strengths that all children have and builds on them. We can not guarantee a future without problems, but we can help them discover ways to cope better. When that is done, we must say goodbye to the therapeutic relationship in a way that does not repeat itself and aggravates the anxieties with which the child presented himself.

    This takes time, involves risk, means being so close to the anguish that it can stir up our own unfinished emotional affair, and treats our children and young people as partners at work instead of passive recipients of formal diagnosis and medication. And at the center of everything, it is not a textbook or a set of guidelines, but the individual experience of the child. His story

    P: Are we overmedicated?

    A: I try not to blame people: the children and young people who are so often blamed for their own anguish and have felt so guilty that they have blamed themselves; parents and caregivers who can not understand what children are going through and who often need help; Professional colleagues, who are desperate to help, but are clinically trained and emotionally more comfortable with traditional ways of doing things.

    So, yes, we run the risk of overdiagnosing distressed children and getting too fast to a recipe more appropriate for an adult's disease. But I understand why. Demonstrating how a young person can or can not meet a set of criteria and distribute a course of pills is obviously "doing" something, and the pressure to do something is enormous.

    Q: What do you think about the new guidelines of the American Association of Pediatrics that say that children over the age of 12 should have yearly screening for depression during routine pediatric check-ups?

    A: Clinical depression has not been recognized in the past.

    As a sufferer, I know how he paralyzed a large part of my adult life before receiving help. Without that help, I could still be drifting through the life of one short-term job to another, metaphorically kicking my father in the crotch. Then I can understand the association's desire to make sure that lack of recognition never happens.

    I worry, though. I am sure that doctors will be mistaken on the security side, so regular check-ups will risk taking the unhappiness of adolescents to the diagnostic network.

    These exams seem designed to capture the established depression that would otherwise escape recognition. Our resources should be used to prevent such disorders from being established in the first place. There is ample evidence that late mental illnesses of adolescents and adults are rooted in childhood and that there are many opportunities in these children's lives to intervene. It requires a change of attitude, on the part of professionals and caregivers, to prevent unhappiness from crystallizing into formal disorders.

    The money spent on early intervention will save many times more in the further development of mental illness and social upheaval.

    Q: How has your work with depression influenced your work?

    A: I have a recurrent depressive disorder. The help I received gave meaning to the terrifying feeling that is inside me discovered their origins in my childhood and allowed me to behave differently with my own family. Talking about it in the media has encouraged more professionals to present their own stories and to the general public to seek help.

    Although my illness has made me more understanding of the young people in my care, it does not give me the right to cross over the uniqueness of their experience. Everyone's depression feels different; We must help young people explain what they feel. The worst you can say is "I know exactly how you feel!"



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