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I had an interesting experience the other day that really got me thinking. I was doing a regular checkup on a 12 year old young man and after we talked for 10 minutes about his health, it was obvious that he was struggling with some anxiety and maybe a little depression. He freely admitted to having a lot of thoughts dominated by worry, he liked to stay close to home, his grades were suffering, and of course like so many anxious children, he was having trouble sleeping. In my opinion, he was somewhere in that zone between just having a lot of anxiety and being depressed. Fortunately, he was not having any suicidal thoughts or thoughts of doing harm to others.
His father was accompanying him during the physical and when we both heard all these symptoms coming forth, we both agreed that some counseling would be of use. The child even saw the need for some help. When I made the suggestion of seeing a counselor, his father, who grew up in Columbia, South America, told me that when he was a child, all children had access to either psychological counseling or the clergy. It was quite acceptable to get counseling and guidance periodically from an adult of authority in Columbian society. As he put it, “Everyone got psychological help from a counselor, a psychiatrist, or the clergy.” I found this fact amazing. I remember friends of mine when I was growing up being very secretive about seeing counselors or psychiatrists. Your peers saw this as a character flaw and a sign of weakness. The whole subject was taboo.
Which brings me to an interesting observation that I have made during my career– the number of children that I am seeing today who act on their self harm thoughts has drastically fallen since I started practicing– at least in the population that I care for. The statistics actually show that the suicide rate among American children has really been very steady for the past 35 years but I think the number of suicide gestures has dramatically fallen. So why has my experience changed so drastically? Maybe having a better acceptance and understanding of psychological problems has translated into children getting access to effective counseling before they become desperate and contemplate self harm? When I started in general pediatrics in the early 80’s, our group of five pediatricians in a nice middle class practice would hospitalize a young teen who had made a suicide gesture or attempt on a monthly basis. Frankly, I can’t remember the last time I had to do this. In my world, this is now a very rare event. Why the change? I’m not sure but maybe the children I care for have other places to get healthcare when they have a mental health crisis like a psych ED or even their pediatricians And I think my patients have come much closer to the Columbian model of accepting that children have anxiety and depression at times and their parents make sure they get help before it is a crisis. In a nut shell, we are less judgmental and more willing to get them help and they must be more willing to be honest about their feelings.
Recently, my pediatric group started using a mood questionaire with the older children when they come for their yearly visit and I have been very impressed at their honesty and frankness when they fill out this instrument. What’s the old expression, “You won’t find out unless you ask”. Well, we are asking and they are telling and getting the help they need. I think as a society, we are more accepting of a child who is troubled and we do our best to get them help. We ask more, and they tell more– and that is a great thing.
If you enjoy Portable Practical Pediatrics, drop me a note or sound off on iTunes, Facebook. or Google plus. I hope you have heard about my first book, “Can Doesn’t Mean Should, Essential Knowledge for 21st Century Parents”. It is doing very well and I hope it is helping a lot of families make many of the difficult decisions parents must make today. Check it out on my Goodreads page. This is Doc Smo, hoping that if your teen becomes blue, you’ll get help for that little buckaroo. Until next time.