Wednesday 21 December 2011

Protection of privacy or impediment to care?

Earlier this week a friend of mine told me his nineteen year old daughter had been admitted to a psychiatric inpatient service. His relationship with his daughter is close, supportive and positive. Her illness had taken a turn for the worse and the difficult decision to hospitalize had been made collaboratively by the young girl, her parents and her outpatient treatment team. The next day he called the inpatient service to find out how she was doing. She was involved in a scheduled activity and was unavailable to chat with him. So he asked the staff member a simple question: “how is my daughter doing”? The response – “I can’t talk to you because that would be breaking her confidentiality”.

As expected, he was shocked. Not only was he one of her major supports, he had been involved in her care, her successes and her sorrows for the entire time she was unwell. He had worked with her and her previous health providers to address the challenges of her illness. And now, suddenly, he was told that he could not even be told how is daughter is doing because of “confidentiality”?

What kind of care is this? Does “confidentiality” mean that a concerned, involved and supportive parent cannot receive the simplest information about how their child is doing from a care provider? Is this barricading of children from their parents common across all types of health care, or is this unique to brain disorders? Is this what are trying to achieve when we work together to help people recover from their mental illness?

Certainly, young people need to be able to share their concerns, questions and problems in confidence with their health care provider. Is this the same thing as denying parents access to basic information about their child? Parents have important and essential roles to play in the lives of their children. This obligation does not end when puberty begins. Indeed, it amplifies: and becomes more complicated. Health care providers need to understand how important the relationship between parents and their children is. They need to understand that “independence” is a relative term, one that continues to evolve over the entire duration of the relationship between parent and child. We have to do better.


--Stan

Wednesday 14 December 2011

Data clarifies 'sexting' panic

Almost every week I hear stories in the media about “sexting”. For those who have been vacationing on mars for the last five years “sexting” is a word describing sexual images that people (often the finger is pointed to teenagers) send to their friends – often these images are of themselves. Given the media coverage it is not a wonder that many parents have been asking me about the “sexting epidemic” (note: their words – not mine.)

So now a study has been reported on the USA prevalence of this behavior, click here.

It turns out that “sexting” is not an epidemic after all. A nationally representative sample found that less than 1.5% of teens reported that they had sent or created an image of themselves that showed breasts, genitals or someone's bottom. Now some would say that is quite a high number, but others would wonder what happened before electronic tools enabled such material to be widely distributed. What was the proportion of teens a couple of decades ago who took photographs of themselves and gave them to a boyfriend or girlfriend? Or before that, who drew a picture of themselves and gave that to a boyfriend or girlfriend? We have no idea. Maybe it was the same number, maybe more, maybe fewer. 

In any case, this is likely not a new behavior. This is likely not a behavior that has been created by newly available technology. It is also not a signal that is showing that our youth are falling apart under the pressures of modern adolescence. 

However, “sexting” can lead to problems. Once an image is available electronically, it can be made available to everyone. This is something that our young people need to understand.  In addition, unlike a traditional photography, it can be passed quickly and widely to many --  that is the issue. We need to help young people understand the consequences of their behaviors in the electronic world. 

New technologies may not only create new human behaviors but they can make longstanding human behaviors more apparent. So, while the sky may not be falling, in terms of “sexting”, we need to make sure that we help young people understand that in the age of instant electronic communication that sometimes a private act can become a public spectacle.

--Stan

Wednesday 7 December 2011

Does anonymity breed cruelty?

I just saw the very powerful You tube video posted a few days ago by a Jonah Mowry (already over 6 million people have watched it).



I don’t want to comment on the video – it speaks for itself. What I want to address are some of the comments that the video has received. 

It is difficult for me (and I am a psychiatrist and am supposed to understand these things) to read so many cruel comments (I will not dignify them by repeating them here). Why are so many people posting such cruel and vicious comments? Are so many people by nature so cruel and so vicious? Is this a phenomenon that is encouraged by the medium of electronic communication? Is this a reflection of levels of homophobia so deeply rooted in our society? Is this the result of anxiety aroused by seeing a young person in distress? Why the anger?

I have no answers to these questions. But I do know that such cruel and vicious comments are wrong. There is no place for such cruelty towards others in our society. Trying to understand why however does not excuse us from taking action to stop such cruelty. This is an obligation from all of us. From those who control the electronic world – there should be no e-space for such attack. From those who are teachers and coaches and parents – we have to stand firm and make it clear that there is no social space for such attack. For peer and friends and all young people – you have to stand up and make it clear that there is no teen space for such attack.

The sooner we get our sh*t together on this, the better for all of us.


-Stan

Thursday 1 December 2011

Is it boys or is it ADHD?

In recent years it has become fashionable in some circles for people to equate ADHD with being a boy. The lack of understanding about what ADHD is, or what is different about being a boy with ADHD from a boy without ADHD does not seem to give pause to certainty of their opinions.  Just last week, I was subjected to one of these passionate diatribes by a Professor teaching in a division of health human resources about the “medicalization of childhood” (his words, not mine).  When I gently reminded him about the brain imaging research on ADHD, his response was not with interest in what had been found, but in denying its importance completely.  “Everyone knows boys are driven by their emotions,” was his reply.  Strange, the last time I checked emotional regulation was a brain function.

 A recent study reported in the June 2011 edition of the Journal of the American Academy of Child and Adolescent Psychiatry (Neuroanatomical and neurophsyological correlates of the cerebellum in children with attention-deficit/hyperactivity disorder – combined type) has added new and more detailed information about brain structures in children who have ADHD.  In this study, the researchers found that a particular brain structure, called the posterior inferior vermis was significantly smaller in children with ADHD than in controls. A  finding that is consistent with a fairly large number of studies demonstrating cerebellar differences in young people with ADHD.  As the cerebellum is important for impulse control, shifting of attention and motor coordination, these finding are very important for they may explain in part many of the symptoms found in ADHD.  A collateral finding, that medications which are effective in treating ADHD impact this part of the brain, lends further support for this consideration.

So what does all this mean for the opinionated Professor and his dogmatic but uniformed certainty?  Perhaps it is time to start teaching neurodevelopment in all human services training programs.   If you are studying to be a social worker, a teacher, a psychologist, a child and youth worker, a nurse, a doctor, etc., you need to know neurodevelopment and understand how brain function underlies human experience, emotions and behavior.   While it may be too late for us to change the Professor’s stigma, the worse since it is cloaked in profundity and ignorance while concurrently enjoying the status of his position, we may be able to encourage reason and curiosity in the next generation of teachers, health providers and professors.

--Stan