TRANSCRIPT
Last night, I went to a continuing education workshop so that I can keep my Social Work license. The workshop was about helping children who are in emotional or psychiatric crises, and I’d like to share the experience.
The first thing that I got by listening to this was realizing how these presenters, they work at a fancy hospital in New York. They work in crisis centers for children and inpatient units and things like that, emergency rooms. It’s all about control. It’s about controlling these children. It’s not about helping them through their crises. It’s not about helping them resolve their problems, resolve their traumas. It’s not about helping them learn to love themselves more. It’s about getting these children to comply.
Now, part of it is these children, you might say, in society and their families and school, they’re kind of out of control. But there was really no mention in this three-hour workshop about why they might be out of control, about why they might be so angry, about why they might be so upset, so hurt, so sad, so depressed. Literally, no mention of it.
So one of the main things when they kept talking about different vignettes with these children, and I kept thinking, “Oh my God, these children have horrible parents.” These children, if they have parents at all, these children do not have love. They don’t have nurturance. They don’t have guidance. They don’t have attention. And there was no mention of this. Instead, it was all about these children’s bad behavior, these children’s inappropriate behavior, these children’s inability to function in society.
Now, one of the main things these social workers talked about was protecting the children from themselves, making sure they’re safe. Well, at one level, that could seem like it’s very loving. They really care about these kids. They want to help them. They want to make sure they don’t hurt or kill themselves. But what I found was that this was just on the surface, really. This whole thing about safety, about protecting kids, was really just another means to control the children, to get them to do what the clinicians wanted.
So basically, the clinicians would try to figure out if the kids were a danger to themselves or others, but primarily it seemed like they were trying to figure out if the kids were a danger to themselves. And what happens is if the kids would admit to having certain suicidal feelings, certain suicidal thoughts, certain suicidal behaviors, then what that allowed the clinicians is the ability to take control of these children’s lives.
The two suicide questionnaires they came out with were both interesting to me. The first I noticed at the bottom was created by Pfizer, Pfizer the drug company. They make psychiatric drugs, so they came up with a questionnaire to determine a child’s suicidal risk. Well, why would you trust Pfizer? Pfizer wants children to be labeled as suicidal because then that justifies giving them the drugs that Pfizer produces, the billions and billions of dollars that Pfizer makes. So they’re making a questionnaire that is going to route kids right to their drugs because that is one of the primary things these social workers talked about as their way of helping these kids, of treating them, was drugging them.
And does that really take away a kid’s suicidality? I don’t think so. I think it would just make a kid maybe a bit more tranquilized or a bit more disassociated away from what’s causing them the pain. But I think in the long run, I think it probably makes the kids a lot, lot worse.
Now, the other question there that they had about suicidality was created by the New York State Psychiatric Institute. Well, my second social work internship 18 years ago now was at the New York State Psychiatric Institute, and I was in a couple of different units, and one of the units had children on them. I watched how they treated those children, and it was horrible. It was disrespectful. And it’s like, that’s a place that’s making a questionnaire to determine best treatment for children. I thought, if I had a kid, I would never trust them to take any control of my child’s life.
Now, another point I touched on it a little bit a minute ago was this whole idea of what children need. Now, that jumped out at me immediately in this presentation. They probably said it 20, 30, 40, 50 times: “Children need this. Children need a higher level of care when this happens. Children need therapy in this situation. Children need medication in this situation. If this is going on, children need, children need, children need.”
If this is going on, children need stimulants. Children need SSRI antidepressants. Children need antipsychotics. Children need different combinations. Children need mood stabilizers. Children need to see a psychiatrist. Children need to have group therapy. Children need to learn mindfulness. Children need to go to school. Children need to be in inpatient units where they can be better protected from themselves. They need, they need, they need.
And I kept listening to this, and I’m thinking, is that what children need? Is this what children were born into the world to need? What I kept thinking is, what about children needing good parents? What about children needing healthy, loving, supportive environments? What about children needing stable home lives? What about children needing two parents who love each other and also care about them, spend a lot of time with them? What about children needing enriching environments? What about children needing healthy, loving, caring, safe peers?
There was no mention of this. And what I thought is these are the real needs that children aren’t getting, and this is what’s putting them in crisis. But there was no mention of that, none at all. And that’s another thing that I heard with all this: they need this, they need this, they need this. What I could hear over and over again in my mind was a lot of self-justification on the part of the mental health professionals, justifying and sometimes using science to justify all the things that they really want to do.
And I listened to it also where they’re working inside a very strict and profound medical hierarchy. I noticed it when they were even showing teamwork because they do a lot of teamwork, which seems like it could be really good. Wow, you get a whole team working for this child. But then you actually look at the team, and what they had over and over again was a list of who was the team members. And it would always start with psychiatrist, psychiatrist, then psychologist, then social worker, then nurse, or sometimes nurse was before social worker, and last was like community liaison, a person who had no credentials but often spoke a language that the family of origin spoke.
For instance, the community liaison could be fluent in English or Spanish or English or Bengali or English or Chinese or something like that. But what I thought again and again was the psychiatrists were at the top of the hierarchy. And what is the job of a psychiatrist in these systems? Well, I heard consistently two different jobs that psychiatrists have. The first job is the psychiatrists run these programs. They’re the main administrators. They’re the top dog. They have the highest level of power. Why is that? How does going to medical school train you to become an administrator? It’s really questionable. I don’t think it does at all. I think it maybe can make people feel like they’re more important and that they know more and they have a higher level of education. But does this education really help people love children more, care about children more, really know what’s in the child’s best interest? I don’t feel that in any way.
The second thing that the job of the psychiatrist does is they medicate the kids. And I mentioned this: well, how many of these kids are being medicated? What percentage? And oh, they got a little uncomfortable when I said that because they already knew where I was coming from, and they were a little defensive. And they said, “Well, a majority.” But I think that’s a lie because what I gathered is every case vignette they gave, all the kids were being medicated. I think it’s probably very, very rare that there are these children in psychiatric crises who are not being medicated. And who’s medicating them? The psychiatrists.
Well, it’s very interesting if you think about it. Is that what children really need? Do they really need medication? Do seven-year-olds need stimulants? They were talking about this. This is good practice. Do eight-year-olds need antipsychotics? Do six-year-olds need antidepressants and mood stabilizers? And what does that teach children? Also, it teaches them in so many ways that when they have…
Feelings that are not acceptable to the world, not acceptable to their parents, not acceptable to the people who are supposed to be helping them. Then they’re supposed to take a drug, and that’s supposed to make them feel better.
Well, one of the interesting things that was a theme throughout this Children in Crisis workshop was when they talked about teenagers was use of illicit substances. Alcohol and marijuana, especially marijuana, seemed to be their big Bugaboo. They were really after that one.
When I thought about that, it’s like, well, I’m not saying marijuana is good for kids; it probably isn’t. But is it worse than a kid taking Ritalin when he’s seven? Is it worse than a twelve-year-old being forced to take Dypraxa, an antipsychotic, or Seroquel? Is it worse than an antidepressant, which can totally screw up their mind? It’s like, I think if we really want to talk about harm reduction, I think you might really make an argument that a kid smoking marijuana once in a while might actually be less bad.
And then there was no acknowledgement of that. It was just simply put into this category of, “sight drugs are good,” and anything else that the children want to choose for themselves is bad. So I think that maybe a big part of it comes down to giving children choice and letting children make decisions for themselves is something that these clinicians don’t like.
That was something that I felt, and I said, especially felt it when I spoke out at this conference. They loved the power. What I gathered is a lot of these clinicians, probably like a lot of policemen, probably like a lot of prison guards, are people who, on a deep emotional level in their lives, probably because of their background, probably because of their childhoods, actually, probably more than probably, were people and are people who actually, in some very deep ways, feel disempowered. They feel, at some emotional level, not in control of their own lives.
And so what do they do? They project it outward onto other people, and they find these vulnerable people and control them. And in a way, what easier people to control than children? Vulnerable children, children in crises, because just by definition, people who are under 18 can’t make their own decisions. They can’t make their own legal decisions. They can’t decide what’s best for them. A lot of times, they can’t leave treatment. They can’t quit therapists. They can’t quit programs.
So what I got from these social workers, these clinicians, is that they’ve got a built-in audience. They’ve got people who are forced to come. They’ve got people who are mandated to come. They’ve got people who are out of control whom they can totally legally control, and there’s no recourse. And all this crap and lies about protecting children for their own safety, and we have to protect them.
Well, one thing I gathered also, because I know this because I was a clinician, and I realized it, is that clinicians can actually get in a lot of trouble legally and in terms of their license if a client does harm themselves in some significant way and the clinician hasn’t done everything in their power to stop this person from harming themselves. So a lot of this supposed need, “Oh, children need to be protected from themselves,” you know, in case they harm themselves, I really think it’s just clinicians are protecting themselves because they’re terrified of what’s going to happen if the children do bad things to themselves. Oh, the clinician’s going to get in trouble.
So they put the need on the children: “We’re doing this all for the child, for the child, for the child, for the child.” But really, a lot of this is just the clinicians covering their own behind. They’re covering their own butt so they won’t get in trouble, and yet they don’t acknowledge it. There was zero acknowledgment of that.
And also, just so many things they weren’t acknowledging. Where was an acknowledgment of trauma? That drove me nuts. No acknowledgment of trauma. Actually, they did mention it once in three hours that these children, you know, some child was traumatized, but it was just a quick mention. There were no specifics given, but the implication was that trauma’s not that common with these children, and it’s extreme trauma. Well, come on, for a child to end up in this system, they’ve been traumatized. They are traumatized. You don’t get there without being traumatized.
The other thing I got with all these things that the clinicians are doing to these children, all these manipulations and getting them to say things, and then taking control of their life, calling 911 on them, getting police and ambulances to go to children’s houses and remove them by force, that’s an extreme thing. But the whole system, what I gathered, all this manipulation and force and forcing medication, this is traumatizing. Literally traumatizing.
So what I see is the children are traumatized to begin with to end up in this system, to be out of control as to in terms of how the system defines healthy behavior, and then they control them more, force them, and harm them and traumatize them. So it’s like, it really makes sense why so many people who were mental patients talk about having been traumatized in the system.
Now, I want to mention one other thing that troubled me probably as much as anything. What these clinicians said several times when they were talking about different children and the vignettes that they presented were, “Oh, they have supportive parents. Oh yeah, they have very loving, caring, some parents. The children come from a stable home. They’ve got supporting, loving parents, biological parents, blah blah blah.” But they’re in the system, and it’s like, right away, it’s like, I don’t buy this – loving supportive parents, and yet the child is in psychiatric crisis and ends up in a system.
I think it’s probably, it may be true in very rare cases, but I think in most cases wherein children end up in psychiatric crises, they don’t have – loving supportive parents. But it brought me back to my time when I was a therapist, and especially for that short internship that I did on inpatient units. I heard them say that a lot, “Oh, this person has supportive parents.” And I remembered, oh yes, what they actually mean. What these clinicians mean when they say someone has supportive parents, some child has – supportive parents, what they really mean is that the parents are supporting the clinicians, not that the parents are supporting the best interest of the child. It means that the parents are allowing the clinicians to do whatever they want to their child, and to me, that’s collusion. That’s really horrible.
Also, when children get these labels of being psychotic and stuff like that, and I’ve heard a lot of people, they grow up and they get these labels, and I’ve heard about their experiences, and they talk about conspiracies. Oh, the world is a conspiracy. Well, when I listen to this workshop and I heard these clinicians talking about how they all work in teams with each other and they’re all on the same page, and it’s wonderful when the parents are on the same page as us because then we can really do what’s best for the child, you realize it actually is a conspiracy. It’s a really large conspiracy to control and force these children into all sorts of horrible places and horrible situations, and it’s like, again, no acknowledgment of that.
Now I want to wrap this up with what finally sent me over the edge because I really was trying to just stay out, just be quiet, just listen, take it in. But I was building up, and I was getting so mad listening to this. Well, finally they described a vignette with a 16-year-old boy patient, and they talked about his life. Oh, how he had two supportive parents and how he’s really been out of control, how he’s been talking about hurting other people, how he’s been a little bit violent, how he wants to harm himself sometimes, how he’s already had a couple of inpatient hospitalizations. And I listened to it, and all in all, I just kept thinking this poor boy, this poor boy has been so mistreated. No one has acknowledged any trauma. There was no mention of anything in his life that ever went wrong, so it’s almost like anything that went wrong in his life just happened in a complete vacuum.
And they gave him a suicide questionnaire, and he said he wasn’t suicidal, but they didn’t believe him. And the clinician said to him, “You…”
Know, I don’t really know if you’re being honest. And if you’re not being honest with me, then that makes me more worried. We have to raise you to a higher level of care if we can’t trust that you’re being honest. So it’s really important for your treatment that you be honest with us, so we know exactly what’s going on.
Because the kid was denying that he wanted to kill her or hurt himself, and that’s when I was like, come on, really? I mean, she’s lying to him. It’s like the kid is not allowed to say that he’s not wanting to hurt himself. So basically, she’s putting him in a position where until he says that he has suicidal thoughts, that he wants to hurt himself in some way, and come on, probably most kids who are being tormented, who are being forced into the system, who are being forced to take medication—this kid was on a bunch of drugs. This kid is not being listened to about what’s going on. Probably no one’s even asking him about what’s really going on in his life. No one asks him what he wants, how he’s feeling.
Oh, and he’s been labeled a drug addict also because he occasionally smokes marijuana. Well, so he’s being forced, and as soon as he admits that he feels suicidal, BAM! They’re gonna put him in inpatient. So really, she was lying to him. It’s like I just felt it was so dishonest.
And that’s when I said, I raised my hand, and she called on me. A lot of times I’ve been in these situations where they actually stopped calling me at a certain point because I’m considered rebellious or obstreperous or a difficult person in the audience, or naive. That’s another one I’ve been labeled a lot—naive. Oh, he really doesn’t understand. It’s like, well, actually, no, maybe I understand a lot better, and you don’t like me to understand. So you’re gonna put me in a position where I don’t know anything.
And I’ve noticed that I’ve been put in a position a lot where I’m looked at in a similar way to how the clients are looked at because I’m speaking against the system, which goes to tell a lot about what happens when people even have less power and are controlled by the system and speak out against it. No wonder they get kept locked up for longer. They get put on more meds.
But I said, you know, if I were that boy—oh, oh, and the other thing was, this is another thing—he stopped coming to treatment. That was another thing that really got her. She didn’t like that, and that’s where they had to force him to come, and they locked him in patients so he could get the treatment he needed. He also wasn’t going to school. He was having truancy issues, and so he was really non-compliant with his life—not from non-compliant with school, not sending to his parents, not listening to the clinician. And also, the school guidance counselor had been pressuring him to go to therapy. So like, no wonder he’s not going to school. No wonder he’s not listening to his parents. No wonder he’s not listening to these clinicians.
But for them, this is a pattern of non-compliance in his life that allowed them to come in and control him more. And so what I said is, you know, if I were that sixteen-year-old boy and I were in therapy with you, I would take what you were doing as a threat. You were threatening that boy when you said, “If you don’t tell how you’re really feeling, we’re gonna control you even more.” She goes, “Oh no, I wasn’t threatening him. I was speaking with him in a very kind way.” And I thought, very kind way? And I said it. I said, actually, you can still threaten someone and supposedly seem like you’re being very kind about it, but actually, the real message is not kind. So even if you’re smiling and speaking with a gentle, soft tone in your voice, you can still be threatening. And a lot of times that threat is even worse because then there’s that disconnect between the tone of voice and what’s really being said, and that can really screw people up.
She really didn’t like that, and that’s when she said to me, “Well, what would you do for him then?” That’s what she said, all the smile, the kindness, and she went like this: “What would you do for him?” And I said, well, for starters, I’d listen to him. I’d find out what he wanted. But another thing is, I wouldn’t want to be working in this whole system that’s based on so many things that I don’t believe are actually really even good for him. So I would want to work in a system. I would want to participate in a world that actually was finding out what he really needed and what was really gonna be in his best interest and offer him that and start there.
But she didn’t like that, and then she just went up. Someone else raised their hand and was arguing, and then she called on them quickly and then just moved on. But it was like, ooh, it was really like it was a reminder to me of how I, as a clinician, did not belong in that system, could not work in that system. The only thing I could do was work in private practice where I didn’t have to refer people into this horrible system. And I didn’t even believe children belonged in therapy at all. And I’ve talked about that elsewhere. It’s like, who belongs in therapy? The people who control their lives? What, the parents come to therapy? What, the clinicians come to therapy? Let the clinicians look at why they’re acting out so much control on these kids and why it is that the children don’t want to come by choice. Again, it’s like when you get a mental health system that operates by force, it can’t be a good one. It just can’t be a good one.
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