Book Text: Part I General Issues: Parenting the Mentally Ill Adolescent Wendla A. Schwartz, MD

 Part I
General Issues: Parenting the Mentally Ill Adolescent 

Wendla A. Schwartz, MD

 Introduction

Louis had long dark hair to his waist. Nobody really knew why he grew it long like that. He just did. He was 13 and really smart. He knew every roller coaster in the country by name, grade of steel and top speed. He was an expert fly fisherman though he had never been and he could talk your ear off about faceted gemstones. He also had Aspergers Disorder (DSM IV) and recurrent depression so severe that his father had found him in bed with a plastic bag over his head on more than one occasion because he could no longer see the point in being alive. For many months he had been stable and doing quite well. Attending a school specifically geared toward his awesome intellect while also offering a supportive and understanding environment for his sometimes, unusual behaviors. He was happy and enthusiastic each day, looking forward to things, actively involved in hobbies, friends and family life. In short, he was a special and wonderful 13 year old boy. One day in session Louis admitted to me he had secretly stopped taking his medications and only admitted it to his parents a few days earlier. His reasoning? Well, he said:  He had been reading in a science magazine and it got him thinking: “just in case the apocalypse occurred” and no more medication was available he thought it “would be best” if he was prepared and had already weaned himself “off of the stuff. He smiled pleasantly at me while carefully explaining his logic. Well, it sounded logical. Of course, the negatives in this situation far outweighed the potential positives. An adult could easily see that the likelihood of recurrence of severe depression and the possibility of tragic consequences was a risk not worth taking when compared to the highly unlikely immediate probability of the end of the world. Louis and I discussed the pros and cons at length but he remained steadfast in his decision. Calm, cool and utterly  steadfast, he let me know he would take my “recommendations under advisement.” At this point, however, he felt confident in his decision.

After speaking with Louis, I brought his father into the room to discuss the issue. Louis’s Dad was truly perplexed. What to do? If Louis were any other teenager, he said, the decision would be obvious. He takes the darn medicine. Period. However in this case, he is so smart. So logical. So powerful. What do we do? Does he get a vote? Does he make the choice?

The confusion here was one that occurs so often when parenting teenagers with mental
Illness. We can easily forget that they are teens first and teens with mental illness second. Louis was not really interested in the apocalypse. He was mostly interested in control. In power. In his burgeoning independence. Just like any young teen he was testing his limits. He happened to have a very high IQ and the capacity to debate anyone into the ground. He could also read and memorize an issue of Fly Fishing in America in a frighteningly short time.  However, he was still a teenager. So the answer remained the same as for any other teen: When a teenager’s judgment is lacking, (which it so often is), we, as parents must step in and make the decision for them. Louis did not have the future orientation, ability to weigh consequences or personal insight to make such a significant decision as to go off his antidepressant medication. Therefore his parents needed to decide for him. His father did not want him off the medicine and so he decided he would simply sit him down and gently let him know that being off medicine was not an option at this time. “Yes,” his concerns were heard. “Yes,” his opinion was heard. “Yes,” he could disagree. And “No” he could not go off his medication. The message would be clear and consistent.  He would carefully remember not to engage in his brilliant debate (no matter how logical it sounded) but he would also remember to talk to him with respect and to validate his concerns. Presuming parental authority to this point had been clear and consistent, the outcome would likely be reasonable. Louis would shrug and eye-roll, maybe even stomp his feet or yell a little,  and think his dad was a TOTAL IDIOT who didn’t have a clue about ANYTHING,  and then move on to another day, another control battle. At 13, of course, this was only the beginning.

 The Three Things All Parents Need to Remember

Parenting the Mentally Ill Adolescent in America provides a continuous flow of suggestions for action and, when necessary for behavioral intervention throughout the chapters. Every attempt is made to insure that parents are given something to "do" about a problem. Although a major emphasis of the book is on letting go of control over the outcome, there is also a significant amount of focus on empowering oneself where possible. In addition, specific themes run through the book reinforcing the main ideas most beneficial to healthy adolescent development and maintenance of healthy parent child relationships. I believe these are the: Three Things All Parents Need to Remember. They are useful for every parent. They are critical for parents trying to raise kids with mental illness.

These are presented from beginning to end as The Three Things:
1. Good Enough
2. Borrowed Creatures
3. The Energy Ball

This text will be published in sections over the next several months on this blog in the hopes that it will provide ongoing support and information for families in need.

Wendla A. Schwartz, MD Board Certified Psychiatrist Child and Adolescent Psychiatrist and Psychopharmacologist