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

Book Text:Parenting the Mentally Ill Adolescent in America: A Guide for Real Families By Wendla A. Schwartz, MD

 Parenting the Mentally Ill Adolescent in America: A Guide for Real Families

By Wendla A. Schwartz, MD

Preface

 Over the last 20 years I have been professionally engaged exclusively in work with psychiatric patients and their families. During that time I can estimate I have conducted tens of thousands of patient visits and had the opportunity to complete thousands of diagnostic evaluations. I have been lucky enough to work with an extraordinary group of patients of highly varied backgrounds in many different clinical settings. Working with people in outpatient and inpatient settings, private practice and public hospitals, large  metropolitan emergency rooms and small town offices, on the West coast and in the deep south, I have seen adolescents and families handling difficult situations with all sorts of psychiatric diagnoses and their consequences. Together with other specialists we have developed treatment plans involving a myriad of interventions: medical, psychosocial, behavioral, nutritional, alternative etc...While I have found it to be  true that each adolescent patient  is as unique as their fingerprint, I have also found something strikingly similar. Many have parents who benefited from a few, not too complex, suggestions that I found myself making repeatedly. These are suggestions and recommendations addressing real life issues facing everyday families trying to live life in this country while coping with the often Herculean task of raising a teenager with a mental illness.

As two of my own children became teenagers, the true power of adolescence became a reality in my life. I have discovered the forces arising during one’s journey from young teenager to adulthood do not politely move aside because we are coping with fatigue, stress, illness or anything else. Hormones, brain chemistry, altered social structures, grand shifts in body design and metabolism, not to mention individual evolution of abstract thought, moral structure, and spiritual foundation interact to reduce the average teenager to a confused, emotional, difficult and sometimes volatile remnant of the happy and robust child they were just months earlier.  For children with mental illness those forces can prove somewhat more challenging and are usually complicated by other factors. Those factors include psychiatric symptomatology, medications and side effects.  I finally decided to put some of the  suggestions and recommendations that have worked for my patients down in this book. As I was already at the task of writing a book, it seemed practical to add a few extra bits about which I am often asked. So, I added some resource information to the end of the book: evaluation, treatment, psychiatric medications, testing and the like.

"Parenting the Mentally Ill Adolescent in America” is primarily a guidebook for parents and guardians. The book addresses the complex, challenging and at times overwhelming task of parenting in the context adolescent mental illness.  It seeks to underscore the fact that parenting does not end where illness begins. A teen diagnosed with diabetes will continue to need parenting.  Similarly a teenager with depression, bipolar disorder or autism does not cease to need parental guidance once they are diagnosed or simply because we recognize certain behaviors as not “normal.”  This book is meant to encourage understanding of teens and to offer education, inspiration and support to parents. Besides parents and guardians, the book will also be of great potential value to grandparents, other family members, teachers, counselors, members of the clergy, primary care physicians, mental health workers and anyone else with an interest or particular love for an American teenager. This book is limited to a discussion of children being raised in our contemporary American society exposed to cultural stimuli typical of America of the twenty-first century.  This book can be used both before diagnosis to assist a parent in determining whether there exist problems that warrant further exploration, and after diagnosis, to manage ongoing parenting issues. However, the book itself is not meant as a substitute for appropriate diagnostic evaluation or clinical treatment.



About the Author
Wendla A. Schwartz, MD is a Board Certified Psychiatrist. She received her Medical Degree at the University of California, San Diego in 1990, completed her Psychiatric Residency at UCLA in 1994 and completed a Fellowship in Child and Adolescent Psychiatry at LSU New Orleans in 1996.   Dr Schwartz continues to practices psychiatry. She lives with her husband, also a Psychiatrist, in the Silicon Valley area of California. They have three children, two of whom are teenagers.

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




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

Caring for Every Child's Mental Health

Caring for Every Child's Mental Health

Wendla A. Schwartz, MDBoard Certified PsychiatristChild and Adolescent Psychiatrist and Psychopharmacologist

Multiple Comorbidities, Adverse Outcomes Common in Children With ADHD

Multiple Comorbidities, Adverse Outcomes Common in Children With ADHD
http://www.medscape.com/viewarticle/737666?src=sttwit



Deborah Brauser

Posted By

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

Dr Schwartz Response to Amy Chua's Tiger Mother

In response to Amy Chua's offensive article in the WSJ (Chinese Tiger Mother) in which she describes her extraordinarily abusive parenting style involving, among other tactics, verbal cruelty ("garbage") and the withholding of water and food from a a 7-year-old child I  post the following for consideration.
Eliza Noh Studies Suicide
 I find it concerning that Amy Chua has not been charged with child abuse for her actions.
Wendla A. Schwartz, MD

Our children are certainly unlikely to achieve more than they believe we believe they can accomplish. We must set the bar high,  then give them tools, support and love as they find their way. Coddling,  protecting and preventing failure produces only weakness.  We do not set limits on our children. We allow them to find their own limitations along the way. Truthfully, we do not know what they cannot accomplish. Only in retrospect do we know what they can. All these things are as true for children with mental illness as for every other child.

 While it is true that all children can benefit from goals, structure, support and direction from their parents, Amy Chua has it wrong.  We  must NEVER equate a child's value as a human, their value to us as parents or their worthiness of our love to their ability to achieve. Giving a child the message "You are only worthy of being loved IF you accomplish" is completely different from saying "I belive in you and I believe that you CAN accomplish". My father used to say: "You are pre-approved." Children need pre-approval. Then they need to know we have faith in them. From that foundation, and with the right tools, all children can go on to reach their fullest potential.

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

Amy Chua's original article can be found at:
http://on.wsj.com/gJPP44

Myelination Mapped in the Infant Brain for the First Time

Scientists have mapped myelin (the neuron's insulating material) content in the brains of infants during the first twelve months of life.  Abnormal myelination is believed to be related to the development of such disorders as autism and schizophrenia. Mapping myelin content in normal brains is hoped to lead to research allowing isolation of the timing of abnormal myelination related to these types of disorders.
Wendla A. Schwartz, MD Board Certified Psychiatrist Child and Adolescent Psychiatrist and Psychopharmacologist

New Noninvasive Imaging May Provide Insight Into the Origins of Autism, Schizophrenia

Kate Johnson

Myelination Mapped in the Infant Brain for the First Time http://t.co/qEcUaPW

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

My 12 year old son seems to be unhappy. He is struggling in school. He cried tonight and didn't know why?

My 12 year old son seems to be unhappy. He is struggling in school. He cried tonight and didn't know why?

Wendla A. Schwartz, MDBoard Certified PsychiatristChild and Adolescent Psychiatrist and Psychopharmacologist