Caught this one through the paper edition that I get through the mail–a long searching piece which is a good illustration of the sheer agony of sustained mental illness. Money line (for me):
Leonard is still struggling, for reasons no one understands. He keeps odd hours, working through most nights and sleeping much of the day. He is not unhappy, he said, but he has the same aversion to washing and still lives like a hermit.
“I still don’t know why I’m like this, and I would still try anything that could help,” he said. “But at this point, obviously, I’m skeptical of the efficacy of surgery, at least for me.”
Read it all–KSH.
Reminds me of a 10 year old I saw 2 years ago who had been unable to function due to severe anxiety, spending hours in the bathroom, and locking herself into the bathroom of a medical center for over 24 hours due to her “anxiety” disorder. She had been on a number of psychotherapeutic agents and had spent 2 years on “play therapy” while being homeschooled.
Bottom line was partial complex epilepsy, improved on Trileptal, back in school functioning normally.
The trouble with the shrinks is they will NEVER come up with a differential diagnosis. If you meet the checklists in the DSM-IV, then you are theirs and they will never consider medical alternatives.
And now they want to bring back what amounts to lobotomy. And obvously there is no way they can do a double blind study with sham surgery to see how much of the “improvement” is due to placebo.
Then there was the 9 year old with “schizophrenia” and “conduct disorder” who ended up in a foster home because her parents couldn’t handle her who actually had sleep apnea due to huge tonsils with paradoxical hyperactivity and REM sleep intrusions simulating hallucinations. (She is getting straight As now her tonsils are out).
Then there was the kiddo who (at 11) was supposedly “hystrionic” and “malingering” while her mother supposedly had “Munchhausen’s syndrome by proxy” and “wanted her daughter to be ill”.
She had narcolepsy with cataplexy and is getting As and Bs with a 20 minute nap in the middle of the day, and low dose stimulants.
I could go on and on.
Until such time as Psychiatry decides to make like a doctor and actually take a history and do a physical examination and rule out confounding medical illnesses before doing their stupid check list thing, they have no business advocating surgery for psychiatric illnesses. They refuse to do physical exams because of “transference issues”. They think that family docs should rule out all medical and neurological illnesses before sending a kid to a shrink. No other specialty acts like this. If I send a kid to surgery because I think he has appendicitis, the surgeon will examine him and tell me if he thinks I’m wrong. Only psychiatry acts as though symptoms inevitably are the result of a psychiatric disease that is written in stone.
I wont even begin to discuss “Attention deficit disorder”.
Aaargh. Well thank God I’m no longer in pediatric neurology. That’s all I can say.