THE MENTAL HEALTH CARE OF CHILDREN, ADOLESCENTS & FAMILIES IN AMERICA: A NATIONAL TRAGEDY
Edited By Mickey Skidmore, ACSW
The majority of this piece is taken from a keynote address entitled: “The Therapist as Humanist, Social Activist and Systemic Thinker”, by Cloe Madanes, Ph.D.,,delivered at THE EIGHTH INTERNATIONAL CONGRESS on Ericksonian Approaches to Hypnosis and Psychotherapy, December 5-9, 2001. To avoid the appearance of plagiarism, the sequencing and length of the material was edited and reorganized to emphasize points of interest shared by the editor. Additionally, some pronouns and subsequent syntax were also changed to ensure grammatical congruence.
Perhaps there are many unaware of the horrors that are committed on children in the name of social work, psychiatry, psychology and the mental health field. Now, more than ever before, we are called to consider confronting the levels of corruption in the field of mental health, and the tax on the profession of psychotherapy that many thought would never be possible.
The work of the family therapist often consists of bringing justice to a family that suffers as a result of internal conflict or that is being mistreated by outside sources — and should also include protecting people, especially children from being labeled and diagnosed in unfortunate ways. Some might even be passionate about the prevention of hospitalization of children and adolescents, about solving problems quickly and painlessly, and about bringing humor and lightness to a field that is populated by pompous psychologists and psychiatrists, and by hard working and too serious social workers.
It was little more that a century ago that Freud shocked the medical establishment of his day by suggesting that mental illness was caused by childhood physical and sexual abuse. Neither the medical establishment, believing that all psychological disturbances were physiological and hereditary in origin, nor Victorian society was willing to peer into the dark closet of unpalatable family secrets that Freud had opened. Nor was either willing to accept his radical idea that family violence might be the key to later psychological suffering.
Six years after Freud was expelled from the Viennese psychiatric society, when his professional colleagues rejected his paper on the long-term psychological damage stemming from real injuries inflicted by parents on their own children, Freud recanted. He proposed instead that the source of hysteria and other mental problems emerged from children’s own unresolved inner fantasies, about what they imagined their parents had done to them.
For the next half century, psychotherapy would essentially ignore actual interactions between family members and concentrated almost exclusively on the private inner world of the individual. Not until the 1950’s did the family therapy movement once again insist that personal relationships between parents and children, wives and husbands, friends and co-workers were the key to understanding human emotional life.
Whether we like it or not, violence (too often in families) has taken the place of schizophrenia as the most serious mental health problem. And the prevalence of incest, sexual abuse and wife abuse has been revealed. As we puzzled on how to understand the mind and the relationships of the violent person, we should perhaps realize that some kinds of pain that human beings inflict on others can only be understood as spiritual pain — as a pain in the soul, if you will.
Freud’s psychological theories radically challenged the standard medicalized view of neurologists and psychiatrists of his time, who believed talking about a patient’s childhood experiences would no more cure emotional problems than it would to heal tuberculosis, ore set a broken leg. Today we seem to be coming full circle to the pre-Freudian neurology, as we watch many mental health professionals rushing to embrace an even more medicalized view of psychological suffering.
Despite coming full circle, many family therapists embrace a fundamental assumption, perhaps even the central point of their professional existence: to change, heal and restore interpersonal relationships. Ironically, these family therapists might be considered early Freudian’s, for believing that disturbed human interactions cause most psychological problems . anxiety, depression, and psychosomatic symptoms . so called psychotic behavior. And also that healthy, positive human interactions provide the cure. Alas, psychotherapy appears to be losing this debate, as evidenced by trends that have emerged during the recent era in the mental health field.
First came the pharmaceutical companies with their promise of quick cures. Disregarding pernicious side effects, turning us into a nation of drug addicts, calluding with teachers and child psychiatrists to use medications for social control in the classroom and within the family. Then came managed care companies, demonstrating that everything good can be turned into its opposite. They took the concept of brief therapy and used it to prevent access to treatment and to downgrade the profession to the lowest level of pay, where in many cases therapist could make more money cleaning houses than doing psychotherapy. Then came the marriage of managed care companies and pharmaceutical companies — a union which is truly demonic.
Psychiatrist began to avoid the practice of psychotherapy and devoted themselves exclusively to the dispensation of medicine. And psychotherapy was no longer taught to psychiatric residents. The old biological model of causation that Freud encountered arguably now has as much prestige as it did a hundred years ago. Why? Not because of the impeccable scientific research behind it. In fact, there is still no evidence that emotional problems and interpersonal difficulties are the result of brain disease. Medications and the biological view of psychopathology that justifies their use, dominate the discussion again because they serve the interest of two major players in the mental health world — the drug companies, anxious to expand their market for psychotropic drugs, and managed care organizations equally anxious to restrict or even eliminate talk therapy in favor of cheaper and faster chemical behavior modification.
Meanwhile, the power of the Department of Social Services all over the nation grew out of control. Thousands and thousands of children and adolescents were taken out of their homes, allegedly for their own protection, placed in foster homes (usually going from one foster home to another), and getting further and further away from their communities. The least fortunate are placed in institutions far away from their families where they are warehoused for years, bringing enormous profits to the corporations that run these institutions, and that collude with the social workers in denying the existence of relatives, and refusing to help the immediate or the extended families so the children can go home.
From the point of view of the institution, there is no financial gain from restoring these children and adolescents to their families. And there is enormous financial gain from not doing so. From the point of view of the Department of Social Services, it is easier to lock up a child in jail — and that is what these institutions are — than to engage in the difficult work of finding family members and reorganizing them to contain the child. Also, by institutionalizing children the workers can avoid taking any responsibility for the child. The child belongs to the institution. By the same token, the institution avoids taking any responsibility for the child’s institutionalization. It was a referral by the Department of Social Services. The Department of Social Services does not want the child back in their community because the child is violent, or much more frequently because the child was victimized.
So thousands and thousands of children and adolescents in our country grow up locked in warehouses, medicated for social control and without love or family. We must do something about this.
There seems to be a growing number of residential institutions prevalent in our communities. What follows are some examples of a particular residential institution which is considered better than many others in the country, yet what goes on is shocking:
*Eight children were sent to this institution by the Department of Social Services in another state, at the cost of $160,000 per year, per child. The files only minimally mentioned the most immediate family. All the children had been abused, with the exception of one child who simply came from a very poor family. During three years, no arrangement was made for any relative to visit these children. And no social worker visited them even though the law requires it. At the end of three years, for political reasons there was some pressure to return these children to their state. The Department of Social Services however, did not act. One of the therapist’s in the institution decided to try and use this opportunity. He knew that two of the boys had grandparents who cared about them. So he contacted the grandparents to arrange for a home visit with the consent of the Department of Social Services, as the first step in possibly returning them to their family. The boys, who were nine and ten years old, were ecstatic. For two months they counted the days until the visit would take place. Three days before the visit, the therapist received a call from the social worker who said the visit was canceled. She felt it was too risky. The ten year old made a serious suicide attempt and almost died.
*A 16 year old Puerto Rican boy had been institutionalized for two years. His greatest wish was to learn to read, but no effort was made in that direction. He had been living with his old grandmother and father and desperately wanted to go home to take care of his grandmother. One day in despair, he banged his arm so hard, and so many times on the counter of the bathroom, that he broke it. Shortly after, while a counselor tried to restrain him, he broke his other arm. So he had both arms in casts. It was suggested that the staff apologize to the boy for having two broken arms, because the institution is suppose to protect the child from this type of occurrence. Everyone refused to apologize. They had dismissed the counselor, and that was enough. Some therapists even suggested that the boy broke his own arm on purpose to cause trouble. Fortunately, some months later, the grandmother had a heart attack and the boy was allowed to go home, where he stayed and is doing well.
*Lydia was a Hungarian girl who was adopted at age six from an orphanage where she had been placed after she was sexually abused by her father. She was told one day that she was going out for ice cream and found herself on an airplane flying to the United States. She had been adopted. She was not even given a chance to say good-bye to her siblings. She grew up to be a troubled adolescent and the adoptive parents consulted the Department of Social Services and a prestigious university. It was recommended that the adoptive parents should place Lydia in an institution and never have contact with her again. She is now 17 and has been in the institution for two years. She speaks with her adoptive parents almost daily on the phone, but they are not allowed to visit her. It was suggested by a consulting therapist that the adoptive parents be invited to visit and re-evaluate the situation to see if the family could be recruited, or at least if they would support Lydia through college. It was also recommended that contact be made with European Red Cross to locate Lydia’s siblings and possibly plan a trip to Hungary. The consulting therapist was later told to stay away from the case since Lydia’s therapist had consulted with this therapist without permission from her supervisor.
*Tenisha is a girl who had been in the institution for two years after her mother’s boyfriend raped her. He confessed and went to jail, but when released it was suspected that he went back to live at her mother’s house. Tenisha had desperately wanted to go home to an Aunt or to her father — both were interested in her. No attempt at family therapy was made, no visits to the family. Tenisha was finally released to her mother’s house, even thought the presence of the rapist was suspected.
*Lucy had been in the institution for four years because she was raped by her brother. She desperately wanted to go home to her parents. The brother is now engaged to be married, but the Department of Social Services refuses to bring her home even though she is now 16. She might be raped again, and Social Services might be held responsible. Lucy recently made a suicide attempt and is in acute care.
*Kelly at age five turned on a lighter looking for a kitten under a couch and set the house on fire. It was clearly neglect on the part of the parents yet, she was labeled a “fire setter” and placed in a foster home. One day she was alone by a swimming pool, playing with a puppy and she put it in the water to see if it could swim. The puppy drownd and she was labeled an “animal torturer.” Clearly the foster parents had been seriously neglectful by leaving a five year old alone by a swimming pool, but by labeling the child they were exonerated of responsibility. Kelly was placed in the institution where she has been for three years. In the meantime, her mother remarried and has two children who are well taken care of. She wants Kelly back, but the staff thinks Kelly might still be a “fire setter” and “animal torturer.” The mother brought two puppies to prove that when Kelly visits she does not hurt them, but that has not helped. Just recently the mother and her family decided to move to California and desperately wanted to take Kelly with them, but it was refused because they were driving and they would have the puppies in the car. It was decided instead that Kelly would be placed in a foster home and then eventually flown by herself to California. This total madness. Kelly now has to adapt to a strange foster family and then fly by herself across the country, instead of flying the puppies and sending Kelly in the car with the family.
*Charles has been in the institution for four years, even though he has a mother, a father and a grandfather who are interested in him. He came in with a normal IQ which now has gone down by twenty points, so he now has become mentally retarded. He spends his days sleeping. The local director of the Department of Social Services however kept paying the institution $160,000 a year and refused to send Charles home. His therapist realized that Charles’ deterioration was out of control and asked to speak directly with the director of the Department of Social Services to convince her Charles should go home. She began the conversation by asking “what can the family give Charles that the institution can not give him?” “Love” the therapist replied. “Just love.” Of course at the institution they cannot give the children love — they have to keep a professional distance. “The only institution that exists for the sole purpose of providing love is the family.” She began to cry. “You remind me of why I went to social work school” she said.
We must do something to change the lives of the thousands of children who have similar destinies. We need to intervene to protect the human rights of these children. We need to act. Not only at the level of the institution, but at the level of the DSS and the governments of the states.
I do not believe that the therapists, the psychiatrists, the social service workers in the earlier described cases set out deliberately to have the careers they are actually having. I think that as students they were probably as idealistic as any of us. But if we do not set a basic standard for what we will accept in our professional life, it is easy to slip into behaviors and attitudes that are way below what they should be. We need to make decisions that are clear and congruent with our values early on in our careers. And if we have not made them, we must make them now.