Tuesday, June 02, 2009

When Mental Health Goes Wrong

Gentlemen, I submit that psychology & psychotherapy has officially slipped off its chump.

Please review the following:

Title of Workshop: "Infant Mental Health 101"

WORKSHOP OVERVIEW: Ways to develop proficiency in the treatment of young children will be discussed. You will also receive exposure to evidenced based practices for children ages 0-5 and the principles of Infant-Parent Psychotherapy.

TARGET AUDIENCE: Clinical staff who work with children ages 0-5.

DATE: Thursday, June 11, 2009.

TIME: 10:00 AM to 12 Noon.

This ranks right up there with animal therapy, paranormal investigation, and Schrodinger’s cat as far as snake oil remedies that you can’t necessarily prove nor disprove.

What exactly constitutes “infant mental health,” if not solely neuropsychology and developmental psych? I’ve been around my share of 0-5 yr olds, and I can tell you that to conduct mental health services with them, to the extent that I understand it, would be pretty damn difficult to diagnose, let alone treat.

For example, let’s take any 0-5 yr old child that you can think of. Now, answer these questions at home, while I answer them for my own example:

- Does the client exhibit disorganized speech? (Yes.)
- Does the client exhibit disorganized behavior? (Yes.)
- Does the client’s behavior appear 1) goal-directed or 2) marked by a maladaptive level of impulsivity or spontaneity? (Number 2.)
- Is the client oriented to person, place, time, situation? (Marginally; client able to differentiate between mother & father w/ approx 30% accuracy, but displays significant gender confusion; poorly oriented to place/location; poorly oriented to date, time, day, year; minimal ability to identify situations/events.)
- Does the client display affective lability, i.e. free & uncontrolled mood expression? (Yes.)
- Does the client display effective reality testing of their environment? (No; client talks to self, exhibits spontaneous speech indicative of response to internal stimuli, indicating possible presence of auditory hallucinations.)
- Describe client’s level of attention & concentration. (Client displays high distractibility to minimal environmental cues.)
- Describe client’s level of recall & fund of knowledge. (Client has moderate level of short-term recall success, poor remote recall; client exhibits age-appropriate level of intellect, pending results of further testing.)
- Describe client’s presenting level of thought process & content. (Client exhibits multifaceted delusional beliefs, including grandiosity on a major scale, w/ ideas of reference – speaks to the television as if it is speaking to them; appears to have occasional intrusive thoughts that result in uncomfortable emotional reactions.)

Okay, what we’ve described here is no longer an infant, but a chronic and severely mentally ill person, clinically referred to in the field as “pretty fucked up.”

What treatment is there to recommend for this at-risk population? Individual therapy? We’ve established that this client’s fund of knowledge and ability to express and process information is highly impaired. Group therapy? The self-centered quality of this client’s functioning might preclude this approach from being successful. How about a structured day group program? Y’know, like a “day care?” That could work. Then, there’s always the tried-and-true use of play therapy; that might be successful, since these clients, pretty fucked up as they may be, do like them some playing.

So, the treatment plan is as follows:

Barring any glaring developmental or neurological deficits, the best treatment approach for these fucked up little clients, ages 0-5, is to put them in day care, where they can play with other fucked up little clients.

And this is what the department of mental health spends money on, in these Harsh Economic TimesTM.

1 comment:

Rev. Joshua said...

I should have replied to this sooner, but I found the concept of children as paranoid-schizophrenics to be wildly hilarious. Specifically "exhibits spontaneous speech indicative of response to internal stimuli, indicating possible presence of auditory hallucinations" and "grandiosity on a major scale, w/ ideas of reference – speaks to the television as if it is speaking to them." Children are our future? Oh shit.