Suffer the Little Children


It is hard to see a child in pain.

I have seen quite a few children in the emergency departments of South Carolina in the past three years, more than I could have imagined just a while ago.

Now, in the interest of full disclosure, I am not a child psychiatrist by trade. Like any general psychiatrist, my training at the Medical College of Georgia Department of Psychiatry and Health Behavior, now at Georgia Regents University, provided me with didactic and clinical training in a variety of sub-specialties in my field, including affective disorders, substance abuse, and the disorders that children may suffer from. Most hospitals that I work in now, desperate for help with children who come in sick and in need of assistance, grant me and others like me privileges to evaluate these kids, simply because they do not have any other choice. There are very few trained child psychiatrists in the United States per capita, and they can pretty much command their price and practice where and how they wish.

That being said, I have been scrambling in the past three and a half years to find my sea legs and get into the rhythm of seeing children and their families in emergency departments and in the clinics of my own home mental health center. It is a different rhythm all together, rewarding when done right but extremely taxing and challenging and physically and emotionally exhausting at times.

In the ED, children come in for various reasons including depression and anxiety, acting out in school, danger to themselves (yes, I have seen children as young as four years old who were actively suicidal and had a specific potentially lethal plan to kill themselves), and for the aftermath of sexual or physical abuse or the effects of other trauma that they have lived through. Witness the recent graphic pictures of children being pulled from the rubble of a school monstrously devastated by a killer 200 mph tornado.

Before I go any further, let me make one thing abundantly clear. Children are resilient. Wonderfully and fearfully resilient. I think this is why we still exist as a species today.

One of the things that bothers me tremendously about seeing kids in the EDs and clinics today is the fact that parents have lost their way. Yes, I am now turning this post about children on its head and speaking about their parents. Indulge me, please.

Parents bring their children in for evaluation, sometimes as young as two years old-two years old, mind you!- because the nursery school can’t handle their outbursts towards other toddlers. Elementary schools tell parents that their child will not be admitted back into the classroom “until you see a psychiatrist and get him put on some medication to control him”. Some children are refusing to get out of bed in the morning, refusing to get dressed and go to school, causing their parents great anxiety because “I just can’t make him do anything”. Some parents are resorting to the old taking away of privileges tactic, retrieving in-bedroom game consoles, televisions, computers, and even smartphones.

Wait. Stop. Hold on.

These parents tell me that their children are out of control, that they need to be medicated, that they “are ADHD and bipolar”, that they are SICK, when actually they are suffering from one thing and one thing only.

A profound lack of discipline in the home and at school.

Parents do not feel that they make the rules any more. There can be no house rules. There can be no punishments, behavioral or corporal or otherwise, because Little Johnny has the Department of Social Services on speed dial on his $600 iPhone and will call them if his parents lift a finger to keep order in their own home.

Teachers are hamstrung, overwhelmed by sheer numbers of children in their classrooms and piles of lesson plans and paperwork designed to leave no child behind, all the while leaving good teachers behind who can no longer stomach the profession they once loved.

My friends, I see a lot of kids in the EDs of South Carolina these days. Granted, some of them need real psychiatric help. Some of them are severely depressed. Some of them have been sexually and physically and emotionally traumatized beyond your wildest imaginings. Some of them truly hear voices and see dead people. I see these kids and I evaluate them and I recommend the treatments they need.

Others are victims, yes, I said victims, of a system that has lost its way. A system that no longer lets parents be parents and set the rules in their household that lead to a healthy, happy functional family. A system that has taken away control of the classroom from the teachers and placed it in the hands of bureaucratic suits who have never had chalk dust on their hands, much less come up with creative ways to engage a classroom of seven year olds for a day. A system that tells us that little children are ill, sick, infested with the seeds of diseases and syndromes like Intermittent Explosive Disorder, when in fact, they are having tantrums and need to be disciplined by strong parents who love them.

I am appalled dear readers, absolutely appalled, that in this age of technology and enlightenment we are too stupid, too afraid or too threatened to call normal behavior by its rightful name and deal with it. I am appalled that we are trying to turn normal, sometimes troubled children who have briefly lost their way into psychiatric patients with diagnoses that will follow them for the rest of their lives.

I fear for our own sanity and wellbeing, and that of our children and grandchildren, if we do not start to , as Vernon Howard said, “Learn to see things as they really are, not as we imagine they are”.

13 thoughts on “Suffer the Little Children

  1. Greg,

    Man oh man, you have it the old proverbial nail directly on the head! Thank you for some HONEST to God, straight forward, no holding back, pure old common sense TRUTH! When I try to think back on our childhood, knowing the discipline we were taught, I can’t help but wonder, “What happened? Where did society begin this downward spiral toward self-inflicted doom? When did the concept of ‘self & selfishness’ become paramount in our world?” One of my last memories as a neonatal nurse is of a 16-year old, already with a 2-year old at home, now sporting twins…preemies at that. The hospital policy was to confirm the home situation for the care of said twins…requiring monitors, meds, breathing tx…you know the drill. But when the home was inspected, said 16-year old comes flying in the unit, whining “it’s not fair. It’s just not fair. I can take my babies where I want & when I want. You can’t have us checked out like that!” Now my first thought was, “don’t you want to make sure you have everything you need? That you will be ABLE to care for these little guys?” But then my own emotions got the best of me. Because I was never able to have kids of my own, I wanted to scream out, “what’s not fair chick is that you are 16, already have THREE children, and I will never have one. THAT’S what’s not fair!” Of course I didn’t. 😉 Another nurse took over for me so I could run to the nurses lounge & scream my frustrations! Well, maybe not scream…vent! This young generation has NOT been taught well. They haven’t been taught at all (as a whole…there are exceptions). Most have learned the nasty, ugly word “entitlement” & feel they DESERVE just whatever they want. And handed over to them on a silver platter at that. My first lesson in this reality was with that 16-year old. My last day to work in the unit wasn’t long after that lesson! I just couldn’t stomach it anymore!

    Good post, friend!



  2. I get your larger point but there are many levels and modalities of treatment between “normal” behavior that can be handled at home and behavior that needs to be handled in the emergency room. Most child and adolescent mental health issues are not addressed in the emergency room. But that doesn’t mean they aren’t real problems. About 20% of children and adolescents have clinically significant mental health disorders. A small fraction of those kids actually get treatment. Now,, this is a different issue from misdiagnosis. For example, people seem to be throwing out bipolar disorder for kids, like it’s candy. It’s a real thing but it’s rare and needs a lot of specialty training to diagnose correctly. Finally, removing privileges is a discipline strategy and within the context of a discipline plan can be effective with the right kids.


  3. Maria,

    I’m sorry that my writing is making you work so hard. Pace yourself. 🙂
    Thanks for the thoughtful comment as always. Once again, I agree with you, which is not surprising for this topic.



  4. Eyes

    You’re right of course that most childhood mental health problems do NOT present to the ED, thank goodness. It just seems to me that a disproportionate number of the ones that DO get there are these cases of dyscontrol, dis-empowerment of parents (often self-imposed) and manufactured severity. Bipolar disorder and ADHD are two of the diagnoses du jour that are indeed handed out, sometimes indiscriminately. Thanks for your comments and reading, as always.


  5. I appreciate your thoughtful reply. It’s hard to be a parent. Parenting challenging kids is my professional specialty and I coincidentally have a really challenging kid. I believe it’s even harder to be a kid these days. Parents have to be incredibly active to be effective with their kids these days. Not everyone is up to the task but most people have children anyway. It is really hard to fight off the lust for electronics as well as our media that is saturated with horrible lessons for children and youth. I understand why some parents give up and let the electronic crack baby sit their kids. I obviously don’t condone it and agree that they are woefully failing in carrying out their parenting responsibilities. But there’s no simple solution to the problem as much as I wish there were. I would happily lose all of my business in behavior problems, really I would.

    As for ADHD, misdiagnosis is a problem as is overdiagnosis in some regions of the country. But imagine my surprise when delving into the epidemiological literature that nationally, it is actually under-diagnosed. You could have knocked me over with a feather.


  6. Greg,

    You’ve just been focused on topics of late that I am either very passionate about, can fully relate to, or just have a definite opinion about. See, this is what happens when you take a little break from writing…you come back with a vengeance!! Because Greg, you really have! It has given me a venue for venting! 😉 I was going to apologize to you for my ad nauseam responses!!

    I’ll catch my breath now…no worries! ;D



  7. Eyes,

    Thank you for this excellent input. I agree wholeheartedly that both being parents and kids is much harder today.

    I think that like a lot mental health professionals I see a very skewed population of kids and adults. In this group, it seems that psychiatric diagnoses are handed out way too easily. So, it greatly surprises me too if an ailment like ADD is actually under diagnosed in some areas. Interesting.



  8. I agree. There’s a psych hospital near us that takes teens. Every time a kid goes there, they come back with a diagnosis of bipolar disorder and a scrip for mood stabilizers. And they don’t contact the kid’s psychologist, either for input. And that was even true when I sent them a release and followed up with a phone call. I complained and I never refer kids there but there are so few beds for minors that kids can end up there anyway.


  9. Exactly. It’s very frustrating. Almost like they just look for the path of least resistance diagnostically and go with it. I just think we don’t have enough time to really evaluate anybody anymore. Everything is rushed, hurried and capped.


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