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Article of Interest - Mental Illness

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Bridges4Kids LogoHow Many Did I Overlook? The Transformation of a School Psychologist
by Sharon Moxley
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During my first ten years as a school psychologist, I was not aware of the neurobiological nature of mental illness. I had no inkling that many of the students that I saw had the symptoms of what we now are beginning to understand as diseases of the brain. I variously labeled these students seriously emotionally disturbed (SED), conduct disordered, and out of touch with their feelings. That many of these children might be suffering from the initial stages of major mental illnesses rarely occurred to me.

After my initial evaluation of the students, I usually called in their parents and, in a self righteous state of ignorance, implied that they were the cause of their child's problem. I then sent them packing to family therapists to help them straighten out their "mixed messages" and "double binds." That was "state of the art" not too many years ago.

I was able to function in this judgmental and confusing manner because my training as a school psychologist had taught me to place most of the blame for the child's problems on the poor bewildered parents. This often overwhelmed them with guilt and most certainly exacerbated the pain.

Then it happened mental illness hit my family! My child suddenly became very ill. Now I was the one whom the professionals indicted. In a deplorable and shocking role reversal, I now held myself as the guilty parent. It seemed like some sinister cosmic joke. After all, I was an informed child psychologist and I certainly knew how to raise this emotionally healthy child whom I loved. I was the expert. How could this happen?

The terrible reality played itself out. Filled with guilt and shame, I walked through hospital halls while the staff watched in silent judgment, their faces stiff and unyielding, a jury who had just delivered its awful verdict. Occasionally they broke their silence to tell me that I "had never set limits for my child." Once they proclaimed that I was "only interested in power." Never mind that I kept telling them these gruesome charges were untrue they didn't seem to listen. But their stony faces silently screamed, "Guilty!"

Given that the "professionals" had no ability to realistically evaluate me as a parent, it was little wonder that they could not treat my child effectively. I began to seriously wonder if they really understood mental illness at all, not to mention the correct treatment for it.

After my initial period of shock and anguish, I began a desperate crash course in understanding mental illness. Since I was a psychologist, I naturally started with the "literature of the field" that I soon discovered reflected all of the outdated theories I had been taught in graduate school.

After my initial period of shock and anguish, I began a desperate crash course in understanding mental illness. Since I was a psychologist, I naturally started with the "literature of the field" that I soon discovered reflected al of the outdated theories I had been taught in graduate school. There were no answers for me in those volumes. Now that I was reading the theories from the perspective of a caring parent, I began to have new insights into the basic flaws in the thinking of the "experts".

These books insisted that parents caused mental illness. Although I had doubts about myself as a parent, I knew somewhere deep inside that I was not a bad parent who had emotionally damaged her child; certainly not the kind of parent that would cause a catastrophic illness. But, if I were not the culprit, what was the cause? And, more importantly, what was the effective treatment? And who was out there delivering it?

My pain and agony spurred a frantic search. I haunted libraries. I sent away for books. I carried books with me almost everywhere. Even when going to friends houses for dinner I brought my books and glanced at them for short moments between conversations. Then finally, after months of research, I stumbled upon the biological theories, at the time kept virtually in the shadows, and I was absolutely overjoyed. I now had external confirmation of what I had already intuited. The illness was not in the parent or the environment. The illness was in the brain. I also discovered that there was often a strong genetic component in these diseases.

Now my search was more focused. I began to examine my own genetic history. It was not long until I realized that I had at last solved the mystery about my family. All my life I had wondered what was wrong with my family? Why were so many of them unpredictable, moody and depressed? This confusion and pain had actually been highly instrumental in my becoming a psychologist. And now, here it was, the answer to the riddle of my family's "curse". My family had depression and manic depressive disorder!

In light of this information, I now clearly understood the puzzling behaviors of my favorite aunt an unusually shy recluse who had sudden episodes of terrible belligerence and unexplained periods of absence, when she went off hitchhiking, abandoning her worldly possessions. I learned that she displayed some of symptoms of bipolar disorder. Then there was my uncle who had significant depressions times when he didn't leave the house for weeks, or wash, or get out of bed. And at least one relative who killed herself, and a young cousin who attempted a bizarre suicide pact with another boy resulting in the death of the other child. As I continued my evaluation, so many pieces of the family puzzle began to fit together. So many mysteries could suddenly be attributed to victimization by a terrible brain disease.
The other side of this dark past was creativity and intelligence. My family had talent in art, music and writing. Their wit and sharp sense of humor was their hallmark, sometimes still evident even during depressions.

It was so painful to me to see their talents and abilities lost. For generations, mental illness, unrecognized and untreated, had robbed my family of lifetimes of their wonderful gifts. Then, I thought about myself, and I realized that I had not escaped. Looking back on my own life, I saw a teenager who suffered significant depression, again without recognition and treatment. If only I had been identified as having a biological illness when I was in my teens, with the appropriate treatment, I might have avoided the ravages of the major depression I had experienced as an adult. Fortunately, my nondepressed periods were long enough to allow me to complete my education and engage in a successful professional career. (In 1990 1 was awarded an "Outstanding Psychologist Award" by
the California Association of School Psychologists.)

After successfully dealing with mental illness on the home front, ( my child improved significantly, thanks to lithium) I was transformed as a school psychologist. I realized that many of the students that I had seen in my career had symptoms indicative of early signs of mental illness. The statistics on mental illness indicate that one percent of children in school would, at sometime in their lives, have schizophrenia, and one to two percent would have bipolar disorder, with even more experiencing major depression. That meant that, on the average, two or more children in each class of 30 students could be expected to develop major mental illness, possibly in childhood and even more likely, in the teen years.

I am now a biological school psychologist and one of the most important things that I ask a parent is, "What is the genetic family history?"

Even more alarming, the statistics also indicated that one student in five would be disabled by some type of mental illness at least once in their lives. This meant that, statistically, twenty percent of the class was at risk!

Armed with this knowledge, I realized that to me mental illness had always seemed to be an adult disease. I didn't quite make the connection with the young students whom I saw daily and adults with mental illness. But it was these children, I finally realized, that were the future adult sufferers of schizophrenia and bipolar disorder. What if they could be identified early, and helped? Was anybody researching that?

They were my students. They were in regular classes, and gifted programs, and special education classes. They were honor students, they were children with learning and behavior problems. They were the hope of the future. They were in school. And it was in school that many people with schizophrenia and bipolar disorder had first manifested their symptoms. I cringed as I realized that I had often been their school psychologist! Had I overlooked them? Were their emerging symptoms right there in front of me?

How many times did I look right past the clues in their school records? "John seems to tune out in class" "Carol has difficulty making friends, and seems withdrawn." Sometimes there were very discernible patterns suggesting early bipolar symptoms: Excellent academic performance and good classroom behavior interspersed with weeks or months of poor grades, withdrawal, or frequent altercations with others. It's shocking to remember that I always assumed that these changes in mood and behavior were exclusively the results of a program, therapy or changes in the home.

Looking back, I now know that I missed recognition of students with neurobiological disorders because of my professional training, which taught me so little about mental illness. My training was heavily analytic and I was very much a disciple of Freud. Through this education, my eyes were trained to evaluate the parent's behavior more than the child's symptoms. Too often my job was to designate blame.

And what kind of a school psychologist am I now? Now that I have been jolted and shaken out of the 19th century by the unbelievable pain and agony of mental illness? I am now a biological school psychologist and one of the most important things that I ask a parent is, "What is the genetic family history?" "Has anyone in your family, including grandparents, great grandparents, aunts, uncles, cousins had a breakdown, experienced depression or other mental illness?"

In my experience, parents of the children who are having depression and certain behavioral difficulties tell me, at least 80% of the time, that there is a strong genetic family history of mental illness. When I have knowledge about genetic family history, the student's symptoms are more easily and accurately interpreted. For example, if the student, who reports previous symptoms of depression, is having symptoms that look like attention deficit hyperactivity disorder (ADHD) and the parents tell me that there is no genetic family history of ADHD, but that the grandmother and the father have manic depression, I would refer the student to a biological psychiatrist who specializes in depression and manic depression. Without the family history I would be more likely to refer the child to the family pediatrician only. The decision to refer the student to a psychiatrist, as well as the family physician, could make all the difference in getting the proper diagnosis and early treatment, not to mention saving the family and the child years of suffering and wasted dollars.

In my family, the glaring clue was our family history. I was carrying the genes of my family, and my life from early adolescence had been marked by those genes. The same genes have been transferred to my offspring and undoubtedly they will be passed on to my grandchildren and great grandchildren. The big difference now, for my family and hopefully for the children that I evaluate in school, is that their genetic family history can help detect the early signs of mental illness. Now I can refer children that I suspect have a biological illness to professionals in the community who have a biological orientation rather than a professional who treats the "worried well". These children may then be appropriately treated in the early stages of the illness. Early intervention, we know, can help children avoid the social and academic failures , the hospitalizations and indignities of the "system". Instead, these children can have the best chance to fully live their lives. In my family, and the families I see as a school psychologist, our children's gifts do not
have to be wasted.

This article was first published in 1995. Sharon Moxley is a parent, a licensed educational psychologist and past co-president of the Sonoma County Alliance for the Mentally Ill.


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