The Child Mind BlogBrainstorm

  • The Ravitz Report: Tarnation
    Jan. 18, 2013 Alan Ravitz, MD, MS

    Dr. Alan Ravitz, a child and adolescent psychiatrist at the Child Mind Institute, is an avid movie watcher who has a keen eye for the pleasures and insights to be found in all genres, from action flicks to intimate character studies. Each week Dr. Ravitz will recommend here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

    Now that I've recommended 56 Up, I thought I'd recommend another documentary about a child growing up. This time the child is an occasionally cross-dressing performer/film-maker, and his mother is a schizophrenic. Jonathan Caouette put together home movies, interviews, even answering machine messages to create a film about what it was like to be him growing up. Tarnation (2003) is an incredible testament to what makes all of us just human.

    This one's really hard to describe, so I'm including a link to its trailer.

    Cauette released a follow-up in 2011, Walk Away Renee, about a cross country trip he took with his mother. I liked it, but not as much as Tarnation.


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  • Mood Disorders and Violent Video Games
    Jan. 17, 2013 Caroline Miller

    If you want to read a provocative, insightful piece on violent video games, mental illness, and mass shootings, you'll find it on Kotaku, a gaming site that's part of Gawker Media. The headline tells the story and sets the tone: I'm Mentally Ill, I Love Violent Video Games, and They've Never Made Me Feel Like Killing Anyone. 

    The writer, Dennis Scimeca, is an articulate and startlingly frank gaming writer in his thirties who has bipolar disorder. And it's much more than a defense of the video games he has been a devotee of since childhood (though it is that). It's a close look at how games have interacted with his emotional life, both in the volatile years before he was diagnosed, in his 20s, and after.

    Scimeca figures he suffered from bipolar disorder for more than a decade before he sought, and got, treatment, and he describes video games as one of the most important sources of pleasure and solace for a kid who was bullied and frustrated as a teenager. It's the skills challenge that made them satisfying, he says, noting that it's pretty hard for those of us who doesn't play to understand the appeal of what he calls first person shooters. "I was rubbish at playing sports as a kid, but I'm a pretty good FPS player and I feel a healthy sense of satisfaction when I beat a Halo 4 level at the Legendary (highest) difficulty level."

    Of course he had revenge fantasies—everybody has revenge fantasies, he notes—but he says it wasn't just the fact that he didn't have semi-automatic weapons at his disposal that kept him from becoming Adam Lanza.

    Even if I had been able to get my hands on guns in high school I doubt I'd have used them. I had a family who loved me, and friends who listened to my suicidal rants and slides into depression. These people comforted me.

    Scimeca makes it very clear that it isn't just medication that helped him get control of his illness, but also his family and friends. And he's also clear that the real problem wasn't anger but emotional pain so extreme that he didn't want to "move or talk or even breathe."  Without that support system and attention to his pain, and with access to guns, he imagines that the outcome could have been very different.

    What might have made me a school shooter in some other reality would have been whether I was lonely, or whether anyone was paying any attention to the fact that I was in constant pain, or whether I could have easily laid my hands on a lot of guns, and I'm very glad that in my case none of those things were true.

    In another post last fall Scimeca writes about why it's important to be open about psychiatric problems, and how long it's taken him to be able to be public about his own diagnosis. We appreciate his candor about living with a disorder that is so easliy and frighteningly misunderstood.

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  • Aaron Swartz Suicide: Genius and Depression
    Jan. 14, 2013 Caroline Miller

    The death of Aaron Swartz, the 26-year-old programming prodigy and digital rights activist who committed suicide Friday, was stunning and upsetting. Swartz, who helped invent RSS as a 14-year-old and contributed to the creation of Reddit, was a passionate believer in the principle of open information. He was being prosecuted for allegedly downloading millions of academic papers collected by JSTOR, which sells digital access to scholarly journals, from the MIT archive. Swartz was said to be very upset about the charges, which carried a sentence of up to 35 years in jail and $1 million in fines. He was also said to be struggling with depression.

    Aaron SwartzMashable outlines the controversy over the criminal charges against Swartz, which his family calls “intimidation and prosecutorial overreach,” and some of the tributes offered by tech leaders, including this description of Swartz from a Harvard academic and activist: "A kid genius. A soul, a conscience, the source of a question I have asked myself a million times: What would Aaron think?" 

    What cuts even closer to the quick is the blog Swartz himself wrote in 2007 to describe his experience with the illness and depression that plagued him. I hope you’ll read it.

    Swartz begins by apologizing for not keeping up with his blog, and admits that he’s been ill with several things, including stomach pain and migraine.

    I have a lot of illnesses. I don’t talk about it much, for a variety of reasons. I feel ashamed to have an illness. (It sounds absurd, but there still is an enormous stigma around being sick.) I don’t want to use being ill as an excuse. (Although I sometimes wonder how much more productive I’d be if I wasn’t so sick.)

    And he writes with painful eloquence about being depressed, about the pervasive sadness and the frustration of being unable to feel the joy everyone else seems to feel.

    At best, you tell yourself that your thinking is irrational, that it is simply a mood disorder, that you should get on with your life. But sometimes that is worse. You feel as if streaks of pain are running through your head, you thrash your body, you search for some escape but find none. And this is one of the more moderate forms.

    There’s more. But he comes back, in the end, to stigma, citing an economist who notes that depression, which affects 1 in 6 people, is the greatest impediment to happiness today:

    Sadly, depression (like other mental illnesses, especially addiction) is not seen as “real” enough to deserve the investment and awareness of conditions like breast cancer (1 in 8) or AIDS (1 in 150). And there is, of course, the shame.

    Swartz’s suicide is another reminder that genius is often no match for depression, and that the shame that inhibits both treatment and research can rob us all of great potential.

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  • CMI Proudly Joins Vice-President in Addressing Gun Violence
    Jan. 11, 2013 Harry Kimball

    This week, Child Mind Institute president Dr. Harold Koplewicz was in Washington, DC, as a part of what he called an "amazing group" of mental health professionals presenting to the Vice President's Commission on Gun Violence. The wide-ranging scope of Vice-President Biden's inquiry into this problem, from public education to increased access to mental health care, fits very well with the Child Mind Institute's mission, and we are thrilled that he and the President have taken leadership in this critical area. We're also proud to be able to work with so many other committed organizations and applaud the efforts of everyone involved.

    Only time will tell, but out of the unspeakable tragedy in Newtown, Connecticut, we are seeing some growing glimmers of hope and a sense of momentum that might just make this a better world for our childeren and children everywhere. You can read more about the Washington, DC meeting here.

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  • The Ravitz Report: 56 Up
    Jan. 11, 2013 Alan Ravitz, MD, MS

    Dr. Alan Ravitz, a child and adolescent psychiatrist at the Child Mind Institute, is an avid movie watcher who has a keen eye for the pleasures and insights to be found in all genres, from action flicks to intimate character studies. Each week Dr. Ravitz will recommend here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

    There's really only one choice for this week, 56 Up. It's at the IFC right now. This is the eighth film in a series that began in 1964, when 14 children were chosen to be followed prospectively from youth through old age, on the assumption that what happens in the first seven years of life predicts what will happen subsequently. Every seven years another documentary is released that addresses what has happened to each of the children. Most have participated with the films over the years, although a couple have dropped out, or have only participated intermittently. Michael Apted, a prolific director of commercial films (e.g. Coal Miner's Daughter, or a recent RR pick, Chasing Mavericks) directed the second through the seventh episodes. In this, the eighth, he is more of a participant. Although each film briefly summarizes what happened in the previous documentaries, after you see this one, you may be tempted to watch all the others. They are available as instant downloads from Netflix, except for Seven-plus-Seven (14-Up).

    This is quite an amazing series. Some people turn out exactly as one might have predicted, but there are also some surprises. Watching 56 Up induces predictive humility. 


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  • Finding a Better Way to Prevent Teen Suicide
    Jan. 10, 2013 Harry Kimball

    A new study out of Harvard on teen suicide makes a sobering observation: 55% of people 13 to 18 who plan or attempt suicide have had some contact with the mental health care system. Which means it's not just kids who are not getting attention who are suicidal. It's easy to draw a disturbing conclusion—that there is nothing we can do for some of these kids.

    But Dr. David Brent from the University of Pittsburgh sees it differently. "One of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide," he tells the New York Times. In other words, what the study really tells us is that we need to look for better ways to help adolescents in distress and leverage the tools we already have by taking a holistic approach.

    We do have good treatments for the depression that can lead to suicidal behavior—but we are not always successful at delivering them, particularly to adolescents. At the Child Mind Institute we often get questions from parents frustrated by children who refuse or neglect treatment for a variety of psychiatric disorders, including depression. Antidepressant medication alone isn't always enough; studies show that the best treatment is a combination of antidepressant medication and behavioral therapy that can be very important in helping kids recognize and redirect their very negative thoughts and feelings.

    The study also highlights a very important point: that kids most at risk for suicide are those who are not only depressed but impulsive, so depression combined with ADHD or substance abuse or explosive behavior is a potentially more toxic situation.

    But it's also the case that adolescents, even as they are more emotionally labile than any other period of development, are in the process of separating from parents, which can make them disturbingly elusive. 

    The Times speaks to a mother who lost her daughter to suicide, who was being treated for depression. "I think there might have been some carelessness in the way the treatment was done, Margaret McConnell says. "And I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn't taking it regularly."

    Knowing what's really going on with a teenager who's seeking independence can be one of the most difficult challenges of parenting. The Times story ends on that note : "Ms. McConnell said that her daughter's depression had seemed mild and that there was no warning that she would take her life. 

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  • Fearless Friends and Canine Companions
    Jan. 4, 2013 Harry Kimball

    We like to think that there is always a little bit of magic going on at the Child Mind Institute, but today was something else. It was the last day of our Fearless Friends program for kids with obsessive-compulsive disorder and specific phobias, and Dr. Jerry Bubrick, who runs it, had told me that a therapy dog would be in the office. At about 11 am I got an email from his iPhone. "Come now to Jenna's desk!!!"

    JezebelThere I met Jezebel, or Jezzie, who was calmly passing the time with two Fearless Friends, a boy and a girl, and eating cucumber slices for some reason. In the course of just a few minutes the girl, who was quite afraid of dogs, pet Jezzie "on her back and on all four legs," as she put it. I think she got the nose, because she said it was "really wet." Oh, and the real prize: "I found her tickle spot."

    Throughout all of this Jerry and his colleagues Dr. Jamie Howard and Dr. Rachel Busman gently guided the interaction, which of course was a clever and delightful bit of exposure therapy. But it was the little boy who truly grabbed my attention. (Jamie told me later that his issue with the texture of cucumbers explained that odd detail.) At one point when the young lady was petting Jezzie, he asked, "Did you let her lick you yet?" No was the answer. "I wonder when you will," he said.

    In case the point is lost, these children were in the care of smart, caring adults, but they had also been taught to support each other. And that says a lot about programs like Fearless Friends and Brave Buddies in particular, and about the Child Mind Institute as a whole. I won't even mention the other therapy dog, Safronelle, that mysteriously appeared, or the visitor who said the atmosphere today was like Google headquarters. I'll close with what the boy whispered to the girl as I walked away; Jamie told me later. "If she sticks her tongue out, she's just yawning," he soothed her. "Don't worry."

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  • The Wrong Response to the Newtown Shootings
    Jan. 4, 2013 Caroline Miller

    The last couple of weeks have been especially painful for people with autism and the people who love them. We've heard from a number of parents that their kids with autism have been the targets of hostility—in person and online—ever since speculation that Adam Lanza had autism hit the media.

    Joslyn Grey writes on Babble about some of the more hateful initiatives out there to link autism to the shooting. Notes Grey, who has two kids with Asperger's, "The worst thing my kids are going to do to you, on the other hand, is entangle you in a detailed discussion of the similarities between Lord Vader and Lord Voldemort."

    There's a kind of awful confusion at the heart of this anti-autism campaign: that the kind of cold-blooded resolve of a young man who kills children and their teachers is connected to the lack of affect many people with autism display. People with autism may have difficulty reading social cues from other people, and responding accordingly, but that doesn't mean they lack empathy. And the kind of explosiveness kids with autism may display when they are frustrated or overwhelmed has nothing in common with premeditated murder. It is, in fact, most often directed at themselves.

    What is true is that mental illness, especially when it's untreated or misunderstood, can result in isolation, frustration, misery and psychosis, and the way to prevent that is to make  it possible for people to be more open about needing and seeking treatment.

    The worst possible outcome of this tragedy would be making parents feel less free to discuss the worries they have about a child for fear that the child will be branded a potential Adam Lanza.

    Let the final word go to the many, many autism parents sharing sweet photos of their kids on Autism Shines, to help dispel the misunderstanding that autism explains this killer's behavior. These kids don't deserve it.

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  • The Ravitz Report: The White Ribbon
    Jan. 4, 2013 Alan Ravitz, MD, MS

    Dr. Alan Ravitz, a child and adolescent psychiatrist at the Child Mind Institute, is an avid movie watcher who has a keen eye for the pleasures and insights to be found in all genres, from action flicks to intimate character studies. Each week Dr. Ravitz will recommend here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

    Still thinking about Amour. It's growing on me. That's always a good sign. Michael Haneke is a great director. My favorite of his films is The White Ribbon, which takes place in a small German village just before World War I. A whole bunch of very bad things happen—people die; children are abused. What does this say about the character of the people (especially the children) who live in this town? And what do these events foreshadow. This movie is intense and very moving. It's horrifying, but in a very indirect sort of way.

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  • Lady Gaga Now Providing Free Therapy to Fans
    Dec. 31, 2012 Rachel Ehmke

    Lady Gaga keeps surprising us by finding new ways to reach out to kids who are struggling. She's has become a kind of pop spokesperson for the importance of discussing—and treating—mental health issues. Now the singer has announced a new plan to provide free counseling before concerts on her current tour. The counseling will take place on the tour's Born Brave Bus and will be part of a tailgating experience that includes food, games, and DJs.

    Okay, mental health care in such a festive atmosphere seems a little incongruous, but Gaga specializes in defying expectations. On her Twitter account she explained, "I feel like most kids don't look for help because they feel embarrassed so mom + I wanted to break the stigmas around 'help' and make it fun." She also wrote, "BornBrave Bus is a place where mental health + depression are taken seriously w/ no judgment, FREE real help available to all."

    No way to know whether kids will take her up on her offer, but Gaga (who is only facilitating the sessions) says fans can expect "professional private or group chats about mental health, depression, bullying, school & friends."

    Given how intimidating it can be to admit you need help for mental health issues, and how often stigma prevents or delays people from seeking treatment, we can't help but applaud. By extending her heartfelt support and resources to fans Lady Gaga is trying to make that first step easier. Sometimes just saying  how you feel out loud can be an important beginning.

    In the past Gaga has also spoken out about her own struggles with eating disorders and started a campaign against bullying.

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