Direction Behavioral Health Associates, LLC

A Case Against "Locking Up the Sharps"

Tue, 02 Nov 2021 17:15:00 GMT

"Should I Lock Up The Sharps?"

Given what we know about Sarah, it sounds like the cutting has been superficial, and she likely falls into the first category. But keep both those categories in mind, as I’ll return to them later.

Let’s say mom decides to go with the “lock-up-the-sharps” approach. She takes all the knives from the silverware drawer, the scissors from the desk in the office, and the shaving razors out of the bathroom. She puts them into a cabinet and locks it up. She only gives them to Sarah when she can supervise their use, and then promptly locks them up afterward again. Let’s also assume, for the sake of argument, that Sarah isn’t a great lockpick. She can’t use those sharp objects to cut herself again.

Less access to sharps equals less chance of cutting again, so the thinking goes. Pretty simple and straightforward. But there are a few problems with this conventional advice that I'd like to raise.

What about securing medications, firearms, and more?

Before we get too far, it's important to make a distinction between "locking up the sharps," and securing firearms and medications. These are two (fairly) common household items that parents also ask me about.

Securing medication in the homes of struggling teens is a different story, and I believe it has to be done . Medications are used for only two things: medical treatment, and intentional overdose. Medical treatment needs to be supervised by parent. Impulsive overdose, in my experience, is much more dangerous than impulsive cutting. And, I would hope I wouldn’t have to say this, but firearms should always be locked up .

A Few Potential Problems With "Locking Up The Sharps"

Now let’s look at some of the problems with the “lock-up-the-sharps” approach, which may not be so obvious:

It’s hard to lock up all of the sharp items at home.

Things that are sharp are everywhere in our daily lives, often hiding in plain sight. It's not just the obvious dangers like knives and razors; there are countless other sharp objects lurking around us. Consider pencils with freshly sharpened points, shards of glass from broken bottles, jagged edges of tin from broken cans, and the fine tips of pins that can easily prick the skin.

With so many potential hazards, it becomes a nearly impossible task to keep all of these sharp items out of someone like Sarah's hands, as they seem to be a constant presence in her environment. Each day presents new challenges in preventing accidents and ensuring her safety amidst this array of sharp objects.

It may set up (or worsen) a power struggle.

Many teenagers – and maybe Sarah is one of them -- like to fight. It’s part of what teenagers do. One can easily imagine the following scenario: mom locks up the sharps; Sarah brings home broken glass she found on the street; mom takes broken glass; Sarah brings in razor blade from pencil sharpener at school; mom takes razor blade; Sarah smuggles in scissors and hides them under her bed; mom starts conducting regular room searches; and so on.

The power struggle between Sarah and her mom isn’t just a pain in the butt. It’s going to get in the way of their relationship . It’s going to negatively impact the chance of any kind of cooperative effort to solve whatever the real because the two are getting distracted by a sharps war.

It gives the message that he/she can’t control their own actions.

Locking away sharps is essentially telling Sarah that she is incapable of managing her own behavior. Worse, it suggests to her that keeping from cutting is her mother’s responsibility, not her own. Sarah may tell her therapist later on that her recent cuts are mom’s fault because mom didn’t do a good enough job keeping her away from sharps. (That’s actually one I’ve heard before.) The message mom is inadvertently giving Sarah is that Sarah is too depressed, too anxious, too angry, too defiant, or otherwise incapable of managing her own behavior. Thus, mom needs to do it for her. This is a very common message that I see parents giving kids these days, and it is a big problem. You’ll see me refer to it in other posts.

In a way, in locking up sharps, Sarah’s mom is taking a shortcut. Whatever mom gains in terms of short-term reassurance, she may lose in terms of hindering Sarah’s long-term development, learning to do things for herself, individuation from her mother, and pursuit of independence. In other words, growing up. And though a single act such as locking up sharps may not be that big of a deal for Sarah’s development by itself, it’s usually part of a larger pattern of “interventionist parenting”. It’s the pattern that can be so problematic – and even damaging -- to Sarah’s development.

Locking up sharps at home gives a false sense of security.

This is the biggest problem of all.

Let’s say Sarah isn’t in the superficial cutting category, but actually trying to seriously injure or kill herself. Keeping her home and “locking up the sharps” is a particularly bad idea because mom feels reassured that Sarah is somehow safe because the knives and scissors are hidden away. It won’t take Sarah much creativity to think of another way to hurt herself, or worse.

If Sarah’s mom thinks that Sarah is suicidal, hell-bent on injuring herself, or otherwise “can’t control herself,” she needs to get Sarah to the Emergency Room ASAP. Why fool around? Mom can’t keep Sarah away from all sharps (or other means of hurting herself) at home, but the hospital certainly can. It’s what inpatient units are designed to do. In this instance, locking up the sharps is a half-measure that may be worse than doing nothing at all.

So will locking up the sharps protect Sarah, or your teen, from cutting themself again? I don’t know. But I think it’s important to consider the potential risks of both leaving sharps out as well as trying to lock them away.

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Reach out today to start the conversation. Together, we can create a path forward.

Psychosis: An Open Letter to Hollywood Producers

Tue, 19 Oct 2021 16:08:00 GMT

Dear Hollywood Producers: Your depiction of mental illness is pretty terrible.

I am writing to offer my services as a psychiatrist with nearly 20 years of experience working with both adults and kids. I think, hired as a consultant, I would be able to help you improve the quality of your movies and shows. I furthermore believe that your increased revenue from a better product (which I can help produce) will more than pay for my services. My rates are quite reasonable.

To be fair, I’m not a film buff, and haven’t seen all the movies and shows. And there are a few psychiatric disorders that some actors have done extremely well. But you really, really need help with the vast majority of conditions. Can’t we have one – just one – movie that accurately portrays bipolar disorder? Or depression? Or schizophrenia?

It doesn’t have to be a main character, nor the focus of the story. A realistic portrayal would not only make for a more powerful film, but it would also be a step toward dispelling some of the myths about mental illness and misconceptions of the general public. Now that would be a truly worthy cause!

To give you a head start and because I feel urgency to begin somewhere, let’s talk about what you, as Hollywood producers, can do to improve your depictions of psychosis.

Recommendation #1: Don't use "psychotic" and "psychosis" incorrectly.

Recommendation #2: Include more depictions of auditory hallucinations in your films.

Recommendation #3: Stop making people psychotic for no reason.

Recommendation #4: Use the term "delusional" correctly, or don't use it at all.

Stop using the terms “psychotic” and “psychosis” incorrectly.

What is “psychosis,” or the state of being “psychotic”?

Before we dive into my recommendations, I'll provide a short primer on psychosis. A textbook definition of psychosis is “ impaired reality testing ,” which basically means you can’t tell what’s real and what’s not. There are really only two ways the brain can’t tell what’s real from what’s not. The first is by the brain’s senses not working right (i.e., having hallucinations ), and the second is by the brain’s thinking not working right (i.e., having delusions ).

So, in general terms, if you do not have hallucinations or delusions , you are not psychotic.

Let’s see more hearing things, less seeing things in your films.

What is a hallucination?

It’s seeing or hearing (or theoretically smelling, tasting, or feeling) something that isn’t there.
Visual hallucinations are less common than auditory hallucinations. Everybody thinks of visual hallucinations, or “seeing things,” when they think of mental illness. Far, far more common is “hearing things,” or auditory hallucinations.
Auditory hallucinations usually take the form of hearing voices. Most often these voices say nasty things about a psychotic person or tell the person to hurt or kill themselves. There are other things that psychotic people hear, but let’s keep it simple for now.
Visual hallucinations are uncommon in psychiatric illness. They occur much more often in medical illnesses and conditions. Some examples include being delirious from a high fever, having a neurological disorder like Alzheimer’s disease, or being intoxicated by illicit drugs.

Use the term “delusional” correctly, and, if in doubt, stick to paranoia.

What is a delusion?

It’s a “fixed, false belief.” That means you believe that something is true (usually something extremely unlikely), and don’t change your opinion no matter how much evidence to the contrary you are presented with.
The most common kind of delusion is paranoia , or believing people are after you in some way. It might be the CIA, police, or your neighbors. You might think people are following you, stealing from you, playing tricks on you, or trying to kill you.
Not all delusions are made the same. Some are “grandiose,” like believing you are the second coming of Jesus Christ sent to save the world. Some are “somatic,” like believing your insides are rotting. Some are “bizarre,” like believing another person is living in your eyeball. Yes, that’s one I’ve personally seen.

Quit having people be psychotic for no reason.

What causes psychosis?

Psychosis always happens for a reason. You don’t just become psychotic without other symptoms. (A rare exception is “delusional disorder,” but don’t worry about that for now).
You don’t have to be schizophrenic to be psychotic. Folks with bipolar disorder and even bad depression can hear voices or have delusions as well. Some neurological conditions, like Alzheimer’s Disease, also cause psychosis.
It’s very rare for young kids to be psychotic. Schizophrenia, bipolar disorder, and depression don’t fully develop until later in life. Although you may see other symptoms of these disorders earlier, you rarely see true psychotic symptoms until the late teens, at the earliest.

What is psychosis NOT?

Psychosis is not “acting all crazy” or doing irrational things. In fact, it has nothing to do with behavior. It has everything to do with sensing and thinking. Remember, if you don’t have hallucinations or delusions, you aren’t psychotic.
Very few killers in real life are psychotic. A huge pet peeve of mine is the notion of “psychotic killers” in movies, shows, and books. They don’t hear voices or have delusions. Usually, they are angry or sadistic people who don’t care about others. They may be psychopaths, which are basically people with zero empathy. It’s like being a sociopath but more extreme. But psychopath and psychotic are two entirely different kettles of fish.

In short, don’t call people psychotic unless they have hallucinations or delusions.

I’m here to help. Together, I think we can really make some progress in more accurate portrayal of psychiatric conditions on the big screen, and at the same time improve the public’s understanding of psychiatric conditions. Feel free to contact me by email if you’d like to talk more about our potential partnership. In the meantime, I’ll be at home watching some movies.

End of lesson.

Sincerely,

Duncan Gill, MD

Call Me Al: My Child Won’t Go to Therapy!

Thu, 07 Oct 2021 15:51:00 GMT

Direction Counselor: “The police are on their way.”

Words you never want to hear, particularly when you are taking care of kids.

“He didn’t want to come into Direction, mom told him he had to. He jumped out of the car, ran around the parking lot, then up into a tree.”

The really strange part is that I was literally writing this post about whether or not you should “make” your child go to therapy, when a counselor interrupted me with this information. When the boy settled down, the two came up to my office. I ended up talking about exactly what I was writing in this post. The two walked out after our discussion, mother quite understandably disappointed and son just happy to be going home. I hope he returns someday soon – he could use the help.

Let’s back up. When kids come in for their first interview at Direction, they often don’t want to be here. I’ve developed a little bit of a sales pitch for this very situation (which as you might guess happens a lot). It’s not that I want to trick kids into coming to the program, or promise them it will be something that it’s not, or just admit them for the sake of raising our census (there are plenty of other kids who need our services). It’s just that kids come in naturally resistant to joining a program like ours. Kids are understandably anxious; we are asking them both to share very personal information with adults they’ve never met, and to join a bunch of other kids they don’t know. The fact that they have often had mediocre (or worse) experiences in the past with therapy doesn’t help. So I just want to counterbalance those prejudices a little bit.

Let’s say a child -- call him “Al” -- is balking at coming to our program. I tell Al this a place kids like to be, that it’s very unlike school, and that many kids who hate the idea initially don’t want to leave the program when their time is up. These are all true statements. I tell him it might be worth a try for a day or two just to see what it’s like. Maybe Al thinks his parents are just excessively worried about him, and his problems really aren’t all that big. I tell Al we’d be happy to let his parents know that we agree with his self-assessment if that’s what it looks like to us once we get to know him. Maybe it’s worth Al’s time -- his spending a few days with us -- to appease his parents and get our stamp of approval.

Sometimes my spiel works, sometimes it doesn’t. If it doesn’t, the conversation might go like this:

Al: “Yeah, everyone seems nice here, but I don’t think it’s for me.”

And… that’s my cue to back off.

Me: “Gotcha. Well, you can talk it over with your parents then. We certainly aren’t going to try to force you to come. If you change your mind at some point, we’d love to have you here.”

Al talks with his father for a few minutes and Al’s dad enters the room.

Al’s Dad: “My kid says he doesn’t want to come. What should I do now???”

A perfectly reasonable question.

Well, what I can tell dad is that “forcing” therapy never works. It just doesn’t. If we don’t have Al’s buy-in -- or at least a willingness to give us a chance -- we have nothing. It reminds me of the old joke:

Question: How many psychiatrists does it take to change a lightbulb?

Answer: Just one, but the lightbulb has to have a sincere desire to change.

I absolutely recommend Al’s dad encourage him to “give it a try.” Al has really nothing to lose, and potentially a lot to gain. But once dad gets to the point where he is starting to plead with or threaten Al, it’s time to back off.

Not only will Al not benefit from therapy that he is unwilling to engage in, but the experience will be counterproductive to the relationship between Al and his dad as a whole. Al will become increasingly resentful at his dad . He will become more and more resistant, and possibly openly defiant. Al’s dad, on the other hand, will become increasingly desperate and frustrated. The two will be locked in an escalating power struggle (which may well be what brought Al to the office in the first place!). This is never productive.

What I do recommend to Al’s dad is that he attend our Parenting Group. And I don’t offer it as a sort of “consolation prize”. Regardless of whether he finds our particular group helpful or not (and I hope he does), Al’s dad is going to have to shift his focus away from Al and to the one person he does have control over: himself. His son is essentially saying “thanks, but no thanks.” That doesn’t mean Al’s dad has to say that too. Al’s dad is going to continue to be faced with the challenges of raising a son who is struggling, and perhaps we can help him there.

Al’s dad will need to deal with all kinds of decisions. Should Al go to school? Should he be allowed to see his friends? Should he be allowed to stay in bed all day? Should he be brought to the emergency room? Should dad call the cops if Al acts out?

In our case example, Al is saying he has got everything under control, neither wants nor needs therapy, and should be left alone, thank you very much. He might be right for all we know. Sometimes we parents overestimate the magnitude of our children’s problems. Sometimes kids outgrow their problems or get tired of their bad habits causing them grief. Sometimes hormones and moods settle down.

On the other hand, Al might not have it all under control. If that’s the case, it’s important Al’s dad not get in the way of his son’s coming to this conclusion himself. That means avoiding becoming overprotective or indulgent of his son’s potentially bad habits. It means not making excuses for his son, or being swayed by his son’s own excuses that he “can’t” control his behavior because he is too anxious, too angry, too depressed. This is a very common trap parents fall into in my experience, and it prolongs the problem. In fact, it deserves a separate post. I’ll get to that at some point.

The key here is that ultimately Al’s getting better is up to him, not his father. The fact that we don’t have control of all our children’s decisions can be a frustrating and disappointing realization to us parents. Particularly as kids get older. But, perhaps in an unexpected way, this realization can also be liberating to us as well. In the end, it’s not up to us, it’s up to them. It places responsibility squarely on the shoulders of our children, which is where it should be. After all, we aren’t going to be there forever for them, scrutinizing and intervening in their every decision.

In Al’s case, we are hoping for one of two outcomes in this situation. The first and best is that Al’s son solves his own problems or outgrows them. This is of course preferable to his enlisting the help of a therapist at all. The next best outcome is that things don’t improve, Al realizes that he could use the help, and ultimately accepts it.

Hopefully, the problem is resolved either way sooner rather than later. Anything that delays such a resolution – such as the power struggle of “making” Al go to therapy, or overprotecting and overindulging Al if he chooses not to go – just gets in the way. It prolongs the problem.

So those are my thoughts on the subject. The boy I referred to in the beginning of this post quite literally climbed up a tree to avoid going to therapy. It’s fair to say therapy just isn’t going to work for him right now, and it is counterproductive to try to force the issue. Best case is he pulls things together on his own, though I must admit that right now I’m doubtful on that score.

Second best case is that he shows up at our door within the next few weeks with a willingness – however grudgingly – to give treatment a try. That wouldn’t surprise me at all. And then we have something to work with.

Johnny: a DSM Diagnosis Dilemma

Wed, 29 Sep 2021 17:55:00 GMT

Mom: “Johnny has been looking depressed at home and stays in his room. He doesn’t do his schoolwork. He sometimes has panic attacks and either can’t or won’t go to school – I can’t really tell which. He also has a really bad attitude.”

“Oh, and he’s been diagnosed with Major Depression, Panic Disorder, ADHD, and Oppositional Defiant Disorder. The doctor thinks he might be developing borderline personality disorder too.”

Uh-oh.

Sitting in my office is a well-meaning, anxious mother who is truly worried about her son. Next to her is Johnny, who looks like he’d rather be sitting in a dentist’s chair.

Me: “Okay, Mrs. Smith. Does Johnny have a therapist?”

Mom: “Well, he had one, but he refused to go back after one meeting. He’s had a few before that but never seemed to connect with them.”

Me: “Does he take any medications?”

Mom: “Yes, I forgot the list, but he’s on four of them.”

Me, to Johnny: “You think the meds help you at all?”

Johnny: “Nope.”

Okay, we are running into “DSM Laundry List Syndrome”.

The problem isn’t so much the list of five diagnoses (which is overwhelming in and of itself), but the fact that mom believes that these five diagnoses mean more than they do. She thinks – and probably has been led to think – that this list of labels contains all the critical information we need to solve Johnny’s problems.

If Johnny has five diagnoses, does it mean that Johnny needs five different types of treatment? Five different medications? Five different types of therapy? Does a list of five diagnoses mean that Johnny is five times as impaired than if he had just one diagnosis? At the very least, in this particular case, a list of five diagnoses makes Johnny five times as angry with his mother and five times less likely to talk to therapists. Which ends up making my job more difficult.

Let’s get some context here. The DSM, or Diagnostic Statistical Manual, is considered by many (importantly, including insurance companies) to be the “bible” of psychiatric diagnosis. In the DSM you will find names and codes for all the possible diagnoses from Antisocial Personality Disorder to Voyeurism. All of Johnny’s current diagnoses are in there. The DSM diagnostic criteria consist of a series of checkboxes for various symptoms. Check enough of the boxes, and you qualify for a given diagnosis.

The DSM has pluses and minuses. On the plus side, it can be viewed as a valiant attempt to establish a common language for clinicians. The idea is to standardize diagnostic criteria so treatment providers are using the same words to describe the same things, rather than everyone having his or her own definition for different psychiatric conditions. You need to have some kind of standardization, particularly if you are going to conduct research. You have to be able to decide, for example, who has bipolar disorder and qualifies for the study, and who doesn’t. And research has been critical to developing fantastic new treatments for psychiatric conditions. So, to that extent, we need a DSM, or something like it.

Now for the minuses. The diagnostic criteria are decided by committee. A group of psychiatrists gets together and debates what should be a diagnosis, what shouldn’t, and what the criteria for each should be. Clinicians have varying degrees of confidence, shall we say, as to how good a job the DSM does at describing any given diagnosis. In my opinion, it does a good job for some diagnoses and a not so-good-job for others. A lot of folks also think the “checkbox” approach is quite limiting. I agree. By the way, the DSM goes through changes every few years (see the picture above), and some diagnoses disappear and new ones magically materialize based on the current zeitgeist of psychiatry.

To be fair to the DSM and its creators, it is important to realize that – as of 2021 – we have exactly zero blood tests and exactly zero brain scans that can accurately determine psychiatric diagnosis. And “standardized tests” and rating scales are only as good as the clinicians interpreting them. Suffice it to say the brain is really, really complicated. The best way to make a diagnosis is to sit down with a patient and interview them.

Let’s get back to Johnny. His list of five DSM diagnoses doesn’t tell us anything about his circumstances. Nothing about his temperament, home life, parenting, or stage of maturity. These factors – let’s call them “developmental” factors – might account for a lot of Johnny’s problems, or maybe even all of them. DSM diagnoses are an attempt to standardize, which is good for a lot of conditions, but developmental factors don’t standardize well, and just end up being omitted altogether.

So, it’s possible Johnny has a real, biological “Major Depressive Disorder,” but it’s also possible his parents are going through a divorce and he’s just having a rough time. The DSM won't distinguish between the two, and of course the approach to Johnny's treatment would be different for each.

The DSM checkbox approach can also be taken too literally. Sure, Johnny technically may “qualify” for all five diagnoses, but is that the most useful way to look at things? Does this mean he truly has five different conditions? Or is he simply depressed, gets anxious and angry when he has to go to school, and doesn’t pay attention in school because he’s got too much else on his mind?

Don’t even get me started on “Oppositional Defiant Disorder”….

Sorry, I can’t help myself. I think Oppositional Defiant Disorder is a prime example of the DSM’s going off track. Kids are oppositional for a whole bunch of reasons. They get tired of being told what to do, they have unreasonable adult figures in their lives, they are immature, they are trying to demonstrate to their friends or their parents or themselves that they are independent and don’t take crap from anybody. Being oppositional is not a “disorder”. It’s an adjective.

Thanks for indulging me there.

All this is a long way of saying sure, DSM diagnoses have some utility, but my goodness we need to understand their limitations. Excessive reliance on them sometimes overcomplicates relatively simple problems, and sometimes it misses the boat entirely on developmental problems.

Back to Johnny.

Me: “Okay, Mrs. Smith, how about we start from the beginning?”

All In The Family: Why I Do What I Do

Wed, 29 Sep 2021 16:24:00 GMT

My father has a thing for guitars and banjos. Like abnormally so. At last count, he had well over a hundred hard-shell cases taking up space in the attic, his home office, the living room, and honestly pretty much every other room in the house. Any remaining space at home seems to be occupied by uninstalled doors and fireplaces, which for some inexplicable reason he also collects. It drives my mother absolutely crazy.

He seems to have unlimited energy, and his mind is always going a mile-per-minute. Throughout his life, he has worked about three full-time jobs at a time. (He recently “semi-retired,” cutting down to the equivalent of one full-time job.) He personally built our house from the ground up, adding rooms left and right, sometimes entire wings. My mother (she really is a saint) has given the rooms creative names such as “The Giraffe Room,” “The Omni,” and “The Purgatory”. The last one was so named because it hasn’t been finished, nor will it likely ever be. My father is great at starting projects, but less great at finishing them.

Bipolar disorder runs heavily in my family, and though he doesn’t meet the “classic” bipolar criteria, it doesn’t take a Sigmund Freud to guess he’s got an undiagnosed, chronically hypomanic bipolar version. He’s actually written several books on bipolar disorder.

Oh, and he’s a psychiatrist. I guess that was a round-about way of getting to that point, but the preamble seemed relevant to me for some reason. He loves what he does and – being articulate and persuasive with words – managed to talk my best friend growing up into becoming a psychiatrist as well.

My (bipolar) aunt once said, “Dave, you make your bipolar work for you.”

My father isn’t the only psychiatrist in the family. His own father and uncle were psychiatrists, one brother a psychiatrist, and the other a therapist. His lone sister escaped our “family gift and family curse” to become an artist. His daughter, my sister, is also a psychiatrist.

Genetically, it would seem I was doomed from the beginning. And, despite all my efforts in medical school to beat the odds and become an emergency room doc, I finally gave in. I realized that rejecting a career that seemed such a good fit for me just for the sake of being different wasn’t a good enough reason. That’s what a psychiatrist would say, anyway. At least I became a child psychiatrist, a novelty in the family, and maybe that counts for something.

Psychiatry is a really a great career, as long as you can get past that pause in the conversation when you tell people what you do for a living. It’s sort of like telling people you work on septic systems or raise llamas. It’s a pause of equal parts horror and fascination.

Once they regain their words, their most common response is: “Wow, I could never do that.”

I forget that not everyone likes working with teens, or even likes teens in general. I think it’s great. I can be my normal, slightly hyperactive, inattentive self. I can rock back in my chair, make jokes, laugh, and goof around with kids. I can talk about music or sports or the latest Warzone loadout with them. I can even swear. Kids do their best to keep me current with the latest kid slang, though even so I always seem to be lagging about 10 years behind. Heck, I even get paid to play the occasional frisbee or foosball game. Life is good!

But most of all, maybe because of my inner teenager, I identify and sympathize with these kids. I see them struggle with the trials and tribulations of adolescence when school is a prison, parents are tyrants, breakups are catastrophes, and the world is a big scary place. It is a great challenge to get them to accept even a tiny bit of perspective from me, someone who has made it to the other side, someone who has made it to adulthood. And any parent can tell you this is no easy task, as kids generally aren’t interested in and / or can’t hear and / or don’t want to hear what adults have to say about anything. This challenge requires first gaining their interest, then their trust, and then their respect as a sympathetic, non-judgmental adult figure. It’s doable in almost every case. This challenge – even more so than the frisbee and foosball – is my favorite part of the job.

So being a child psychiatrist suits me on many levels. I feel lucky to be one of those people who doesn’t dread going to work or coming home from vacations.

I can hear my aunt in my head saying: “Dunc, you make your inner teenager work for you.”

People sometimes ask me if being a child psychiatrist makes you a better parent. It’s a good question, and I’m not sure of the answer. I think it does help in that you get to see so many struggling kids that you tend panic less when your children act out or otherwise hit bumps in the road. I’ve been asked for reassurance by many friends and family about their own children, and my usual conclusion is that they are suffering from a normal variant of adolescence. I have to say, though, it sure is different when it is your own kid. One of my favorite mentors when I was in residency – one of those guys who you think was just a master at what he did – admitted that he had to stop practicing psychiatry entirely for the period that his daughter was a teenager.

I’m not sure if the three-generation psychiatry Gill-line ends with me, but I hope not. Given half a chance, I’m sure my father can talk at least one of my kids into going into the family business….