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[Susan notes: These letters offer a good gloss on the article, which is well worth re-reading.]

Published in New York Times

To the editor

Re What’s Wrong With a Child? Psychiatrists Often Disagree (“Troubled Children” series, front page, Nov. 11):

We are in full sympathy with the families featured in the article. As we struggle to find the causes of our daughter’s mental depression, it is more than a relief to know that we are not alone.

The most important thing for any family that has similar issues is not to be in denial. Although in recent years mental illness has been given equal time as other illness, it is still a taboo in our society.

We must treat mental disorders as we would any other diseases — aggressively. Thank you for bringing our troubled children’s plight to light.

Nancy Bruni

Brooklyn, Nov. 13, 2006

•To the Editor:

According to the surgeon general, one child in five will have signs and symptoms of a significant mental illness. These are very real conditions that interfere with the ability to function at home, in school and with friends.

Fortunately, there have been encouraging advances in our ability to identify and treat these debilitating disorders. For example, we can reduce the relapse rate for children with depression by more than 40 percent, and we can reduce the actual risk of suicide for adolescents with bipolar disorder by 50 percent.

We can also successfully treat the majority of young people with anxiety and attention disorders.

There’s no question that we need more child and adolescent psychiatrists. We also need increased financing for research on the causes, diagnosis and effective treatment of these illnesses.

Finally, we need to eliminate discriminatory insurance policies that limit access to appropriate intervention for people of all ages with psychiatric disorders.

David Fassler, M.D.

Burlington, Vt., Nov. 11, 2006

The writer is a child and adolescent psychiatrist and a clinical professor of psychiatry, University of Vermont, College of Medicine.

•To the Editor:

Your discussion of diagnosis in child psychiatry does a service to your readers. It emphasizes the absence of rigor in the nomenclature, a lack of unanimity among diagnosticians and uncertainty about the response to pharmaceuticals.

When patients are so very different from one another, and where no objective, universally accepted diagnostic tool is available, diagnostic clarity is bound to be elusive. But today, the problem has intensified.

Too often, patients are seen not as human beings who have experienced emotional development, but solely as sets of behaviors to be assigned a label and to undergo biochemical manipulation.

There remains a role for the clinician who takes the time to know a patient and who recognizes complexity. That clinician will recognize the major role that can be played by neuroscience and pharmacology in the care of certain psychiatric patients, but will not offer knee-jerk diagnoses and therapy.

Charles Goodstein, M.D.

Tenafly, N.J., Nov. 11, 2006

The writer is a clinical professor of psychiatry, N.Y.U. School of Medicine, and chairman of the Section on Child and Adolescent Psychoanalysis, N.Y.U. Psychoanalytic Institute.

•To the Editor:

Katherine Finn, 14, is reported in your article as having experienced intense “feelings of worthlessness as early as the fourth grade.” This example suggests that the public would be better served if mental health professionals paid careful and early attention to these disruptive, painful feelings in children and adolescents.

We need to provide services to enable children and adolescents to deal with such intense painful feelings, rather than waiting until severe defensive reactions are established, like oppositional and destructive behavior, and then devoting energy to trying to classify such defense reactions and searching for medications that might control them.

Sidney J. Blatt, Ph.D.

Woodbridge, Conn., Nov. 12, 2006

The writer is a professor of psychiatry and psychology at Yale.

•To the Editor:

You report how “checklists of symptoms” are used to fit children’s behavior into diagnostic boxes. This process is part of the problem.

Symptoms are a language of behavior; they tell about the child and her feelings.

One of the most useful things I learned in graduate school was that the symptom does not determine the diagnosis. Five different children can exhibit the same symptoms for five different reasons.

For example, a child who appears to have attention deficit hyperactivity disorder, or A.D.H.D., could be mourning a loss, feeling friendless or unable to cope with the school curriculum. But we won’t know until we get to know the child.

By focusing on the symptoms alone, we contribute to the disconnect between the inner world and outer behavior. Real cure happens through connection — connecting feelings with their causes, connecting children with people who care about them. That doesn’t come in a pill.

Ellen Luborsky, Ph.D.

New York, Nov. 13, 2006

The writer is a clinical psychologist.

•To the Editor:

In your article there was not one mention of troubled society — troubled parents, troubled schools, troubled marriages, troubled jobs, troubled media and troubled neighborhoods.

Surely these “troubles” must enter into the mix, not to mention how deadly boring school is to a creative, sensitive child and how too-busy parents may be unaware of the need to attend to the unique requirements of their special children as the schools fall down on the job.

Some attention must be paid to the crazy-making qualities of stressed, broken families struggling with our crazy-making culture, not to mention the fact that most child psychiatrists suffer their own tunnel vision and are too quick to push the latest pills rather than do the long, hard (unaffordable to most) work of talk therapy.

Chris Hudson

Bellingham, Wash., Nov. 12, 2006

•To the Editor:

I was interested to see that symptoms of mental illness in children include “does not seem to listen when spoken to directly”; “often leaves seat in classroom or when sitting is expected”; “argues with adults”; “skips school”; and “often stays out late at night despite parents’ rules.”

Perhaps if children had as much clout as parents and teachers, symptoms of mental illness in parents and teachers would include “expects attendance and attention during boring speeches and lessons”; “expects unquestioning obedience”; and “makes unreasonable rules about staying home at night when there are more interesting things to do outside.”

Felicia Nimue Ackerman

Providence, R.I., Nov. 11, 2006

multiple authors

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