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Psychiatry and Society
by Keith Russell Ablow, M.D.
May 1996

Anywhere But Home

I was sitting in silence with a 15-year-old girl in the interview room where I meet psychiatric inpatients for the first time. She was gazing through her long black hair at her forearm. I watched as she used a finger to trace the superficial cuts she had made with a razor the night before when she had nearly decided to take her life.

"I'm not going back there," she finally said, looking up at me. "I'll kill myself if they make me live with my parents."

"What happens there?" I asked.

"Constant fighting. Screaming. Swearing. Hitting. It's been like that my whole life."

"Do they hit you?" I asked.

"They used to. A lot. They don't anymore. They hit my brothers, though. And they keep telling me I'm ugly... and stupid. Worthless." She looked back down at her arm. "I don't care where I get sent. I'll go anywhere but home."

I was almost certain she would return home. Social service agencies had already been involved in her case for years and never removed her. There would be another family meeting during her hospital stay, perhaps more frequent home visits by a social worker, but the mental health system's overwhelming prejudice in favor of keeping biological families intact, as well as a perennial shortage of acceptable foster parents, would likely keep my young patient in peril.

Again and again, as part of my work as an outpatient and inpatient psychiatrist, I meet young people like this girl who have already been severely psychologically scarred by their biological parents. They are victims of everything from sexual abuse to a pervasive lack of nurturance, and they end up with symptoms ranging from panic attacks to depression to psychosis. Many are addicted to drugs before they begin high school. Some, like the young woman I have described, see suicide as a reasonable way to end their pain. I prescribe them a variety of antidepressant, antipsychotic and antianxiety medications, hoping their psychiatric symptoms are temporary, but worried the damage may be permanent. All the while I know I am treating preventable illnesses.

Part of the stress of working with adolescents is, in fact, that they often see the psychological dangers confronting them quite clearly, but are powerless to deal with them. Occupying this watch tower on developing mental illness has convinced me that society must reassess how we balance the rights of children to develop strong minds with the rights of adults to rear their offspring. If we are to make a serious attempt to prevent mental illness, parenting must be seen as a privilege. There should be far less tolerance of abuse and neglect and far more resources devoted to providing alternative living situations for children and adolescents in harm's way.

Parents need to get a clear and consistent message: If you do a lousy job parenting, you lose your job.

Not that we should take any joy in cleaving families. I have met no one who invented his or her shortcomings as a parent. While some meanspiritied adults probably victimize children for pleasure, I haven't run into them. The vast majority of psychological trauma seems to be perpetrated by parents who are doing their best, which turns out be to be not nearly good enough.

This is why any social policy that would raise expectations for healthy parenting and more frequently and quickly impose the loss of parental rights should include a vigorous attempt to educate parents on how to avoid harming their children. Most people who harbor rage from their youth don't know to expect it to surface during the years their sons and daughters are developing. They may not see the traumas they survived as continuing risk factors for another generation.

Foster parenting would need to be promoted as a public service so that many more quality foster families could be recruited.

The prospect of the state intervening more vigorously in parent-child relationships carries with it the possibility that government could become overzealous in prescribing standards. A social initiative intended to prevent harm to children could lead to unfair toward protecting and nurturing its citizens carries with it this potential hazard to personal freedom. Perfecting a society is a constant fine-tuning of the forces of autonomy and responsibility. And in the arena of nurturing and protecting children, far too much latitude has been granted adults who are ill-equipped or unwilling to do so.

Keith Russell Ablow, M.D., born in Marblehead, Massachusetts in 1961, is a psychiatrist, author and journalist. Dr. Ablow graduated from Brown University, the Johns Hopkins School of Medicine and the Tufts/New England Medical Center with a Residency in Psychiatry.