O'Malley, the Lancelot of Truth

Tim O’Malley has had the courage to say that the ‘Emperor has no clothes’, meaning that psychiatry is a profession that may promise a lot, but delivers little.  But, somehow, when any branch of medicine is challenged, there is an outraged response from the Irish Hospital Consultants Association defending their position.  If before the sexual revelations, the Catholic Clergy were the ‘untouchables’, it would appear that the new untouchables are medical consultants.  If they are so convinced of their position why would they react so vehemently to Mr O’Malley’s most recent opinion that ‘some people (consultants) like having long waiting lists?  It makes them feel very powerful if they have 100 or 200 people waiting.’  This is an accurate observation of how ‘some’ people’s vulnerability may, indeed, manifest itself.  After all, consultancy status, university education, age and gender are no guarantees of emotional and social maturity!  I have no doubt that Mr O’Malley had particular, not all consultants, in mind when he made his statement.  But, of course, the knives are out for Tim O’Malley and consultants’ scalpels cut fine and deep.  The reality is that if consultants were in a stable and mature place they would not react to Mr O’Malley’s authenticity, but they would give his opinion due listening and consideration.  The fact is that when consultants (or anybody else) react, they actually spill the beans on the very vulnerability that had been targetted.

The new O’Malley controversy arose during the RTE Prime Time programme which was presenting the results of a survey on the purported level of undiagnosed psychiatric problems among primary school-going children.  My concern here is the use of the term ‘psychiatric problems’ among children.  It is certainly the case that children do have serious psycho-social difficulties that require the intervention by clinical psychologists, psychotherapists, family therapists and social workers.  The involvement of the family of these children and the children’s teachers are crucial to the resolution of children’s distress.  If we persist in labelling our children with psychiatric tags, we will be going down the road of America, where one sixth of children are on anti-depressants and an even greater proportion on Ritalin.  It perpetuates the neglect of children to psychiatrically assess them, because such assessment involves ‘closed’ questioning in order to categorise a child’s distress and prescribe medication to match that umbrella label.

The six per cent level of undiagnosed children’s distress reported in the Prime Time survey is probably an underestimation.  A survey last year found that twenty to twenty-five per cent of fifteen to seventeen year olds had undetected serious emotional turmoil.  My clinical experience is that when children or adolescents present with inner turmoil, their parents and, sometimes, their teachers have serious undetected intrapsychic and extrapsychic conflicts.

The psychiatric route is not the one to go down for our children who are in serious distress.  It is not psychologists or sociologists who are the main critics of psychiatry, but members of the psychiatric profession itself.  In America, fifty per cent of psychiatrists have also trained as psychotherapists and their approach is primarily psycho-social in nature.  I am not at all ruling out that there may be a biological origin to children’s distress, but apart from severe autism, I have had no need to have recourse to a possible biological hypothesis.  Children’s challenging behaviours are not designed to make life difficult for parents, teachers and communities.  However, they are designed to bring attention to the difficult lives that they are undergoing.  Psychiatry claims that to involve the parents in the assessment of children’s turmoil is ‘blaming parents.’  In my practice I have never come across any parent who deliberately sets out to block the progress of his or her child.  But, if truth be told, and hopefully Tim O’Malley will continue to throw down the gauntlet of truth, parents (and teachers) can only bring children to the same level of development they have reached themselves.  Teachers tell me that they know that the child who is most challenging in class, inevitably comes from a conflictual home situation.  If we are to truly help children who are in deep distress, we need to start with parents.  Working with these parents, who are troubled in themselves, needs to be done with unconditional care, understanding, compassion and definite ways of helping them to more effectively parent themselves so that they can more effectively parent their children.  I wonder which politician is willing to bite the bullet on this issue?

Dr. Tony Humphreys is a clinical psychologist and author of All About Children.