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 How
Many Did I Overlook? The Transformation of a School Psychologist
by Sharon Moxley
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During my first
ten years as a school psychologist, I was not aware of the
neurobiological nature of mental illness. I had no inkling that
many of the students that I saw had the symptoms of what we now
are beginning to understand as diseases of the brain. I
variously labeled these students seriously emotionally disturbed
(SED), conduct disordered, and out of touch with their feelings.
That many of these children might be suffering from the initial
stages of major mental illnesses rarely occurred to me.
After my initial evaluation of the students, I usually called in
their parents and, in a self righteous state of ignorance,
implied that they were the cause of their child's problem. I
then sent them packing to family therapists to help them
straighten out their "mixed messages" and "double binds." That
was "state of the art" not too many years ago.
I was able to function in this judgmental and confusing manner
because my training as a school psychologist had taught me to
place most of the blame for the child's problems on the poor
bewildered parents. This often overwhelmed them with guilt and
most certainly exacerbated the pain.
Then it happened mental illness hit my family! My child suddenly
became very ill. Now I was the one whom the professionals
indicted. In a deplorable and shocking role reversal, I now held
myself as the guilty parent. It seemed like some sinister cosmic
joke. After all, I was an informed child psychologist and I
certainly knew how to raise this emotionally healthy child whom
I loved. I was the expert. How could this happen?
The terrible reality played itself out. Filled with guilt and
shame, I walked through hospital halls while the staff watched
in silent judgment, their faces stiff and unyielding, a jury who
had just delivered its awful verdict. Occasionally they broke
their silence to tell me that I "had never set limits for my
child." Once they proclaimed that I was "only interested in
power." Never mind that I kept telling them these gruesome
charges were untrue they didn't seem to listen. But their stony
faces silently screamed, "Guilty!"
Given that the "professionals" had no ability to realistically
evaluate me as a parent, it was little wonder that they could
not treat my child effectively. I began to seriously wonder if
they really understood mental illness at all, not to mention the
correct treatment for it.
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After my initial period of shock and anguish, I began a
desperate crash course in understanding mental illness. Since I
was a psychologist, I naturally started with the "literature of
the field" that I soon discovered reflected all of the outdated
theories I had been taught in graduate school.
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After my initial period of shock and anguish, I began a
desperate crash course in understanding mental illness. Since I
was a psychologist, I naturally started with the "literature of
the field" that I soon discovered reflected al of the outdated
theories I had been taught in graduate school. There were no
answers for me in those volumes. Now that I was reading the
theories from the perspective of a caring parent, I began to
have new insights into the basic flaws in the thinking of the
"experts".
These books insisted that parents caused mental illness.
Although I had doubts about myself as a parent, I knew somewhere
deep inside that I was not a bad parent who had emotionally
damaged her child; certainly not the kind of parent that would
cause a catastrophic illness. But, if I were not the culprit,
what was the cause? And, more importantly, what was the
effective treatment? And who was out there delivering it?
My pain and agony spurred a frantic search. I haunted libraries.
I sent away for books. I carried books with me almost
everywhere. Even when going to friends houses for dinner I
brought my books and glanced at them for short moments between
conversations. Then finally, after months of research, I
stumbled upon the biological theories, at the time kept
virtually in the shadows, and I was absolutely overjoyed. I now
had external confirmation of what I had already intuited. The
illness was not in the parent or the environment. The illness
was in the brain. I also discovered that there was often a
strong genetic component in these diseases.
Now my search was more focused. I began to examine my own
genetic history. It was not long until I realized that I had at
last solved the mystery about my family. All my life I had
wondered what was wrong with my family? Why were so many of them
unpredictable, moody and depressed? This confusion and pain had
actually been highly instrumental in my becoming a psychologist.
And now, here it was, the answer to the riddle of my family's
"curse". My family had depression and manic depressive disorder!
In light of this information, I now clearly understood the
puzzling behaviors of my favorite aunt an unusually shy recluse
who had sudden episodes of terrible belligerence and unexplained
periods of absence, when she went off hitchhiking, abandoning
her worldly possessions. I learned that she displayed some of
symptoms of bipolar disorder. Then there was my uncle who had
significant depressions times when he didn't leave the house for
weeks, or wash, or get out of bed. And at least one relative who
killed herself, and a young cousin who attempted a bizarre
suicide pact with another boy resulting in the death of the
other child. As I continued my evaluation, so many pieces of the
family puzzle began to fit together. So many mysteries could
suddenly be attributed to victimization by a terrible brain
disease.
The other side of this dark past was creativity and
intelligence. My family had talent in art, music and writing.
Their wit and sharp sense of humor was their hallmark, sometimes
still evident even during depressions.
It was so painful to me to see their talents and abilities lost.
For generations, mental illness, unrecognized and untreated, had
robbed my family of lifetimes of their wonderful gifts. Then, I
thought about myself, and I realized that I had not escaped.
Looking back on my own life, I saw a teenager who suffered
significant depression, again without recognition and treatment.
If only I had been identified as having a biological illness
when I was in my teens, with the appropriate treatment, I might
have avoided the ravages of the major depression I had
experienced as an adult. Fortunately, my nondepressed periods
were long enough to allow me to complete my education and engage
in a successful professional career. (In 1990 1 was awarded an
"Outstanding Psychologist Award" by
the California Association of School Psychologists.)
After successfully dealing with mental illness on the home
front, ( my child improved significantly, thanks to lithium) I
was transformed as a school psychologist. I realized that many
of the students that I had seen in my career had symptoms
indicative of early signs of mental illness. The statistics on
mental illness indicate that one percent of children in school
would, at sometime in their lives, have schizophrenia, and one
to two percent would have bipolar disorder, with even more
experiencing major depression. That meant that, on the average,
two or more children in each class of 30 students could be
expected to develop major mental illness, possibly in childhood
and even more likely, in the teen years.
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I am now a biological school psychologist and one of the most
important things that I ask a parent is, "What is the genetic
family history?"
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Even more alarming, the statistics also indicated that one
student in five would be disabled by some type of mental illness
at least once in their lives. This meant that, statistically,
twenty percent of the class was at risk!
Armed with this knowledge, I realized that to me mental illness
had always seemed to be an adult disease. I didn't quite make
the connection with the young students whom I saw daily and
adults with mental illness. But it was these children, I finally
realized, that were the future adult sufferers of schizophrenia
and bipolar disorder. What if they could be identified early,
and helped? Was anybody researching that?
They were my students. They were in regular classes, and gifted
programs, and special education classes. They were honor
students, they were children with learning and behavior
problems. They were the hope of the future. They were in school.
And it was in school that many people with schizophrenia and
bipolar disorder had first manifested their symptoms. I cringed
as I realized that I had often been their school psychologist!
Had I overlooked them? Were their emerging symptoms right there
in front of me?
How many times did I look right past the clues in their school
records? "John seems to tune out in class" "Carol has difficulty
making friends, and seems withdrawn." Sometimes there were very
discernible patterns suggesting early bipolar symptoms:
Excellent academic performance and good classroom behavior
interspersed with weeks or months of poor grades, withdrawal, or
frequent altercations with others. It's shocking to remember
that I always assumed that these changes in mood and behavior
were exclusively the results of a program, therapy or changes in
the home.
Looking back, I now know that I missed recognition of students
with neurobiological disorders because of my professional
training, which taught me so little about mental illness. My
training was heavily analytic and I was very much a disciple of
Freud. Through this education, my eyes were trained to evaluate
the parent's behavior more than the child's symptoms. Too often
my job was to designate blame.
And what kind of a school psychologist am I now? Now that I have
been jolted and shaken out of the 19th century by the
unbelievable pain and agony of mental illness? I am now a
biological school psychologist and one of the most important
things that I ask a parent is, "What is the genetic family
history?" "Has anyone in your family, including grandparents,
great grandparents, aunts, uncles, cousins had a breakdown,
experienced depression or other mental illness?"
In my experience, parents of the children who are having
depression and certain behavioral difficulties tell me, at least
80% of the time, that there is a strong genetic family history
of mental illness. When I have knowledge about genetic family
history, the student's symptoms are more easily and accurately
interpreted. For example, if the student, who reports previous
symptoms of depression, is having symptoms that look like
attention deficit hyperactivity disorder (ADHD) and the parents
tell me that there is no genetic family history of ADHD, but
that the grandmother and the father have manic depression, I
would refer the student to a biological psychiatrist who
specializes in depression and manic depression. Without the
family history I would be more likely to refer the child to the
family pediatrician only. The decision to refer the student to a
psychiatrist, as well as the family physician, could make all
the difference in getting the proper diagnosis and early
treatment, not to mention saving the family and the child years
of suffering and wasted dollars.
CONCLUSION
In my family, the glaring clue was our family history. I was
carrying the genes of my family, and my life from early
adolescence had been marked by those genes. The same genes have
been transferred to my offspring and undoubtedly they will be
passed on to my grandchildren and great grandchildren. The big
difference now, for my family and hopefully for the children
that I evaluate in school, is that their genetic family history
can help detect the early signs of mental illness. Now I can
refer children that I suspect have a biological illness to
professionals in the community who have a biological orientation
rather than a professional who treats the "worried well". These
children may then be appropriately treated in the early stages
of the illness. Early intervention, we know, can help children
avoid the social and academic failures , the hospitalizations
and indignities of the "system". Instead, these children can
have the best chance to fully live their lives. In my family,
and the families I see as a school psychologist, our children's
gifts do not
have to be wasted.
This article was first published in 1995. Sharon Moxley is a
parent, a licensed educational psychologist and past
co-president of the Sonoma County Alliance for the Mentally Ill.
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