Why Bother? When You Just Don’t Want To

A young man said to me in a mental health appointment a few days ago that (after he emerged from a long period of depression), he knows he needs to reconnect with some friends, get out of the house, find a new job, and get his life back on track, but he doesn’t want to do any of it. And then he looked at me, and he made a peculiar remark: “It must be easy for you to get up and go to work every day. You like your job.”

Well I do like my job, but I don’t think anyone bounces out of bed and off into the world day after day, year after year, without encountering times when doing so is difficult. I told him so.

If that’s true, he asked me, “Why does anyone do it?”

What makes any of us roll out of bed every day? Or call a friend or family member, despite feeling tired from a long day? Why do we overcome our feelings in a given moment and do what is important, or promised, or valued over what is fun or easy? For a young person starting out, or someone trying to bounce back from depression, the answer to a question like this may not be intuitive or obvious. 

Feelings are only a small part of the equation.
Most people would agree that getting ready to go to work every day involves some measure of dread. “I loathe the commute to the office.” “I’m worried I’ll never catch up on my paperwork.” “It’s been a long week, and I just wish I could sleep late today.” However, in the presence of such feelings, most people move forward anyway. Doing the thing that is right, or important, supersedes the emotion. We do it anyway.

Once we get going, the feelings might change.
In transit to the office, commuters might find that the drive is not as stressful as anticipated. Maybe the morning talk show on the radio draws us in, or the blue sky is clear and beautiful. Maybe we misjudged the unpleasantness of the transition, and getting to where we were going wasn’t so unpleasant after all. Maybe starting a conversation with a friend is rewarding and positive in ways we hadn’t anticipated before dialing the phone.

What about the bigger picture ?
When it comes to maintaining relationships, or getting to work, many of us don’t just participate because it’s easy and fun in the moment, often there’s a larger context. Maybe we return a call to a friend who is grieving because she needs support (not because it’s an enjoyable call). Maybe we go to work because someone relies on us to be there, or because we need money to pay rent. Not every task begins with an overwhelming enthusiasm for the activity itself; sometimes there’s a larger context driving our motivations.

Sometimes it’s just about moral values.
Some days people accomplish things because we believe the tasks are the right things to do. We straighten our living spaces out of consideration for family members or roommates who share them. We fulfill our contracts because we gave our word to do so. We perform our roles because we see ourselves as part of a larger community, contributing for the benefit of others, not just ourselves. We strive toward important goals to accomplish them for the betterment of our communities. We do many things because we believe those are simply the right things to do, based on our moral values relevant to the situations we face.

Parents and Kids Can Mindfully Unwind Together

Our lives are overfull. Even when we sit down to “relax,” our homes are filled with artificial noise and light. Screens are bright with intrusions that constantly flood our brains.

If your life needs a little quiet, try these family friendly steps to mindfully unwind:

1.    Turn off the TV
2.    Put down the smart phone
3.    Turn down the lights
4.    Quiet the chatter in your mind
5.    Check in with all 5 senses
6.    Notice your breathing. Count the number of seconds you take to breathe in, and then the number you breathe out.

Or

1.    Put on your walking shoes
2.    Head outside into nature
3.    Stop and look up. Notice what you see.
4.    Stop and look down. Notice that too.
5.    Find a tiny bug and watch how it moves
6.    Listen to the outdoor sounds and wonder what makes them

“Why Is It Impossible to Find a Psychiatrist?”

Over the weekend, I received calls from two old friends, both requesting advice about how to navigate the mental health care system during a crisis with their child. One child is preschool aged and has been “tantruming” for 75% of his waking hours for most of the past year, and now has been getting suddenly worse. He screams and writhes around on the floor most of the time. The other is a teen who cut herself with a razor and told her parents she hears voices and wants to die. These are serious situations in need of psychiatric opinions.

Their families live in different states and have different resources, but they ended up having very similar experiences when trying to get mental health services for their children. After exhausting the knowledge and resources of primary care providers, they needed a specialist. But then neither family could get an appointment with a psychiatrist, even with the assistance of their primary doctor. They offered to pay out of pocket, or do anything necessary to facilitate getting the child seen, and both families were told that nothing was available for many weeks. 

They faced the impossibly difficult decision of considering hospitalizing the child just to get the expert opinion. One family opted for hospitalization, where their child was locked in (and they were locked out), and although the child was placed on psychiatric drugs to stabilize symptoms, the parents still never directly spoke with a psychiatrist to hear advice or even education about what brought on the symptoms in the first place. They left the hospital without securing an outpatient appointment, and just hours after they got the child home, it was clear that the treatment wasn’t working and there was no one to call.

“Why has it become so impossible to access mental health care services?” was the question both families asked. 

I wish I fully understood the answer to that question. It seems many factors have contributed to the growing state of impossible access to psychiatric services. Foremost among them, there just aren’t enough psychiatrists. Filling psychiatric residencies is nearly impossible; it’s not a prestigious or high paying medical specialty. And then as the public raises awareness and encourages those in need to seek out psychiatric help, the need is increasing and no new providers are available to meet the increased need.

I don’t see access to care in psychiatry being resolved by training more doctors. My own premed, medical school, and then residency training spanned (a standard) twelve years. We can’t wait more than a decade for a solution. Physician’s assistants (PA’s) and psychiatric nurse practitioners (NP’s) can be trained more quickly and can therefor meet some of that need, but even then, psychiatrists have a great deal more specialized training and seeing a PA or an NP isn’t always interchangeable. Even primary care physicians, trained in a wide array of medical care, often say they lack specialized knowledge to feel competent in treating serious mental disorders.

I have concluded that psychiatry is going to have to change. Psychiatric physicians are going to have to alter the age old model for delivering mental health care. We cannot just work faster and see patients in 3-minute time slots to fill this need. We are going to have to be innovative and work in teams with our fellow professionals (PA’s, NP’s, and primary care doctors). Not every family has the ability to call a psychiatrist friend for advice, but everyone deserves basic access. Psychiatry is going to have to find a way to address the need. 

Here are ways to expand access now:

1.    Psychiatrists can provide case consultation services to primary care physicians to help them stabilize and manage complex cases.
2.    Psychiatrists can offer one time clinical “second opinion consultation ” services to aid in diagnosis and treatment planning, and them allow other professionals to manage care long term.
3.    Psychiatrists can work closely with well-trained physician extenders in their outpatient clinics.
4.    Psychiatrists can offer educational and support services to the public, and to other providers.
5.    Psychiatrists can coordinate medication refill services for stable patients with primary care, so that unstable patients can be seen in open/available time slots in the psychiatric clinic.

There are probably many other ways to expand access as well. Share your suggestions in the comments section below.

Have Overprotective Parents Really Ruined a Generation of Kids, or Is It All Hype?

Are we really a generation of helicoptering, overparenting, overprotective, crippling-our-kids-by-doing-everything-for-them, parents? Are we running behind all our toddlers while they climb up playground slides, pressing preschools to give them Ivy League resume building skills, and guarding them against any opportunity to develop autonomy or self-effectiveness? Do we only care about college, and do we measure our success by whether our kids get accepted to Harvard or Stanford? 

As I write this, my kids are not overscheduled and no adult is hovering to keep them safe. 2 kids are at a traditional summer camp where they are hiking and making crafts, singing songs and swimming, all while supervised by a group of teenaged camp counselors. They have no electronics, no email, and no cell phones and they don’t much care. If I’m lucky, I’ll get a scrawled letter or two by the end of the week. A third child has been running in and out of the house sopping wet this morning with a friend, lobbying for a sleepover, giggling at pop culture references, all after eating an impressively large pancake for breakfast. Nothing here seems much different than my own upbringing, except perhaps the latchkey kid part. But even those still exist in my neighborhood.

Articles and books tell me how my peers (and I?) are parenting from conception and I think, “Is this a real thing?” Is some author, somewhere living in a world where constant helicoptering, overscheduling, intruding, and otherwise invasive parental behavior is not only present, but is commonplace? Because I’m a parent, and truly, my life is not like this. I did not drive frantically across the city on the day I found out I was expecting a child to register for the best preschool. I don’t write my children’s homework essays or do their science fair projects or lash out at teachers when my child gets a bad grade or a note in his or her communication log alerting me to a discipline problem. And save for a few difficult parents (or more often, a few isolated misunderstandings or profoundly bad days) I don’t see other parents in my community behaving this way either. 

So this leaves me wondering, am I just blessed to live in a better community? Or has the whole narrative about how our generation of parents is helicoptering just been overblown? Perhaps much of what has been written is dramatized, highlighting the worst examples and adding quite a lot of embellishment. But why?

In the era of 24-hour news cycles, parents hear about every rare disease, every child abduction, and every fluke head injury, so perhaps many parents have a heightened sense of danger. Maybe we should be letting our kids walk to and from elementary schools alone. Maybe we should let them play in the park unsupervised while we work our shifts at McDonalds. Parents these days may be fearful, and restricting previously “normal” activities for children.

But isn’t the sensationalized fear of our “helicopter” parenting culture just the next in a series of overreactions and overdramatizations in the world of child-rearing? Now we should be afraid of being afraid?

Parenting is about facilitating growth. In some instances, developing kids need parental oversight and protection. In other instances, kids benefit from exploration, independent discovery, and self-driven problem solving. But as the pendulum begins to swing away from “overdoing” and toward backing off, let us parents not forget that our role is all about being mindful and making sound, sane, in the moment decisions based on what is best for our children, in their given stage of development, to support the shaping of each child’s skillset for emotional health and lifelong independent adulthood. And no simple soundbyte captures our job fully.