From http://www.globeandmail.com/gam/TopGlobeReview/20000527/SAGROW.html }}>Begin GROWING UP ON THERAPY In the past 30 years, it seems like whole generations of middle-class kids have grown up on the couch. Is this just good mental health, or are parents abdicating responsibility and, as one critic complains, 'outsourcing the management' of their children's personalities? LEAH McLAREN The Globe and Mail Saturday, May 27, 2000 The first time I sat in a therapist's office, I was 7. My parents were getting divorced, and they wanted to make sure this wouldn't turn my little sister and I into pregnant, speedfreak teens. The therapist had a bad perm and a goopy-lipstick smile. She ushered us in, instructed us to sit on a love seat surrounded by potted fronds, and reassured us (unnecessarily) that our parents loved us and that nothing -- absolutely nothing -- was our fault. Today, in my 20s, I've noticed that most of my friends my age have been in therapy at one point or another. Some of us were coerced; others went willingly, even eagerly. One thing is certain: Spending a few sessions on the proverbial couch has become as common an experience among middle-class urban and suburban kids as summer camp or tap-dance lessons. Middle-aged writer Joan Acocella recently said in The New Yorker that for her generation, "Psychotherapy is not so much an issue as a history. A language in which they learned to speak of themselves and of life." If therapy is a language for the baby boomers, it has become a way of life for many of their children, millions of whom were passed from child psychologists to adolescent specialists to university mental health clinics throughout the 1980s and 1990s. Whenever I consider my generation, I think of a T.S. Eliot line: "The whole earth is our hospital." Emily Fox Gordon agrees. "It's as if therapy has become the new institution that structures family," the author of the new, acclaimed memoir Mocking Bird Years: A Life in and Out of Therapy suggested to me. And she takes a harsh view of it. "It takes away authority from the parent and ends up infantalizing everybody." The numbers are startling. A recent Statistics Canada survey found that in the past five years, children and young adults aged 12 to 24 have been more likely to be treated for depression than any other age group. From 1994 to 1995, for instance, Canadians aged 15 were twice as likely as their 45-year-old counterparts to report having experienced a depressive episode in the previous 12 months. StatsCan also found that those identified with depression in the youngest age group are much more likely to have future depressive episodes. Strangely, this pattern is the reverse of decades past, when depression was prevalent mostly among older adults. The study goes on to suggest that the statistical shift occurred in the late 1970s -- around the time the my generation was entering kindergarten. And the field of psychology expanded to accommodate our growing melancholia. (The number of licensed psychologists jumped 52 per cent in Canada between 1982 and 1997.) During my teens, I watched dozens of my peers drift in and out of therapy. Eating disorders were rampant at my Toronto high school. We used to joke that Anorexia/Bulimia 101 was a compulsory course. It was not this way everywhere. Clare Bergman, a 27-year-old Internet consultant living in New York City, tells the story of seeing a therapist about her bulimia during a year she spent in France as a high-school student. "It was ridiculous," she remembered. "This therapist thought I had indigestion. I had to explain to her five times, in French, that I was sticking my fingers down my throat and making myself throw up. France and eating disorders do not go hand in hand." But in North America, by the time I hit university, Prozac had become a ubiquitous presence on campus. The mental-health clinics at both schools I attended had waiting lists weeks long. The therapist I saw in first year was so overworked she forgot my name after six months of weekly appointments. Once I accidentally went on a date with a guy who had the same shrink as me. Friends in their late teens signed up for couples therapy with their steady boyfriends or girlfriends when things got rocky. A small handful of the seriously depressed checked into clinics. Old friends from my year in high school bumped into each other in the hall of a mental hospital. For the most part, I am describing a group of young people suffering not serious chemical imbalances, but the normal pangs of being human. Our teen angst, childhood shyness and academic anxieties have been pathologized by a therapy-obsessed culture. It's made us an overly neurotic and inward-looking generation. The solution? More therapy of course. Gordon's memoir is a cautionary tale of the potential dangers of growing up under the lens of psychoanalysis. "I am one of those people -- we're not so rare -- for whom life has been not so much examined as conducted in therapy," she writes in the opening pages of her book. Gordon grew up the sixties, but her coming-of-age story is not unlike those of many young adults today. A sensitive, overweight child, Gordon began her journey through therapy at the age of eleven, when her parents sent her to her first therapist -- a traditional Freudian analyst. Once a week she reclined silently on a couch for fifty minutes, while the therapist looked on, equally mute. This therapeutic pattern continued, more or less unmarked by communication, until the age of 18, when Gordon was checked into Austen Riggs, a posh mental hospital in Stockbridge, Massachusetts. (Gordon's parents sent her there after she scratched her wrists with a pair of nail scissors.) Once admitted, Gordon was diagnosed as having a "schizoid personality disorder with borderline trends," and stayed on as a patient for three years. In a telephone interview from her home in Houston, Texas, Gordon described her adolescent therapy as a debilitating, rather than healing, process. "I got used to the notion of myself as having very little agency at an early age," she said of her early sessions in orthodox analysis. "I became addicted to this amniotic sense of nothingness." Most damaging in Gordon's view, however, was therapy's non-judgmental outlook at a time when what she craved most was a moral education.Therapy, she said, encompasses "a kind of relativism that can't give young people what they're really hungry for." While critics like Gordon complain that morally relativistic child therapists have simply re-labeled bad or weird children as "sick" children, many parents disagree. Donna Moss, a 47-year-old mother living in Napean, Ont., put her daughter, Lisa (now 18), into therapy at 6, after noticing she exhibited a distressing fear of the wind. "At that point in her life, [Lisa] didn't seem like a really happy person," Donna said. "And I felt like I'd failed her in some fundamental way. The therapist managed to get to the root of her problem immediately." Daniel McGee, 25, is a humanities student from the University of British Columbia, who is in long-term treatment for depression and anxiety. He sees his generation's increased need for child and family therapy as kind of demographic fall out from the soaring divorce rates in the mid-1980s. "The boomers created therapy as it is today to deal with their crises -- they pushed therapy further than it had ever been pushed before. And we became the recipients," he said. "Therapists are only starting to understand what has happened to us kids as a result of our parents' legacy." There's no question that the peaking divorce rate in the mid-1980s was responsible for introducing millions of children to their first therapy experience in the form of family counselling. But many children of therapy report positive results, and still pursue it today. Clare Bergman began seeing a psychiatrist with her family at the age of 11 and continued her treatment into adulthood. To date, she has been treated by no less than 10 therapists. Unlike Gordon, she believes her experience as a young patient provided her with the tools to conduct healthy relationships later in life. In addition to short-term cognitive and regular talk therapy, Bergman and her now ex-boyfriend recently spent a year in couples counselling. "It would have worked, too, except my boyfriend was broken," she deadpanned over the phone. Bergman insisted that her lifetime of therapy has not been part of a destructive pattern. "I'm happy that I've done this," she said. "I certainly don't see it as symptomatic of an addiction to talking about myself. It's just a non-personal forum to get issues out." What's more, she said, "People who've never done it have no idea how fun it can be. What's more fun than talking about yourself for half an hour?" At the same time, Bergman readily pointed out that therapy can sometimes result in a vicious cycle of passive over-analyzing -- a danger she is careful to steer clear of herself. "When you're pretty analytical and self-aware, as my friends who are in therapy tend to be, there's a danger of getting stuck in the process," she explained. "You end up constantly discussing the issues without dealing with the issues. You're discussing the relationship, not having the relationship." Larry Gaudet is the author of Media Therapy,a recently-published novel which, in his words, "explores the role of therapy in a highly mediated world." In a telephone interview from his home in Montreal, Gaudet said he views Bergman's therapy-saturated generation as blind followers of consumer culture. "Therapy is basically outsourcing the management of your personality," he said. "Lifestyle economics is all about segmenting our lives into different appetites and then getting professionals to manage them. The therapy experience is like hiring our own ghostwriter. You hire somebody to give you a good story about your own life." This much is certain: for young people today, therapy is a far more widely available, mainstream phenomena than it was in the days when traditional Freudian talk therapy dominated. One major transitional factor was the return of the biomedical approach -- an approach which classified such disorders as anxiety and depression as essentially biological, and thus treatable. This approach, which reigns today in the psychiatric world, helped to break down the social stigma surrounding therapy. As Acocella writes, "[Biomedical] theory rose because there was science to support it. It also had humanitarian appeal: if mental disorders were biological, patients shouldn't be blamed for them, shouldn't be stigmatized." The biomedical approach came on especially strong in the early 1990s, in the form of a pill known as a selective seratonin re-uptake inhibitor -- Prozac. Around the same time, my peers and I found ourselves smack in the middle of the 12-to-24 age group, those years in which depression is most prevalent. With Prozac as its chariot, the biomedical approach rode to dominance, and as Acocella writes, North American society proved ripe for such a development: "The return of the biomedical approach also occurred within the con text of the despiritualization of our society after the sixties, that it fit in so well with the abandonment of any value that was not commercially profitable (as psychotherapy was not, and drugs were)." Leigh Solomon, a Child and Adolescent Psychiatrist at North York General Hospital, specializes in drug consultation for children. She reported that SSRIs are the major pharmacological treatment for young people diagnosed with mood and anxiety disorders. While public debate rages over the ethics of medicating children with anti- depressants, Solomon defends the practice, saying that when it comes to kids, time is of the essence. The assumption here is that drugs offer faster and more effective results than talk therapy can. But Laura Green, a 25-year-old Montrealer who spent nine months on Prozac as an adolescent, is skeptical about pharmacological treatment. "I don't remember a lot of feelings from that time," she said. "The drugs didn't solve things by any stretch; if anything they worsened things after the fact. As far as I'm concerned, anti-depressants are just a way to repress stuff." Since her time on Prozac, Green has eschewed drug treatment in favour of regular talk therapy and an array of alternative psychiatric treatments, from art therapy to naturopathy. During high school and university, she estimates she was treated by at least seven or eight therapists. Helen Foster, a high-school chum of Green's, started therapy at the age of 13. ("All the girls in Grade 7 ganged up on me and I got depressed," she explained.) By the time she was finished university she had been prescribed all the major SSRIs -- Paxil, Zoloft and Prozac. Although Foster laments the disappearance of traditional talk therapy, she is less critical of SSRIs. "When you're talking about therapy patients like me, people who don't really have real problems anyway, anti-depressants can make your life a lot more pleasant," she said. And according to Dr. Solomon Shapiro, a child and adolescent psychiatrist at Toronto's Centre for Addiction and Mental Health, patients who have a positive therapy experience at an early age are "more likely to see therapy as an option at different stages in their development and periods of stress." Dr. Shapiro sees this willingness to return to therapy as a healthy thing. "A good experience of psychotherapy early in life can prevent problems later," he said. "It can help people to learn how to be more aware of their feelings and to see a broader range of options when faced with problems and dilemmas." Still, growing up in therapy, even without going to a therapist, is something few young people can avoid in today's world of psycho-jargon and Oprah moments. As Gordon writes, "The world we live in now is one in which nearly all of us, whether enrolled formally in psychotherapy or not, are so thoroughly indoctrinated in the ideology of therapy that society has remade itself in therapy's image." INFANTS ON THE COUCH Do babies actually need therapy? Jean Victor Wittenberg is a Toronto psychiatrist who works with patients between the ages of 0 and 4. While he admits that neurotic infants don't generally have a whole lot to say, Dr. Wittenberg said that many do display early signs of trauma and anxiety. According to a definition from the Minnesota Infant Mental Health Association website, baby psychiatry is an increasingly popular field that concerns itself with "the infant's emerging self" as it "unfolds in relation to the parent." Wittenberg describes his work as a kind of relationship counselling for infants and their primary caregivers. "Some infants have trouble matching with their parents," he explained. "For instance, if a quiet parent has a noisy, exuberant baby, the parent might believe that when the baby cries it's rejecting them." Dr. Wittenberg said that infants, no matter how troubled, are eager to improve relations with their parents. "Babies never reject their mothers," he said. "They want to get along more than anybody." Yet many of his patients actually show signs of anxiety even upon delivery. "Babies," he said, "don't come into the world with nothing." --L.M. WHEN THE KIDS WEREN'T ALL RIGHT Until the 1970s, few children were involved in therapy -- but the field has exploded since then. At first, most psychotherapists started by examining the effect of talk therapy on changing "bad" behaviour in children, buoyed by trendy developments of such psyche-exploring treatments as play therapy. By 1980, though, the rise of psychotropic drugs prescribed in psychiatry caused a shift in the treatment of childhood problems, pathologizing many behaviours into disorders. And as the century closed, kids were increasingly diagnosed with adult conditions such as clinical depression. Here are some of the major developments in family and child therapy over the past 30 years. 1970s Behavioural psychology reigns, including Pavlov-style reinforcement therapy -- rewarding good behaviour with treats or praise. Play therapy and art therapy emerge. They take play and artistic expression as an integral component in the therapeutic process for children, who can't fully express themselves in words. Family therapy takes hold as an alternative to individual therapy. It looks at children's problems in the context of family relationships with parents and siblings. 1980s Drug therapy begins its domination. Psychiatry starts treating hitherto undiagnosed disorders in children, mostly hyperactivity and attention deficit disorder (ADD), as medical problems, prescribing Ritalin and other drugs regularly. Conduct disorder, eating disorders (anorexia, bulimia) and shyness disorder are among the many much-diagnosed youth disorders. Bioethical issues are raised: Can a child consent to drug therapy? 1990s Adult therapies start to be applied to younger and younger patients. Children, now routinely diagnosed with adult psychological disorders such as depression and anxiety, are treated with grown-up drugs like Paxil and Prozac (which have yet to be extensively tested on children). Critics suggest true mental illness in children is unusual and heavy reliance on drugs could cause behaviour to change to meet the diagnosis. 2000 Rebirth therapy reemerges from its 1970s roots as a new-agey treatment in which the patient is wrapped in blankets and forced to "push" his or her way out of the "womb" again. A girl dies of suffocation in Colorado while undergoing the treatment. Eye-movement desensitization therapy is part of a new wave of therapeutic trends. The latest technique involves accessing and processing memories by rapidly shifting the eyes from right to left. --Staff Copyright © 2000 Globe Interactive End<{{ A<>E<>R ~~~~~~~~~~~~~~~ Integrity has no need of rules. -Albert Camus (1913-1960) + + + + + + + + + + + + + + + + + + + + + + + + + + + + The only real voyage of discovery consists not in seeking new landscapes but in having new eyes. -Marcel Proust + + + + + + + + + + + + + + + + + + + + + + + + + + + + "Believe nothing, no matter where you read it, or who said it, no matter if I have said it, unless it agrees with your own reason and your common sense." --Buddha + + + + + + + + + + + + + + + + + + + + + + + + + + + + It is preoccupation with possessions, more than anything else, that prevents us from living freely and nobly. -Bertrand Russell + + + + + + + + + + + + + + + + + + + + + + + + + + + + "Everyone has the right...to seek, receive and impart information and ideas through any media and regardless of frontiers." 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