Firstly, I’d like to give a big thanks for all the comments and support from last week’s debut of Mental Health Monday.
Again, let me offer the disclaimer that this is intended for tips on writing authentic scenes regarding mental health. This IS NOT intended for treatment or medical advice.
Also, I’ve moved the NetworkBlogs tab higher up on the page, so hopefully it’s easier to see if you’d like to become a follower. (Thanks!)
This week, I’ve been honored by two great questions!
The first I’ll discuss is from Zoe C. Courtman, blogger, freelance copywriter, and horror fiction writer. Her blog: http://zoecourtman.blogspot.com/
Question: If a 16-year-old’s parents are both committed to a residential treatment center, and the 16-year old had a 19-year-old brother, would the officials release the teen into her older brother’s care? Or would DFACS (Department of Family and Children’s Services) be brought in?
Answer: Great question! As with most things in mental health, the true answer is: It depends. And that’s what makes it important to check with a variety of sources and then put the information together. (Kinda like figuring out the publishing game, eh?)
That really clarifies things, doesn’t it?
That being said, if the 19 year old brother is the logical next of kin (and maybe no other family member exists), then it is quite possible that the brother could be named guardian or given custody of the 16 year old. If, however, another relative is around–an aunt, uncle, grandparent, etc–and is a better option, then maybe they would be granted guardianship of the 16 year old.
Bottom line, the courts DO want to see children stay with their family whenever possible! That’s not to say the minor would or would not spend some time the foster system. Every case is different. AND, of course, there are kinks in thst system that make each person’s experience unique.
On top of that, this varies from state to state or maybe even county to county, I’m sure. And I would imagine the Department of Family and Children’s Services would be involved to get the custody arranged. They would no doubt work closely with the parents, the treating clinicians (psychiatrists, therapists, social workers, etc), and the children themselves. They would also be involved in any court proceedings.
The second question comes from Pete Morin, www.petemorin.wordpress.com. He’s an attorney and member of a writer’s group in Boston called Grub Street (http://www.grubstreet.org/). He posts a free classified ad in their newsletter answering writer’s legal questions, much like Lydia and I are doing with Medical Mondays and Mental Health Mondays! Write on, Pete! Awesome!
Question: Pete is hoping for some authentic “psychiatrist-speak” (I just made that term up) to incorporate dialogue in his writing, as well as information on addictive behavior.
Answer: Classically, addiction was treated like something that had to be forced out of a person, almost like an exorcism. Seriously. Rehab treatment often included yelling and belittling the “addict” for choosing their drug over their sobriety.
Well, that didn’t work. People relapsed. Antagonism between treatment providers and patients increased exponentially.
Over the past decade or so–after a nice, “DUH!” moment–treatment of “addictions” revolutionized. Firstly, the term “addict,” though still widely used, was debunked. (It’s pejorative and doesn’t really do anything to help the person caught in the throes of dependence on a substance. It’s sort of like calling someone “a diabetic” instead of “a person with diabetes.” See the difference? It’s subtle, but it’s there.)
Research has taught us that working WITH the person is much more effective than putting them down and kicking them to the curb (sometimes literally!) when they relapse. Programs like AA and NA (perhaps you’ve already surfed their sites) are fantastic resources for people to get engaged in group situations. Developing a support network is one of the most important things a person can do. Because, bottom line, the drug will win if no plan is set in place. It’s just how our amygdala and limbic system work (jargon for “pleasure centers” of the brain).
I’m rambling, but the long and short of it is that someone is considered DEPENDENT on a substance when they show either TOLERANCE (requiring higher doses of a substance to get high) or WITHDRAWAL (symptoms that emerge when enough time passes without taking the drug), when they devote an inordinate amount of time seeking the drug, when they experience dysfunction in several areas of their life–financial, health, relationships, legal, employment, and when they know or think they should cut back, but they just CAN’T.
The cycle of sobriety alternating with relapse is, in effect, to be expected. Relapse no longer means failure. It doesn’t mean the person is weak-willed. (This, in itself, is a radical shift in theory.) If the person engages in treatment, it is the provider’s goal to establish a plan with the patient and tailor it to their specific weaknesses and strengths. Another goal is to maintain a non-judgmental and supportive stance. That does NOT mean condoning the person’s use of any substance. It means accepting them back and helping them get on their feet again.
Regarding resources, for technical definitions, I’d refer you to the mental health professional’s “Bible,” The Diagnostic and Statistical Manual-IV. I defines Substance Abuse and Dependence as based on available research and a panel of “experts.” If you’re interested in techniques, look up “Motivational Interviewing.” (Here’s the site: http://www.motivationalinterview.org/) It was developed by William R. Miller & Stephen Rollnick. (Dr. Miller is a super-nice, down to earth, kind of guy. I had the opportunity to take a seminar workshop with him. I’ve had great success using his techniques in working with my own patients. *two thumbs up!*) Basically, the technique allows the clinician to sift through any barriers blocking the patient from progressing and, in essence, you help the person find their own motivation to keep moving toward their goals. It’s more effective than over 50 other therapies they’ve compared it to. AWESOME!
Another theory to familiarize yourself with would be the Stages of Change, by Prochaska and DiClemente. (This site has links for Motivational Interviewing and sample scripts: http://www.cellinteractive.com/ucla/physcian_ed/stages_change.html) Though described in linear fashion, consider it spatially to be more like a spiral. People progress from Pre-Contemplation (they don’t know there’s even a problem, though others around them might), Contemplation (problem is known, but no thoughts of changing it have come up yet), Planning (problem known, plans to change developing), Action (plans of change enacted and practiced), Maintenance (problem “gone,” full change effected)…Relapse (oops, old behavior back). The idea is that people shift between categories quite fluidly and it’s important not to give up on a person if they go “backward.”
The answer to how psychiatrists talk with their patients is: It depends. (Yeah, I know, I used that one already, but it’s true.) I’m gonna pull out the old snowflake reference. For every psychiatrist there is, there are just as many approaches to each patient. This is a double-edged sword, no doubt. Where do you start when the options are so broad? On the other hand, you’ve got a lot of space for artistic license!
Let me share an example, based on how I “grew up” clinically. I focus on empathizing with my patients and helping them process their thoughts and feelings so they can develop healthier approaches to life and relationships. I often “reflect” back to them what they’ve told me so they know I’m actually listening–which I am! I get them brainstorming ideas because it helps motivate people and helps them choose options that more readily fit in their lifestyle.
Ex (NOT A REAL PATIENT/DOCTOR DIALOGUE):
PT: “So, doc, it’s been really tough this week. My ex moved back in and he’s a total jerk. I haven’t been able to sleep, I skipped work, and I drank a six pack.”
DOC: “Sounds like you’ve been really stressed out with your ex moving back in.”
PT: “Yeah, exactly. I don’t know what to do.”
DOC: “Okay. Let’s explore this more. What do you do when you feel stressed?”
PT: “I drink. A lot.” Shakes head and sighs. “I’ve been sober for six months. ‘Til he came back.”
DOC: “Sounds like you feel you’ve had a set back.”
PT: “You’re not kidding.”
DOC: “How does alcohol help?”
PT: “I feel relaxed, less angry, you know?”
DOC: “It numbs the stress.”
PT: “Sure does.”
DOC: “Let’s think of some other things that lessen stress.”
PT: Nods. “Now that the weather’s nice, I go for walks.”
DOC: “Great idea!”
PT: “I feel so much better when I exercise. If I just get past that ten minutes, the craving goes away.”
DOC: “So walking could be a great substitute.”
DOC: Glances at clock. “Well, looks like we’re out of time for today.”
(I couldn’t resist the last line, sorry!)
Thanks for your great questions Zoe and Pete!