Monday, August 29, 2011

Medication = Incapable?

In response to Capable or Not, Does it Matter? Lisel wrote:

Well, but, if you want to medicate her, this would also imply that you think she CANNOT hold it together without medication. So where is the difference between your point of view and mine?

I think originally it was a good idea to speak of "CHOICES", because it meant to the children that they are not their acts.

It was meant to tell them: you screwed up once, but this does not mean that you have screw up every time. We do not like the way you act, but we still like you as a person.

However, I now get the impression that the use of the word "CHOICES" has evolved. It is used to indicate that everyone is responsible for his actions and that the bad behaviour was done on purpose, since it implies that the person could have chose to do otherwise.

I do not believe that your daughter's behaviour is a CHOICE in this sense of the term.

I think it is more about she lost it or never learned how to hold it together. So I think that an approach trying to deal with why she looses it could be more beneficial than a pure behavioural approach.

Sadly, therapists who know to delve into those kinds of problems seem to be few and far between. And it might not work for everyone. 

The point I was trying to make in my earlier post was that it really doesn't matter if my child (or any child, for that matter) can make better behavioral choices.  The point I was trying to illustrate was that once my child gets out into the cold, cruel adult world, nobody is going to care if she is able to control herself or if she simply refuses to do so.

If my young adult child throws a temper tantrum at work, starts calling people foul names, makes threats, and slings furniture around, there will be consequences.  At the very least, she'll lose her job.  She might even find herself arrested.

Do I think Danielle can control her behavior?

Yes, absolutely.

I've seen her do it.  I've seen her keep a lid on her rages, even when she was absolutely, over-the-top furious.  I know she can do it, because I've seen it happen.  I've also seen her consciously choose to misbehave, and to tell me she was doing it.  I've seen her be absolutely, completely, and totally obnoxious, just because she can.  I've seen other times where she's exploded because she hasn't even tried to put the brakes on things.

Why does she do it?  I don't know.  Maybe it's simply because she's in the mood for a good temper tantrum.

I believe she can control her behavior.  I also believe that she frequently chooses not to do so.

But again, I don't think it matters whether she can or cannot. What matters is that once she reaches adulthood, there will be profound consequences if she exhibits the same behavior out in the world that she does at home. Employers, teachers, friends, law enforcement and judges won't really give a hoot anymore about why she does what she does.  They will only care that she did what she did, and the natural consequences that follow.

I don't agree that offering Danielle medication is an acknowledgement of her inability to control herself.  I simply see medication as adding another tool to her toolbox that will help her do what she already can, should, and needs to do.  I see it akin to giving a kid a bicycle to ride to school.  Sure, he could walk to campus, but giving him a bike will enable him to get there faster and more easily.

Sure, there are some kids out there who can't make it without medication.  I agree that out-of-control, violent and dangerous kids should be medicated.  If we have to dope them into submission so they are no longer violent, then that's what should be done.  There are some kids, even with medication, who won't make it because they truly are not capable.

But again, it doesn't matter.  The long-term consequences for those adults are the same either way.  A person who commits criminal acts will eventually be locked up.  The "lucky" ones may end up in mental facilities as opposed to jail or prison, but the consequences of their actions will follow.  People won't care a great deal why a young woman is violent; they will simply demand that she be locked away to keep society safe.

So that's the point that I'm really trying to make here.  Everyone, even the sickest, most mentally ill people, are ultimately held responsible for the choices they make.  Even if someone isn't capable of rational thought, the system will still impose consequences.  Violent people, regardless of the reasons they are violent, will face repercussions when they are caught.

My biggest concern about assuming some kids can't control themselves is this: if we spare children the consequences of their negative behaviors, we teach them that they will get a pass if they do wrong.  I think we should assume that every child is capable of doing better, and teach them as such, because to do otherwise is a huge disservice to them.

If we hold the bar low, children never learn to jump high.  It's true that children often don't meet our expectations for their behavior.  Still, I think it's important to set the bar high because they will almost never give us more than we expect.


  1. "I think we should assume that every child is capable of doing better, and teach them as such, because to do otherwise is a huge disservice to them."

    Well, the question is, I suppose, how we teach them. And how high the bar has to be in order to fit for them without being too high.

    I agree that this situation is very difficult, because, ultimately, nobody really knows how to deal with it.

    I would hope that somehow the "bad", the internalized trauma, could come out of the young girl, thanks to a relationship of confidence that allows her to catch up what she did not get as a child, to feel well cared for, and eventually to quit this disturbing behaviour.

    Are all the instances where it works just myths? Are they different cases than your child?

  2. Dear Lisel

    I've been reading this blog for a long time. I have never once gotten the impression that this kid is incapable of making the right choices in terms of her behavior. I have also not gotten the impression that these people are simply looking for an easy way out in dealing with the kid.

    In fact, the impression I have gotten is just the opposite and FA and FE should be commended for sticking it out as long as they have in light of the circumstances.

    I also believe that under the circumstances that have been clearly stated on this blog many many times, that at this age it does not matter whether or not the kid can control her behaviors or not. The parents have just as much a right to be SAFE as any child. These behaviors ARE dangerous and could potentially cause serious harm to self or others as well as drastic consequences to herself in regards to her future. Therefore whether she can control them or not does not matter, they must be dealt with before somebody gets hurt.

    In a perfect world, this kid would have been given all the chances and taught the right ways of dealing with things from the beginning, in which case she would probably not be behaving in such dangerous ways today. Unfortunately we live in the real world so that is not the case.


  3. When I was diagnosed with depression, I was offered medication. I was resistant to it, because I felt that I could handle it myself. However, my doctor disagreed. She told me that if I was sick, I would want to take medication to treat my illness. She explained that I should treat this in the same manner. I have a chemical imbalance in my brain, and while medication isn't the cure-all, it pushes me in the right direction.

    You aren't offering this form of treatment because you don't like her and don't care about her, you are including medication as a way to help treat what ails Danielle, and hopefully this will push her treatment in the right direction.

  4. Definitely unacceptable behavior will impact her life. Schizophrenics can't control themselves and need medication, but still can't function normally. They will likely have few social contacts at the very minimum, might end up hospitalized, or in a group home. It's just the way it is. What I believe you are missing with Danielle though is that there is still a ton of maturing that will happen in her brain development, specifically her frontal lobe, which controls "executive functions,", especially her impulsivity. I believe that it will greatly improve and she will not act exactly as she does now. she may not be perfect, but things will improve. I did some really stupid stuff when I was 16 that I would never dream of doing now, and I am a relatively normal adult, and was a pretty normal 16 year old as well. I would focus on the here and now and not worry so much about adulthood. Really, all you can do is teach her and help her as best you can, at 18 the choices will be her's to make.

  5. I really appreciated your thoughts on the comment. I was reading on another blog about FASD that FASD is NOT considered a mental problem in the eyes of the law, therefore any child or adult who has a FASD will go to jail for their actions and not a mental institution. No matter what we deal with in life, there is no excuse for bad behavior. You do not get a free pass for physically hurting people, ruining other people's property, or acting like a baby. (The reason for the behaviors may be there but you are not excused from them.) If we can find a way to help our children to live a truly full and meaningful life then that is the thing we need to do. I may not make the same choice as you, but I certainly don't condemn you for your choices. You are the one walking with Danielle, not anyone else, and you know far better then anyone else what Danielle needs and when.


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