Friday, April 6, 2012

Psychiatric Follow-Up

Recently, we paid a follow-up visit to Danielle's psychiatrist.  As planned, she made some adjustments to Danielle's medication regimen.  She left her at the same relatively low dose of the new anti-depressant she started last month, and added a new drug that will function as a mood stabilizer.  I think it will be interesting to see how this medication affects Danielle's behavior, as this drug is classified as an atypical anti-psychotic.  She has expressed some pretty delusional thinking at times, and I hope this will provide some relief in that area.

The psychiatrist seemed to think that the new drug will help Danielle solidify her identity.  I see this as a positive, as I have sometimes wondered if she even had one.  She has no interests, no hobbies, and nothing really motivates her.  She often reminds me of a chameleon, taking on the coloration and characteristics of the friend she happens to be with.  I've wondered, for a very long time, where is the authentic Danielle?

I have a hard time believing that her true self is limited to being The One Who Rages.  There has to be more to her than that, but it is invisible and unknowable, at least in her unmedicated state.

Here's to hoping the medication works.

The doctor also shared with us a rather discouraging factoid.  She said that kids Danielle's age, with the issues she has "almost never" experience successful adoptions when they are adopted. Although the county is always happy to see these kids find "forever" families, they are rarely happy and successful in their new homes.

Our unfortunate outcome, seems to be the rule and not the exception.

If that wasn't depressing enough, we got some more discouraging news.  The psychiatrist told us, after having time to look over Danielle's file in detail, that she felt that it was reasonable to confirm a diagnosis that we'd asked about at least five years ago.  Unfortunately, for all of us, Danielle didn't receive help for it when she was younger, and possibly more malleable.  Still the psychiatrist told us that even though there are supposed "experts" who specialize in treating kids with this particular disorder, there is no scientific evidence that the treatments actually work, and a growing body of evidence that at best they don't work, and at worst do more harm than good.

The doctor's remarks made us curious, so we started doing some research.  Some of the stuff we learned was pretty stomach-churning.  It turned out that the discipline program that our county teaches and encourages all foster parents to use was created by someone who has been highly criticized, and who later lost his license.  We spent quite a bit of time researching all of this, and even the program that has been claimed to be the most effective "evidence-based" treatment wasn't tested using true scientific method.

It turns out, if you talk to real scientists, there is no agreed-upon treatment for Danielle's disorder, and there is no consensus that anything really works.  Sure, there are anecdotal tales from families that claim that x treatment or y treatment helped their troubled child, but no scientific, double-blind studies that have proven that anything works.

When we met with our family therapist this week, we shared what the psychiatrist had said, and what we had found in our research.  She confirmed what we had discovered, and we all agreed that we have a child who cannot be fixed.  Danielle can be given training and coping skills to better deal with her problems, and we can always hold out hope for a better future, but she will likely not be "cured," at least in any traditional meaning of the word.

There are some physical injuries from which the majority of people do not recover.  Spinal cord injuries, for example, rarely heal to the point that a quadriplegic has completely recovered.  Someone who suffers a complete separation of the spinal cord will likely never walk again.  I think, in this case, that Danielle suffered permanent psychological injuries as a child that are so severe she will never recover.

Is there such a thing as a spinal cord injury to the soul?

Perhaps there is.

Both the psychiatrist and the family therapist understand why Danielle will not be able to live with us past her 18th birthday, and so the focus is beginning to change.  We are all acutely aware that she is a mere 18 months away from becoming emancipated, and we all see a certain amount of urgency in helping Danielle come up with a workable plan for independence.

The troubling thing, we all realize, is that Danielle may not be willing to put in the work required to execute that plan.

1 comment:

  1. You can plan and plan and plan and ultimately, Danielle will do what she wants. Maybe the key is to get her to think she is calling the shots in her plan. We filled out reams of paperwork to try to get some of our kids help - only to find out they didn't qualify for a particular program (after being steered in that direction by people who assured us they did) or the kids sabotaged the plans. We have laid out thousands of dollars for things that we believed might help, but the kids absolutely refused to do their part. The answer is not to stop trying, but to understand that there are no guarantees of a good outcome no matter how much effort WE put into it. There were a few programs towards the last few months before my dd turned 18 that we just refused to even contemplate because we'd already researched those options and realized that even if our daughter agreed to go and I did all of the work to get her there, she wouldn't stay there once she turned 18. She would change her mind about what she wanted and who she wanted to be over and over - sometimes from one minute to the next. It's great to make plans, but it seemed like as soon as the ball was in their court and they had to actually DO SOMETHING on their own behalf, it fell apart. I hope your experience is more positive than ours was.


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