From time to time I am asked to help emotionally troubled children with behaviour disturbances whose problems I diagnose as untreatable or, at best, highly resistant to treatment. This situation perplexes and frustrates any professional, myself included, since each of us would like to feel and be sufficiently powerful to cure any possible problem for any patient. Nevertheless, doctors and society in general must recognize that there are some problems that a patient simply must learn to live with. Why? Because to treat the emotional problem is more disruptive for the troubled patient than for him to learn to cope with the problem directly. Acknowledging the limits of treatment hurts the unscrupulous professional in the pocketbook; it hurts the most professional professional in the ego. Let me give you an example.
Recently I was called in to see a youngster who had contracted a blood disease that required hormone injections for him to survive. The little boy, aged five, was given high daily doses of male hormones. He became aggressive, his voice took on a deep tone, hair grew on his face, and he showed many of the other characteristics of a normal adolescent. In particular, he began to show sexual interests, demanding to be cuddled by the nurses who cared for him. Perhaps incidentally but yet significantly, the hormones that were administered caused the boy‘s penis to become rather large. The youngster was confused, the staff was perplexed, and other patients to whom he exposed himself were curious. Overall, the boy‘s behaviour somewhat overwhelmed the doctors and nurses who had to handle him, since they could not recognize that he was still a young child who happened to have many adult physical characteristics. They were inclined, consciously and unconsciously, to react to him as an immature adolescent, not as a young child who was artificially (as part of his treatment) afflicted with certain adolescent secondary sex characteristics. As hard as it was for the doctors and nurses to care for him, it was even more difficult for the boy to cope with his own impulses and particularly with the feedback he got from other people. He was totally confused.
The doctors and nurses were ready to try anything. They wanted a psychological explanation for the boy‘s behaviour and they wanted me to get the child to behave normally. I told them I couldn’t help because the hormones were causing the abnormal behaviour, not emotional disturbances. They must either stop the daily hormone injections or live with the abnormal behaviour.
A more sophisticated example involves a twelve-year-old girl who had had a brain tumour removed one week before I first saw her. She complained of severe headaches and showed excessive clinging behaviour. She was extremely demanding toward her mother. At times the girl responded to voices and people not apparent to others. These visions particularly distressed the doctors and nurses who had to care for the girl, so they referred her to me. Although the girl‘s mother had clearly been inconsistent in handling her in the past, I had to consider that the disturbed behaviour might be a reaction to her brain tumour, her operation, and the unpleasantness of the postoperative period. I felt it was best to tolerate her disturbed behaviour, offering her simple reassurance until she was sufficiently recovered for me to evaluate the true nature of her emotional problem. I declined to initiate psychotherapy. As it turned out, the girl‘s behaviour returned to what was described by her mother as “normal.” True, “normal” included behaviour I might have characterized as demanding and clinging. But neither the mother nor the daughter felt any particular concern. Apparently I had been wise to consider that the girl had experienced a severely traumatic surgical procedure. I was correct in deciding to leave her behaviour problem alone rather than push this youngster into intensive psychotherapeutic sessions. She was having enough trouble as it was, without having to cope with a professional. Incidentally, you too must accept the fact that your child will have problems that you cannot help him with.
