What is the “Mind?” Treatment of Psychiatric & Physical Illness in Children

George "Bud" Vana
uvmmedicine blogger George “Bud” Vana

Retiring Associate Dean of Student Affairs Scott Waterman devoted almost an entire hour of lecture during Foundations (our pre-clinical instruction) to the question of whether or not psychiatry should even refer to something called the ”mind.” He explained that the words you use when discussing ‘mental health’ or psychiatric illness are very important to how you conceptualize what you are treating in a patient who has depression or anxiety or any number of other disorders. As I went through my clinical experiences in the hospital I tried to think of how I described these illnesses and what words I used. The treatment of ‘mental’ illness also seemed to be imagined differently than physical illness – different drugs, different techniques and different ways of measuring success. But things became clearer after I spent a month in the Hasbro Partial Hospitalization Program at Brown University (where I’ll be spending the next five years of residency).

The Hasbro Partial Hospitalization Program is a medical-psychiatric program for children and adolescents. Patients there need to have both a chronic medical issue with a diagnosis as well as a psychiatric problem which could benefit from a temporary stay at this integrated program. I wasn’t quite sure what to expect; I didn’t know how the discussions of patients’ multifaceted treatment might go, and I did not know who exactly these patients might be. But many of the patterns in patients who came to the partial hospitalization program made sense. If you had asthma attacks, you’d be more likely to have anxiety – for example, worrying about when such an attack might happen again. Fecal incontinence usually was paired with depression. Eating disorders were paired with anxiety or depression.

Other chronic medical issues there might include ‘functional’ disorders. This is when a problem – pain, weakness or abnormal movements – persists without explanation, especially when a person is under a lot of psychological stress. Generally all of the patient’s structures – body tissues, brain etc. – appear to be fine. Other words used to describe these might be ‘psychosomatic’ – the combination of psych (the mind) and soma (body) – or simply ‘psychological.’

Patients arrived in the morning, ate breakfast – which sometimes needed to be monitored for patients with eating disorders or food aversion – participated in therapeutic sessions, ate lunch, did school work and talked a lot about what was going on for them as related to both their medical and psychiatric problems both in groups and in one-on-one sessions. They also received their medical care –medicine and other procedures – from pediatricians and nurses.

An entire team looked after each of the children and was able to communicate about what individuals within the team were seeing during the day. Team members, while specifically trained as pediatricians or child psychiatrists or child psychologists, each might comment on both ‘mental’ and ‘physical’ challenges for the patients alike not only sticking with that which reflected their discipline. The process was amazingly collaborative and integrative. Outside of team meetings patients would have collaborative sessions with their family and psychologists or psychiatrists as well.

The program was exciting to be a part of – children made progress in fits and starts. As the child worked through his or her struggles, you wondered whether the medical diagnosis or the psychiatric diagnosis caused the most problems for the child and whether one could really separate on from the other. The children who succeeded within this program took part in another program called The Adolescent Leadership Council or more often TALC. Kids who had graduated from the partial program and might benefit from additional community activities could take part in TALC and its monthly meetings as well as summer camp, getting advice from college students who had succeeded while having chronic medical diseases. This too was inspiring, and the adolescents seemed much more at ease talking about their on-going issues in front of other children and young adults who understood their struggles.

All in all, my month at this program seemed very brief, but I did get to see progress in several children while I was there. I also got some sense of what skills I could develop to better help these children and young adults. I will be getting a chance over the next five years to do just that. Hopefully I’ll be able to work in this space between what we call mental and physical illness – maybe even figuring out the right language to describe it.

What are your thoughts about this topic?