Emily Thomas

Mr. Rhodes

Advanced Placement Language and Composition

23 February 2017

Returning Lost Minds: A Career in Child Psychiatry

An uncomfortable silence fills the bare waiting room as a young girl sits listening to the

ticking of the clock, wearily watching the large door across from her. Fiddling with her hands

and tapping her foot anxiously on the leg of her chair, her head throbs with worries. Suddenly,

the doorknob turns and a warm smile brightens not only the dim psychiatrist office waiting room,

but the girls anguish. A painless smile crosses her face as she rises and follows the woman into

a back room. Without saying a word, the woman fills the girl with a sense of comfort, a feeling

that maybe she will finally feel better. The doctors ability to offer a comfortable and positive

environment from the initial interaction makes the process of treating the young girl much easier

for both the psychiatrist and the patient. A career specializing in child psychiatry requires the

ability to have a keen sense of how to communicate with minors, as well as an understanding of

how to gain the patients trust, and uncover a diagnosis that will provide a happy and secure

future for the child.

In a world without psychiatry, the concept of mental illness does not exist. In the early

1800s, the method of handling those whose minds differed from societys idea of normal,

suffered many hardships throughout their lives. In early 1800s Ireland, individuals deemed

mad often ended up living the rest of their lives imprisoned inside a five foot deep hole within

their homes, covered by bars to prevent them from standing up (Shorter 1-2). In other areas of
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Europe, psychiatrists told stories of patients found chained up, restrained in their homes, or

bound to a stake in public places such as workhouses or poorhouses. While exposed to the

community, the public often ridiculed the mentally disabled, creating awful sayings or rhymes to

antagonize them (3). Throughout a significant portion of history, individuals with mental

illnesses or disabilities lived under unfortunate circumstances. A majority of those labeled mad

received unjust treatment from their families, who rarely strayed from conventional societal

views and seldom offered any level of acceptance or assistance. This led to many mentally

unstable individuals roaming the city streets as the village idiots, most of whom actually

suffered from schizophrenia or mental retardation since birth (1-2). When asylums finally gained

credibility in the Middle Ages, wrongful treatment escalated. One of the oldest psychiatric

hospitals in Europe, Bethlem, stands as a prime example. Founded in the 13th century, this small

hospice center, housing only six insane men, continued to develop further in the following

centuries. Eventually, this hospital developed the name Bedlam, also meaning chaotic

madness. Scholars recount horrible conditions that occurred within these walls, where neglected

patients laid manacled to the floor in gruesome conditions (5). Most psychiatric hospitals at this

time simply housed the insane, without attempting any forms of treatment or recovery.

Over the centuries, many forms of treatment and medication came into play in the world

of psychiatry. The first appearence of medicine to treat the mentally ill in the 1800s began with

John Haslams use of laxatives to cure insanity. Haslam and many others at the time believed

that toxins within the colon induced insanity, in turn making laxatives a cure to purge their

systems (Shorter 196). Other new medicines included the use of opium, morphine, and chloral as

sedatives, apomorphine to prevent mania, and hyoscyamus, a homeopathic sedative, as a

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hypnotic (196-199). Eventually, in an attempt to not only sedate but subdue symptoms, Charles

Locock introduced bromine into the equation (200). By the late 1800s and early 1900s, bromine

became the most widely used sedative in public asylums, due to its reasonable price and success

rates (200). In April, 1938, Ugo Cerletti took inhumane treatments to a new and disturbing level

with the introduction of electroshock therapy (218). After years of using animals to test the

effects of giving electric shock to the brain, Cerletti and his assistants discovered that placing

electrodes on the patients temples achieved the most practical results (219). With a wide range

between convulsive and lethal doses to the subjects brain, more experimentation began to take

place (218-219). On April 15, 1938, the first human attempt took place on a 39-year-old engineer

from Milan, who ultimately slipped into an epileptic fit and ceased breathing after experimenters

turned the machine up to over 90 volts of electricity (219). Once the patient finally let out a deep

sigh after 48 seconds, Cerletti and his team confirmed their hypothesis that electrical currents

possess the potential to safely produce convulsions in humans (220). After 11 treatments of

electroshock therapy, the patient showed much improvement, appearing well even a month after

discharge (221). Electroshock therapy soon became the first independent therapy method utilized

by psychiatrists, replacing the roles of neurologists in treating mental illnesses with techniques

such as spa therapy for nerves (224). At around the same time, another form of treatment

surfaced. While experimenting unsafely with the lobes of the brain, psychiatrist Gottlieb

Burckhardt introduced a new surgery that later became known as lobotomy (227). By destroying

a certain part of a human brains lobe, this treatment tamed wild patients who continuously posed

problems to psychiatrists trying to manage them. However, as a result of the the procedure,

patients lost much of their judgement, as well as control of many of their cognitive, social, and
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motor abilities (225-227). Considering the widespread uneasiness of this method by the

psychiatry community, lobotomy quickly disappeared just as quickly as it came into the world of

mental illness (228-229). Although still vaguely present even today, these harsh treatments began

to fade with the introduction of new antipsychotic drugs within psychiatry.

At this time in history, Sigmund Freuds views caused much controversy within the

community, as they still do to this day. Freud began his work with the human mind in a similar

manner to many other doctors at the time. Working as a neurologist, Freud utilized hydrotherapy,

electroshock therapy, hypnosis, and dietetic therapy (Shorter 146). In order to convey a sense of

care throughout the treatment process, Freud shifted to psychoanalysis. Through communication

between the doctor and patient, psychoanalysis created the belief that the patient received

sufficient emotional care. Through his work with psychoanalysis, Freud developed a theory that

repressed sexual impulses pose as the driving forces of neurosis (152). Although many do not

agree with this, Freud still remains one of the most influential public figures within psychiatry

and psychoanalysis.

When considering education options for pursuing a career in the field of psychiatry, the

appropriate path may not appear clearly. Many educational and professional opportunities lead to

careers in psychiatry, but the most beneficial course of study includes focusing on natural

sciences as an undergraduate student, and a pre-medical degree prior to attending medical

school. Those pursuing careers in psychiatry must attend medical school following the

acquisition of a bachelor's degree in order to have the authority to prescribe medicine (Fukami).

In general, the majority of colleges and universities in the United States offer psychology and

pre-medical majors, making the cost, reputation, and campus activities some of the main factors
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in deciding which school to attend. Based on this, some schools that make the best fit for

potential psychiatrists in the south include the University of North Carolina at Chapel Hill

(UNC), the College of Charleston, and Elon University. The differing sizes and semblances of

these colleges offer a multitude of opportunities for an array of students. UNC, for instance, has

a large student body of almost 30,000 students, the College of Charleston with almost 12,000,

and Elon University with approximately 6,500 students (College Search: SuperMatch).

Although Elon offers a smaller, more intimate atmosphere, the tuition poses as an issue for many

applicants. With a tuition averaging slightly over $31,000, compared to UNCs in-state tuition of

a little over $8,000, the differences in price may sway families when making their decision

(College Search: SuperMatch). In the case of the College of Charleston, in-state tuition costs

about $11,000, however the in-state and out-of-state costs differ; students living out-of-state,

such as in North Carolina, pay $28,000. Besides the cost and majors offered, the location of the

school and the acceptance rate play a big role in the decision-making process as well. UNC and

the College of Charleston sit in the middle of small urban areas, in comparison to Elon

University, where suburbs and small towns surround the campus. As far as acceptance rates,

UNC becomes more of a reach, considering the acceptance rate of only 28 percent (College

Search: SuperMatch). The College of Charleston, on the other hand, accepts 78 percent of

applicants and Elon University accepts 54 percent (College Search: SuperMatch). Considering

all of these factors, the decision of which college to attend lies within the individual students

preferences, price limit, and study habits.

After leaving college to enter the world of psychiatry, a physician must feel comfortable

working closely with patients struggling with conditions such as anxiety, depression, stress,
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suicidal thoughts, or mental disabilities. Persisting as some of the main challenges within this

profession, these aspects require an extensive knowledge and understanding. In order to obtain

this knowledge, psychiatrists must identify relationships between different factors affecting the

minds of young individuals. The World Health Organization (WHO) report Health for the

Worlds Adolescents, identified that the main cause of both illness and disability in youth from

the ages of 10 to 19 stems from depression, while the third mortality cause within this age group

comes from suicide. These statistics support other studies proving how 40-50 percent of these

cases result from stressors and negative or traumatic events (Ciubara et al 398). Based on this

conclusion, results indicate that a correlation between depression and anxiety may exist,

considering they coexisted in 30 percent of the cases presented (399). Although anxiety does not

always display psychotic symptoms, some include intestinal discomfort or palpitations. In

contrast, depression has visible signs such as anger bursts, social withdrawal, and feelings of

sadness or helplessness (399). Currently, a large percentage of children and adolescents remain

underdiagnosed due to the current staffing crisis in the psychiatric field of medicine, proving that

the diagnosis and treatment protocols require assistance (401). In some cases, psychiatrists must

deal with young patients who have gone through traumatic experiences. Children who have

experienced trauma often hesitate to talk about how they feel. Indicators of post-traumatic stress

include fear, anxiety, emotional pain, pessimism, nightmares, fatigue, difficulty concentrating,

and a sense of loss. In order to overcome these feelings, children must go through stages of

emotional recovery to move past their traumatic experiences, making trust crucial between the

psychiatrist and patient (Cole 90-92). The patient may consider opening up about their

experiences voluntarily if presented with a safe and comfortable environment. Whether through
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conversation, play, or storytelling, psychiatrists must understand how to analyze a childs

behavior to determine the best course of treatment. Varying forms of communication may also

help the child lighten their emotional load without even realizing it (94). With the ability to make

a child feel safe and comfortable when talking about difficult topics, followed by watching their

progress, a career in psychiatry provides both difficult and rewarding experiences for individuals

willing to put forth the time and patience necessary.

In pursuance of success in a career in child psychiatry, an individual must accept that

they will need to deal with disturbing and heartbreaking situations. Although rewarding, this job

also exhausts individuals emotionally, resulting in the dwindling number of people pursuing the

career. One must have the ability to set feelings aside and not get caught up in the emotions

evoked by the job. With a thin line between helping a patient and becoming too emotionally

involved, this job requires a special type of person who realizes the road to recovery does not

always end with them, even though they may help the young patients take their first steps to

patching their physical and emotional scars. Setting negative factors aside, a career in psychiatry

also boasts exciting experiences and opportunities. Within this field, a doctor will walk into the

office never knowing what the day will hold. The multitude of possibilities make each day an

adventure in which the psychiatrists get to explore the human mind. Considering the fact that

each client comes with their own issues, a psychiatrist never stops learning or encountering new

situations (Fukami). With the right mindset, a job in child psychiatry poses as a journey to better

the minds of young individuals.

To provide a sense of comfort to a child, a psychiatrist must gain the patient's trust, and

analyze how they speak and move in order to come up with an appropriate diagnosis. The
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younger the patient, the more difficulty the individual may experience when trying to

communicate how they feel. Because of this, child psychiatrists must invent creative ways to

examine and analyze a childs behavior. This may include methods that seem strange for

diagnosing an illness, such as drawing pictures, playing with puppets, or telling stories (Pierini

112). Depending on how the patient draws a picture or reacts to a story, certain responses

provide an idea of how to come up with a diagnosis, and allows the therapist to understand how

the childs mind works. Playing with the children allows the therapist to observe their behavior

within a controlled setting, while analyzing how their responses may shift (Pierini 111). Before a

patient gets to this point however, they must trust their therapist. By providing a positive and

empathetic attitude, as well as acknowledging and making an effort to listen closely to the patient

from the very beginning, children will more likely let a therapist deeper into their mind, no

matter the means of communication (Hartzell et al 178). Playing with children in order to

analyze their behavior and come up with a psychiatric diagnosis makes this field unique

compared to other careers, considering how creativity plays a significant role in the treatment

process.

In order to encourage a young patient to look forward to meeting with a psychiatrist, it

makes sense that pets might soon become a more common form of therapy in situations dealing

with mental health and disabilities. Many children do not know exactly how to react when

stepping into a psychiatrists office, making first impressions extremely important. The first 10

to 15 minutes of the appointment become critical in determining how the rest of the visit will go

(Hartzell et al 177-178). With evidence depicting positive interactions with animals benefit

people by creating a sense of comfort and happiness through the release of endorphins, including
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pets in therapy sessions has the potential to benefit both the patient and the doctor

(Chandramouleeswaran et al 5). Some of the uses of animals within the therapy setting include

pet visitation, animal-assisted therapy, and hippotherapy, a form of physical therapy that utilizes

the movement of a horse. In allowing pets to become a part of the treatment process, oftentimes

the need for psychotropic medications decreases due to the increased social interaction, as well

as the fact it provides a form of sensory stimulation to bring patients into touch with real life

(Chandramouleeswaran et al 5). In terms of children with psychiatric disorders, recent studies

show pet assisted therapy benefits people suffering from disorders such as autism, attention

deficit hyperactivity disorder (ADHD), grief, dementia, and chronic physical disabilities

(Chandramouleeswaran et al 6). Introducing dogs to the therapy setting resulted in a greater

ability for children with autism to focus and better their communication. In recent studies, the

introduction of therapeutic horseback riding also benefited autistic children by showing a

decrease in autistic rating scale (Chandramouleeswaran et al 6). Owning a pet gives individuals a

companion that provides unconditional love, comfort, and stress relief, proving the utilization of

animals within the therapy setting might benefit mentally and emotionally disabled patients.

Implementing pets into the therapeutic treatment process makes up only a single piece of

the new discoveries and advancements within the field of child psychiatry. While some of this

new knowledge generates excitement, other aspects uncover concern. One example of this

includes the need for a better understanding when it comes to global child psychiatry. Currently,

more than 200 million children around the world do not have the ability to reach their mental

developmental potential (Tripathi et al 1). Although many factors play a role, one of the more

significant traces back to immigration and the stress that comes with it. Considering how every
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childs mind functions differently, American children do not compare to those who must move to

a new country and adapt to a completely new and foreign way of life. With every immigrant

child comes a much different history American psychiatrists must take into account when

deciding upon a treatment plan. Between the stress of moving and altering ones lifestyle, to the

hardships and trauma faced back home, psychiatrists must approach these children with patience,

as well as a different and deeper understanding. Immigration takes quite a big toll on a child,

especially when they become expected to learn and translate a new language for their parents as

the only bilingual member of their family (Childrens Mental Health Field 6). Young refugees,

on the other hand, pose a challenge due to the situations they come from. Between 80 and 90%

of these children faced some form of trauma, whether in the form of mass killings, lack of food,

or forced labor (Fritz 5). The experience of traveling to America results in unique challenges,

such as political unrest, extreme poverty, or persecution, all of which may lead to mental illness

or violence (Fritz 1). With a growing need for global mental care for children, the 42% of

psychiatry programs that offer training in this specialty must rise quickly in order to provide the

care necessary (Fritz 6). However, it might become quite difficult to recruit psychiatrists willing

to specialize in global child mental health when staffing poses a challenge right in their own

backyards.

Staffing the field of psychiatry has presented a major issue in recent years. By the year

2020, statistics show an estimated 8,312 people employed in child and adolescent psychiatry,

although the nation will need 12,624 (Childrens Mental Health Field 4). With a growing

population of children suffering with mental, emotional, behavioral, and developmental

disorders, the shortage of doctors to accommodate for their growing patient lists must change. In
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order to accomplish this, the quality of teaching in medical school needs to focus on psychiatry

as much as other medical specialties. Due to the lack of time spent encouraging medical students

to consider a career in this field, postgraduate training in psychiatry has fallen behind the rate

other medical specialties take in students, with psychiatry residency programs growing at nearly

half the rate of programs in other fields (Volpe et al 261). According to medical students, some

of the factors deterring them from choosing a career in child psychiatry include a less prestigious

reputation, a limited amount of exposure during training, lack of respect within the medical field,

and difficulty with treatments, considering the complexity of the field (263-264). In an

experiment conducted where psychiatry residents sat and listened in on psychiatry lectures

within a medical school, some noticeable issues became apparent. According to these residents,

although the instructor taught with interest and in enthusiasm, only 52% of the classes began on

time, yet 75% ended on schedule. Additionally, of the 68% of lectures that involved the use of

audio-visual aides, 30% had some sort of technical difficulties (Melamed et al 516). Based on

this information, the residents concluded the main problem lies within using class time

efficiently and preparing lectures around the idea that technology may fail or malfunction.

Although this experiment does not speak for general medical students, psychiatry residents serve

as adequate reviewers considering they become the targeted audience once students choose a

specialty within psychiatry (Melamed et al 518). In the end, the main problem continues to trace

back to the point students enter medical school. In the past decade, the number of training

programs dropped from 120 to 113, while the number of trainees dropped from 712 trainees in

1990, to 680 in 2003 (Wun Jung 24). Because of the lack of early exposure to psychiatry, along

with the limited availability of relevant electives, lectures, and various treatment environments,
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students do not even get the chance to consider a specialty in child psychiatry (Volpe et al 264).

In order to provide children globally with adequate mental health care, medical schools must put

a much more substantial emphasis the quality of teaching and encouraging students to pursue

careers in psychiatry.

In almost every career, the comparison of men and women within the workplace poses a

great interest to many. Considering that female enrollment in medical school has now reached

nearly 50%, the number of women within all medical fields, not just psychiatry, will most likely

continue to rise (Georg et al 645). Keeping this in mind, an increase in the number of women

going into the medical field may not benefit the field of psychiatry as much as one may assume.

With the new and expanding opportunities for women in medicine, many have begun reaching

higher, by pursuing careers in more challenging, prestigious, or rigorous medical specialties men

previously dominated (Volpe et al 264). However, when analyzing the roles of males and

females specifically within the field of psychiatry, their different approaches in the diagnosis and

treatment process reflect which gender the scale of child psychiatric employment tilts toward.

For instance, in a study conducted in 2007 by American psychiatrists, the research collected

helped identify whether the gender of psychiatric residents affects their decisions when it comes

to diagnosing patients and coming up with treatment interventions (Mihai et al 233). Although

the researchers discovered no significant differences between male and female psychiatrists

within certain scenarios, women appeared more receptive to psychotherapy overall. Due to some

of their natural characteristics, women tend to boast a more emotionally expressive attitude

when dealing with patients, as well as an interest in discussing problems instead of rushing to a

conclusion or acting immediately. Men, on the other hand, appear to let their masculinity play a
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larger role in their approach. This causes them to become more controlling and independent,

more likely to hide their emotions, and more intent on proving power and working based on

action, rather than discussion (237). Based on this information and womens general role in

society overall, it appears female psychiatrists place greater importance on emotions and

personal relations compared to their male counterparts (Georg et al 639). Considering their

willingness to spend time establishing an emotional connection with their patients, female

psychiatrists have the potential to take over this field in the future.

Technology has started to become a staple in the the current working world of psychiatry.

With the use of the Internet and electronic devices, treatment processes in all medical fields stand

to advance more in the near future. Psychiatrists benefit from these changes by having the ability

to utilize these technologies when communicating with patients, keeping client records, and

developing diagnosis and treatment plans. For instance, in a case study conducted at the

University Hospital of North Norway, psychiatrists and nurses experimented with the use of

tele-psychiatry by implementing real-time video conferences (VC) in psychiatric emergencies. In

doing so, psychiatrists gained access to nurses, physicians, and patients no matter their location,

which made assessments and treatments much easier (Trondsen et al 1). In the event that a

patient does not have the ability to contact a psychiatrist in person, the use of VC provided an aid

for face-to-face interaction, even when distance posed an issue. After introducing this

technology, patients remained calmer and more willing to accept psychiatric help, which

strengthened communication, decision-making, and the quality of care between the doctor and

patient (3-4). For nurses, the VC worked as a safety net to increase confidence and certainty

when assisting a patient whom they do not see in person (5). To make the job easier in everyday
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medical practices, the introduction of innovative information technology has proven useful.

Developing electronic patient record systems increased documentation accuracy, decreased time

coordinating patient care, increased information access, and decreased the multitudes of

exchanges from person to person (Ammenwerth et al 480-481). When switching to electronic

patient records, information overall becomes more accessible and accurate when compared to

paper-based records that rely on overlapping and unstructured content, as well as handwritten

documentation (482). With implementation of this system, individuals do not have to worry

about unlegible handwriting, or losing a patients records.

A career in the field of psychiatry requires an individual willing to deal with difficult and

heartbreaking situations. Although emotionally exhausting at times, working in child psychiatry

provides the opportunity to guide patients toward happy futures through a multitude of methods.

With new forms of treatments and technologies becoming available, the field of psychiatry as a

whole stands to come out of its staffing crisis and advance in the future.
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