Owl Newsletter

April 2019 e-Newsletter

Photo by Fred Seligman, MD

Inside...

Painful Meanderings on the Differences Between Child and An Owl in Myanmar...... 15 - 16 General Psychaitry...... 3 - 6 Vital Involvement in Old Age...... 17 - 20 Pop Culture...... 7 - 14 Donors to AACAP’s Life Members Fund...... 21 Throughout the Years ...... 24 COMMITTEE Harry S. Truman (1884-1972) Richard L. Gross, MD Painful Meanderings on the Differences Between Child and General Psychiatry Jokes submitted from Martin Drell, MD Cynthia R. Pfeffer, MD In looking through a 2006 book on Presidential humor Perry B. Bach, MD by Liz Carpenter, I was reminded of the wit and wisdom Many years ago, someone After more discussions with myself, I ended up of Harry S. Truman, who was President when I was born at a meeting asked what the doing an uncomfortable “flip flop” and wondered if the Marilyn B. Benoit, MD (1945-1953). Here are a few of his best quips: difference between adult and differences between general and child psychiatry were Martin Drell, MD child psychiatry was. I was not not widening but were actually narrowing. This led me Editor sure what I thought was the to envisioning a time when one would ask what the • “If you can’t convince them, confuse correct answer, and was loathe difference between general and child psychiatry is, and them.” • “You don’t set a fox to watching the John E. Dunne, MD to answer, lest it was a trick the answer would be “none.” This did not seem right chickens just because he has a lot of question. I prevaricated and let to me! experience in the hen house.” Joseph J. Jankowski, MD the questioner answer his own • “I learned that a great leader is a man question, which he seemed Perhaps, I have been blinded and biased by my anger who has the ability to get other people Allen Mark Josephson, MD Martin Drell, MD burning to do. at the general demise of psychotherapy training in to do what they don’t want to do and general psychiatry, which I have written and talked like it.” Paramjit Toor Joshi, MD “The difference,” he proclaimed, “was a belief in about over the years. Could it be that I am a victim of • “Polls are like sleeping pills, designed development.” I thought it was a very good answer! “assortative mating” in that most of my professional to lull the voters into sleeping on elec- Douglas A. Kramer, MD, MS Over the past decades, I have returned every once and friends are “therapy enthusiasts” who reinforce my tion day. You should call them a while to this question. The last time I thought about unconscious and conscious biases towards training in ‘sleeping polls.’” this, I was absolutely sure the differences between • “Whenever a man tells me he is bipar- John Schowalter, MD psychotherapy? If I lift my blinders, isn’t it the reality tisan, I know that he is going to vote general and child psychiatry were widening, leading to that child psychiatry is following general psychiatry in against me.” Ellen H. Sholevar, MD the sense of different tribes. As I approach the subject its de-emphasis on training in psychotherapy and that • “A Statesman is a politician who died now, the question remains a valid one, but deciding this difference seems gone also (much to my dismay)? 10 or 15 years ago.” John B. Sikorski, MD what constitutes the difference seems harder for me to • “Any man who has had the job I’ve answer. One of the differences I had thought about in I ask myself over and over - why would general or had and didn’t have a sense of humor Samantha Phillips the past was the use of medications by general child psychiatry knowingly narrow their scope of wouldn’t still be here.” Managing Editor psychiatrists, but child psychiatry has embraced practice? • “Never kick a fresh turd on a hot day.” medicines so fully that we are often portrayed by the • “You want a friend in Washington? Get Jaime Owens public as “pill pushers.” The news speaks daily of Returning to the original question, I then wondered a dog.” Production Editor polypharmacy and the overmedication of children, • “If you can’t stand the heat, get out of whether child psychiatry was also losing its traditional the kitchen.” especially young children. So I don’t think the use of focus on development. My “therapy enthusiast” friends • “You can’t get rich in politics unless medications is an adequate answer, as child surely agree with this and frequently ask me, “Does you’re a crook.” Get involved - psychiatrists seem, in this regard, to be more like and anyone read Mahler anymore, or what happened to the • “When you have an efficient govern- not less like general psychiatry. psychosexual stages, you know, like oral, anal, submit articles for the ment, you have a dictatorship.” oedipal, latency, adolescence, or the psychosocial • “Being President is like running a cem- Owl Newsletter! While thinking this through, I couldn’t stop thinking stages of Erik Erikson?” etery. You’ve got a lot of people under of Stephen Sharfstein’s oft quoted remark that the you and nobody’s listening.” Get involved - submit articles for the Owl “Biopsychosocial Model” seems to have been replaced • “Imperfect action is better than perfect Have these been lost to civilization like the art of Newsletter! We want to hear from you! Let by the “bio bio bio model.” Perhaps, the answer is that embalming that was perfected by the Egyptians? At inaction.” us know what you are up to, how you’re • “The reward of suffering is experience.” general psychiatry focuses more on biology than child this point, I found myself becoming anxious and then doing, and more! Please send materials to psychiatry, but surely no modern child psychiatrist • “The buck stops here.” [email protected]. The deadline for the defensively flippant. I repeat, with hyperbolic distain, would disavow the importance of biology in this age next issue is June 15. a frequent remark of mine that the “newer generations” of neuroscience, brain scans, medications, and do indeed have a sense of development: iPhone 1, 2, 3, Martin Drell, MD genomics. 4, 5, 6, 7, 8, 9, 10 or DSM I, II, III, IV, IVTR, and 5.

3 Painful Meanderings on the Differences Between Child and General Psychiatry Painful Meanderings on the Differences Between Child and General Psychiatry

In reality, few younger child psychiatrists have He paused for a very long time before responding, Engel’s “developmentally influenced and system’s I suspect many training programs are doing too little ever seen DSM I, II, or III. I appear like an an- “I’m not sure... perhaps Erikson?” informed biopsychosocial model“ has an with regards to the neurosciences and brain cient book seller as I share with them my dusty overarching model which seemed to inclusively development, and some are doing too much. I think copies of I, II, and III to show what changes have I am not a purest who demands faithful allegiance accommodate all the theories that I read about and often of the Three Little Bears and Goldilocks story. occurred in our field over the past decades (“Look to the psychosexual stages. In fact, I never felt that juggled in my mind.Over time, I have continued to What is the “baby bear” approach that is “just right?” how skinny they are!” “Look how few diagnoses they were enough to fully explain the cases I was add new developmental theories to Engel’s model to I find the neuroscience literature interesting. I there are!”).After such “flights into flippancy,” I seeing and don’t directly use them as much these better explain differing time periods of the lifespan. especially love the anecdotes that condense years and reestablish a serious tone and return to thinking days. They were, however, an academic starting years of painstaking research into useable sound bites about the “lack of a developmental perspective” point for me, especially after David Freeman, MD, To me, these theories are like looking at the same of information. Despite my love, I have trouble in general and child psychiatry. In my experience, a psychoanalyst and general psychiatrist at Baylor microscope slide with differing powered lens finding how it can be helpful with the patients I see when I discuss development with people, the con- in the 80s, informed me that Freud’s theories were Mahler certainly helped me focus more in-depth and other than adding immeasurably to my abilities to versation invariably leads to whether there are any imperfect, but the most comprehensive models to better figure out the toddler period of the “anal provide fancier and more cogent scientific recent “good” textbooks on development. Does concerning normal development, the development phase.” Similarly, there are times when a “wider psychoeducational explanations to the people I see in this mean that they have not been keeping up with of psychopathology, and therapy available. angle” lens has proven helpful, like the addition of my clinical work. this area which they say is so important? At this the psychosocial foci of Erik Erikson, point, it is amazing how often my contemporaries He fascinated me by pointing out that these family-systems theory, and the family life cycle Many patients and their parents especially enjoy and lovingly harken back to Mel Lewis’ venerable Freudian developmental insights were constantly that are so helpful in couples, parenting, and family can relate to my seemingly scientific explanations, developmental book. They seldom get the title being interpreted and re-interpreted and that even work. especially when I use “top down” and “bottoms up” correct (Clinical Aspects of Child Development), the most eloquent of formulations did not guarantee metaphors, although my “inner” flippant, defensive but usually are able to describe the colors on that Freudian therapy would “cure” the problems In keeping with the best of Engel’s model, you self can’t help but note that the bottom up seems the cover (depending on their age - orange and identified, or even be the treatment of choice. These should not be surprised that I have been an advocate awfully like the id, while the top down is not unlike blue, which is the 1981 second edition, or orange were important distinctions for me at the time and for the addition of brain development and the the ego/superego. Am I missing something when it and white, which is the original 1971 paperback remain so today. My work with infants validated neurosciences to the child training curricula. seems to me that all the brain scans always point to edition). My personal 1971 copy got waterlogged my problems withthe psychosexual stages. Calling the “top down” frontal lobe? when my ice cooler leaked into a box of books in an infant “oral” doesn’t help very much. Information on these topics are developing apace my car while I moved from my residency in and will be more and more necessary for future I suspect Jonathan Cole, an early Boston to my first job at Baylor in 1979. To help with this population, I needed the assistance child psychiatrists. Unfortunately, I have to learn psychopharmacologist, thought similarly when years of latter developmental theorists, most of them the subject matter before I can teach it. Towards that ago, he humorously and perhaps flippantly chastised I personally cannot fathom the world of child and psychoanalysts, such as Piaget, Spitz, Emde, end, I have gone to several American Association of psychopharmacologists for chastising psychoanalysts adolescent psychiatry or general psychiatry Sanders, Sameroff, Mahler, Klein, Winnicott, and Directors of Psychiatry Residency Training for explaining “everything” with the trilogy of the id, without some sort of developmental perspective to the object relation theorists. Each of these theorists (AADPRT) Brain Institutes that try and show how ego, and super ego. “After all,” said Cole, “don’t you help understand the vast differences between added differing perspectives on development, some one can teach the neurosciences. pharmacologists explain everything with the trilogy infants, preschoolers, middle childhood, of which were more useful and understandable than of serotonin, norepinephrine, and dopamine!” adolescents (younger and older), transition age others. I find it daunting! At these institutes, I find that I youth, and adults (younger and older). am not alone in my feelings. My favorite “honest” We all start with the models we are taught and do the I sadly admit to still struggling with the Ruth and presenter on the subject of teaching the best we can with them. Hopefully, we add to them or To check my bearings, I recently asked a general Pre-Ruth stages of Winnicott. At around the same neurosciences, at a recent institute, said that he replace them with newer models that we determine psychiatrist who works at a mental health center time, in the early 80s, I took an ongoing interest in wasn’t quite sure how to teach this material in an more helpful in our overall clinical work.I suspect what development theories he uses. George Engel. acceptable and digestible manner, but that we all that some feel that I do not practice what I preach. I needed to attempt it to do so. His advice was to know that I have been accused by being “reactionary” “just do it.” due to my love of therapy.

4 5 Painful Meanderings on the Differences Between Child and General Psychiatry Pop Culture: An Integral Element in Molding Children’s Development

Indeed, I have been told more than once to my I sincerely hope that the answer to the question of the Recently when visiting These trends are changing markers of face that I do not prescribe meds. This is simply difference between adult and child psychiatry will end friends, their son asked if I human existence that are reactions to the past and not true! In my defensiveness, I usually direct my up being answered as “none,” as they both encompass have a Samsung need for change. accusers to read my “Clinical Vignettes” column all the best system’s informed, developmental, and Galaxy Note 9 smart which often mention that my patients are biopsychosocial information and skills we have and phone. He told me that he I wrote this column especially for AACAP Life prescribed medications by me. I then add proudly will, in the future, have available to us in pursuit of plays Fortnite, a popular Members to recall historic events of past decades that I am a state consultant to foster care for quality patient care. The acquisition of new video game, and that he and to understand the emergence of congruent polypharmacy and boast of being an “early information and skills should be a “this and” and not wanted to get a “skin”. pop culture. It may serve as a reminiscence, ed- adoptor” of SSRIs. In truth, the latter act was an “either or” proposal that favors inclusiveness vs. ucation, and aide for use in applying knowledge mostly due to my anxiety concerning the lethality exclusiveness. Cynthia Pfeffer, MD of pop culture to work as child and adolescent of the tricyclic antidepressants that I used before psychiatrists in mentoring, teaching, and helping SSRIs came out. It will hopefully include diagnosis and formulation, as He knew that he could get it by ordering with a patients. well as psychopharmacology and biological Samsung Galaxy Note 9. He was very happy when I love avoiding anxiety of that sort almost as much treatments, plus a range of therapies in its training I told him that I have this phone. Soon, he returned Pop culture is not static and is important to our as I love being able to help my patients. If my curricula. Meanwhile, I will continue my learning, and was overjoyed to show me the “Fortnite skin” knowledge for helping youth, especially those accusers persist, I then mention that I was orches- questioning, and thinking, exciting and painful as these that he ordered. who suffer from trauma, anxiety, sadness, and trating chloripramine treatment for an adolescent meanderings may be. developmental problems. patient of mine with severe OCD in the early 80s. His younger sister was watching a very popular children’s animated movie, Frozen. Sitting beside It is a reminder to be knowledgeable about At that time, the meds were secured from Canada her was an American Girl Doll dressed in a beauti- historical and daily events as well as pop culture by the family, as they were not as yet approved or ful winter outfit. trends and to be able to apply such knowledge in distributed in the United States. Why do my psychotherapeutic work with youth. A teenage accusers think I can’t walk and chew gum at the Having visited the American Doll Store in New patient recently said to me, “I like my history same time and force me to say which of the two York City and seeing the large number of girls and teacher because when she teaches she makes it practices (psychotherapy or pharmacology) their mothers at the store, I realized how these dolls enjoyable to learn because she knows what kids I prefer? Can’t I prefer “both” even if, in reality, have become among the most popular possessions like.” I prefer one treatment modality (psychotherapy) of today’s young girls. In fact, the American Girl more than the other? Is this more tribe like dolls may replace the iconic Barbie Doll in Pop culture changes over time. During the 1930s behavior? popularity. and early 1940s, women took care of their families at home. As the Decade of the Brain in the 90s was initiated Recently, I watched a CNN TV documentary called 29 years ago, I know we are in a long and slow “American Style” about trends in woman’s Once World War II commenced and tragic deaths launch sequence that will definitely lead to the fashions from the 1930s to the present. at Pearl Harbor occurred, large numbers of wom- neurosciences being more and more helpful to our en entered the workforce to help the war effort. patients. As this eventuates, I know that whatever This program highlighted changes in fashion styles They took work roles of men and were consid- discoveries are made will fit nicely into Engel’s resulting from interrelated sociocultural, current ered “tough” as characterized by the pop cartoon overarching systems model, which incorporates a events, financial, and global trends. These examples figure, Rosie the Riveter. Popular toys included developmental biopsychosocial perspective. illustrate pop culture, the expressions of societal doctor and nurse kits, which were often sold with creations resulting from periodic changes in world the advertising statement, “Every Little Boy Can events, human interactions, creativity, and Play a Doctor and Every Little Girl Can Play a materialistic endeavors. Nurse.”

6 7 Pop Culture: An Integral Element in Molding Children’s Development Pop Culture: An Integral Element in Molding Children’s Development

The pop icon poster of Rosie the Riveter, however, The launching by US President Lyndon B. Johnson Public awareness and support for the Gay Rights Such musicians had large youth followings, who identi- changed children’s views of gender roles. In the 1950s, of “Operation Rolling Thunder” (1965), began a Movement was promoted by the first Gay Pride fied emotions and themes in their own lives. Technology families moved to the suburbs and had stability, pros- three-year campaign of sustained bombing in North Parade in New York City (1970), which helped blossomed with the development of the first micropro- perity, and the appearance of mass conformity. The Vietnam. This stimulated Vietnam War protests liberate inhibitions about expressing one’s gender cessor, The Intel 4004 (1971), and stimulated the “elec- 1950s ushered in the era of TV entertainment; children lead by youth movements in Washington, DC, New identity. tronics and digital revolution,” illustrated by the first enjoyed watching the Mickey Mouse Club, adventures York City, and Los Angeles (1967). A popular anti- video game (Pong, 1971), creation of Microsoft (1975), of Superman, and other shows. Iconic children’s toys war song was “Day Is Done” sung by Peter, Paul, The ability of teenagers to make meaningful choices and Apple Computer Company (1976) which changed were Mr. Potato Head (1952), Legos (1958), Hula and Mary (1968). Its meaning was that “Children in politics occurred when the US voting age was people’s lifestyles. Children’s electronic toys with LEDs Hoops (1958), and Barbie Dolls (1959). will lead us to a better world.” Youth unrest was lowered to age 18 years from 21 years (1971). The were popular. depicted in a popular movie The Graduate which Supreme Court decision for the Roe v Wade case The Cold War with the Soviet Union produced represented the confusion of a male college gradu- (1973) produced a significant benefit for women’s Ronald Regan’s election (1980) stimulated an era of repression, the threat of communism, and an increase in ate rebelling against his parents’ world by having an reproductive rights. glamor and extravagance. Standing before the Berlin conformity. Women increasingly stayed home to care affair with the wife of his father’s business partner. Wall, President Regan challenged Soviet leader, Mikhail for their children. Youth rebelled against their parent’s Movie depictions previously kept hidden included Gorbachev, by saying, “Mr. Gorbachev, tear down this roles and conformity by expressing this in music with This era involved the counterculture music of James brutality (A Clockwork Orange, 1971), corruption wall” (1987), and the Berlin Wall came down (1989). the advent of rock and roll and their rebellious Brown, Stevie Wonder, and The Rolling Stones. (The Godfather I and II, 1972, 1974), mental illness There was a vitalization of the English Monarchy when behavior. They clung to different role models, such as Cinema was groundbreaking with its expansion (One Flew Over the Cuckoo’s Nest, 1975), survival Prince Charles married Lady Diana (1981), and Prince Elvis Presley (You Ain’t Nothin’ But A Hound Dog, into animation techniques and color TV programs (Jaws, 1975), governmental failure of the Watergate William was born (1982). Lady Diana, although from 1935-1997) and James Dean (Rebel Without A Cause, (1967). Fashions in the early 1960s were conser- Scandal (All the President’s Men, 1976) , science royal lineage, was considered a school teacher when she 1931-1997). They experienced personal vulnerabilities vative with classic styles. In contrast, Twiggy, a fiction (Star Wars, 1977), teenage stressful family married. and isolation. 17-year-old English trendsetting woman, became a life, unfulfilling work, and complex friendships fashion model phenomenon, who revolutionized the (Saturday Night Fever, 1977), parental divorce and The world watched her with amazement as she revised The 1960s was an era of youth cultural revolution. fashion world by creating the “youth look” (1967). child custody (Kramer vs Kramer, 1979), and the the activities of royalty with her interests in social Youth embraced a hippie culture of being wild, using Women wore short skirts and bright colors while Vietnam war (Apocalypse Now, 1979). TV had bold justice and charity. She was internationally admired for drugs, and wearing long hair and unique clothing. men wore long hair, beards, tunics, and capes. programming of ethnic humor and taboo “adult her kindness, efforts to make connections with people, themes” illustrated by the situation comedy show and ease with children; her visits with AIDS patients, The election of John F. Kennedy (1961), the youngest Social unrest was stimulated by the killing of four All in the Family, expressing themes of bigotry holding their hands and encouraging them, were unique. President of the United States, was the embodiment of Ohio Kent State University students, who were in (1971). She modernized the monarchy and brought royalty to optimism. The popular movie West Side Story (1961), opposition to the continued Vietnam War, by the the people! She was “The People’s Princess.” The world with music by Leonard Bernstein, depicted intense National Guard (1970). Relief occurred when Presi- Pop music expanded concepts of how people faced mourned when she was fatally injured in a car accident ethnic rivalry among gangs in New York City. dent Richard Nixon ordered withdrawal of US mili- adversary or gained satisfaction with their lives. (1997). tary troops from Vietnam (1973), and the war ended The emergence of hip hop in the Bronx, New York, It was an era of extensive and revolutionizing pop (1975). By the mid-1970s, hippie culture waned. highlighted, through dance and music, the discon- Her children carry on her legacy with acts of kindness music creativity, epitomized with the counterculture Social and political progressive values increased, nect of Black youth in city settings (1973). Their and charity. High suicide rates throughout this decade music of The Beatles (Sargent Pepper’s Lonely Hearts and the iconic peace symbol continued to be worn music became mainstream culture and gave birth to occurred among US 15 to 24-year-olds and alarmed Club Band), Bob Dylan (A Hard Rain’s A Gonna Fall), by social activists. popular urban music. communities to seek ways of identifying youth at risk Mamas and Papas (If You Can Believe Your Eyes And for such death and self-injury. Additionally, crack Ears), and The Rolling Stones (Paint It Black). Personal liberation and rebellion against authority Other popular musicians were Aretha Franklin, cocaine was used widely in the United States (1985). President Kennedy’s assassination (1963) produced became issues for sexuality, politics, and pop known as “The Queen of Soul” (pop, R&B, soul), Parents, especially those who lost a child to these national demoralization. culture. ABBA and the BeeGees (pop, disco), Bruce problems, formed volunteer programs and charities to Springsteen (folk, rock), and James Brown (Urban). increase awareness of youth suicide and drug deaths.

8 9 Pop Culture: An Integral Element in Molding Children’s Development Pop Culture: An Integral Element in Molding Children’s Development

These movements stimulated the National Institute Enthusiasm developed for movies relevant to Bill Clinton was elected US President (1992) because The Real World (1995-2007), a reality show, was of Health and private charity organizations to advances in technology and mental health he was perceived as being connected to the favored by TV viewers as a way to think about provide funding for research and prevention problems. people. He remained in office after his one’s potential to reach goals and interact with programs against these mental health problems. impeachment proceedings (1999). others. This stimulated fantasy about future space The importance of suicide risk reduction was exploration and communities on other planets in Oprah Winfrey was viewed as a self-made person Children and adults enjoyed animated programs recognized when Prozac was marketed to treat the universe. Popular movies illustrating these and able to comfort others; she was thought of as a such as Tiny Toons Adventures (1990-1992) depression (1987); extensive discussion in the concepts were: Star Wars: The Empire Strikes “spiritual guru.” Nelson Mandela, released from a because it enabled parent and young children to media and at social gatherings propelled national Back (1980), ET (1982), The Right Stuff (1983), South Africa prison (1991), was elected President of spend time together. A favorite movie was Star Wars mental health awareness. Return of the Jedi (1983). Mental health issues South Africa (1994), and became a beloved leader Episode I: The Phantom Menace (1999), which were represented as well (Rain Man, 1988). The who liberated Africa from apartheid and enhanced aimed to tell about the early years of the characters. Medical advances included identification of the creation of cable TV networks, such as Cable civil rights. Harry Potter and the Philosopher’s Stone AIDS virus by the Centers for Disease Control Network News (CNN, 1980), Music Television (1998) became the most popular book among chil- Many new rap music genres were produced (1981) and the development of an AIDS test by the (MTV, 1981) and The Weather Channel (1982) dren and adolescents. Parents read it and shared in including Gangsta, Fusion, Alternative, and Pasteur Institute (1986). Fears were strong about increased accessibility to programing at home. their children’s interests. Country that utilized electronic music and contagion among same sex couples and about lack included young musicians from the Generation X. of treatment for this illness. Bereavement among Excessive fashion styles were bright colored Women were leaders, exemplified by Madeleine friends and relatives of those who died from AIDS sunglasses and teased and other unusual Albright, who became the first woman Secretary of Such music influenced people’s personal expression was profound, and hopelessness about surviving hairstyles. The music and dance of Michael State (1997) and broke barriers inherent in govern- in fashion in the early 1990s, which was colorful, AIDS contagion was extensive. Technological Jackson, known as “The King of Pop”, and Prince ment bureaucracy. The era of the “digital revolution” loose fitting, including turtle neck sweaters, tapered developments created by Apple, Microsoft, IBM, stimulated focus on race and gender and that of emerged significantly with the introduction of Mic- pants, and grunge style of wearing old clothes and and Intel produced cheaper, smaller computers used Madonna transformed concepts of femininity and rosoft Windows 3 (1990), World Wide Web (1991), flannel shirts. In the mid-1990s, under the influence for business and at home. The computer was named sexuality. The death by shooting of musical icon first internet browser Netscape (1994), Windows 95 of hip hop, urban styles were popular, while in the Time Magazine’s “Man of the Year” (1982). John Lennon (1980) was mourned worldwide. (1995), first Apple iMac computer (1998), search late-1990s, glamorous fashion emerged with a rich engines Yahoo (1998) and Google (1998), and cre- look. The Macintosh computer was released for sale Sally Ride, first American woman in space ation of a file-sharing service, Napster (1999). The (1984), and Microsoft released Windows (1985). (1983), stimulated women to recognize their “Internet Meme” was developed as media transmitted Children’s toy development produced computer Sony developed the Camcorder used for news potential to achieve roles in scientific through the internet as a catchphrase, drawing, or gaming systems with improved graphics, such as stories (1983), and Motorola presented the first investigation typically assigned to men and to picture to indicate concepts (1993). Super Nintendo and Sega Genesis. Popular video mobile phone (1983). These commodities were make courageous intellectual contributions. games were Super Mario Brothers, Gran Turismo, widely sought after and enthusiastically used. Children’s toys derived from technological Meme is an exceptionally popular way among and Tetris, and first-person shooter platforms achievements produced an “age of video games,” teenagers to communicate. Mobile phones were included such games as Goldeneye 007, Doom, and Communication became fast and easily accessible. such as Space Invaders and Pac Man (1980) and owned by significant numbers of people of all ages Quake. Fighter games were Tekken 3 and Street The U.S. stock market plunged 22.6% on October Nintendo Game Boy and teenage Mutant Ninja (1990). These advances facilitated ease and rapidity Fighter. Sega developed a rating system for their 19, Black Monday (1987), as part of a worldwide Turtles (1989). of communication to bring people together and have games (1993), and parents could call a toll-free ho- stock market crash. The cause was debated, but one exposure to knowledge far greater than previously. tline to learn about the contents of a Sega game. potential cause was “program trading” with newly Less formality and more lifestyle freedom Seinfeld was rated as one of the best shows (1989- developed computers. Contagious fears and emerged in the 1990s. The glorification of 1998) in TV history because its mild humor The 21st Century began with intense turbulent discussion occurred about coping with significant heroin and other addictive drugs and the freedom epitomized audience yearning for personal quietude. events and fears. financial losses. of sexual expression among women occurred.

10 11 Pop Culture: An Integral Element in Molding Children’s Development Pop Culture: An Integral Element in Molding Children’s Development

Just before the year 2000, people worried that The “Civil Partnership Act” announced that Environmental and manmade ecological problems It was a favorite for all audience age groups. technological advancements in computers and same-sex couples have equal rights as heterosexual occurred, natural disasters abounded, and terror- networks would crash with the advent of Y2K; this married couples (2005). Election and reelection of ist attacks continued. The Boston Marathon terror Diversity was present among movie themes, did not happen. The most infamous terror attacks Barak Obama (2008, 2012) as US President was attack (2013) was the first in this decade; thereby actors, and Tony (2018), Oscar (2019), and music on US soil simultaneously occurred at the World considered “a triumph of change” which continuing the anxiety about terror. Awards. Trade Center, Shanksville Pennsylvania, and the suggested that “America can be open-minded and Pentagon on 9/11/01. that all things are possible.” Women’s efforts in human rights and the workforce TV programing presented drama, comedy, reality, were strong. This may be the Decade of Women. history, and commentary. Oprah Winfrey’s show Significantly, eighty-four acts of terrorism Harry Potter and the Goblet of Fire, written by ended after 25 years of broadcasting (2011). occurred in the United States from 2000 thru 2019. J.K. Rowling, became the fastest selling published The Presidential Medal of Freedom was As a result of the shooting at Marjory Stoneman book (2000); the final of this series was Harry awarded to poet-author Maya Angelou (2011). Songwriter Bob Dylan was awarded the Nobel Douglas High School in Parkland, Florida (2018), Potter and the Deadly Hallows (2007). Malala Yousafzai was awarded The Nobel Peace Prize for Literature (2014). Jay-Z was the first surviving students at that school became activists Prize at age 17 years (2014). Prince Harry, son of rapper inducted into the Songwriters Hall of Fame to promote strong gun control laws. Ethnic diversity in the movie industry was Princess Diana, wed a biracial, divorced, African (2017), and Kendrick Lamar won a Pulitzer Prize recognized when Halle Berry became the first American woman, Meghan Markle (2018). for his song “Damm” (2017). The most notable Social media, primarily Twitter and Instagram, black female to win a Best Actress Oscar for her pop culture song was Despacito by Luis Fonsi, a connected these students with other youth performance in Monster’s Ball (2002). This promoted a continued modernization of the Puerto Rican songwriter; it was the most streamed throughout the United States to help promote their British Monarchy. Like Princess Diana, Meghan song played (4.6 billion times, 2017). important cause. President Bush ordered the Similarly, Slumdog Millionaire (2008) was Markle desires to accomplish benevolent works invasion of Afghanistan which began the US War considered the “world’s first globalized popular worldwide and is admired by people internation- Popularity of sports increased due to greater on Terror (2001) and the Iraq War (2002-2017). movie masterpiece” because it included an ally. Actress Alyssa Milano tweeted, “If you’ve audience access to viewing competitions in real international cast and crew. Reality TV shows with been sexually harassed or assaulted write “me too.” time formats; fan gatherings created communal Fears were stimulated by environmental disasters large numbers of viewers included American Idol subsequently, the “#MeToo” movement began and enjoyment and discussion. Sports milestones were and financial crises. Technology expanded its (2002), Survivor (2000-present), Amazing Race focused on awareness and means to decrease sexual notable and promoted increased fan attention. innovations and influences with development of (2001-present), and The Apprentice (2004-2017). harassment and abuse of women. Jessica Watson, age 16 years, was the youngest smartphones as well as more sophisticated Popular musicians who embodied ethnic diversity person to sail solo nonstop unassisted around the computers and gaming systems. were Beyoncé, Jay-Z, Lady Gaga, Madonna, The US Supreme Court ruled same sex marriage is world (2010). Britney Spears, and Kanye West. a legal right in all US states (2015). In this decade, These increased opportunities for self-expression theater, movies, and TV received exceptionally high Globalization, good will, and high fan viewing and communication through social media, blogs, Problems related to race and focus on diversity ratings in press reviews and by audiences for occurred for the Rio de Janeiro Olympics (2016) and texting. were increasingly apparent (2010 to 2019). productions about historical renderings, fantasy, and where Usain Bolt won the 100-meter Olympic perspectives on youth. Gold Medal, and Michael Phelps won his 19th Sony released the PlayStation 2 gaming console President Obama continued in office until ending swimming Olympic medal. (2000-2013), which was the best-selling gaming his second term (2017). Donald J. Trump was There were box office sellouts, appreciation for console in history until replaced by PlayStation 4. elected President of the United States, beating diverse casting and themes, large audience Promotion of social justice was evident when Social media changed the way people Hillary Clinton (2016). He recognized that attendance, and favored long performance runs. Colin Kaepernick, quarterback of the communicated due to founding of Facebook by connections made with the US populous are best The Tony Award winning Broadway play Hamilton San Francisco 49ers Football Team, kneeled during Mark Zuckerberg (2004), launch of YouTube done using social media, such as Twitter. Two (2016) was exceptionally popular for its important the pregame US national anthem to object to US (2005), release of Apple iPhone (2007), and billion people logged onto Facebook to connect to theme, talented ethnically diverse cast, unique hip racial injustice and police brutality. Fans development of Twitter (2009). others worldwide (2017). hop choreography, and rap music. supported him for his silent demonstration.

12 13 Pop Culture: An Integral Element in Molding Children’s Development An Owl in Myanmar

Popular children’s toys had computerized Child and adolescent Psychiatrists must know about After a five-year career as a His death triggered many other unhappy kids mechanisms enabling movement, talking, and social media and the internet, explore their patients’ board-certified family to begin to express themselves, and the school complex interactions with a playing child. knowledge and experiences with social media and the physician, I retrained in desperately called for help from the College of internet, and guide parents about how to protect their psychiatry, child psychiatry, Medicine Department of Mental Health, of which Examples are BB-8 (Star Wars remote control droid, children from misuse of these means of social and, eventually, I was one of the three members. After six months 2015), Hatchimals (interactive egg needing love to communication. psychoanalysis. All of this of getting my feet wet, I opened a second room in hatch and grow, 2016), and Fingerlings (interactive training has meant that I the clinic through which the psychiatry residents baby monkeys, 2017). Notably, child and adolescent psychiatrists must be needed to live a long time to rotated under my supervision. knowledgeable about pop culture and able to warrant the effort put out by Child and adolescent psychiatrists must focus on interact with their patients in discussing this topic. my numerous wonderful I also included the mental health nurses who, all new issues. George Stewart, MD teachers. having children, took to it like butter to croissants. It is vital to know what children like and encourage In addition, I started the rather grandly named Attention to the professional development of them towards wholesome endeavors for a better life So when I got lung cancer in 2008, and when it Blantyre Child Study Group which met every other women to foster their aspirations and contributions on earth and possibly beyond, sometime in this 21st metastasized to the other lung in 2010, I feared not week for 1.5 hours. It was composed of teachers, is mandatory. Means to enable boys and young men century. (a whopper!), knowing I’d not finished up here. I social workers in orphanages, the other members to feel strong of character, successful, and limit closed my private practice after the return of my of our department, an acupuncturist, and various sexual transgressions are needed. It is essential to “Hakuna Matata” (The Lion King). cancer but continued working half-time at Seneca primary care physicians with a bent toward enhance youth’s creativity, technical abilities, and Center for Families and Children as their medical children’s mental health. We discussed papers, realize that work opportunities are precious to help Most Cordially, director and as a consultant. child development, and, mostly, the cases or an individual put a positive footprint on the dilemmas that one or another of us would present. community and our American legacy. A divorce after 43 years and two grown children (no Both the clinic and study group are still going at grandchildren) left me free to pursue another path. this time, but I fear they will not continue Be aware and teach that diversity is a cherished I’d flirted with working in developing countries robustly without another infusion of child aspect of the modern American spirit, and everyone earlier, teaching short courses in Vietnam, the psychiatry expertise. is entitled to improve our civilization. Philippines, and Saipan, and in 2016, freed from responsibilities, I joined the Peace Corps (GHSP) We traveled extensively throughout Malawi and Social media and the internet are beneficial for with my partner, a nurse midwife. We moved to Southern Africa during our time there, camping a people to communicate, learn, and observe what Malawi in southern Africa for two years. lot, occasionally staying at amazingly posh others are doing. resorts, and having a broad exposure to the beauty There I taught in the six-week course for fourth year and struggles of those regions. Just to dispel any Unfortunately, such activities may damage the medical students, supervised our fledgling psychia- concerns, in two years we never were threatened mental and social condition of youth. Social media try residents, and performed a mountain of clinical by a person, a venomous snake, a hippo, or a large communication limits direct interactions and full service. My real interest, as the only child psychi- feline. We never had malaria. use of language skills. The internet and social media atrist (and only child mental health clinician) in a may expose youth to problematic images, such as country of 18 million people, of whom 50% are 16 I’m currently in Myanmar on a Fulbright for a bullying, private body parts, brutality, or sexual years old or under, was to try to make a dent in that year. As soon as my curriculum clears the acts. Parents often do not know what their children vacuum (block that metaphor!). appropriate government academic screening are exposed to when using social media or the process, I’ll begin to teach nine psychiatry faculty internet. I started a pediatric mental health clinic in response from the various (there are six total) universities of to a 12-year-old boy at a local international medicine in Myanmar. secondary school hanging himself.

14 15 An Owl in Myanmar Vital Involvement in Old Age: A Group Process

They’ll move to Yangon for seven months for a We talk daily, and she’ll visit at some point so The famed general Douglas Drawing on the story of Dr. Borg’s memories full-time immersion in child and adolescent psy- we can travel together. MacArthur was alleged to and dreams from Ingmar Bergman’s “Wild chiatry, with supervised clinic and consultation/ have said, “Old soldiers Strawberries,” they consider ways in which liaison experience. Until then I am busying myself I have learned to seek the beneficial facets of never die. They just fade America’s elders today might improve their with activities of daily living and teaching Masters difficult life experiences. I like Mark Twain’s away.” lives. in mental health nursing students a 12-hour crash epigram, “Life isn’t about holding good cards course in child and adolescent psychiatry. Access but playing a poor hand well.” I think of George So what happens to aging My wife and I often joke that an implanted to JAACAP and the affiliated journals have been so Vaillant’s longitudinal study of Harvard child and adolescent memory chip could greatly simplify the writing helpful in assembling the curriculum, as well as the undergraduates and how unhappy and isolated psychiatrists? of an after-we-die narrative to our survivors. A free online child and adolescent psychiatry textbook some of his subjects were toward the end. Nathaniel Donson, MD post-mortem re-implantation in a chosen from IACAPAP. Jim Harris, MD, an Owl like me, Perhaps an early hard start accustomed me to beneficiary could then pass on our life-long has spent time here over several years and has been seek the best wherever I find myself at the mo- Our lives have been rigorous, and most of us, accumulations of hopes, purposes, of great help orienting me. ment. despite our belief that we will last forever, will competencies, knowledge, love and caring - either slow down or simply leave the field for all that we want to leave to our children and I rent a two-bedroom penthouse in the middle of In any case, I’m learning Burmese, eating great greener pastures. Peter Blos Jr. once told me the five to theirs. In the meantime, however, how can Yangon’s Chinatown and have had a birds-eye view food, enjoying novelty, and meeting new col- ways that most professionals end their work: (1) we remain generative (vs. stagnation) in ways of the large, loud, and extensive Chinese New Year leagues and friends. Today I await the daughter, You die in your chair; (2) You or your partner needs which matter? celebrations, as my block (Upper Block) on my with her chum, of Malawi friends. They’ll stay medical attention; (3) Your closest colleagues take street (Sint O Tan Lan) turns out to be the center of with me for two days before setting out for you aside and tell you, “Enough!” (4) You decide I have always liked starting and joining groups. it all! While the two-person dragon dancers/acrobats points East. This evening I’ll have dinner at a to end practice on a reasonable future date; or (5) Long ago I put together a group of early are amazing, spinning and jumping about on the Myanmar-French Restaurant, Le Bis Tro Ke, You take no new patients, hoping that attrition will education and mental health professionals for a four to eight foot high pedestals, the rock bands and with an acquaintance of a good friend in take care of winding up - but one patient hangs on series of meetings which we called crashing cymbals have gotten a bit old. The celebra- Berkeley. and hangs on until you finally are the one to say, “Intervention with Under Fives.” That group tion draws huge crowds who all appear to enjoy it “Enough!” topped 24 members and included directors and immensely. It ends this weekend, I hope! I bought an ostrich-skin belt in the Indian Spice teachers from private preschools, head start Market in Durban two years ago. I asked the What then? How do we even begin to sustain a centers, therapeutic nurseries, and day care I am writing this to encourage others, who may woman selling it how long it would last. She “Vital Involvement in Old Age,” the title of Joan centers. We met monthly in a member’s home. wish for a more adventuresome, exotic, or needful said her grandfather was still using his after 40 and Eric Erickson’s book (with Helen Kivnick context for their work. Their experience would be years. A quick calculation put me at 116 years - Norton, 1986). Their narrative consists of the Our discussions energized all of us to learn highly valued in the developing world. In sub-Saha- old minimum, so I instantly bought it, a most authors’ joint reflections on old age, derived from about and better understand the minds and ran Africa, for example, there are no child psychia- sensible life insurance policy! interviews with twenty-nine octogenarians who had feelings of very young children - mostly trists in most countries; only S. Africa and Nigeria, been followed since childhood via the 1928 because we were able to listen carefully to the I believe, have child and adolescent psychiatry I feel blessed to have found and created such a “Guidance Study” of the University of California’s people who actually spent time with them day training fellowships. I suspect SE Asia is similar. I fulfilling life. When interviewing for my Institute of Human Development. after day. am 78 years old, so age isn’t really a determinant. psychiatry residency, the Chief of Department asked how long I thought I might want to work Their chapter headings follow Erickson’s For seven years we had case presentations, I miss my children, my good friends in the United in the field, referring to my leaving family well-known sequences contrasting life’s virtues and invited guests, and reviewed both lay and States, and my partner, who at the moment is in medicine so quickly. I never imagined anything failures, beginning with Wisdom - the most desired professional literature; minutes were Malawi for a few weeks working on a midwifery could continue to hold my interest this long. outcome in our last decade’s struggle with distributed. ward start-up at the teaching hospital. Lucky man! “Integrity vs. Despair.”

16 17 Vital Involvement in Old Age: A Group Process Vital Involvement in Old Age: A Group Process

As our interest in preschoolers became known in At monthly meetings, the director acted as host in In recent years I joined another group, of men Instead, I gave a very well received talk about how the community, practice referrals poured in; her center and invited her staff. Our discussions only, who call themselves the “Old Boys” - a trauma in infancy may burn out caring for oneself colleagues became friends. were similar to those in the “Intervention with monthly lunch group in upstate New York with a and others, speaking about what I theorized had led Under Fives” project. We paid close attention to total email send out of about 70, an average age to the lack of compassion in our current political We learned about the early life origins of many of the concerns of the directors, as well as provided over 80, and a usual attendance of 15-20. climate; and I spoke as well about several high yield the diagnostic categories used in middle childhood them with onsite support for difficulties which early intervention programs based on principles of and with older children, and we even got to know often seemed so insoluble. Some are retired; most are still sharp; all are infant developmental research. I also gave a what very young children are really like - which vigorously in touch with our complex political discussion of ADHD and about “Being and rarely happens during child and adolescent psy- So what about old age? and social world. All have led or continue to lead Becoming a Grandfather.” For those meetings, wives chiatry training. Our discussions certainly made interesting lives in a variety of professional roles and partners were invited. clear why most mental health professionals were so When we opened a child psychiatry practice in ranging from medicine, law, academics, afraid of treating preschool children. We knew so 1971, my office partner and I began a weekly jog journalism, etc. A friend who died recently had been a member of little about them! and chat (subsequently a walk; now just lunch). In still another group called ROMEOS = Retired Old addition, several years later we began a monthly Whatever sexism this group’s composition implies, Men Eating Out. I liked the name, so currently I am Most of all, we provided support for each other’s lunch meeting which included an adult psychia- I have always supported the idea that there are inviting a group of local male friends, some work, and paid careful attention to the immense trist/psychoanalyst, another child psychiatrist, and emotional issues common to each of us which are widowed, some retired, others still hard at work, stresses which dysfunctional families and their a family therapist who had at times helped each of enhanced by same sex relationships in our lives. some just beginning to slow down, to begin a series children impose on center directors and staffs. And us out. We talked about our struggles with psy- For me, a few close male friends will do, and so of lunches together. It remains unclear as yet what we began to appreciate that early child care centers chotherapeutic work, and - in the 90s “decade of I found myself among the minority who voted to we will do during our time together, and how and in are usually the first places in a community where the brain” - mostly about medication usage. Forty include women in the group. what ways we might include our partners. We are all children and families appear who will eventually years later we continue to share diagnostic and curious to see what may evolve. need our help. therapeutic muddles and often support each other We meet in a local restaurant and talk about through our puzzling counter-transference reac- everything. Members take turns presenting In Bergman’s “Wild Strawberries,” Dr. Borg says, This first group eventually evolved into three tions with difficult patients. Two patient suicides favorite topics. We often invite guests who “At the age of seventy-six I am much too old to lie separate working groups specifically intended and several attempts have kept us on our toes sometimes become members themselves; and we to myself.” Indeed, although Dr. Borg’s life had been as outreach projects to aid center directors in the caring about our colleagues. occasionally yell at each other over political one of isolation, pedantry, and loneliness, Bergman community (which I reported on at AACAP’s 2018 matters. implies that our aging should allow us to become Annual Meeting). Several mental health profession- We continue to rely on our intimate knowledge of more acutely curious and far less recondite about als from the first group - all recently trained and just each other and have come to care for each other When one of our speakers informed us about the themes in one’s life - our earlier experiences of beginning their careers - were interested in onsite with the sort of love that only an ongoing peer substantial studies showing an increase in area autonomy, doubt, intimacies, betrayals, initiatives, consulting in early child care centers. supervision experience can bring. Despite feeling voting percentages following face to face failures, fidelities, confusions; of honor and of grateful for my other loving life relationships, canvasing, many of us, before the last election, shame; which choices led to happiness; which led to Each working group was composed of four to eight these gatherings have become bedrock, contribut- joined organizations which had organized such emptiness, sadness, and despair; what was fulfilling; center directors who were teamed up with a mental ing a powerful sense of who I am both personally efforts. I was pleased that some useful action could what was disappointing. And certainly at least some health professional who would spend weekly time and professionally. Our group has been a source emerge from all that talk! of those conflicted memories may be contemplated at their center. Each therapist/director consultation of friendships, as well as cross referrals, and is far more easily within the company of loving and relationship - as well as each group - lasted for something I strongly recommend to all of my Eventually I understood that I had become their trusted friends and colleagues. many years. students starting out in their mental health careers. designated house psychiatrist/psychoanalyst when I was asked to speak (in these troubled times) So where does that leave us as retiring and aging about diagnosing various political figures. child and adolescent psychiatrists?

18 19 Vital Involvement in Old Age: A Group Process Donors to AACAP’s Life Members Fund

Perhaps we need each other’s presence and support The Owls continue to demonstrate their long-term Up to $99 to remain integrated and generative in our lives commitment to AACAP and to supporting the next Etta C. Bryant, MD (vs. despair and stagnation) - until we can’t any generation of child and adolescent psychiatrists. Alice Buchdahl, MD more. As with Dr. Borg, all of us have plenty to Owls make a difference in the lives of other Kieran D. O’Malley, MD reflect on since the time of our search for, and AACAP members as mentors, advisors, and Jean Retta Schwartz, MD choice of, a professional identity as a doctor, and friends. AACAP is thankful to the following Life potentially have lots to share with each other about Members for their generous donations. 1953 Society the many different directions which our personal Anonymous (5) lives and professions have taken us. $1,000 to $4,999 Steve & Babette Cuffe Joseph J. Jankowski, MD James C. Harris, MD & Catherine DeAngelis, Perhaps too, we can still do some things within our MD, MPH local communities to be, and to feel, industrious. $500 to $999 Paramjit T. Joshi, MD Lawrence Brain, MD Joan E. Kinlan, MD One could begin by gathering older child and Bernard Hoffman, MD Dr. Michael Maloney & Dr. Marta Pisarska adolescent psychiatrists within our local Allan H. Rabin, MD Jack and Sally McDermott communities for regular meetings, lunches, Patricia A. McKnight, MD schmoozes. $100 to $499 Scott M. Palyo, MD Anonymous The Frank A. Roberto, MD, Family Another tack could be to seek out younger Perry B. Bach, MD Diane H. Schetky, MD members of our own and affiliated mental health Sherry Barron-Seabrook, MD Gabrielle Shapiro, MD communities so as to mix newness and wisdom in William H. Beute, MD Diane K. Shrier, MD & Adam Louis Schrier, discussing ongoing professional Anthony A. Bottone, MD D.Eng., JD matters. Martha Collins, MD, MPH Andrew Cook, MD Perhaps we not only need each other’s collegial Douglas C. Dicharry, MD Every effort was made to list names correctly. If support during our transition into old age, but can John E. Dunne, MD you find an error, please accept our apologies and discover as well that we may feel generative by Phillip L. Edwardson, MD contact the Development Department at giving back to our younger colleagues some of the Henry J. Gault, MD, SC [email protected] or 202.966.7300. good care we once received from older John P. Glazer, MD Margery R. Johnson, MD professionals in our long and productive work Harvey N. Kranzler, MD January 2019 to March 2019 lives. Spencer D. Marcus, MD Cynthia R. Pfeffer, MD A great example would be our Owl membership, Frances Rodriguez, MD which skillfully blends support of our members Daniel Rosenn, MD and mentorship of AACAP’s newer members. Herschel D. Rosenzweig, MD Given the luck of good health, some of my more Boris Rubinstein, MD “local” suggestions may be fulfilling ways to age Robert L. Schmitt, MD well. Alberto C. Serrano, MD Sarabjit Tokhie, MD Anna Vander Schraaf, MD

20 21 AACAP 2019 66th Annual Meeting

Oct 14–19 Chicago, IL Hyatt Regency Chicago

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James J. McGough, MD Margery Johnson, MD Child mental illness is a complex issue that needs urgent attention, long-term Program Chair Local Arrangements Chair vision, and new financial resources. When you become an American Academy of Child & Adolescent Psychiatry Hope Maker with a monthly donation, you are helping us to tackle this issue head on. Save the Dates New Research Poster Deadline: Please consider a Monthly Hope Maker Gift June 4, 2019 You will be investing in the next generation of Preliminary Program / Hotel Reservations: child psychiatrists, who will lead in innovative June 14, 2019 research, training, and treatment.

Member Registration Opens: Your recurring monthly gift will allow us to August 1, 2019 plan ahead with confidence and maintain a consistently excellent level of programing General Registration Opens: throughout the year. August 8, 2019 Your gift is safe, automatic, and effective. Visit www.aacap.org/AnnualMeeting-2019 for the latest information!

It’s easy to sign up: just visit www.aacap.org/donate or give us a call at 202-966-7300 ext. 140. Throughout the Years...

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