In Masterson’s The Psychiatric Dilemma of Adolescence, published in 1967, the problem of treating kids in the psychiatric setting is exhaustively examined. Noting the tendency of clinicians to dismiss diagnoses of clients, saying “he or she will grow out of it”, in reference to a plethora of acting out and mental health problems. Meanwhile, Masterson recounts that social scientists in the 60s were attempting to organize the phenomena they studied, rather like researchers of the physical sciences, and thus methodology changed; so-called objective research, focusing upon variables like validity, reliability, and statistical analyses, were coming to the fore and changing the ways clinicians addressed problems. Masterson, however, grew conflicted about the differences between the social science methodological point of view, and his and others’ clinical observations.
Masterson found after his twelve year study, that 50% of the adolescents he studied did not “grow out of problems” upon five year follow-ups, and that while symptoms like anxiety, depression, and acting out (with sex, drugs, or violence) did diminish, but that which brought the most difficulty, in terms of sustaining meaningful relationships, activating healthy goals, ambitions, accessing creativity and self-care–their pathological character traits–had not been touched upon in treatment…at all.
As much as anything, my reflections in Working Through Rehab: An Inside Look at Adolescent Drug Treatment, are derived from Masterson’s implied warnings about the costs of a superficial treatment approach. I recall working with a young lady in my private practice–a late teen–who was supposedly drawn to relationships with boys “from the wrong side of the tracks”. Much thought, encouragement, argument, and time had been put into making her see reason, re-think her “choices”, and make “rational” decisions. The cognitive dissonance was pervasive: she wanted safety and “respect”, but was drawn to men inclined to hurt her. She wanted independence, but ended up feeling anything but. She was drawn to the bohemian, the pull of rebellion, and found separation in rejection of her family’s fears. Little did she know how conflicted she was with herself, not others, and how long the conflict would last if she did nothing about it. In my first novel, Living Without Blood, I presented the consequences for a family living by the rule, “time heals all wounds”. The Metcalfs discover that time passage without conscious intrusion does little more than fossilize understandings, generating alienation.
In Working Through Rehab, I depict therapeutic environments that are either forgetting, actively disregarding, or plainly ignorant of Masterson’s now forty year old caveats. Programs working with kids are operating upon the assumption, “they’ll grow out of it”, seeking to emphasize kids’ positive traits in the hope that their deficits will fall away under the power of love. Or, they’ve taken a subtly defeatist tact, thinking the wounds are too great, the fossilization too hard and too widespread, such that the roots of problems are impenetrable.
Do you think this, my would-be reader? Are you a mental health practitioner? A consumer of services. Who are you that you might be interested in this topic? Who do you need to be? Who am I to make pronouncements on trends that flit in and out of fashion, some sticking, some not. Who do I need to be?