Childhood Psychiatric Symptoms and Anger

Children are sent to mental health professionals for a variety of reasons, from behavior problems, to mood volatility, to family conflict. Witnessing a child experience psychiatric symptoms can be a frightening, heart-wrenching experience. Young people with such troubles tend to trigger strong feelings in the people around them, which can further complicate matters. Sometimes a key element gets lost in the shuffle, that the child is upset.

The consensus among researchers is that a variety of remedies are most helpful for each child. Family counseling may help sort out interpersonal issues. Medication may provide relief from certain symptoms. Cognitive Behavioral Therapy might help children and their family members modify problematic thinking and behavior. While these and other methods can be beneficial, this essay is concerned with the emotional experience of children with psychiatric symptoms.

Psychodynamic therapy is specifically suited for improving emotional functioning. It can be effective for children with a variety of symptoms. I have seen numerous children, in both private practice and inpatient situations, whose symptoms improved remarkably when they learned how to talk about their emotional experience. This is a repetitive process of experiencing feelings and talking about them, rather than simply learning how to use certain words. While psychotherapy can take time, if done well the changes can be permanent.

Three young people from my private practice come to mind. First, a boy who started with me at age nine had been repeatedly diagnosed with ADHD from the age of five. In therapy he played out intense feelings having to do with his family situation. When he got good at talking about his inner experience (mental/emotional) his ADHD symptoms went away. The second is a thirteen-year-old depressed girl who attempted suicide and engaged in other risky behavior. After a year-and-a-half of talk therapy she was no longer depressed. She is now an honors student and an athlete at a prestigious college. The third is a fourteen-year-old boy who also attempted suicide. He was so defiant he couldn't make it through a single school day in the three months before we started therapy. Within a year he lost his symptoms and graduated on time. While it was not apparent on the surface, the common ground among these three was that they were struggling with intense emotions they could not handle.

Talk therapy? You might say, "no way, my kid won't listen," and you wouldn't be the first. Since childhood mental disorders are usually complicated, simply telling the child what to do is often not enough. The three kids I mentioned above all had helpful adults in their lives. The adults listened to them and offered thoughtful advice, but the support did not change their symptoms. Psychodynamic therapists are trained and practiced in working with people who resist certain kinds of change. Such therapists believe that the child's central struggles will show up in the ways they interact with the therapist. A hundred years ago Freud wrote that patients do not explain their problems to the therapist but instead act them out repeatedly in the consulting room. In my experience children repeat problematic relational patterns again and again, starting early in the therapy. The child diagnosed with ADHD mentioned above used to provoke and ridicule people around him, especially those bigger and more powerful. Needless to say, people didn't like him very much. When we started therapy he greeted me each visit with an insult, then proceeded to do everything in his power to annoy me. It turns out that talking with him about how he felt small, weak, and powerless set some major positive changes in motion. Of course, he had to trust me before he could take this discussion in. The dynamic therapist's job is to help the child understand and talk about what he or she is struggling with.

A common misconception about this type of therapy is that it encourages the dredging up of, and wallowing in, past painful experiences. Exploring links to the past can be useful, but the aim is to improve the present and future quality of life. In fact, psychodynamic therapy deals with how a person's emotional situation affects them right now. Once trust is established the therapist can help the child interpret the meaning of their experience. The defiant teenager mentioned above made many references to the death of his grandmother over the course of several months. When I asked him about her he denied any significance. Later in the therapy we learned that his grandmother had something to do with some destructive ways he felt about himself, and her death was connected with the onset of his depression. She was not blamed in any way. Rather, he had not yet mourned her death. In this type of therapy, the child's mind develops in the area of emotional learning and regulation. Research has linked emotional regulation to the reduction of symptoms.

Emotion cannot be separated from thought. Both originate in the mind and are inextricably bound together. For a time researchers in the field of psychology separated thought from feeling, and understood mental activity as only thought. Many contemporary leaders in psychology, neurology, and psychoanalysis have shown that the two are undeniably linked, and that the ability to understand and regulate one's emotions is essential to mental health.

When psychotherapy goes well, a child's ability to tolerate and regulate strong feelings improves. Neurobiology and neuroimaging studies have shown that areas of the brain are stimulated, and actually grow, during emotionally evocative experiences like dynamic psychotherapy. Before we knew much about neurobiology and psychiatric medication, therapists successfully treated children with mental disorders using dynamic psychotherapy. We now know that it promotes physical brain growth as well as mental/emotional development.

So what does this have to do with anger? All people experience anger frequently in their lives, and they are not necessarily aggressive or destructive. We, of course, have social prohibitions against aggressive behavior, so we generally learn how to deal with our anger one way or another. Most children struggle with learning how to express their anger and other emotions appropriately. It is an important part of growing-up. Sometimes we have family and social prohibitions against the non-aggressive expression of anger. Sometimes a child's life situation and predisposition come together in ways that inhibit their ability to even feel strong emotions such as anger and sorrow. Many children feel that they are not allowed to be angry. While it is an oversimplification, the young woman I mentioned above had not yet learned how to cope with being angry with the people she loved, so she turned the anger against herself.

With the three young people discussed in this article, the revival and discussion of their repressed, pent up, feelings certainly seemed to lead to recovery from their symptoms. They developed the ability to manage their emotional lives. They grew mentally in ways that modified or resolved their symptoms. While psychodynamic therapy does not work for everyone, it can be a highly effective aspect of the treatment of childhood psychiatric disorders.