Young people (which for the purposes of this blog post I will define as ages 15-25) are faced with a unique challenge as we approach the 2020s. Growing up in a connected world, they have been exposed to the lives of the social and economic elite in ways that persons a generation ago could not have imagined. Part of growing up alongside the heros of pop-culture, tech, and sports, along with the ever-more manicured public personas of classmates and “friends,” comes the inevitable – and frequently unenviable – comparisons that come along with it. No longer are we “keeping up with the Jones;” kids today measure their lives alongside the Kardashians, Biebers, Zuckerbergs, and (Lebron) James. The result? A virtual neighborhood where not only do you have the shabbiest house but almost no chance of realistically catching up.
Part and parcel with the above, we have raised a generation of kids that has been protected from not only life’s dangers, but life’s decisions too. Suddenly, a young person wakes up only to find that not only can that not live the life of social media mega millionaires, but it will be darn difficult to achieve the same level of success that mom and dad have afforded for all of these years. School is hard, the real-world is unforgiving, and many have not formed the skills necessary to deal with these challenges. The result I see all too often: bowing out. Taking a semester off turns in to dropping out entirely. Moving home temporarily becomes indefinitely. Enough time goes by and a “short break” has become “the new norm.” This can be difficult for the young person to handle. It can be difficult to generate inertia from stop. It can be depressing and anxiety provoking, too. And it can lead to some very maladaptive habits.
Fortunately, there is hope. It will not feel easy, but I say again, there is hope. This young person can get back to the life they were meant to lead. Come talk to me about how.
Perhaps the single most important step in the new-patient relationship is obtaining a full psychiatric history. The psychiatric history contains more than simply a list of your prior psychiatric treatments (although this is - of course - an important component. It should contain elements of your reasons for seeking psychiatric care, as well as key features of your developmental history, educational history, social history, family history, and legal history. It should contain information relating to your religious beliefs, hobbies/interests, a detailed description of your substance abuse history, as well as any information on previous medical illnesses/surgeries, and medication trials. There should also be time devoted to getting a better understanding of your personality (including any personality vulnerabilities). Finally, all good psychiatric histories should include a comprehensive snapshot of the patient's current mental state to be saved and reviewed over time as a measure of progress.
Once all of these pieces are gathered together, a much more faithful and accurate understanding of the patient is gained. There is no substitute. At this point, the conscientious physician will be able to make his comprehensive assessment and plan.
One of the most important gifts any psychiatrist can give to the patient is the gift of a safe, honest environment. Too often, patients feel forced to hide, distort, or even lie about the true nature of their situation. Whether it is a perceived lack of understanding or judgement, I always tell my psychiatric patient's at Main Line to treat our space as a safe, zone where they can say anything so long as it is authentic and true. I find that most patients already feel that way, but every once in a while you a reminded of what a gift this can really be for the patient. This is especially true when teenagers are struggling with self-injurious thoughts or substance abuse. After all, whether you are practicing psychiatry in Wayne or anywhere else, if the patient does not trust you and feel they can be open and honest, how can you help them?
- Michael Silverberg, MD
One of the most important things any patient can o for themselves is be a good self-advocate. In psychiatry - perhaps more so than any other medical specialty - we rely on the patient self-report to impact treatment. As any good psychiatrist on the main line or elsewhere will surely tell you, we value the input of the patient. I tell all of my psychiatric patients in Wayne, Bryn Mawr, and Exton to be their own best advocate. Nobody is going to advocate for the patient more than they will and nobody can see what is going on inside a patient's head. If you are feeling a certain way, thinking a certain way or just generally have something on your mind: advocate for yourself! You'll be happy you did.
-Michael Silverberg, MD
One of the most interesting - and often variable - experiences I have as a clinician involves the other members of the patient's family. Whether a patient is suffering from Major Depression, anxiety disorder, Bipolar Disorder, substance abuse/substance dependence, or a psychotic disorder chances are excellent that there is a person (or persons) who are suffering right along with them and their illness. Here on the main line, my psychiatric practice has been colored not just by the patients I treat, but by the family members who love them into treatment. No that is not a typo. Family members must frequently love the patient into treatment. It takes love because the stigma surrounding mental illness often requires that the parent, spouse, or sibling of the patient often must overcome societal pressures to say "enough is enough" and bring that loved one into care. There is nothing more difficult than for a parent to make an honest assessment of their child and determine that yes, this child requires psychiatric care. When looking for a psychiatrist on the main line, whether you live in bryn mawr, wayne, paoli, or any of the other stops along the old R5 corridor, I hope you find a provider who is willing to treat the family as much as the patient, because it is often the family's love that determines whether the patient comes to treatment. Michael Silverberg, MD