Thus, according to the latest data of statistics of the Healthcare Ministry of Ukraine, about 4.7% of children require psychiatric assistance. Child psychiatric disorders make 34.5% of all mental sickness rate. In 2009 there were 23 979 disabled children with mental disorders, and 2352 of them were recognized disabled for the first time. Mental diseases, manifesting themselves at early age, brings sorrows and worries not only to the family of children, but to the whole society.
In an interview with Anatoly Chuprikov, Doctor of Medical Science, professor and child psychiatrist, ForUm learned about peculiarities of modern generation and how to notice problems in time.
- Why did you decide to practice child psychiatry?
- I started as adult psychiatrist and even wrote two theses in this sphere. Then I started studying neuropsychiatry and came across an interesting fact: it turned out in the Soviet Union there was a tendency to retrain left-handed children into right-handed. I could not ignore it. With my colleagues we examined almost 16 thousand children, teens and adults and found out that forced retraining resulted into relatively small number of left-handed people among Slavic population, way less than in US, England, France, Germany. And it was not clear why it was happening. The only reference we found was methodological recommendations of 1930s, according to which children must take a pen with right hand. In 1980 my interview "If you are left-handed", in which I stood against retraining of left-handed children, was published in "Pravda" newspaper, but was slammed. Then healthcare minister Borys Petrovski felt offended by the fact that some doctor Chuprikov appeared in such a respectful newspaper, and my problem at work began.
I had to leave Moscow and came to Ukraine. At first I took charge of the chair of psychology department of Luhanks medical institute, where I worked for 11 years. I was a right time to study child psychiatry. The regional hospital included children's clinic and I had to consult and treat children. At the same time, my student Svitlana Kazakova wrote her thesis on negative consequences of forced retraining of left-handed children. It became a serious argument in my dispute with the Healthcare Ministry of the USSR. Basing on the thesis we worked out methodological recommendations, which put an end to the retraining. That was the beginning of my acquaintance with child psychiatry.
Then I came to Kyiv and headed Kyiv (then Ukrainian) scientific research institute of social and legal psychiatry. Back then, during "Chernobyl wave" we had to deal with radiation effect on children, pregnant women, fetus. At the same time I headed the department of child, legal and social psychiatry of the National Shupik's medical academy of post-graduation education, where I taught child psychiatrists. Today, due to the age I've handed the chair to Vyacheslav Mishiyev and work there as a professor. Moreover, I manage the city center "Mental health of children and teens".
- Do young specialists willingly join the sector of child psychiatry?
- No, not really. We have mostly elder specialists. For various reasons there is no renewal of the staff. In fact, the profession of a psychiatrist has lost its prestige. In soviet times psychiatrists received 25% bonus to the salary, duties in hospitals were usually calm and doctors could pay attention to their own families. Though some doctors were coming for selfish motives, sooner or later everyone started empathize with patients and take good care of them. Nowadays, our biggest problem is small salaries. Earlier we could not only live on salary, but also spend money for travel and conferences. Now we cannot afford it. When I was told that 60 graduates of one of the medical universities left the country right after the graduation I was not surprised. Specialists leave abroad, take positions of family doctors, get decent salaries and apartments. It is a pity that business eats the most talented and active specialists. But it is a nowadays reality and we cannot do anything about it.
- Is it true that family medicine is killing child psychiatry?
- I would not use the term "killing". My colleagues from another department, which train family psychiatrists and family doctors, often say "how wonderful that our family doctors do not compete with doctors of other specializations". But it won't last forever, only until they get used to their new profession. Later on family doctors will not willingly share their income with other specialists, as it happens in western countries. My principle position is to keep child psychiatry separately. The number of specialists we have is not that big, and we cannot afford to lose them. By the way, Scandinavian countries already regret that they completely liquidated child psychiatry once. For the moment, it is planned to keep this sector in Ukraine, but not wide spread. And I worry not only about doctors with unique experience, but also about children who needs their assistance. I would really like future family doctors to refer mentally sick children to child psychiatrists.
- Is it more difficult to work with children than with adults? And if yes, what are the difficulties?
- I cannot say that children are more difficult to deal with. Adult psychiatry is also a complicated specialization. However, child psychiatrist has a peculiarity - the whole family suffers, and psychiatrists have to deal with both children and their relatives. Doctors are often "terrorized" by parents and grandparents, who continuously ask about the problem, treatment, results. We have to explain and warn that results will not come fast and that there is no need to hasten doctors.
Psychiatrists are never indifferent to the patients, and such stress affects their health and family life as well. And the most important thing is that parents should seek assistance of child psychiatrists as early as possible, and not at the age of 6 or 7 with the questions whether their child can study at school. In such cases parents are 5-6 years later. The biggest problem is that patients come already with advanced stage of sickness and chances for recovery are not very big. Psychiatrists sympathize with parents, but cannot do much. The fact is that a psychiatrist is only one specialist among the whole system of assistance for such children.
- Is it humane to hospitalize children?
- Hospitalization is not obligatory and looks different now. Small children can stay with mothers. If a family is local it can take the child home for the night, if of another town - can stay in the hospital. Treatment is not as horrible as before, when children were locked up for months without permission to see parents. Once I visited a Dutch children's psychiatric clinic and ask what children they isolate. "We isolate those, who cause big problems to the parents", I got the answer. Do you understand? Cause big problems to the parents...like parents are victims here. They lock children in isolation for a month and forbid to see parents. Of course, children miss their parents and try to behave. When I asked if they have the same rule like in Ukraine when everyone, including chief doctors, fights for reduced isolation, they said: "No, not at all. The child will stay as long as needed."
- I know there is an initiative to separate adult and child inpatient units. What do you think about it?
- I agree. It would be wonderful, though it requires financial investments. Moreover, there is a presidential decree, according to which child departments in adult hospitals should have been closed back in 2012, but the decrees has not been observed till now. As far as I know they do not have enough means. Anyway, the problem is that the stamp "psychiatry" is considered a curse in Ukraine. If a person went to a psychiatrist for consultation and then accidentally told it to his neighbor, he risks to be labeled as "psycho" till the rest of his life. It is a serious problem, and psychiatrists regularly gather and consider how to fight this stigma for people not to feel desperate after a visit to a psychiatrist.
- Do we need schools for mentally-retarded children? Or can they be sent to regular education institutions?
- I think residential schools should not be closed immediately and entirely, otherwise we may lose experienced specialists in this sphere. Moreover, children following special school program may not feel comfortable among peers in regular school and will not full understand full school program. On the other hand, standard school program cannot not simplified just for impaired children. Exclusive education is a complicated thing, and the Education Ministry is working on the issue. Besides, children- autists should not be put in line with mentally-retarded, because doing this we deprive autists of hope to improve the level of mental development. The issue is complicated, and differentiated and individualized approach is required.
- Parents often do not believe that their child may have mental disorders. How do you work with parents to prove their children do need help?
- You know, today the relations between parents and doctors can be considered as partnership. We tell them everything as it is and propose various alternatives. If we cannot treat their child, we explain where and how it can be done. Treatment of children with mental disorders is a long process, which may take years. Besides, some tests we cannot take in Ukraine and have to send samples abroad, in Russia for example. There are also parents who do not trust much psychiatrists and prefer to study their case in Internet. But even such parents can be persuaded into treatment.
- What about general figures? Are Ukrainian children healthy? How many of them are registered and undergo treatment in psychiatric institutions?
- Unfortunately, according to the statistics, in 90s for example, there were only 20% of healthy children studying in schools, the rest suffered various medical conditions. Today, only 5% of school age children are fully healthy. However, epidemiological survey for mentally ill children is not pursued, but I can tell that autism is becoming a problem in Ukraine. Autism prevalence rate grows by 25% annually. In the world autistic individuals are protected by the state, but in Ukraine we only start working on it. There are 2500 autistic children officiallyy registered in Ukraine.
- What mental disorder are most common in your practice?
- Delayed psychoverbal development. It can be of various nature and intensity, but is pretty common. I've had many cases of children, who do not speak and do not evolve intellectually. I believe we should pay more attention not only to autistic children, but also to children with genetic mental deficiency, like Down's Syndrome. Though there are various communities and support groups of parents of such children, child psychiatry should be closer to the problem and to the children.
- What about childhood schizophrenia?
- It is uncommon before the age of 10 and makes only 0.02% of total number of cases. Schizophrenia manifests at adulthood.
- Is it true that schizophrenia is incurable?
- No. As a rule, it is a genetic disorder and its certain states can be treated. The problem is poor financing. After the financial deficit in 90s we lost many psychologists, and only then we understood how important they were for psychiatrists. In Holland, for example, there are 30 psychologist per one child psychiatrist. A psychiatrists makes a diagnosis, prescribe treatment, and that's it, then it is the turn of psychologists to follow the patient. Russia has already adopted such practice. In Russian mental hospitals every psychiatrists is assisted by two psychologists and two social workers, and statistics prove that the chance of a recurrence among mental patients has reduced. In Ukraine, however, there four doctors and only one psychologist in a children's department. That is not it. I wish free-lance specialists fought for increase in number of psychologists and teachers in the sector of special needs education in psychiatric hospitals. I think humanization of domestic psychiatry is impossible without significant amount of psychologists among us.
- Some feral children, abandoned by parents, were discovered recently in Lviv. Do they have a chance to recover and come back to normal life?
- As a rule, no. Such Mowglis, who lived among animals, lost forever the ability to socialize. Even if such children had been taken in the society and taught to be its member, they failed. Feral children lack the basic social skills that are normally learned in the process of enculturation. Every person undergoes the so-called sensitive period in his life. It starts with birth, includes physiological and social contract with parents, peers and other adults, and lasts till the age of five. And God forbid if such contract has not happened during this period.
- What methods of thepary do you use in your practice?
- Drug therapy, spread all over the world. We can also use certain light atypical antipsychotics to treat autistic children. Moreover, I often prescribe animal-assisted therapy: canis therapy (dogs), dolphin therapy, equine therapy (horses).
- Modern children do not go out much to play with peers in the yard, but stay inside paying computer games or communicate with virtual friends through facebook or skype. How does it affect their mind?
- It is a very negative tendency. Even small children, who do not even speak yet, operate mobile phones and computers better than adults. What can I say, we are on the verge of new civilization. The era of IT penetration changes people. Children develop different brain regions, which were suppressed before, but lose those, well developed in their ancestors. However, this new civilization is not coming tomorrow, thus I would recommend parents to measure out the time for computer games and virtual reality and to motivate their children to join sport activities, music classes, etc. for children to develop harmoniously. Virtual communication deprive children of certain nuances, needed for socialization, including communication with opposite sex.
- What about children of migrant workers, who live with relatives and do not see their parents. What will they grow to be?
- You know, it depends. There are children, mentally stable, who accept the fact and grow to be adequate adults, who respect their parents. However, health of our children has deteriorated lately, and many problems could have been avoided if parents were by their side. Observant eyes of parents will notice abnormalities in behavior in time.
- Does aggressive behavior of teens mean certain mental disorders or it is just age?
- Adolescence is a difficult period for both teens and their parents, and I must say misbehavior is often the fault of the whole family: conflicts between mother and father or disputes when each parent tries to draw over the child... It affects mental health of the teen. Thus, during such period parents should be especially attentive and sensitive. It will pass. When hormonal and physiological upheaval in organism is complete, the teen will become an adult and will calm down. There are cases, though, when teens remain teens in mind regardless of age. Such case are common among drug addicts, alcoholics or people with other types of addictive behaviour.
- What about unrequited love, which puts teens up to suicide?
- In virtue of vulnerability, unhappy love happens quite often. Once I was investigating into peculiarities of the so-called suicidal behaviour. There was a case when six girls between 16 and 20 years of age were hospitalized with attempted poisoning, and all because of unrequited love. one girl was in really grave condition. Parents should remember about sensitivity of teens to insults on the part of parents, teachers, peers. In every conflict situation adults should first of all evaluate their own reaction, behaviour and correctness. A teen is already a formed person and must be treated as adult, meaning without authoritarian pressure on the part of parents.
- At what age does infantile sexuality reveal itself and what can be considered abnormal? What should parents do if notice something strange?
- First of all, they should stay calm and not panic, not to apply any force but consult a specialist. It happens sometimes, and it does not always mean some mental disorders. The child may have seen a negative example, that's it. Growing up, children start hiding their sexuality. Thus, parents should not hesitate to talk on the subject. Parents should also understand that in case of disorder the treatment may take time.
- What is the signal in child's behaviour for parents to visit a psychiatrist?
- Unusual behaviour in dealing with outside world, problems at school or with peers. If a child does not have any neurological complications, such behavior deviations should put parents on guard. There are community-bases centers for psychological assistance, both state and private, which readily works with children and teens. And if there you are told that a psychologist can do nothing, you must seek assistance of a psychiatrist.
Anastasia Pika, photos by Viktor Kovalchuk
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