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Archive for July, 2011

I just wanted to post a link to a post written by a woman called Danni Miller that includes an article by Jessica Rowe, who has spoken publically about her own experiences with postnatal depression. I think it’s beautifully written, and honest, and is worth a read here.

If you are at all concerned about your own mental health, or that of someone close to you, please talk to your doctor. More information on PND can be found at justspeakup.com.au

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Every parent will have had the experience of their toddler having a screaming fit in the middle of Target over some bright pink shoes with flashy lights in them. As frustrating as they are, tantrums are a completely normal part of childhood development. There are lots of theories about what is happening for the child at this age, and the one that makes most sense to me is that of Erik Erikson.

Erik Erikson was a psychologist and psychoanalyst mist famous for describing a list of stages that he believed every person passes through in their lives – from infancy to old age. The second stage that he described, occurring at the toddler stage (18 months – three years) is the stage of autonomy – v – shame/doubt.

Erikson believed that a toddler’s task is to develop a sense of autonomy, and if the toddler doesn’t do that, she will be left with shame, and doubt about her ability to function independently.

 

It can be a difficult stage for us as parents to negotiate as the toddler challenges our authority. On one hand, we want to let our child become more independent: to learn how to put her own shoes on and make decide what kind of sandwich she wants (inevitably jam), but on the other hand we also need to set boundaries and limits. Outside of the house, children need to learn social rules, and of course, be safe.

I think the best way to manage the battle of wills with a toddler is to pick your battles. If a toddler wants to wear a fairy dress over their pajamas, along with a sun hat, sunglasses, scarf and pink slippers, then that really doesn’t matter. It does help to give the child that sense of control over their day and their life.  But if they refuse to sit in the pram and insist on walking, then they must hold mum’s hand. There will be tears and anger, and little ones become overwhelmed by their feelings very easily. But by being firm, while telling the toddler that you understand how they feel when you stop them from climbing up the bookshelves in the shop, the tantrum will pass. And in time, the child will develop a sense of independence and autonomy, and have no doubt in their own ability to be a big kid.

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I found this article today online in the British Telegraph. It reports that a group in the UK are about to start a lottery, where a twenty pound ticket may win you GBP25000 (about AUD$37500 at today’s conversion rate) of fertility treatments: IVF, donor eggs/sperm, and even surrogacy. According to the article, it also includes extras such as hotel accommodation, mobile phone and chauffeur trips.

Wow. I can only imagine the stress and anxiety that infertility causes, and by all accounts, it is a very expensive process.

But I can’t help but think that all this does is add to the cycle of anticipation, hope and despair that couples go through with fertility treatment. For the families that do win, I’m sure it will be a fantastic opportunity and one that could give them what they desperately want and need. But for the vast majority of people who enter the lottery, it will be another anxiety in their life, another build up of hope that will ultimately crash down. And like all forms of gambling, it can easily get out of control, financially and emotionally.

Gambling on a prize as emotive and personal as this, in my view, is wrong.

What do you think?

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Chiropractic Activator Device by Michael Dorausch

There was a great article in The Weekend Australian magazine this weekend about chiropractors treating children for  conditions other than mechanical spine issues (note that it does say that only some chiropractors do this). It grabbed my attention because the article stated that some parents take their children to chiropractors to treat autism and ADHD – conditions that I see in clinical practice.

Wow.

I have never been to a chiropractor but know many people who swear by them, and I have absolutely nothing against alternative health practitioners. But there are two issues that worry me. First, when practitioners say they can treat conditions with no evidence to back it up, and second, when there is a risk of harm from the treatment – either directly or indirectly.

Lack of evidence

I will point out that the chiropractor in the article above says that he never claimed to be able to cure autism, but rather, a parent was convinced that the chiropractor cured her son’s condition.The practitioner quoted in the article does imply that chiropracty – through realigning the spine – can help with colds, ear infections, bed wetting, ADHD, and can even ‘repair’ DNA.

In clinical medicine, we are taught to look for evidence that the treatments we use work. Some treatments are straightforward: we can see in the lab that a particular antibiotic will kill certain bacteria. I know that in my own speciality, psychiatry, some of the evidence for treatments (particularly psychotherapy) is less strong because of difficulties in measuring what we do. However, the vast majority of treatments – physical and behavioural – have good scientific evidence to back them up. In the case where the evidence is lacking, but we have reason to try a particular treatment, we explain the risks and benefits to patients and come to an informed decision together.

I am not aware of any scientific evidence (randomised placebo controlled trials with statistically significant results) that chiropracty can cure asthma, allergies, reflux or autism.

Risk of harm

Many of my patients ask my opinion about unproven remedies for various disorders and I always encourage them to try anything they want to – as long as it’s in conjunction with proven treatments, and that it does no harm. And in the vast majority of cases, alternative medicine doesn’t do any harm, and may help. I don’t know of any direct risks from chiropracty.

I have seen ‘harm’ caused by other alternative medicines: I have once seen a woman who became pregnant after using St John’s Wort to treat mild depressive symptoms, because she wan’t aware that it interacted with her contraceptive pill and made it less effective. She had the idea that because St John’s Wort was ‘natural’ it didn’t have any side effects or interactions.

In the article above, parents say that they see their chiropractor before their GP, and one mother lists her chiropractor on forms as her family doctor. In my mind, this is risky. A chiropractor is not medically trained and cannot diagnose medical illnesses, and there is a risk that children will be wrongly diagnosed, or that illnesses will be missed. Children may therefore miss out on proven treatments, and in the case of disorders such as asthma, allergies or autism, this can have grave  consequences. Some believe that chiropractors can replace immunisation in children – again, this has potentially serious consequences.

What to do?

Overall, my advice to parents and patients won’t change: by all means try alternative medicine if you want to. But make sure that you have a medical diagnosis and treatment plan, and that your medical doctor knows what other treatments you are having. Ideally, medically trained and alternative health practitioners can work in tandem to treat each individual patient.

Reputable health practitioners – medically qualified or not – will always explain risks and benefits of their treatments.

One sad fact is that the parents quoted in the article  feel that they get much more holistic and empathic treatment from their chiropractor compared with their GP. It’s an important point: our medical system is busy and understaffed, and perhaps sometimes the patient as a person gets lost in amongst the science. That is one thing that medical professionals need to take note of.

I would love to hear from anyone with any experience or comments…

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I just wanted to say thanks to phdinpsychology.org for listing this blog in their top five blogs about developmental psychology. There are fifty blogs listed there, many of which would be of interest to readers of this blog.

I haven’t been blogging much recently as I have been finishing my novel (more on that to come) but hopefully will be a bit more active now.

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