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The Baylor College of Medicine Resonance Podcast is a student-run podcast aimed at showcasing the science at Baylor through the eyes of young professionals. Each episode is written and recorded by students who have a passion for research and the medical community. Guests on the show include both clinical and basic science research faculty who are experts in their fields. We hope that whoever listens in gains new insight into the exciting world of biomedical research.
Beyond Diagnosis: The Art of Child Psychiatry with Dr. Maldonado
Synopsis:
In this episode, we sit down with Dr. Jesus Martin Maldonado, a distinguished child and adolescent psychiatrist with over 40 years of experience, to explore the profound impact childhood experiences have on mental health. Dr. Maldonado shares his expertise on child psychiatry, emphasizing the importance of understanding the child’s environment, including family dynamics and school interactions, in diagnosing and treating psychiatric conditions. He discusses the value of play therapy as a unique tool for connecting with children and uncovering their emotional worlds, as well as the crucial role of family therapy in fostering better communication and healing. Together, we delve into the evolving landscape of psychiatry, including the challenges posed by social media and technology, and the importance of empathy, patience, and relationship-building in nurturing young minds.
Transcript:
Gianni Calderara:
Hi and thanks for listening to Resonance podcast, a podcast run by medical and graduate students at Baylor College of Medicine, where we interview faculty, clinicians and researchers in an effort to promote health education and ingenuity. My name is Gianni Calderara. I am a fourth year medical student at Baylor College of Medicine. In this episode, we are going to be interviewing one of my psychiatry preceptors, Dr. Jesus Martin Maldonado.
Dr. Maldonado is a distinguished Baylor faculty member. He's got over 40 years of experience in the field of child and adolescent psychiatry, as well as an extensive background in family therapy and psychotherapy.
I think clinicians often take for granted the very simple fact that all of our adult patients were once children themselves. I think that many disorders, both mental and physical, often originate from maladaptive processes formed during childhood and adolescence, whether in the family unit themselves, or in another scenario. By better understanding Child and Adolescent Psychiatry, I think we can build a stronger foundation for interpreting disease in adults and better comprehend the experiences of those around us in our community.
I first met Dr. Maldonado during my psychiatry core clerkship at Baylor College of Medicine. I had the privilege of rotating with him at Texas Children's hospital for two weeks. Over that time frame, I witnessed the artful nature of his work and the mastery he has developed over decades to help pediatric patients from diverse backgrounds who struggle with psychiatric challenges.
One of the most memorable aspects of my time with Dr. Maldonado was his innovative use of play therapy. This approach allows him to create common ground, foster open communication and build trust with patients and their families. We often played simple games like chutes and Ladders or Jenga, which provided a comfortable and non-threatening way to engage with children while gaining insight into their thoughts and emotions. For me as a learner, it was truly a unique and eye opening clinical experience, and it was one that I often look back to as I've progressed through my training.
I'm truly excited to bring Dr. Maldonado’s wisdom and insights to you today, and I hope that you find our conversation both engaging and insightful.
So, what role does childhood really play in shaping adult mental health, and how can the principles of family therapy help us improve our relationships at home? We'll hear about these topics and more with Dr Maldonado.
Gianni Calderara:
All right, well, Dr. Maldonado, thank you so much for agreeing to be on the show with us. I'm really excited to talk to you. I had a bunch of questions I wanted to ask, just about your work and kind of what you do at Texas Children’s. So thank you so much for being here.
Dr. Maldonado:
You're welcome. It's very nice for me to see you again.
Gianni Calderara:
Yeah, I was wondering if we could just get started by having you tell us a little bit about what a typical patient encounter looks like for you, and what a typical day of work looks like in your practice.
Dr. Maldonado:
Okay, well, we have a few little tracks here. You know, we have the general child psychiatry, where a person comes with their parents for problems at school, problems in the family and so on. Then we have another clinic called the mind-body clinic for children with neurological disorders that are functional. So we have one day a week where we evaluate in a multidisciplinary team children with conversion disorders, now called somatic symptom disorder. And then we have the complex hair clinic on Mondays for children with complex medical conditions. We see their children and the children and the families
together. And finally, we have an early childhood clinic now on Thursdays where we see children under five, be it babies or preschool children, who are having difficulties.
Gianni Calderara:
Okay, and what is your role in each of those clinics? And what, what role do you play with these families and with these children?
Dr. Maldonado:
Well, the first role is to be a diagnostician, but in a more, perhaps comprehensive sense of the word, which means to understand the child's life, not just assigning a diagnosis in the DSM-5 categories, but to understand the life of the child, the life within the family, the family interactions, the school interactions. So we try to see the child in the sort of surrounding environment, not as an isolated individual, but as a person with relationships that impact their emotions, their behavior, and that guides us in our intervention.
You know, when we understand what's happening, then we can design an intervention that addresses those issues.
Gianni Calderara:
In one of the questions that I wanted to ask, I think, I think historically, children
have been mislabeled by Medicine as sort of miniature adults in many ways. And I think over the last few decades, we've become more aware of how that's not the case, in that children have their own unique disease processes and pathology and I guess, how do you approach those differences, and how does that inform how you approach child psychiatry versus adult psychiatry, and what are some of the important differences that you think exist that we must be aware of?
Dr. Maldonado:
Well, I think you're very right. You know that people used to see children as miniature adults, but they are not. They have different ways of thinking, different ways of reacting, and move in the world of emotion rather than the world of thought and words, particularly the younger the child is. So, our focus in understanding the child is to kind of translate the child to the parents.
You see, instead of saying, well, “Johnny is oppositional. He doesn't obey his parents, he throws temper tantrums”, instead we try to put ourselves in the mind of the child, understand how the boy or girl might feel, you know, vis-a-vis the parents, for example, or a teacher, and then translate how the child might be feeling and find ways of reacting in a different way, rather than what they are doing. So we privilege psychosocial interventions over medical interventions, meaning medicines. You know, we try to utilize psychological therapies. We use a model we call multimodal, which involves family therapy, individual psychotherapy, play therapy. Sometimes we use relaxation techniques and hypnosis, etc. We don't go first to medications.
Gianni Calderara:
Okay. And is that more so in child psychiatry than you would see in adult psychiatry, where there's more of an emphasis on some of those multimodal techniques, I know, like cognitive behavioral therapy and psychotherapy is also really important in all psychiatry. But
are you more hesitant to go to medications in children than you would say in adults?
Dr. Maldonado:
Yes, we should be. You know, we don't know what the medications do to children in the long term. You know, particularly the neuroleptics, which are very readily used nowadays.
You know, one of the trends that I worry about in child psychiatry is a reduction in the time of the consultations, and many of our new trainees all over the country, you know, not, not necessarily, in Baylor, get very little exposure to psychotherapists, so their main instrument of helping is medication. There is a great deal of emphasis on medicine, short interventions, quick diagnosis.
And you know, that is not very helpful for the child.
I always like to quote Kafka. You know, Kafka wrote a story called A Country Doctor, and in that he says a phrase: “It is easy to write prescriptions. The difficult thing is to understand people's lives.” So that's what we try to do, to understand the life of the child, and to help parents see how the child sees their circumstances, why they might feel a certain way, and what to do to help the emotions and behavior of the child.
Gianni Calderara:
I think one of the things that I got an impression of when I rotated with you was understanding the importance of educating parents about what their child is going through or what their child may be thinking. And I think that's something that parents often worry about in terms of not necessarily recognizing patterns of disease, or, you know, at what point should they seek, you know, a psychiatrist or help. And I guess, to give our listeners sort of a
some early signs of disease or pathology that you typically see, or things that are kind of common in young children that we may not recognize.
Dr. Maldonado:
Well, you know that the most frequent causes for consultations have to do with disruptive behavior, children who get very upset, who are disruptive in the classroom or at home. You know, the second is anxiety, fears of separation, fears in the night, difficulties falling asleep. Sadly, we see many children with trauma, chronic trauma, or in the individual experiences of trauma. The sad part is that we often don't see children who are depressed. You see these children tend to not be noticed because they are not disruptive. And you know, if you see that a child is sad, you should worry about it. If a child has excessive fears, if a child is.
very angry. It doesn't mean they have a mental disorder, but they are not happy.
You know, life is hard, so that would be a reason to kind of get some help.
Gianni Calderara:
Yeah, okay. And kind of going off of that idea of trauma that you mentioned, what are some ways that trauma may manifest differently in children than it does in adults?
Dr. Maldonado:
Well, that's a very important question, you see, because we often discover trauma in many of these children, for instance, with somatization problems, with conversion disorders.
So the body speaks of the trauma. So many somatic problems, stomach aches, sleeping problems, chronic pain, chronic fatigue, very often are related to traumatic experiences and dissociative experiences.
You know, the children who have high reactability, even hyperactivity. You know, like the public is very aware that a child is hyperactive and restless, but very often that has to do with chronic stress, rather than a chronic disease in the child. Sure, it's an adaptation to unpredictable circumstances. Parents, very, very busy. You know, difficult parent-child relationships, all of those could cause those difficult behaviors,
Gianni Calderara:
What role would you say - I guess as social media and technology have become a bigger part of our lives and has inevitably, sort of trickled down to younger individuals than it has in the past,
What impact has that had on your practice, and what are some of the concerns that you have regarding that trend, and is there anything that you recommend to parents?
Dr. Maldonado:
Yes. Well, you know, that is a difficult question, but you know, in general, of course, we see a biased sample of children who struggle with social media, be it, for instance, kind of addicted to them, basing their self-esteem on how many followers they have, you know whether they are liked or not liked, etc. So one could not very well generalize to all children.
But one could easily say that, you know, if a child is spending too much time on social media, if he or she is obsessed with them, with being liked, you know, having followers, there is perhaps a problem in self-esteem that needs to be addressed. And you know, parents need to be very mindful of what is going on. And you know, we wouldn't like to introduce them too young. You know, children are very vulnerable in the middle school age and even early preschool to the opinions of their friends, their colleagues at school, their peers. So, you know, that's a vulnerable population.
Many girls are very upset if they are not liked if somebody calls them overweight or whatever, or boys as well. So, you know, having the child have a variety of experiences, finding some successes in life, such as art, sports, ceramics, drawing or reading or academic things, finding something besides technology.
Gianni Calderara:
Are you aware of any research that has shown, like, neurological changes related to this technology being passed down to younger kids? Sorry to kind of put you on the spot.
Dr. Maldonado:
That's okay.
No, I don't think there is much research you see on, you know, the neurological effects.But we certainly see many children with challenges, for instance, like intellectual challenges or handicaps. Their parents find that the iPad keeps them occupied. And, you know, very busy parents do the same, so children may become a little dependent on them rather than interpersonal interaction. So it's very tempting, the child is highly stimulated by the materials in the iPads and such, and they keep them entertained, but they miss out on the human experience and exchanges with people that are close to them.
The second part of your question was, we do find a lot of parents who spend a lot of time on the telephone, yeah, you know, their own social media, their own issues. So, you know, I say that, you know, the cell phone is the enemy of young children. Sometimes we see a mother pushing the swing, you know, with one hand and the other hand she's checking her email, Instagram, Facebook, etc, so she misses out on the total experience of being with the child and vice versa.
Gianni Calderara:
We also talked about how child psychiatry differs from adult psychiatry, and kind of talking about this implementation of technology and social media in children. How have you seen child psychiatry evolve over the course of your career, and what, what sort of changes do you anticipate in the coming decades?
Dr. Maldonado
Well, you know, child psychiatry in the US, I started working 40 years ago, so I've had a very long career. You know, disorders come and go in the diagnostic classification, and they have multiplied like by 10 times. So that's one worrisome trend. You know, the new classification seems to be very inclusive, and things that, before we called symptoms now are called diseases onto themselves or disorders. Another is the emphasis on pharmacology, as I mentioned before, and the changes in the training, you know, with the ascent of more behavioral and cognitive therapies, you know, they are kind of given to psychology social workers. But you know, something that is being lost in this is the emotion, the human relationship with a doctor, the psychiatrist. And you know, many child psychiatrists have no training at all in psychotherapies, particularly family therapy or even individual psychotherapy. The psychodynamic schools have gone out the window with the emphasis on cognition and behavior, you see. But I think emotion is a central part of both psychodynamic thinking and of relationships between people. So we find that it's a very powerful instrument. We try to train our fellows in family therapy and in psychodynamic psychotherapy still.
Gianni Calderara:
So that emphasis on family therapy that you mentioned, and that I kind of experienced when I rotated with you, I think, is really interesting. And specifically, I really enjoyed getting to see play therapy for the first time and how you utilize that to connect. I was wondering if you could just walk us through what play therapy is and why it's such an effective tool in your work.
Dr. Maldonado:
Play therapy, you know, play therapy was kind of of course, children always have played, but the therapeutic use was, you know, discovered about what 80 years ago, Melanie Klein and then Anna Freud used it. So play is a form of communication that we use from children to adults. You see, the way a child plays spontaneously tells you what is in their mind. So it's very similar to dreams. If I ask you to tell me a dream, you know, particularly if you have an anxiety dream, that tells me something about what worries you. If in your play, you show, like, parties are fighting, or, you know, the father leaving the house, or somebody being run over by a car. Then we ponder, “what does this mean?” You see, so the child speaks through action and emotion in the play. So we try to understand the emotional life of the child through play up to age 11 or 12, we use puppets, we use miniature toys, and we use games.
Sometimes children don't talk very much when you ask questions face-to-face, but they talk through when you are playing a game, then they relax and they start talking about their feelings and their experiences through the medium of the game.
Gianni Calderara:
Yes, if there are any parents listening that are interested in strengthening their relationship with their child, or understanding their thoughts a little bit better, is play therapy something that they could try at home? Or is that something that you would really only recommend, you know, doing it with a psychiatrist or with a counselor?
Dr. Maldonado:
No - play. Play. Let's call it play. Play with the child. You see, not so much therapy, but playing with the child is a naturalistic way in which all good parents engage with their kids. You see, because it creates a pleasurable interaction, a moment of solace for both the adult and the child. So the adult who loves their child is very happy to see the child laughing, coming up with new ideas, funny situations. So play is a space which we often recommend to parents, you see, who are very busy, who may not know how to play, we try to show them how to play with their child and to take pleasure in the interaction, and this sometimes is highly therapeutic because it's a connection. You see, where you encounter another human being, and you both enjoy the pleasure of the moment, so to speak, a moment of mutual enjoyment, empathy, and liking each other.
So, it's a healing technique, in a manner of speaking, that parents use naturally all the time. But when parents don't do that, we recommend that they try it.
Gianni Calderara:
And you mentioned teaching parents how to play with their children. Let's say I was somebody that was very busy, and I came to your clinic, and this idea of playing with my child was totally foreign to me, and I was unsure of how to even go about doing that. What are some of the things you would tell that parent or advice and steps you would take?
Dr. Maldonado:
Well, we try to do an experiential approach. So very often the play therapy is not with the child alone. You see, the parent is right there in the room. We try to kind of explain to the parent what the play themes might mean. And we often engage the parents in playing with us, you see, so they can see how it can be a moment of revelation, of expression of emotion. Sometimes there is expression of aggression, fear, but also pleasure, you see. So we try to engage the parents in connecting with the emotions and the emotional life of the child.
Very often, the parent is touched by what the child is saying. Let's say, you know, if a child is displaying a scene of the parents fighting, that is an emotional education for the parent, because the parent is seeing firsthand how this is impacting the child, what goes on at home. And then they say, “Oh, I did not realize he was noticing,” but they see it in the play.
Gianni Calderara:
I think one of the things too, I'm realizing as I'm getting older is the importance of maintaining a child-like attitude and a sense of play, kind of in my everyday life and in my relationships. And I think that's something that people kind of generally lose touch with in a lot of ways as they go through life. One of the thoughts that I had when I was kind of brainstorming things to ask you for this episode and my own experience with play therapy was, if you just think there's any applications for play therapy in adults, I know you mentioned that we typically stop using it around age 11 or 12, but either in the field of psychiatry or in other fields of medicine, do you see any instances where play therapy could be utilized in ways that maybe it isn't currently?
Dr. Maldonado:
Yeah, you know, I mean, in many centers, they use other forms of therapy, such as recreational therapy, group therapy, in which games are involved. And, you know, kind of art therapy is another form you see. So those are forms of play for adults. And you know, you can express yourself there, show your emotions, kind of draw or display what is worrying you. So you know all adults play, can play, but you know when one is so busy and exhausted, or whatever, that you lose the ability to play. One should take a look and say, you know, maybe I need to take care of myself as well. And, you know, play with someone. You know, sports, recreational activities, going to the park, enjoying each other. You know, sometimes it's lost with all the duties that people have, the jobs and the stress and so on, but those activities are highly pleasurable and they reduce the stress. Yeah, being with one another is really a healing thing.
Gianni Calderara:
Yeah, I think that's something we've kind of lost sight of in our kind of just our culture,
you know, at a larger picture, just the importance of play for well being and mental health, I think is something that we sort of lost touch with.
Dr. Maldonado:
I think so, yes.
Gianni Calderara:
You also mentioned that you like to involve more than just the child when you're in play therapy, and you often have the parents in the room and kind of go through this experience together. And I think family therapy is obviously a very large part of your practice. Can you talk about your experience in family therapy specifically, and why having the whole family present is so important and impactful?
Dr. Maldonado:
Well, you see, when I started training, we used to recommend to children to go to psychoanalysis four times a week and for the parents to get their own analysis four times a week. So that would be very impractical. So the family therapies were, you know, kind of implemented around the 70s and 80s of the last century. And, you know, I have continued to use them because they are very efficacious in getting the whole family together, if possible, and then discovering the patterns of interaction and why they exist.
For instance, you know, many parents bring to their experience of parenting the experience they had with their own parents. And sometimes, you know, there is a lot of suffering and pain that has not been dealt with, so the parent may apply this to their child, you know, like spanking, yelling, etc, etc. And you know, when the parent hears the child say, you know when you yell at me, I feel scared. When you hit me, I feel mad. They have no reason to continue doing it because they love their child, you see, so we are kind of a
mediator, a forum, where people can talk about their reactions and experiences. And parents are more than willing to change because they see the effect, you know, what they do has on the children, for example, and the effect, for instance, of the behavior of the child has on the mind of the parent. And sometimes we see the parents alone to discuss, you know what a child triggers in your mind. You know if a child makes you mad or makes you exasperated or whatever.
I think another idea that I learned rotating with you is this idea that
relationships don't exist in a vacuum, and family dynamics exist for a reason, and kind of evolve together, sometimes almost for survival and to keep peace in the household. Or,
you know, things are all intertwined. And what, I guess, what are some, some of the common issues you encounter related to family dynamics and how that manifests in disease or disorder?
Dr. Maldonado:
Let's take the example of the so-called oppositional defiant disorder. You see, many children are brought in because they are said to have that such disorder. But then you discover that, you know, the parent might be a little authoritarian, not thinking about how certain orders or expectations impact their child. And you know, when the child’s voice says, “Well, you know, you want me to respect you, but you don't respect me. You yell at me, but you say we shouldn't. You say we shouldn't use bad words, and you use bad words.”
So we, you know, we kind of help the child to acquire a voice. And then, you know, when the parent empathizes with the child and says, “Oh, I see what you mean.” So you know this is more of a two way street, rather than obeying blindly everything I say in a certain tone that makes you upset. So then the defiant behavior disappears when the parent tries to use a more empathic technique to deal with the child. That's just an example.
So, you know, we all bring to the family our own family history, and we may implement it, but in the normal course of circumstances, the child teaches the parents how to be, you see, because you may decide, okay, I'm going to use this technique, but if the child cries or makes him upset, then parents change. The problem we find is when people use very rigid strategies and they find it hard to change. So we help them change.
Gianni Calderara
Okay, I have come to sort of conceptualize the family unit, almost as an entity in and of itself that needs to be treated and that is sort of going through changes and trying to survive and maintain some sort of balance or some sort of order. And I think for me, that helps me sort of conceptualize the family unit. Is that a fair way to think about the family unit and how can we better understand the role that the family plays in child development and child psychiatry?
Dr. Maldonado:
Well, it's a very crucial thing you see when you know, when you study medicine, they say, well, first there are atoms, then molecules, then maybe compounds, then cells, then tissues, etc. So you know one thing. So quote psychopathology as an individual phenomenon. That's one thing. But we think of psychopathology also from the point of view of the family. So when, when a child, for instance, is cutting on herself, we also think, you know, why is she doing that? What does it mean in the family? What message is she trying to convey? Or he to the parents? And very often, we see an adaptive value of the behavior.
Or you even see maladaptive behavior, because you know a parent would stop on his tracks if your daughter is cutting herself, and you say, what's going on? And she might say, “Well, I feel very lonely. I feel very isolated. You guys are fighting all the time,” and parents pay attention, and that often brings about changes, you see, so that the symptoms are a form of communication. That's how we view them in family therapy.
And you know, it's not just like you shouldn't do that. It's,” what does it mean in the context of a wider system,” how the parents respond and very often the child brings about changes because parents love their kids.
Gianni Calderara:
Yeah, I think that's a really practical and helpful way to view disease or patterns of behavior, because I think so much of what we do, especially children, is influenced by those around us. And I really like the idea of viewing symptoms as a form of communication, I think that's something that allows people to kind of view others' behaviors within their family. And what does this mean?, and why is this behavior coming out?, and why is this context bringing forth a behavior in someone in my family?
Dr. Maldonado:
Yeah, you know, we now use the concept of mentalization, which is thinking about other people's minds. So we help parents to think about their mind and the feelings of their child and vice versa. “Why do you think your parents react this way?” So, you know, sometimes when children start to realize why their parents operate in a certain way, that brings about changes.
Gianni Calderara:
And I guess talking about the family unit and having both children and their parents in your room with you at the same time, how do you navigate circumstances when the child's goals and the parents goals may be different, or they're coming at it from a different viewpoint. And I'm sure that it changes depending on the age of the child. When, you know, as adolescence approaches, and children have more autonomy and or have more of a self identity. How do you approach those situations? And how does it kind of change depending on the age of the child?
Dr. Maldonado:
Well, you know, you're quite correct. You know, working with a teenager is different than working with a younger child. So, you know, younger children are very highly dependent on their parents. They love their parents. They want to keep them happy. But that should be a two way street, you know, like if your child, for instance, you hope your boy, you know, he’s very tall, he's very strong - he should be a football player, but your son doesn't like football. He prefers theater. Well, that is a thing you know, that you might say, well, you know, he should be a football player, but he doesn't like it. So again, you know, we try to help the communication and the flexibility to allow the child to be who they really are.
We often try to translate this to parents like if the child has learning disabilities, he might not be a scientist like his father, but he might be a very good person in another field that the child likes. In adolescence, the challenge is for the family to modify, to accommodate the individuality of the child who is more interested in peers, in more you know, being autonomous at times and at times dependent.
You know, that's how adolescence is. One day he says, “I am enough of an adult to know enough to make big decisions,” and the next day they want you to cook breakfast for them, because they are like a baby.
So, you know, you have to navigate this and understand this is what comes with age. And, you know, preserving the communication, the empathy and you know, mutual love and respect and dialog, which very often is not maintained. You know, because people get very scared, parents get very scared of who their child might turn out to be, because of ghosts from their own life, perhaps sometimes.
Gianni Calderara:
What advice would you have for parents that are really interested in forming a healthier family dynamic, and, you know, really want more connected relationships with their children? What sort of things would you tell them?
Dr. Maldonado:
The main recipe that I think, you know, shields parents from hurting their kids is to put themselves in their shoes. You see, to empathize. You know, if a child is throwing a fit, you could say, “well, he shouldn't throw fits.” But if you instead say, “Why is he throwing a fit? How does he feel?” Obviously, the child might feel very hungry, very destroyed. Dysregulated, maybe confused. So then that takes you outside of the realm of discipline and more into the realm of understanding and trying to figure out, you know, how would I see the world if I were my son or my wife? Or my teenage kid?
See, the maneuver of empathy and putting yourself in the shoes of the other helps you to at least be a little more understanding and less reactive. You see, so we help parents to try to not get too upset and then not overreact while they are upset, but to go to a state of calmness before they say, “so what am I going to do about this,” not to act on the spur of the moment, for example, from fear or anger.
Gianni Calderara:
And as one of my last questions, I just wanted to ask if there are any common misconceptions about child psychiatry that you think exists, and any sort of myths that you know you'd like to expel or you think people or maybe other clinicians need to hear.
Dr. Maldonado:
Well, you know, a child psychiatry should be an expert in family relationships, in child development, and you know, it should not be a scary thing to see a psychiatrist.
A psychiatrist should be a person who listens and who understands, doesn't judge, doesn't tell you what to do, but teaches you an approach to relationships and to understanding the Other. So you know the thought that, you know, you only go to a psychiatrist when you need medicines probably is not a good one.
You know, any mental health professional, a person that is interested in the mind and the feelings of others, would be helpful. Most of psychotherapy is conducted informally by teachers, neighbors, prisoners, peers, you know,
Gianni Calderara:
Your friend Tyler.
Dr. Maldonado:
Yes, of course, you know, because you know being with the other and trying to help them understand what's happening. But you know not to see psychiatry as a sign of mental illness. Unfortunately, we have contributed a lot to this misconception because of the reduced role of the psychiatrist to a psychopharmacologist. Nobody wants to be put on medicines, and they shouldn't.
Gianni Calderara:
So you attribute that sort of taboo alleviating a little bit by that emphasis of the psychiatrist as the pharma…
Dr. Maldonado:
Yes yes, you know, because now almost you know, people would not refer a person to a psychiatrist in the modern times, you know, unless they thought, “Well, maybe he needs to be put on medication,” you know. And parents dread medications. Naturally, I would rather not, you know, put my five year old on antipsychotic medication. And that's done a fair amount of the time, you know. So you know, it is important also for the psychiatrist to have a set of skills that involves understanding the mind, emotions, development, family relationships and schools. You know, the schools are a big factor in the problems that children have.
Gianni Calderara:
Yeah, that's interesting. I hadn't thought about that. So I guess the counselors and therapists being more accessible has kind of had this other, I guess, downstream effect of atra nsition to more of a medical psychiatrist than previously, whereas before, psychiatrists were more involved with therapy; it's become more taboo to see a psychiatrist.
Dr. Maldonado:
Well, you know, see, imagine if you only do pharmacotherapy, that would not be a very fulfilling career because, you know, the time has been reduced now in many centers for us, even in child psychiatry. Spending time with children, and the follow ups, and getting to know a child is hard, you know, because children don't come and say, “let me tell you my problems.” You have to discover them through these techniques.
We talked about the play, the discussions, you know, discussion with other people. And you know, it takes time. And you know, children should get that process. You know, we see deformities very often, like I just saw a two year old who was on two neuroleptics, you see, because the parents thought the child needed to sleep.
And when I asked the parents, “so how did you put him to sleep?”
“Well, we just send him to his room.”
Well, most parents would know that a two year old doesn't just go to the room. They need their parents there. So the parents were more than willing to try. You know, it just hadn't occurred to them, they weren't aware that they needed to be there, as they never had that as kids. They had suffered a lot as children.
So when we said, “Why don't you try this?”, they were willing to try it. But, you know, we had to take away the neuroleptics because, you know, we don't know what they do to a two year old child in the long run
Gianni Calderara:
I think another thought that I had was just, I read recently that people are very willing to change, if not for themselves, for the people that they love. And
I guess, do you find that maybe in child psychiatry, getting parents to change their behavior, I'm assuming you probably have better response and sort of adherence to, quote/unquote, treatment in child psychiatry with parents then you may have when treating those parents themselves in adult psychiatry.
Dr. Maldonado:
Yes, you know, we have about 70 to 80% success rate with any mental health intervention. You know, there is a woman called Sally Province who was an old therapist who said, “when you deal with children, God is on your side.”
Yeah, parents are willing to change many things because they love their children. They want to give them a better life than they had. So, you know, we use that because parents do change when they notice they are hurting their kids.
Gianni Calderara:
Yeah, I think that's a great message and a really optimistic sort of viewpoint.
Yeah, thank you for sharing all that.
Okay, I think, I think the last question I like to ask all of our guests, Ilike to just kind of hear about, if you have any recommendations or pieces of art or culture that you've consumed recently, whether like a book, a movie, a podcast, something unrelated to psychiatrist or it could be related to psychiatry. Something you've consumed recently that you thought was great and you would recommend.
Dr. Maldonado:
Well, I'm going to sound very old, but I just finished reading War and Peace, Leo Tolstoy’s novel is noble, which is huge.
You see, all of these works, you know, like reading Virginia, Woolf, Charles Dickens, you know, Leo Tolstoy, are an emotional education. You know, manner of speaking. You know, because they describe the characters, feelings and emotions. And you know, they are really pleasurable to read, and they kind of teach you about the human condition. Imagine War and Peace you see, very relevant to our times,
Gianni Calderara:
I guess most times.
Yeah, that sounds awesome. I'll check it out. I appreciate you, Dr Maldonado. I enjoyed talking to you.
Dr. Maldonado:
Take care. All right.