Rescue Fantasies

RMS Titanic. Photo credit: Wikipedia Commons.

Dr. Coplan unloads on the hardest part of a pediatrician’s job

What do you suppose is the hardest part of my job as a pediatrician? If you guessed “Giving bad news,” you would be wrong.

Make no mistake about it: giving bad news is never easy:

1. Your son / daughter has died.
2. Your son / daughter has :

• Cerebral Palsy
• Intellectual Disability
• Autism
• Brain Damage
• Spinal cord injury
• Cancer
• A degenerative disorder for which we have no treatment
• Other [fill in the blank]

Surprisingly, however, giving bad news is not the hardest part of my job. Properly done, giving bad news is an act of compassion that sustains parents and helps to assure that family healing will (eventually) take place. Giving bad news requires me to practice my profession at the highest level. As painful as the process may be, it offers me the satisfaction of a difficult job well done.

So, what is the hardest part of my job?

In episode 23 of The Twilight Zone (The Nightmare at 20,000 feet), a passenger (played by a very young William Shatner, pre- Star-Trek fame) spots a monster on the wing of the airplane, and watches with horror as the creature slowly begins to devour the wing of the aircraft. This plot device forms the basis for innumerable movies: Only the protagonist sees the danger– everyone else is placidly unaware. The “Invasion of the Body Snatchers” is another great example: The hero struggles to stay awake. Everyone else is either ignorant of the danger, or their minds have already been taken over. (Written and produced during the McCarthy Era, this film is also a metaphor for America’s fear of creeping Communism: Substitute “Reds” for “alien pods,” and you get the idea.). Read the rest of this entry »

Out and About

It’s always good to get out into the real world, to share my ideas face to face. I was fortunate enough to be invited to give a presentation this past week at the Autism Society of America’s annual national convention: (Mental Illness in ASD – The Elephant in the Room  ). It was hard trying to squeeze six hours of material into a 75 minute session, but I managed to cover the key points:

• The bright line between ASD and “mental illness” is a myth.

• DSM-5 perpetuates the “gumball model” of psychiatric diagnosis: A given patient may have one or more discrete disorders, that happen to co-exist. “Co-Morbidity” is the necessary fiction on which this model rests. In reality, disorders shade into one another along a continuum, or undergo metamorphosis over time.

• ASD, Schizophrenia, ADD, Bipolar Disorder, Generalized Anxiety Disorder and Depression have shared biological roots. A given genetic defect can give rise to disorders that “look different” on the surface (pleiotropy). Conversely, disorders that look the same on the surface may actually be due to very different underlying genetic mechanisms (phenocopies).

Myth and Reality in the etiology and classification of ASD and mental illness.

 (Click on graph to enlarge.)

Myth and Reality in the etiology and classification of ASD and mental illness Read the rest of this entry »