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04.24.2014
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Bridget Foley's Diary: Pediatric Mental Health, Let's Start the Conversation

The tragedy of the Newtown, Conn., school shootings shed light on another social issue that counts among its advocates the founders of the Child Mind Institute.

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Harold S Koplewicz Brooke Garber Neidich

Harold S. Koplewicz and Brooke Garber Neidich

Photo By Thomas Iannaccone

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Guns. The hot-button subject, pushed acutely into the forefront of national consciousness by the Newtown, Conn., school shootings, is getting major attention this week. On Monday night, the New York State legislature was expected to vote on a package of tougher regulations, while at his press conference earlier in the day, President Obama called on Congress to find “answers that set politics aside.” Vice President Joe Biden is expected to present his proposals for new national legislation today.

The tragedy shed light on another social issue as well, that of child and adolescent mental health. Unlike guns, that topic may already be slipping from the national focus, even as those associated with the cause are determined not to let the moment pass. Case in point, Brooke Garber Neidich. “I hope,” she said recently, “that this tragedy doesn’t become about gun control only. The children’s mental health aspect is huge.”

Neidich’s passion on the topic is highly informed. Together with the well-known child and adolescent psychiatrist Harold S. Koplewicz, she founded the Child Mind Institute in 2009.

Ultrachic, Neidich wears her glamour the way a leopard wears her spots — obviously, yet with ease. By day, she favors crisp shirts and trousers, their simplicity offset by a tower of malleable white- and yellow-gold bracelets running up one forearm and, around her neck, dramatic multistrand necklaces. Her conversation offers updates on her three adult children, insight into her friend-of-Hillary status, glimpses inside the art world (she’s a collector and cochairman of the board at the Whitney) or the latest on her jewelry business (the aforementioned items, her own). We’d met at the Core Club with musician John Forté to discuss their upcoming collaboration under the mantle of Sidney Garber Jewelers, founded by Neidich’s father, which she now owns.

As planned, we discussed the jewelry-music-art convergence of a sort that made the Forté project sound plenty compelling (if not fully resolved). When talk turned to the Newtown massacre, I asked Neidich if I could meet with Koplewicz.

Brief history: The philanthropist and doctor got to know each other many years ago when one of Brooke’s children displayed signs of ADHD. At the time, Koplewicz was affiliated with New York University’s Child Study Center, of which he was a founder. Neidich soon became a major supporter and fund-raiser. Two or so decades and some political infighting later, they broke from NYU and founded the Child Mind Institute, as, its literature states, “the only independent nonprofit organization exclusively dedicated to transforming mental health care for children everywhere.” In its brief three years, CMI has become a go-to resource for families seeking treatment and professionals seeking advice and collaboration and treatment, as well as a center for intense research. A favorite Koplewicz refrain: “We’re about the science.”

My visit to CMI at 445 Park Avenue started with a tour. In the spacious waiting room, “child-friendly” upgrades from cloying to chic, without allowing style to trump function, even if the modernist mood reflects a connection or two: Thad Hayes, the pro bono designer; furniture provided at cost by Knoll; healthy vending machine lineup selected by “Today” show nutrition and health expert Joy Bauer; photos on loan from the family of the late Lillian Bassman, whose daughter-in-law Caroline Miller, a former editor in chief of New York Magazine and the current editorial director of CMI, produces the Institute’s Web site. In the upstairs hall space, numerous cityscapes by Chapin School third graders (the latest in a monthly rotation of school art) hang near a few loaners from Neidich.

Koplewicz is a direct, affable man whose mission and message are steeped in facts; more than 15 million American children have a psychiatric or learning disorder. Of those, fewer than half will receive treatment. Seventy-five percent of psychiatric illness presents before the age of 24; 50 percent, before the age of 14. At 20, Adam Lanza, the Newtown shooter, is considered by the psychiatric world as a pediatric case. Koplewicz stressed the importance of relying on facts rather than dangerous supposition; the word “Asperger’s” was invoked liberally during news coverage based, he said, on absolutely nothing. Not only has no definitive diagnosis of Adam Lanza been confirmed, he noted, “We haven’t found a treating doctor yet.”

Settled into his office, beige-ier and less pretty than the outer sanctum’s pristine whites with gray accents, I wanted to talk about Newtown and its possible ramifications for the pediatric mental health industry. Koplewicz understood the normalcy of my request, but stressed that catastrophe was a rare event; children with psychiatric disorders are far more likely to hurt themselves than others.

“It’s time for a national conversation,” he said.

The mental health care system, particularly as it pertains to children, he maintains, is sorely broken. The reasons are long: stigma; parental denial; inadequately trained pediatricians and teachers; the fact that when problems are identified, meaningful treatment is difficult, at times impossible, to come by.

Nor is the cause a philanthropic cakewalk. Due to research, a great deal is already known about how the “typical” brain works and is supposed to work, and about atypical activity that could result in aberrant behavior; many treatments are currently available to those with knowledge and access. But there’s a long way to go, which requires money. In terms of attracting corporate funds, “It’s not the Whitney,” said Neidich, a serious and practiced fund-raiser. “If I go to a corporation and say I need $25,000 for the Whitney, for that you’re going to get a private tour and everyone who works here is going to have a card.” She implied that unlike mental diseases associated with aging, such as Alzheimer’s, pediatric behavioral issues can make major-fund types uncomfortable.

Fueling stigma at all levels: ignorance. On one hand, as a culture, we think we should be able to control our behavior. On the other, because we so commonly invoke terms such as “anxiety” and “depression,” most people misunderstand their serious medical implications. “We advertise pharmaceutical drugs on television, so everyone thinks they have a social phobia,” Koplewicz said. “Paxil: ‘Haven’t you felt like a spotlight’s on you and you are terribly uncomfortable?’ Everyone has. [The difference] is distress and dysfunction. [Does it bother] me enough every day that I can’t do what I want to do?… It doesn’t mean you’re quirky, it doesn’t mean you’re ADD-ish, it doesn’t mean you’re a dizzy blonde.”

Koplewicz calls for “a change of paradigm” that acknowledges the medical reality of psychiatric maladies. “We have to start talking about these disorders with the same kind of respect and acceptance that we talk about diseases below the neck. There are biological markers that say this brain communicates to itself differently than a typical brain. It’s real — and treatable.” Once a diagnosis is made, treatment must be as flexible and in-depth as each patient requires, in extreme cases even up to daily sessions for a period of time.

Most important, mental health issues must emerge from the shadows of embarrassment, fear and discomfort. “We used to think people were crazy when they had seizures. Now, when we can see the electrical activity in the brain, we give them a pill that normalizes that and [the seizures] stop,” Koplewicz noted. “For God’s sake, [in the Eighties] we were petrified of AIDS. We wore gloves. If a kid bled in school — treat him like he has AIDS. After a while people said, ‘This is absurd; we can’t do this.’ Because we got more knowledge, we learned how you caught the virus, we did research.”

En route to eradicating the stigma, he noted the power of positive role models, of success stories: “If there were ever a time to say, ‘I’m Bill Gates and I have signs of Asperger’s and I’m the wealthiest man in the world,’ or, ‘I’m Orlando Bloom and I have signs of dyslexia and I struggled through school and I’m still good-looking and I’m an actor,’ that time is now.”

The world, thank God, is not full of Adam Lanzas. Indeed, as Koplewicz pointed out, mentally ill children, adolescents and young adults are far more likely to harm themselves than others. Few do so out of the blue. Allowing amply for the various quotidian manifestations of anxiety, insecurity and quirkiness that make many of us who we are, some people — including many young people — exhibit behavior that is just off. Koplewicz noted that obvious markers of potential violence — both suicides and violence against others — often go unidentified, or at least undiscussed, until after an episode. This happens within families, with parents who may be in denial and desperate to protect their children, and in larger cultural groups, from schools on up, whose members may themselves fear being labeled unkind or intolerant.

Such political correctness stifles frank conversation and must be tossed. Solutions must come on levels both macro — funding for ongoing intense research — and micro — teachers must feel empowered to bring what they consider distressing behavior to the attention of parents and guidance counselors.

“This is a national tragedy. It was a national tragedy before the shootings,” Koplewicz said. “If kids aren’t graduating from high school, if kids are killing themselves, if kids are taking substances to self-medicate, it’s a tragedy. AIDS — we were scared; we were frozen. But then we rose to the occasion.

“If we could do that for AIDS,” the doctor questioned, “why not in our approach to mental health? “How many more teenagers have to kill themselves? Let’s start the conversation.”

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