Pay It Forward
I had no way of knowing one afternoon last week, when I stepped onto the deck in my backyard, that my mood would soon be soaked in worry. Or that a New York Times article on children’s mental health would ignite such a change in my emotions.
This particular morning, I’d grabbed the paper without hesitation and settled myself into a recliner under the trees. Nothing unusual there: as a “Summer Girl” who suffers from depression caused by “Seasonal Affective Disorder,” June is when I begin to spend as many hours outside as possible, moving indoors only when autumn chill descends. I sipped on an iced tea and relaxed into some of my favorite childhood memories, those which the warm weather always triggered.
Once in a while, a fragrance or a physical sensation sparked a flashback that reigned with tenderness. The texture of the slice of fresh rye bread that I’d carried out to my chair with my drink, for example, evoked a mental picture of my beloved Uncle Tony, whose habit it was to arrive at our door on sweltering Saturday mornings with a crusty loaf of deliciousness tucked under his arm.
The tang of spearmint in my tea, which I’d plucked earlier from my garden, evoked similar memories and I thought of Proust’s madeleine in In Remembrance of Things Past: one small sip from my glass and I’d been flooded with the image of my father’s immigrant mother; when we were kids, we’d referred to her, with affection, as “Fat Grandma.” In my mind, this stout relative, with a babushka of many colors tied under her chin, moved slowly with arthritic pain toward her garden. She was aiming for the riot of these herbs. I’d watched her bend to pull a leaf from its stalk, and with a shy smile, offer it to me.
The stretch between Memorial Day and early September had sustained me throughout the years: long days of light; the escape that so much time outdoors provided from the emotional tumult that dominated our cramped house; and most importantly, my increased contact with our extended family. Together, these formed a balm that soothed the ache in my chest. I did not know then, or even later, that the pervasive and chronic anxiety I experienced during the long Chicago winters had a name: SAD. This seasonal disorder came to be recognized as a major form of depressive illness, and was a respectable entry in the Diagnostic and Statistical Manual of Mental Disorders, the bible psychiatrists used to pin down a new patient’s ailment.
Eventually, the newspaper snagged my attention again—but not in a positive manner. A line in a wellness article stated that “the number of children who need urgent mental health care has been on the rise for years, and spiked during the pandemic.” After reading the entire piece, the air around me closed in.
The increasing number of children who appeared in crisis while under the age of thirteen alarmed me the most. So, too, the statistics regarding emergency room mental health visits among girls younger than eighteen, which problem appeared to be especially dire. Nevertheless, as I read further, I wondered about our boys in that same age group, as well. Knowing that boys often repress their emotions, might they not be as likely to struggle the ways their female counterparts did—but simply be less likely to express their pain?
None of this was surprising to me—these alarming official statistics only corroborated what I had already observed myself when I was still seeing patients. Before I had retired from my clinical practice three years before, both my office colleague and I had witnessed a decade-long uptick in the numbers of severely anxious and depressed children and the teens who had been referred to us.
Furthermore, as passionate as my fellow psychologist and I had been about our work in this area, the difficulty we had had in coordinating treatment with other health care providers in order to access help for these kids had been staggering. Too often, the skilled child and adolescent psychiatrists in the field had full practices closed to any sort of patient: despite the size of a large city like Chicago, there weren’t enough psychopharmacologists available or affordable enough to consult even about medications.
Coordination with intensive outpatient programs were similarly difficult: most couldn’t accommodate children; many did not provide quality care. And among the worst of the problems we encountered, insurance company roadblocks always ranked the highest. The “rabbit-hole” associated with pre-authorizations often seemed to be designed specifically to dissuade families who were already beleaguered by their child’s condition; how difficult, then, for them to make an effort to challenge their insurance company about coverage. As a parent myself, I remembered how terrifying it had been when, many years ago, my own child had struggled emotionally. How had I managed that—caring for a daughter teetering on the abyss of despair while fighting to get her good professional help simultaneously. My medical connections had saved me in some ways. How lucky I had been.
I put down the newspaper, and the article I’d been reading. It had filled me with anxiety, and I felt shaken. Indeed, hadn’t the isolation COVID had inflicted on all of us, and introduced into our psychiatric community, exacerbated a crisis among vulnerable children? It was one that had been fomenting for years.
Nevertheless, I was determined not to acquiesce to feelings of depression on the subject. After all, this was summer. My favorite and most hopeful time of year. Surely there would eventually be better help for these kids, even if it took a lot of help from the professionals who cared enough to take time away from their busy practices to contribute. Perhaps someday I might be part of such an effort as a volunteer. This idea was a comfort to me as I pushed myself up out of my chair and headed back into the kitchen for a refill of my iced tea.
So, as June slips into July, my memories of the people who made a difference in my life continue to shine like fireflies on a hot muggy night, like Uncle Tony and Fat Grandma. They had been like lights in the dark. I am renewing my vow to be of service to affected children in any way I can. Like many of us who have reached “elder” status in our families, I want to give back. I’m still uncertain about exactly what that will look like, but in my mind, I am hearing the voice of the young girl I once was. Pay it forward, she says. Pay it forward.
Best,
