An Interview with a Child Psychiatrist

By Eman Is’haq Al Bader

For my project, I decided to have an interview with someone who I'm really proud of …Someone who worked very hard in the beginning of her career. Her intelligence, insistence and her self confidence also helped her and were the main impulses behind letting her achieve a lot in a few years, and these impulses made success obtainable. I'm talking about my cousin, "Dr. EMAN AHMED HAJI", a chief resident in the Child and Adolescent Unit of the Psychiatric Hospital. She is a great mother of a brilliant little boy and a cute little girl. She is a busy young woman. She works almost all day and she sometimes has to be in the hospital late at night. But, I managed to steal some of her precious time to make this interview. So, let's start diving with Dr. Eman into the psychiatric world.

Interviewer: Everyone knows that being a doctor or let's say a good doctor requires a lot of effort and surely you have been through many levels and faced a lot of challenges before becoming a chief resident. Tell us about the obstacles you've faced and the levels a doctor goes through before becoming a chief resident or a consultant.

Well, first of all I have to draw your attention to the fact that everything I've achieved is because of the blessing of God and the infinite support of my parents and my family. At the beginning of my journey, there were times when I felt that I couldn’t handle more pressure and that I was falling apart specially because I was studying abroad…but then I gathered my self up and stood on my feet again. I can’t describe the hard work that I did, and the things I gave up and put off just to reach the unreachable. My perseverance helped me a lot, but honestly I thought my life was miserable till the end of the second year when I was the first among my colleagues. I was over the moon. Suddenly I forgot all I’d been through. Happiness filled my life. So, I kept up the hard work and I did the best I could, although the system of my university was incredibly difficult and it was very hard to maintain the success. Five more years passed and I graduated the second in the university. About the levels a doctor goes through, they are as follows: a junior, a senior, a chief, a chief resident, a specialist, and a consulant.

Why a psychiatrist? And why exactly child and adolescent psychiatry?

Well, I always knew that something inside me can analyze people, and when I got to know about this science I felt like it was related to my personality. But when I chose this branch of psychiatry, which is child and adolescent, it was because I thought the mental health of children is essential for normal cognitive and social development and it absolutely affects their performance and function. On the other hand, I believe that preventive medicine is much more important than the treatment after the occurrence of diseases. Dealing with minor psychological problems during childhood and adolescence properly may prevent many mental and psychological disorders later on.

What are the common cases which are referred to you?

The majority of cases are referred from schools, mostly due to learning difficulties and behavioral problems (believe me or not but we have patients who are less than sixteen years old and are dealing in drugs and heroin).

Briefly, how do you manage those cases?

We have specific tests, measures, and scales to discover and diagnose specific learning difficulties. And we also have specific programs to modify unwanted behavior depending on positive and negative reinforcement.

There are times when we all say, “ I’M DEPRESSED.” Does this term fit the scientific definition of depression from your point of view ?

Well, the patient’s feelings and thoughts help us in diagnosing depression but we have to follow the International Diagnostic Criteria for diagnosing mental diseases which depends on a number of symptoms, signs, duration and the extent of functional deterioration.

I heard someone saying that depression can affect children. Is that right?

Yes, that’s right, actually even an infant of one month can be depressed, but the presentations are different in different ages and genders. It is obvious that women are more affected by depression than men, unfortunately. I must also say that there are specific times ages and life circumstances when some people can feel nothing but depressed. Like a 45 year old single women (assuming she doesn’t want to be single), or a 35 year old unemployed man.

What are the main factors that lead to psychiatric problems in children?

Well, there are many factors. It could be environmental factors related to events, stresses, loss of a close person, or it could be due to a genetic predisposing factor.

Nowadays, the issue of child abuse is well known to almost everybody. There is no more fear of talking about this issue, which becomes the concern of the media. What is your role as a psychiatrist in dealing with this problem?

First, there are things which I have to clarify before explaining my role. Child abuse is mistreatment of a minor under the age of eighteen. The definition of child abuse in the Child Abuse Prevention and Treatment Act (Public Law 100-294) defines child abuse and neglect as:
the physical or mental injury, sexual abuse or exploitation, negligent treatment, or maltreatment of a child (a person under the age of 18, unless the child protection law of the State in which the child resides specifies a younger age for cases not involving sexual abuse) by a person (including any employee of a residential facility or any staff person providing out-of-home care) who is responsible for the child's welfare under circumstances which indicate that the child's health or welfare is harmed or threatened thereby.

No matter what state or country you live in, there are strong laws against child abuse, harsh punishments against offenders, and swift reactions to protect victims of child abuse. So as we can see and understand there are four subtypes of child abuse: Sexual abuse, physical abuse, emotional abuse, child neglect. In Bahrain, a Child Protection Committee was formed by members of the Ministry of Health, Ministry of Interior and others. All cases that present to the accident and emergency department or a clinic or the police where child abuse is suspected are referred to the committee and then referred to the psychiatric unit for further assessment and management.

How are these cases presented to you, or to be more specific, what do they suffer from?

Most of the children are presented with anxiety symptoms after being abused and those symptoms may affect their academic performance or the way they behave with others, e.g. impulsivity and aggressiveness and reduced concentration are common. And usually they need long sessions of treatment, including individual sessions and even chemical treatment.

Finally, I think that now it’s the time for us to educate and make society aware about different mental disorders in childhood and how to deal with and treat those problems. We have to admit that not only we get ill physically but mentally as well and it needs to be treated, so we have to stop looking at psychiatric illnesses and treatments as a stigma. And try our best to cooperate to stop child abuse.