How well do you do with taking medication? I don’t mean are you able to swallow a pill. I mean are you willing to take medication when it could help you feel better.
I know some people who will walk around with a headache for days rather than take an aspirin or aspirin substitute. I know other people who don’t think twice about taking medicine that they think might help them feel better.
I also know people who use alcohol as a form of medication because they see that as socially acceptable whereas taking medication would leave them feeling stigmatized.
Stigma is a serious concern for many children as well. Some children do not want to take medication because they believe it would mean there’s something wrong with them. To avoid this entire issue, parents sometimes tell young children that the pill they offer them every morning is a vitamin. If your child’s pediatrician recommends this as an appropriate way to work with your child, follow his or her guidance. Just be careful to tell your child the truth before he finds out on his own.
What is the truth? What is wrong with your child that you don’t want to tell him? You don’t want to tell your child that he is hyperactive? Or that he is attention -deficit or that he is bipolar or oppositional/defiant? I don’t want you to say any of these things to him, either. He is none of the above. He may, chas v’shalom, suffer from and struggle with any of the above disorders and they can make life difficult for him, but they do not define him. He may struggle with bipolar disorder; he is not bipolar. He may suffer from oppositional/defiant disorder; he is not ODD. Yes, I know that many people use those terms in that way, and most adults understand that being described as bipolar doesn’t mean that’s all that they are. Children don’t yet know who they are, and it is important to help them separate their challenges from their basic sense of self.
Think about the words borei n’fashos rabbos v’chesronan. Every one of us has chesronos, every one of us is incomplete. Some chesronos are more painful and stigmatizing than others. Teaching your child to be discreet is important. Speaking with your child honestly about his challenges is vital.
Borei n’fashos rabbos v’chesronan. The words also mean: HaShem has provided for the chesronos, every one of us can be complete enough to serve HaShem. Sometimes, medication helps with overcoming challenges or coping with them more effectively. First, you need to understand each chesaron.
The purpose of diagnosing someone is not to label them. The purpose of diagnosis is to understand the nature of a challenge in order to address it as directly as possible. For example, depressed mood may be effectively addressed by one medication while labile, or fluctuating, mood may be worsened by that same medication. The way that we hope a medication will help someone is called the main effect. For example, the main effect of an anti-depressant is to reduce the feelings and the thoughts of depression.
Medications also have side effects. Some side effects are merely unpleasant and should be tolerated, while some are dangerous and should be reported to a physician or emergency care provider immediately.
You should have a clear understanding of the desired main effect, and the side effects, of any medication that is prescribed for your child.
I encourage parents to discuss both main effects and side effects with children who are taking medication. I want a child to know how a medication is supposed to help him, and to be alert to how it might be affecting him in other ways he should report to a parent.
In addition, I want hear from a child what it means to him to be taking medication.
Dovid R. sounded embarrassed. His voice was halting and soft. He asked if I could tell him how to get his son to take the medication that he was refusing.
Me: You said, Dovid, that you haven’t been able to get your son Nissie to take his medication. What’s your impression of what it is that Nissie doesn’t like about his medication?
Dovid: I’ve explained to him why he needs to take his medication and he’s still refusing.
Me: And when you asked Nissie what it is that he doesn’t like about the medication what did he say to you?
Dovid: Actually, my wife tried that and it didn’t help at all.
Me: What did your wife say to him?
Dovid: She asked him why he refuses to take it, and he yelled back at her, “you can’t make me!”
Me: So you’ve told Nissie that he has to take his medication, your wife asked him why he won’t take his medication, and he’s still not taking his medication?
Dovid: Exactly. So what else can we do?
Me: Dovid, what do you think will happen when you say, “Nissie, what is it about your medication that you don’t like?”
Dovid: I’m not really sure, but I can tell you that this is the kind of stuff my wife does not want to hear. She told me she did not want to meet with you because Nissie’s medication is not optional, and she was afraid you’d make it sound like it is.
Me: Dovid, if the prescribing physician considers the medication to be necessary for Nissie, I would never mean to imply that it’s optional. My concern is that when your wife asks Nissie a “why” question, Nissie becomes defensive. You’re explaining how important it is that he take his medication, but he never gets to express what it is that’s hard for him about it.
Dovid: But I think that’s my wife’s point. It doesn’t matter that it’s hard for him; he needs to take the medication anyway! And you said you also don’t think it’s optional, so what’s the point of asking Nissie what’s hard about it for him?
Me: The point is that there may be something about taking the medication that you could make less unpleasant for Nissie, but we won’t know what that might be until we ask Nissie for some more information about what is hard for him. It’s more likely that Nissie will answer you when you ask him an open-ended question rather than putting him on the defensive by asking him “why” or trying to guess at what’s hard for him with a series of questions to which he has to answer yes or no. So, what do you think is going to happen when you sit down with Nissie in a private, quiet place and gently say to him, “Nissie, what is it about your medication that you don’t like?”
Dovid: I’m not really sure, but you know what; I’d like to give it a try.
Our conversation resumed the followed week.
Dovid: This is my wife Shany. She decided to join us after she heard the outcome of my conversation with Nissie about his medication. The first thing I realized about what you had said to me was that I’ve never had a “private, quiet” conversation with Nissie about his medication before. Just sitting down alone with him in the guestroom, we both seemed so much more relaxed.
Then, I did all the things you suggested. I made eye contact with him, I told him that I think it’s really important that he take his medication, and I asked him what’s hard about it for him. He said he hates it when his sister Devorah points out his pill on the breakfast table and says, “Well, Nissie, I guess you’ll have your head on straight for a few hours.” Then, like you had said, rather than offering a solution, I asked Nissie what he would suggest. He said he wanted to keep a bottle of water in his room and take the medication there before coming to breakfast. And he’s taken it every day since we spoke about it.
Rabbi Yitzchak Shmuel Ackerman is a Licensed Mental Health Counselor with specialties in marriage, relationships, and parenting. He works with parents and educators, and conducts parenting seminars for shuls and organizations. He can be reached at 718-344-6575.