Dr. Kurland Narrative
When I started out in the 70’s, I practiced child psychiatry in West Hartford. The high school was in the center of town then. The kids easily wandered into the shops and cafes of the town. Many looked bedraggled, in the clothes of the time. Their hair was long, dressed out with bands or left untended, to hang down or spread as it pleased. They gathered on the green. In two or three years, the town’s elders would move the whole scene, kids and all, to the outskirts, their wandering confined to the new featureless school-building, and a dress code imposed.
For now, they remained a part of the town, a part of the community. My office was in the center as well. Some were my patients. Others showed up in my waiting room, were introduced, hung out. We talked. They valued their thoughts and feelings, laughed a lot. They had convictions, often intense, sometimes political. They had problems, which they shared. They liked to move about. A few biked or hitched on the weekends to a grandparent in Gloucester or the Connecticut shore, whom they felt akin to. One came alone to his weekly appointment all the way from Winsted.
They needed me to be “Dr. K” (“Special K” on friendly days) as much as they challenged my more formal or professional ways. I opposed their substance use and “poor boundaries”, but encouraged their convictions, their intensity, their communality. I hadn’t “taken this course” in my residency; I made it up as I went along. They saw the value of much of my psychiatric stuff, adopted some of it among themselves, were sometimes outspoken in opposition. Beyond all this was the sweetness, vulnerability, need, and time-honored consciousness of the adolescents they were. And I carried on my work: the evaluations, the therapy, the responsibility. I read my journals, attended my conferences, kept learning and developing. I kept them safe, improved their school performance, helped them gain insight and helped them make progress at home. This era would soon give way to the more sober, “corporate” kids of the 80’s and 90’s. My practice would look more traditional. I did more work in agencies and programs, became medical director of this or that, did my research, went back to Harvard (the School of Public Health) for a few years. But I never stopped working with individual children and adolescents and their families. The basic work didn’t change though I got a lot better at it.
This June, I moved my work up to Cambridge, primarily to my private practice. The times have changed but there’s something everlasting about children and adolescents (and their parents, as well). That’s where I belong; that’s what I do.
I bring to each child a range of experience in multiple and varied sites. I’ve worked with children in private practice and in public agencies. I’ve worked with private school students (psychiatric consultant to Loomis-Chaffee School for 20 years) and with severely disturbed children in placements. I continue to be the child psychiatrist for 4 crisis programs in Southern. My primary work at this time is my private practice in fall River.
I am systems-oriented. I work with family as well as the child. I work with your therapist, your school, anyone who’ll help us. I’m outcomes-oriented (I get results). Progress is more achievable than most people assume. It’s in the nature of childhood that children advance, develop. To stay in place is to lose ground.
I’m experienced, skilled, well-trained (Harvard, Yale Child Study Center).
Children need much love. Sometimes they also need the help of a very good child psychiatrist. My effort doesn’t stop at rendering services. I’m your psychiatrist. I assume responsibility. Medication is often unnecessary. When it is needed, it must be effective and well-monitored. It needs to be individualized to the specific child. This is based in understanding and should not be left to some formula. My training includes child development and family systems and an additional degree from the Harvard School of Public Healthy. I have been the medical director of three agencies for children. I don’t take insurance but I’m attentive to your costs. Please ask me about fees.
Work and Findings
David Shaffer, director of child psychiatry at Columbia, an excellent researcher, told me “The more research I do, the less psychiatry I know”. True research is a demanding taskmaster. The genuine stuff requires rigorous fidelity to the highly focused testing of a narrowly defined hypothesis. Great effort is expended on some very limited question while yes most psychiatry lies neglected.
I’ve completed three of these projects in my career, published and presented them. Most of my work with data and data analysis, in contrast, has taken the form of surveys and studies of broader issues more relevant to my clinical work with children and families. One, for example, was a study of which children get placed outside the home and which do not. Studies yield suggested answers to meaningful questions but lack enough focus and rigor to prove anything. The studies I’ve done have been important to me and my work with children. They’ve been meaningful to some. To others, they’ve not been rigorous enough to prove anything.
What are some of the things I’ve found?
- Children are admitted to residential placements not because of mental illness alone or antisocial behavior alone or parental failure alone but because two or three of these factors are present together.
- Residentially placed children are assuredly more disturbed than children see in an outpatient clinic.
- The SF36 scale, which is widely used as a measure of the severity of emotional/behavioral conditions, is a good measure of depression, which manifests as distress, but poorly picks up alcoholism, which manifests as a disorder of function and behavior.
- The command hallucinations, which appear in a number of severely traumatized children, respond well to antipsychotic medications.
- The parents of children who are admitted to an emergency service are markedly more disturbed than average parents.
The psychiatrist who engages in research and investigative studies disciplines himself to know what it is he really knows, what he doesn’t know, and to know the difference. After all, the child psychiatrist has few tests, laboratory or otherwise, on which to base his judgments and decisions. The child and parents then rely on his judgment, perceptiveness, mind. He must develop and improve his abilities to understand, analyze, and decide as he evaluates and treats. For this, the psychiatrist who’s done research has a decided advantage. A record of research and studies should positively recommend a psychiatrist.
I have been the medical director of a hospital, an emergency program and three agencies in the course of my career. Earlier on, being a medical director was a highly psychiatric position. It involved launching and implementing psychiatric programs, tending to the psychiatric functioning of clinical staff- psychiatrists, psychologists, social worker therapists, case-managers et al. representing psychiatric concerns and proposals in meetings and conferences. At this time, in response to the economy, to rapidly increasing influences of managed care, and to changes within the state’s Departments of Mental Health, Child and Family, and Developmental Disabilities, the position of medical director has become largely administrative and little to do with psychiatric matters. My interests and my abilities are not administrative. I made the decision in June to return to private practice. I’d worked with many children as individuals while medical directing- Entering private practice was not as much of a sea change as it sounds.
Medical directing until very recently was exciting and dramatic. Blue Hills Hospital was Connecticut’s flagship substance disorder institution. The first great program for alcohol studies began at Rutgers (N.J.) and moved to Connecticut. I took the position at Blue Hills as an alcoholic hospital only to have it immediately convert to alcohol and drugs. 5 recovering heroin addicts were brought up from the federal drug institution (Lexington) to form the peer counseling tier of a two-tier system. Psychiatry was the other tier. This was a terrific learning experience. Our results were good until the recovering addicts, one by one, relapsed into drug use. I remain secure in my skills with substance disorder, particularly as it occurs in teenagers.
Connecticut’s emergency child psychiatric program was new when I became director in 1970. Our beds were located in a pediatric ward. I’ve continued to do emergency work with children since then, at St.Vincent’s, and currently I am the psychiatrist for 4 mobile crisis programs for children and adolescents, under the auspices of the Department of Mental Health. I worked as psychiatric consultant to Loomis-Chaffee School for 20 years, in conjunction with the chief of counseling. I left the school to come up to the Harvard School of Public Health in 1992.
My work at St.Vincent’s occurred at a time of relative affluence. There were 11 different programs at different times in the 12 years I was there. We started and implemented 6 of these, with good results. Community Counseling (CCBC) was in poor shape when I started as medical director in 2010. Most of the psychiatric staff had resigned in discontent and relationship with the state Department of Mental Health was problematic. The work then was venturesome and the demands were psychiatric in nature. As matters improved, the work became administrative in nature. In June of this year, I moved my work to Cambridge and my current private practice, keeping only the crisis centers from my time at CCBC.