After hearing from parents of psychotic children (here and here, for example) and learning the views of two leading experts (Professor Pélicier and Professor Duché), we offer some practical guidance on managing childhood psychosis.
Key Principles
- Do not let indifference paralyze you. At an age when every child responds to affection from those around him, the autistic child shows nothing in return. This often helps with diagnosis, but it carries a real risk of despair. When a caregiver receives no response to his attention and affection, he grows discouraged, gives up, and withdraws. From that moment, the child becomes trapped by the label of illness. What he actually needs is stimulation, affection, tenderness, and connection—far more than anyone imagines.
- Never lose heart. It can help to remember simply that he does not dare, or cannot, or will not. Perhaps he is very particular about the quality of the exchange!
- Never stop reaching out to him through action. Build bridges into his world constantly, and try to draw him out through every kind of stimulation—especially by talking to him a great deal. He has far more capacity to learn than he shows.
- Never speak in front of the psychotic child about the worries he causes you—about difficulties in relating to him, about affection, about how he seems indifferent or incomprehensible or frightening. (He is already so frightened!) Such words can drive him deeper into his distance, can raise a second barrier on top of the one he has already built as his only defense. But here is what happens: those around him build yet another wall in return.
- Treat him as a normal child as much as possible, regardless of appearances.
- Build up the psychotic child from his earliest years, giving him every opportunity to find some trust in himself. (Often an overwhelming fear of failure inhibits him so much that he refuses to try at all.)
- What parents find hardest is bringing themselves to ask for help: the suffering is so great that they believe no one could possibly bear a child so strange. But relief is vital. To be effective, you must sometimes step back and breathe. And certainly you must explain to friends the difficulties they will encounter, prepare them carefully, and help them welcome the child for at least a few hours now and then.
- Even if the autistic child acts strangely and seems lost in his own world, never forget that he understands far more than he shows—and registers it in ways almost beyond imagining. (You may see proof years later when he recalls an event that struck him deeply.) He may not grasp the words, but he reads the face, the expression, the tone of voice.
- Faced with his "oddities," do not let the autistic child feel—or risk letting him feel—that you have lost faith in what he can do: he would lose the small trust he has in himself.
- Remember that there are wonderful friends and that they become more willing to help if you trust them.
- Friends often know how to approach him more simply than specialists do—and this can be invaluable help for his possible integration later on.
And then, finally, always remember this: for those who know how to listen with the heart, our children know how to give, in their own way.
The Therapeutic Community
The setting of a therapeutic community should be welcoming and stimulating, with qualified staff.
The community should not exceed about twenty users, organized into small educational groups of no more than three or four children. Therapeutic interventions include medical and pharmaceutical treatment, psychotherapy, rehabilitation, psychology, and education.
Using appropriate psychotherapeutic methods, the child is guided to receive external stimuli and seek out messages. Integrative work in psychology and sensory perception follows, and educational groups develop their work. In this environment of varied, appropriate stimulation, the child is encouraged to respond with positive movement and behavior. When intervention is timely, recovery of language is also possible. Coordinating these interventions is the therapeutic community's main task. Through the staff, patients experience the environment in which they live.
The therapeutic community aims to reintegrate the patient into the world at the right time and in the right way.
Therapeutic communities should be distributed across the region so that families can easily stay in contact—and so that families themselves can receive ongoing support.