Sunday, September 28, 2014

Water First

from The Heart of the Matter blog 
My garden was out of control this year. I blame the compost bin, which split down the sides this year and forced us to chuck a full year's worth of loamy chunks into our raised beds before we planted, but my son Chris takes credit for emptying his pond filter into the fallow beds, disgorging all manner of scum he's convinced is the source of all bounty.

Or maybe we have tiny gardening gnomes who weeded at night. None of us did the weeding.

Regardless, the few plants we inserted did well. Better than well. Not all of them, actually. A couple of pepper plants were routed by the insane growth rate of one pumpkin and two watermelon plants, plus a couple of eggplant and cucumber plants. And a billion tomatoes we did not plant. Have a look.

watermelon and cukes

rogue tomatoes (and an oak sapling)
 We watered, the sun shone, and the plants grew because whatever was in the dirt was apparently a veritable feast of nutrients. The vines stretched under the picnic tables, the tomatoes leaned over the fence. You couldn't gently step between the cucumbers to pick the three kinds of tomatoes (cherry,
 grape and roma) without squishing a stem. We all got into the habit of snacking on overflowing bowls of tomatoes in the evening while dinner was in motion but not quite taking form. And if we could find them, we picked the cucumbers when they were smaller and sweeter and snacked on them that way too. Making room for more cucumbers to come.

The pumpkins and watermelons were a whole other matter. We've tried to grow them before, in the ground above a rock wall in our backyard, but the soil wasn't as rich or deep and they never took off. Not until this year did we learn that for all those buds and flowers and leaves, only a few pumpkins and watermelons grow, and they need to be nurtured and guarded and protected. Lifted off the ground with cardboard so they wouldn't start to rot. Marveled at every day, with all of us peeking in on them and saying "wow, that's amazing." When they were picked, the pumpkins were different shapes and sizes, and one took about a month longer than the others to mature.

Kind of like kids.

This week I thought of little else beyond my friend Lesley Siegel, who died on Wednesday of cancer. She was a marvel of a woman, an inspiration, a kick-ass boss and a crusader. She gave me many of my sharpest, most accurate criticisms, and the one compliment about my work as a psychologist that I hold nearest to my heart.  She was the Medical Director where we worked at Riverview Hospital, and then for the whole of DCF in our state. She was a crusader for kids in state care, who were the majority of who we treated as a state-funded psychiatric hospital, and  moved the state mental health system as a whole toward effective, trauma-informed psychiatric care in less restrictive settings and with minimal use of meds.

When she was blocked or frustrated in her first two missions, she focused on the third, because that was within her control. She made every doctor who wanted to prescribe psychotropic meds to a child in foster care convince her and her small battalion of nurses that the plan was sound and the meds were needed. Often they couldn't, and this is why:

This is a tomato plant that was badly supported. I have a piece of PVC and some yarn rigged to hold up the plant (because I wasn't prepared for tomatoes, and couldn't keep up with their growth), but in the process I tied the yarn too tight and cut off the supply of water. The leaves withered, and the plant looked sick. Chemicals added to the soil would not have helped, It needed better, looser, kinder supports.

If a plant is dry, water first.

There's an opinion piece by Michael Price about being moved from home to home and treated more casually than the furniture that Lesley commented on, and she's right. I have one son who was in foster care and very much needs his neuroleptics. I have another who weaned himself off when he turned twenty and looked and felt better immediately. I felt like a fool for keeping him on so long, and his psychiatrist shook her head and said she should have considered he had a personality disorder earlier, and tried him off meds and with a different kind of therapy.

That treatment will at some point probably be DBT,  which is intensive and complex but often effective for kids who have experienced trauma, and another treatment Lesley championed. Under her guidance, we were trained by the treatment developers, and rather than asking why a child in distress would need the treatment, we reversed course and asked "why not?" If trauma was the cause of a child's distress, then DBT and related treatments should come before meds, or instead.

My poor plant here was splashed with pond goo, which Chris thought would be good for them like it was for the soil, or maybe he was just careless, but the plants were hurt and never recovered their photosynthesis balance. Again, adding chemicals to the soil wouldn't help, they needed to be washed off  as soon as we noticed signs of distress, and then given added supports so new, healthy leaves could grow. And they needed to be protected from humans randomly chucking pond goo their way.

Lesley wrote up her approach to giving medication approval, without the plant metaphors, for this national presentation. In her approach, she's helped a lot of kids. She also helped me, with her example. She seemed fearless, though I know this must not have always been true. She was funny and original, in the way she told me to match my shoes to my pocketbook once in a while, or to read this book tonight, or to think again when I came up with a too-pat answer. She was brilliant.

Because she always remembered that kids need love first. Then support and a healthy environment. After that, if they're struggling, then fine, get them some good mental health care. Even meds.

But never instead.

Love, Lisa


  1. Oh, sweetie, I'm so sorry for your loss. Heck, her passing is a loss for us all. How many people out there are medicated when they really don't have to be? Tis easier and more cost-effective to throw pills at folks. But she was also your friend and, for that, your life was blessed with the gift of her presence, especially her friendship. Your essay is a lovely tribute to her.

    1. Thank you Rhonda, and you are right. She was a gift to me, and to many.