I got a letter from a child psychiatrist scolding me for not recommending a psychiatric evaluation for a 10-year-old boy who used a school writing assignment —a poem—to express sadness at the state of the world. He wrote he was afraid of death, afraid of life, had scary dreams sometimes, wanted to die, and wonders how life will turn out. The rest of the poem was about things he loved and looked forward to, like eating macaroni and cheese and reading.
When his mother asked him about the poem, he broke down crying, saying that life is made up of good and bad and the bad dominates. In general, his mom said, he's bright, articulate, and "cautiously happy."
What we have here is a sensitive kid who's becoming aware that life is not a plate of macaroni and cheese. He's losing his innocence, which is too bad, and, lacking emotional maturity, feels at times overwhelmed by things. He uses a poetry assignment to express what he hasn't felt free to express otherwise. I advised the child's mother to not overreact. It was obvious from her letter that this gloominess was not a regular feature of her son's personality.
The psychiatrist felt I was being irresponsible and thinks the mother should take the child to a psychiatrist for evaluation.
I think it might completely unnerve this child for his mom to take him to talk to a professional because he seized upon the license of a poetry assignment to purge himself of certain feelings. It could possibly cause the child to resolve to never talk to his parents about anything other than macaroni and cheese again. Keep in mind, too, that the overall tone of his poem was upbeat. All in all, this child had the equivalent of a runny nose, not symptoms of a life-threatening illness.
What alarmed the mother was that the child was usually a "cautiously happy" kid, not given to pathos. What about that word "cautiously"? I took that to mean that while this little guy isn't exactly happy-go-lucky, he's generally in good spirits - happy enough, in other words.
Speaking of caution, common sense should tell us that prudence should temper any consideration concerning psychiatric or psychological services for a child. In that regard, I generally recommend bouncing the idea off someone who knows the child's history—the child's primary physician, for example—an objective third party who can help the parents put their concerns into proper perspective. Taken out of context, molehills can sometimes look an awful lot like mountains.
