Wow. Bravo, Dr. Kaliebe! This a very thoughtful piece, and incredibly brave of you to write. (I wish that weren’t the case - it shouldn’t be.)
As someone who trained in child psychology 2002-2010 and then was out of practice for a decade, it’s been simply stunning (whiplash, really!), to see the changes in our professions on this particular issue. Diagnoses, formulations, and treatment approaches have always changed over time, of course (from Freud to behaviorism being the prototypical example!), but this has been a particularly rapid swing of the pendulum. I do hope we’ve reached peak and are beginning to swing back towards the moderate middle (where most all “right answers” regarding complex human beings reside, IMHO!)
Thank you so much--we need more voices like yours. Looking back over my 37 year career as a psychotherapist I make the following observation: In the late 1980s and early 1990s, multiple personality disorder (MPD) was all the rage, and psychiatric hospitals opened special units to treat dissociative disorders. So many (mostly women) with a history of trauma, it seemed, coped through dissociating. In the later 1990s eating disorders were all the rage. Disordered eating was seen primarily in adolescent girls and younger women. In the early 2000s cutting was in. Adolescent girls (mostly) engaged in self mutilation as a way of expressing distress and trauma, and it was rampant (I had to screen carefully for "cutters" because I could only manage so many on my caseload at one time). Now, I can't remember the last time I had an adolescent cutter. In the late 2000s, rapid onset gender dysphoria was "in". Suddenly, so many young people (mostly girls) are gender dysphoric.
Years ago I read Ethan Watters book, Crazy Like Us, which explores cultural expression of distress and the ways in which we identify and label our experiences. From my vantage point, what I see in these historic "trends" of diagnoses are socially accepted expressions of distress....an implicitly sanctioned pathway of expression....for people suffering from all varieties of Big T and Little T traumas and emotional/social distress. By 2030 I suspect our teen/young adult caseloads will be populated with a new diagnosis du jour. I am not saying that dissociation, eating disorders, self mutilation or gender dysphoria are not real or "legitimate", only that there seems to be a cyclical (dare I say "fad") component to these trends that should cause us to stop and reflect.
Very much appreciated reading this. I'm not a medical scientist and so im limited in how to determine one way or another, but it would be far more encouraging to see those who are pro-affirmative care respond in good faith to any of these criticisms. At the end it just looks like they don't have anything to defend themselves with.
Thank you for writing this!
Wow. Bravo, Dr. Kaliebe! This a very thoughtful piece, and incredibly brave of you to write. (I wish that weren’t the case - it shouldn’t be.)
As someone who trained in child psychology 2002-2010 and then was out of practice for a decade, it’s been simply stunning (whiplash, really!), to see the changes in our professions on this particular issue. Diagnoses, formulations, and treatment approaches have always changed over time, of course (from Freud to behaviorism being the prototypical example!), but this has been a particularly rapid swing of the pendulum. I do hope we’ve reached peak and are beginning to swing back towards the moderate middle (where most all “right answers” regarding complex human beings reside, IMHO!)
Thanks for adding your thoughtful analysis.
Thank you so much--we need more voices like yours. Looking back over my 37 year career as a psychotherapist I make the following observation: In the late 1980s and early 1990s, multiple personality disorder (MPD) was all the rage, and psychiatric hospitals opened special units to treat dissociative disorders. So many (mostly women) with a history of trauma, it seemed, coped through dissociating. In the later 1990s eating disorders were all the rage. Disordered eating was seen primarily in adolescent girls and younger women. In the early 2000s cutting was in. Adolescent girls (mostly) engaged in self mutilation as a way of expressing distress and trauma, and it was rampant (I had to screen carefully for "cutters" because I could only manage so many on my caseload at one time). Now, I can't remember the last time I had an adolescent cutter. In the late 2000s, rapid onset gender dysphoria was "in". Suddenly, so many young people (mostly girls) are gender dysphoric.
Years ago I read Ethan Watters book, Crazy Like Us, which explores cultural expression of distress and the ways in which we identify and label our experiences. From my vantage point, what I see in these historic "trends" of diagnoses are socially accepted expressions of distress....an implicitly sanctioned pathway of expression....for people suffering from all varieties of Big T and Little T traumas and emotional/social distress. By 2030 I suspect our teen/young adult caseloads will be populated with a new diagnosis du jour. I am not saying that dissociation, eating disorders, self mutilation or gender dysphoria are not real or "legitimate", only that there seems to be a cyclical (dare I say "fad") component to these trends that should cause us to stop and reflect.
Very much appreciated reading this. I'm not a medical scientist and so im limited in how to determine one way or another, but it would be far more encouraging to see those who are pro-affirmative care respond in good faith to any of these criticisms. At the end it just looks like they don't have anything to defend themselves with.
How could I contact Dr. Kaliebe?, thank you
kkaliebe@usf.edu