Life is With Others: Selected Writings on Child Psychiatry

NEW HAVEN — Dr. Andres Martin, associate professor of child psychiatry at Yale University School of Medicine and medical director of the Children’s Psychiatric Inpatient Service at Yale-New Haven Hospital, credits his mentor, the late Dr. Donald Cohen, with his own decision to become a child psychiatrist.

Now Dr. Martin — along with his colleague, Dr. Robert A. King – have edited “Life is With Others: Selected Writings on Child Psychiatry” by Donald J. Cohen. The book is a sampling of important papers by Cohen, a pioneer in the fields of child psychiatry, autism, and Tourette’s syndrome.

Dr. Martin grew up in Mexico City in a Conservative Jewish family. He completed his medical training in Mexico City, a year of training in internal medicine at Jackson Memorial Hospital in Miami and then a general psychiatry residency at the Massachusetts Mental Health Center in Boston.

Dr. Martin is an associate professor of child psychiatry and psychiatry at Yale, associate training director of the child and adolescent psychiatry fellowship program, and the director of medical studies for the Yale Child Study Center

He lives in the Westville section of New Haven with his wife, Rebecca, and their four young children. He recently spoke to the Ledger about his mentor, Dr. Cohen, and the field of child psychiatry.

Q: You and your colleague Robert A. King have edited a book on Dr. Donald Cohen’s selected writings. Who was Donald Cohen and what were some of his contributions to the field of child psychiatry?

A: Donald was the late director of the Yale Child Study Center. He was a larger than life figure in child psychiatry – not only in New Haven, but around the world. He was one of the towering figures in child psychiatry in the 20th century, and he sadly died at the relatively young age of 61. Robert King and I have been trying to capture Donald’s essence through some of his writings, and to make his teachings and approach known to a new generation of clinicians and scholars.

Donald was a peerless mentor. He had a strong commitment to Israel and was very comfortable with his Jewish self: Judaism marinated all of his life. He dealt with patients in the best Maimonidean tradition of caring deeply for their lives. Like the Rambam, he too was a globe-trotter, equally at ease with princes and paupers, and someone who approached the written text in a profound and loving way – be they holy or technical writings. Donald’s memory lives on, and he remains my main source of inspiration as a physician, an educator, and a father.

Q: Why did you decide to become a child psychiatrist?

A: Actually, I never planned to become a child psychiatrist. I planned to return to Mexico and open a private psychiatry practice serving everyone. I wanted to be well-rounded, so I participated in child psychiatry rotations. During my residency, I met Dr. Donald Cohen and that was the clincher. Now, 95 percent of the patients I see are children.

Q: In what ways is or should the Jewish community be involved in mental health issues?

A: Attention to mental health is as old as we are — Jacob and Sigmund Freud as dream interpreters provide readily recognizable signposts to this passion of ours. At some level, it makes perfect sense for the Jewish community to be very active in mental health initiatives in general, and in those focused on children in particular — We are the People of the Book and have historically been educators. While current psychiatric treatment sometimes involves medication and psychotherapy, the bulk of interventions for such conditions as autism are largely school-based. The school becomes the source of the treatment. While part of the role of psychiatry is to deal with issues of genes, brain imaging and traditional medical approaches, the role of the child psychiatrist and other mental health professionals has a lot to do with education and prevention as well, as exemplified by our routine involvement with parents, with families and communities, or by dealing with neglect, abuse and trauma.

Q: What are some of the “hot” issues and developments in the field of child and adolescent psychiatry?

A: As your readers know from a recent cover story in the Jewish Ledger, autism and Asperger’s are “hot” topics. Juvenile bipolar disorder and suicide are also important issues. There are a large number of children given the diagnosis of juvenile bipolar disorder these days, and all of them no doubt often have serious impairments. One issue we are studying is how to differentiate cases of “true” bipolar disorder (with very specific illness course, genetic loading, brain anatomy, or treatment response profiles), from other forms of serious psychopathology that may represent very different conditions (and entail, for example, a different prognosis or treatment approach).

There has been a lot of attention recently to the safety and risks of antidepressants and questions of whether these medications could contribute to increased suicidality in children. While data show that they may increase suicidal thoughts ever so slightly, the more important public health concern is the effects of having depression go untreated. Untreated depression is a deadly disorder, with significantly associated mortality across the world – especially among young people in their prime (suicide is one of three leading causes of mortality for individuals in their 20’s and 30’s). And so, our primary focus should be on the risks of having depression go undiagnosed, untreated, or insufficiently treated.

Q: You have followed in your mentor, Donald Cohen’s footsteps through your interest and involvement in Israel. Tell us about the field of child psychiatry in Israel.

A: Israel is a country with a very strong group of child psychiatrists and, for a country its size, one that produces a disproportionate amount of research in all areas. Some in Israel are focusing on very narrow fields of psychiatric research (i.e. in an attempt to find certain genes), others are developing interventions, while yet others are taking innovative policy and large-scale public health interventions. In the case of autism and mental retardation, Israel has more of a “cradle to grave” approach than we do: individuals get better coordinated care throughout their lives (including, for example, expensive school placements, adequate living and social support services, etc.

Q: You have been serving as a consultant to Camp Ramah in New England and have been in contact with colleagues serving in this role in other camps. What issues are consultants seeing these days in our overnight campers?

A: We tend to think of the child psychiatrist seeing patients in hospital or office settings. But children tend to spend much larger chunks of time in settings such as school, home and areas that we don’t usually think about-like camp. Camp is a more naturalistic, non-artificial setting for seeing kids, where kids can be themselves-away from their primary caregivers and families. Kids are also testing out their peers, dealing with being away from families, etc. This is growth-promoting, but it can come with speed bumps. Parents may find it reassuring to know that people are watching out for the mental health of their children – just as they know their physical health is being attended to. In a few cases, we do see children at camp with frank psychiatric disorders, such as depression, anxiety, or eating disorders. However, most of the times, such campers are able to receive the necessary help to make for a successful camp experience.

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