Published on March 6, 2014
“The more research I do, the less psychiatry I know.”! ! Dr. M David Kurland received these wise words from David Shaffer, director of child psychiatry at Columbia (and excellent researcher).! ! True research is a demanding taskmaster. The genuine stuff requires rigorous ﬁdelity to the highly focused testing of a narrowly deﬁned hypothesis. Great effort is expended on some very limited question while most psychiatry lies neglected.! ! Dr. Kurland published and presented three of these projects in his career. Most of his work with data and analysis, in contrast, has taken the form of surveys and studies of broader issues more relevant to his clinical work with children and families. One, for example, was a study of which children get placed outside the home and which do not. Studies yield suggested answers to meaningful questions but lack enough focus and rigor to prove anything. They have been meaningful to some. To others, they have not been rigorous enough to prove anything.! ! Dr. M David Kurland has made the following observations through his research…! Children are admitted to residential placements, not because of mental illness, antisocial behavior, or parental failure alone, but because two or three of these factors are present together.! ! Residentially placed children are assuredly more disturbed than children seen in an outpatient clinic.! ! The SF36 scale, which is widely used as a measure of the severity of emotionall/behavioral conditions, is a good measure of depression, which manifests as distress, but poorly picks up alcoholism, which manifests as a disorder of function and behavior.! ! The command hallucinations, which appear in a number of severely traumatized children, respond well to antipsychotic medications.! !
The parents of children who are admitted to an emergency service are markedly more disturbed than average parents.! ! The psychiatrist who engages in research and investigative studies disciplines himself to know what it is he really knows, what he doesn’t know, and to know the difference. After all, the child psychiatrist has few tests, laboratory or otherwise, on which to base his judgments and decisions. The child and parents then rely on his judgment, perceptiveness, and mind. He must develop and improve his abilities to understand, analyze, and decide as he evaluates and treats. For this, the psychiatrist who’s done research has a decided advantage. A record of research and studies should positively recommend a psychiatrist.