schneider hospital 88.
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All too often, the implications of sweeping the problem under the carpet are not fully realized. Like an infected wound or a broken bone, anxiety problems can - in nearly all cases - be fixed. Untreated, anxiety syndrome can soon cause serious complications. Untreated anxiety can lead a young person into an inescapable vortex of depression, self medication and, at its worst, to suicide. It is a disturbing fact that each year about 150 young people needlessly take their own lives in Israel, representing just over a third of all recorded suicides.
Clinical psychology and psychiatry can change a child's life for ever. At the Department of Psychological Medicine at the Schneider Children's Medical Center in Petah Tikva, psychiatrist Professor Alan Apter and clinical psychologist Danny Lotan head a team of dedicated professionals who are leaders in the field of treating anxiety problems in the six-to-18 year age group. Despite a widely-acclaimed high cure success rate which allows the youngsters to return to a fulfilled and productive life, the threat of closure hangs over the department due to a lack of funds.
It is an anomaly that the treatment of anxiety is not recognized by Israel's various health funds. Anxiety syndromes are perhaps intangible illness, not as obvious as a broken bone or an infected wound. Yet in some cases, if anxiety syndrome is not treated properly, the cost to the health fund in looking after a patient because of untreated anxiety problems in their youth is far higher than had the problem been attended to when it first became apparent.
"Today we can deal with anxiety syndrome in a relatively short space of time," says Lotan. "What is more, the treatment has about an 80 percent success rate, and even in most of the remaining 20% a significant improvement can be seen."
The preferred treatment Lotan is referring to is known as cognitive behavior therapy, or CBT for short. Developed in the 1960s, CBT is a psychotherapy based on modifying everyday thought and behavior with the aim of positively influencing emotions. The treatment brings the patient into direct contact with their anxiety. The negative and irrational results of anxiety, which might lower a person's self esteem, are faced directly. Clinical depression, which can result from childhood anxiety, can be avoided and the patient can take his place in society. A clinically depressed person experiences thoughts that are beyond his control. If not dealt with, they can become self-perpetuating and automatic.
"Today a patient on a CBT program normally comes to Schneider for 16 meetings with a clinical psychologist," explains Lotan, director of the Anxiety Disorder Clinic. "In its simplest terms, the CBT treatment consists in most cases of cognitive therapy combined with anti-depressant drugs such as Prozac. Our experience shows that a combination of CBT and medication is the best formula for successful treatment."
While the success of CBT is not in question, the future of the department is uncertain. "Our department could be closed down next year if funding dries up," points out South African-born Apter, head of the psychological medicine department. "We see about 400 children each year in our department, at a cost of $600 to treat each child for a period of four months. We have about 20 psychologists working part-time in the anxiety clinic, but this still means that there is a waiting list of three to four months."
Because of the department's budgetary squeeze, parents will have to pay out of their own pockets if their child is going to be accepted into a CBT program. "This is a big concern to me because it will mean that children from poorer backgrounds will not be able to avail themselves of the treatment," says Apter. "Thousands of children in Israel live with the suffering and emotional distress brought on by anxiety disorders."
Apter had particularly in mind the problems caused to the many children with anxiety syndrome who live in the north of Israel or close to the Gaza border, especially in the town of Sderot that has been suffering sporadic Kassam missile barrages for years. Scores of extra children have been coming to the clinic from towns like Kiryat Shmona in the north following last summer's Second Lebanon War, when they had to remain in bomb shelters, sometimes for days at a time. As in the case of Sderot, many children from lower socio-economic families did not have the funds to enable them to leave for safer locations in other parts of the country.
The vexed question of funding is not being left to chance. The department is doing everything it can to initiate fundraising events, organized by the recently-formed Friends of the Schneider Children's Hospital Department of Psychological Medicine. "I hope that when potential donors become familiar with the work we do, they will feel that they, too, would like to ensure that there will always be a place to go for children suffering from anxiety," says Lotan.
Parents of children with anxiety disorders are in touch with the clinic on a daily basis. "These children cease living their lives; they stop eating, studying and sleeping; their lives at home become a nightmare. I'll give you some examples," says Lotan. "The parents of 11-year-old Meiron noticed that he began to be afraid of noises and lights. Whenever he was outside his home, he would rush to his parents in fear if he heard a noise. Afterwards they noticed that he was avoiding many activities. He didn't want to eat or swallow; he didn't want to go and play with friends and was afraid to be left alone in the house. Ido, a 16-year-old, is another example. He moved to a new neighborhood and tried to meet people, but had thoughts and fears that perhaps he would not fit in. He had never felt like this before."
Ido, who was treated at the clinic for about 10 months, explained his predicament: "At first my anxiety was just in my mind. But later it developed and grew within me, sending shivers and butterflies in my stomach. I felt like I was going to faint all the time. I felt dizzy and had pressure in my chest. My teeth, fingers and hands felt very strange."
He then described his feelings after the treatment: "I have undergone a tremendous change since the time I arrived at Schneider as a closed, lonely person. I am now becoming somebody who lives and enjoys his youth and his life, who respects himself - something that didn't previously exist. I hated myself. Now I have discovered things about myself that I didn't even realize before coming to the clinic."
Orly, the mother of a teenage daughter suffering from anxiety, presented a parent's perspective. "We're going through things that we can't really talk about or explain to people. To see your child missing out on her childhood and youth is very frightening."
"It is often thought that the child has attention deficit problems, but the problem really is that he is wrought with fear and worry," points out Apter. "He is unable to concentrate on his studies. As a result he fails in school, which causes him to become even more depressed and anxious. It becomes a vicious cycle, with one of the complications of untreated anxiety being depression. A more dramatic complication of anxiety is suicide."
It is clear from listening to the parents and their children that the earlier they turn to the anxiety clinic, the better the long-term result. Also, parents can learn how to best help their children overcome their anxiety and maintain the improvement.
"The changes in children once they have started CBT therapy is incredible to see," says Lotan. "If we can reach the children in time, our ability to influence them, help them and return these children to normal life is amazing. Sometimes within a month of being treated, children who have stopped going to school are back on their feet and totally functional. On the other hand, children who don't reach us in time or don't receive treatment develop overwhelming complications. We are talking about terrible deterioration such as addiction to alcohol and drugs, and then deep depression. These are children who have 'checked out' of life - they need professional, experienced help. It is unacceptable in a country such as Israel, with all its problems connected with the security situation, that children who are more prone to develop anxiety disorders are possibly being denied funds for their care."