Power of Rage, The

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2005 by McCabe, Susan

Where do the seeds of rage get planted? On what issue, with what action, for what patient does such a seed blossom and grow? I have been asking myself these questions for some time as anger simmered within me, lacking clarity and focus to evolve into rage. Where does rage begin? For me, it begins in the eyes of a child, who could have been any of the 72.9 million children living in the United States.

Anger was born of countless incapacities to help, of powerlessness, finally crystallized into rage with one brief contact with one diminutive child. A child, a mirror image of so many others, who did not get the so needed mental health care. Like a molten lava flow, my anger hardened to rage by the simple act of this child's eyes capturing mine, pleading for help. In that brief exchange of human contact, rage bubbled up out of the fault lines that have been fracturing each year, for too many years. Fault lines of a mental health care system that fails to give appropriate care for children in need. Rage over fault lines that have grown so large they swallow children within cracks and crevices of discontinuous, unaccommodating, or missing services.

My rage is fueled by facts that are as inescapable as they are indefensible. Children comprise 25% of the total American population from which, 88% are covered by some form of health care (DHHS, 2000). Yet, as you read this today, almost 80% of children with psychiatric problems will never receive needed mental health care (Katoaka, Zhang, & Wells, 2002). Tonight as you tuck in your children, 2,000 American children will sleep in detention centers because no accessible mental health services are available for them (CAS, 2003). If a child is Latino, African American, or otherwise marginalized, they will fare even worse. A Latino child for example, despite having the highest incidences of childhood suicide, is the least likely child to be screened or identified as having a psychiatric disorder (Brazelon, 2003). Perhaps no other statistic labels my rage better than the revolving-door marker that annually, 11% of children aged 12-17 are victims of serious violent crimes, while an equal 11% of children of the same age are the offenders of such violent crimes (HRSA, 2004). I wonder how America would respond if 80% of children with asthma, diabetes or chicken pox were placed in detention centers because no health care services are available for them.

These are the immutable facts that burn in the eyes of the children we all see in clinical practices. I suspect I am not alone in my rage as I try to match child with needed services, only to find no services, no openings, no room for mental health care in America. And so I rage. I rage knowing what awaits the untreated child in America; the academic failures, social inequities, and broken lives that will be a visible lava that flows from the fault lines of an absent mental health care system, a flow that hardens these children as they age to adulthood. Fault lines that produce the next generation of adult psychiatric patients and that leave me wondering about what might have been, could have been.

My rage is even more hard-edged as I realize that science has given us more hope than at any other time for the treatment of psychiatric illnesses. Neuroimaging enables us to look at the human brain in vivo to literally see emotions and behavior. Evidence-based knowledge has opened tantalizing windows to potentially life-altering, brain-based treatments. Concepts such as neuroplasticity accentuate awareness of the brain's extraordinary capacity for modification and adaptation, which gives insight to the critical timing in the development of brain function or dysfunction (Mohr, 2003). We know a child's brain is more plastic than adults, a fact of inescapable wonder highlighting the true potential for learning and healing as well as the devastation that can occur unchecked in the brain of a child experiencing abuse, neglect, or untreated psychiatric illness. Prevention through medical science, which involves using neural plasticity capacity and therapeutic modification of neural circuits, is increasingly possible. The science exists. The services do not.

And so I rage, not by myself I suspect. We have all seen the eyes of the same child. How many of us, I wonder, push aside our rage in order to deal with the needs before us? Perhaps, it is time we all let ourselves feel the rage, to use the energy of anger to collectively and proactively address the barriers toward effective mental health care for children. As advocates and educators, psychiatric nurses are poised in distinct and unique ways to raise our voices in powerful changing ways, if only we first feel the rage. Perhaps it is time for us, for our professional organizations, to collect our rage and channel it in cogent ways that harness new preventative science into nursing interventions for early prevention. Perhaps quite simply, it is time that we refuse to deny children the needed mental health services. Over 70 million children are waiting for us to rage loudly and well.