It is obvious that child mental health is related to the environment. Mothers and infants form an equation that gives unexpected results. It appears to run in my family that the Bittencourt men have an easy way with young kids. So much so that I had a dozen godchildren before I turned 21. My father and at least one of my sons are like this. And I have been a child neurologist for some 30 years, always in Southern Brazil. I did practice Neurology, mainly with young people and adults, in many countries in Europe, Africa, Asia and North America, and my interest in the human sciences and in the behavioral and psychological aspects of neurological practice is clear from many of my publications, including the book “Fora da Casinha”.

A special problem occurs in the case of mothers of children that become autistic, epileptic, or have developmental communication disorders. Specifically infants that look and initially are normal, but then become “possessed” by a disorder that does not appear in the reports of hard exams, as CT and MR scans, biopsies and body fluid analysis. These young women, as a whole, fail entirely to accept the situation that unfolds before them. Neurology, Psychiatry and medical science fail to make them understand what is happening in a manner that accommodates this reaction of denial of the clinical picture of abnormal child mental health. The consequences of the denial of scientific fact that ensues is loss of quality of life for all involved. The greatest loser is the patient, but the family, the medical and health community suffer, because there is considerable increase in the level of disease, and dysfunction.

What we see in practice is that a child with aggressive behavior or slow to speak spends a couple of years in speech or psychological therapy, sometimes under the care of teachers and education specialists. It is only when the problem really is installed, frequently when it leads to a difficulty with reading and writing, that medical care is sought. Even then, in many cases the possibility of abnormal child mental health is not in the radar of the young mothers.

To make to situation less dramatic and avoid guilt being distributed to young parents, I tend to make analogies, stories almost like jokes. One is that the denial is due to the religious nature of Brazilians, who believe that anything may be cured by praying. Brazilians really believe in miracles. Not only Catholics but also the Pentecostal and Evangelical church followers that have spread throughout the country, somewhat like what happened in the USA a few decades ago. This belief in miracles is in direct opposition to the classical European Protestant ethic that relies on hard work to achieve things in life. The Christian Inquisition was powerful for many centuries, and lasted until only 100 years ago in Spain, the country with the strongest influence in Brazilian culture. It is quite obviously related to the Franco regimen and the military dictatorships in Latin America, which remained in power until a few decades ago. Spanish women were allowed bank accounts in 1985.

The Inquisition and ignorance in general made matters much worse in the field on mental health, by taking it away from Medicine and placing it on the realm of the inquisitors, a mix of the justice and religious realms of society. In Africa, Christianism and Islamism spread so widely because local beliefs are barbaric. An enormous part of children born with “unwanted” things are linked with the devil. That includes albinos, twins, epileptics, and so the list goes on. They are under the care of all kinds of shamans.

Young mothers deny diseases in the spectrum of child mental health because it is linked to magic, the devil, or its various disguises in retrograde societies. Matters are made worse by the fact that mental disturbances are not visible nor palpable. There is no pus, blood, redness, swelling, fever, diarrhea. Signs and symptoms of abnormal child mental health may be more easily ascribed to the environment and not to disease. And mental health may, of course, be amplified, or even caused, by environmental factors. But the denial of the problem is a guarantee that it will not follow the best path. Mental health depends on multidisciplinary action led by a correct diagnosis, which is medical and scientific, not magical, religious, political or imaginary. Throughout the Inquisition, the upper classes in Spain relied on Arab and Jewish physicians not only for Medicine but also for mental health. It was only to their enemies that mental became judiciary or religious.

The consequence is that many of these kids do not achieve independence. Personal, financial, professional and social independence is a progressive achievement started in earliest childhood, and the delay and difficulty in development of an appropriate therapeutic environment has obvious consequences. I have many examples of girls and boys that have never become independent, much less productive members of society.

Paulo Rogério Mudrovitsch de Bittencourt

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