Saving Sammy: Curing the Boy Who Caught OCD - a book review

In the summer before sixth grade, Beth Alison Maloney's middle son suddenly began to exhibit severe obsessive-compulsive behaviors. She documents his ensuing multi-year battle with mental illness in her book, “Saving Sammy: Curing the boy who caught OCD.”

The ordeal began over the span of just a few weeks. A formerly “bright and charming” child, Sammy was suddenly unable to shower, walk up and down stairs, enter a car, leave the house, touch a doorknob, lie in his bed, or interact with people unless he performed an increasing number of incredibly exhausting and seemingly ridiculous compulsions. He couldn't sleep. He often couldn't eat. He definitely couldn't sit at the table, except for occasionally when he sat in a specific spot, in a specific position, at a specific time. Despite his desire to be with his friends and attend school, there were hundreds of necessary behaviors that had to be performed in order for him to get dressed, climb into the car, and arrive in his classroom. These compulsions, including jumping, touching, breath-holding, running, shouting, or spinning, would sometimes cause him to be six hours late for school. At that point, Maloney kept Sammy home, neglected her other work, sent her youngest son to live with her parents, and watched her son spiral downhill, fast.

The sudden onset of Sammy's illness was dramatic. One day he seemed completely well, and then suddenly he wasn't. He started swirling his feet with every step, snorting and huffing and puffing and crossing his eyes while looking at the ceiling, shouting randomly for nobody in particular to “stop it!”, slamming doors six times to make sure that they closed completely, putting his head inside a cabinet and holding his breath every time he had to go upstairs, counting invisible walls that he constantly needed to travel over, needing to have every single window closed even in the middle of summer, demanding that his family speak in certain ways... These were the compulsions that filled his “good” days, and the situation was only getting worse.

The first counselor said that Everything Was Due To Stress. This psychologist recommended Giving It Some Time--during which Sammy got worse. The next psychiatrist diagnosed “OCD,” and prescribed a steadily increasing dose of zoloft--and on this, Sammy got worse (and nearly overdosed). “I never,” Sammy said lucidly one day, “knew there were so many things to be anxious about.”

At one point, a psychologist asks Maloney to “find out what behavior was causing Sammy the most anxiety at school. The plan was to tackle one behavior at a time. When Sammy had mastered one behavior, they would move on to conquer the next. The technique is called Exposure Response Prevention, or ERP. In our house, we called it 'urp.'

“I dutifully e-mailed his homeroom teacher and asked the question. She wrote back, 'I think the behavior that stands out the most is jumping over the blue part of the rug while entering classrooms or flinging himself at the lockers, and the way he goes to classes/lunch while walking down the hall (climbing under and over something imaginary near the lighted section by the bathroom) and the way he follows a pattern while kind of running in spurts down the hall, holding his breath, bent over in the shape of an upside-down L.'

“Where exactly, I wondered, would one start?”

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Natasha Campbell-McBride says that there are no more motivated people in the world than parents of autistic children, because having a disabled child is one of the biggest challenges in the world. I'd venture to guess that even if your child has a “better” diagnosis than OCD, or isn't completely and profoundly autistic, you are just as motivated to find treatments that work.

Maloney writes of a conversation with her eldest son, who is home from school for a week's vacation:

“'I think he's doing better,' I concluded. Maybe if I said it enough, it would be true.

“The next morning, I fixed breakfast for Josh.

“'Sammy's doing better, don't you think?' I asked, sliding the scrambled eggs from the pan to his plate.

“'No, Mom, he's not,' Josh answered impatiently. 'And why do you keep saying he's getting better when he's not?'

“A muffin popped up from the toaster. I grabbed it and dropped it on the plate.

“'Because if I thought this was it, that he'd never get better, and that for the rest of our lives it would be like this, I'm not sure I could get up in the morning and keep going.' I shoved the plate at him. 'Got it?'”

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Maloney documents the hell that it is, to watch her child suddenly deteriorating into this strange caricature of himself. His “crises” are screaming fits that escalate in pitch and duration. He is essentially incapacitated, needs constant supervision, often refuses to eat, sometimes runs away, and yet is still occasionally articulate enough to shout in frustration at his own, suddenly debilitated existence. “I can't do any better than I'm doing!” he screams one day, trying to explain his shouted, crazed demands that impact the entire family with their draining constancy, irrationality, and decibel level.

You can almost laugh about the assumptions people make about children's behavior, at least in Sammy's case. It would be ludicrous to think that his sudden-onset case of OCD could be caused by a lack of Proper Early Intervention, or not enough Occupational Therapy, or Bad Parenting.

But many people, in many situations, believe that “stress” and “family life” and “parenting techniques” are at the root of a child's behavioral problems. If a kid has OCD or Asperger's or just plain “difficult” behaviors from the start, it's especially easy to slip into this mindset. Children with “argumentative” temperaments need “effective parenting strategies.” These kids have problems due to their “personalities,” or maybe because of fallout from abuse, or because nobody “disciplines” them properly. Sometimes, I'm sure, these factors contribute to the problem. Occasionally, abuse or trauma must be a primary cause of mental illness. But I think that assuming a “psychological” cause of mental illness is getting in the way effectively treating our children.

Maloney writes, “I still had not told Sammy the name of his disorder. There are two theories when it comes to children and mental illness. One is to treat the behaviors and keep the diagnosis confidential. The other is to share the diagnosis. Even some grown-ups never fully recover from some truths, so when it comes to children, I feel it is best to err on he side of caution.

“Another reason to be cautious is that a mental illness diagnosis is never certain, and once a child is labeled, it tends to stick. Unlike cancer or diabetes or HIV, there is no test that can pinpoint a brain disorder. Instead, there are a series of diagnostic criteria that lend themselves to a diagnosis 'consistent with' a particular disorder. Sammy's behaviors were 'consistent with' a diagnosis of obsessive-compulsive disorder.”

Soon, Sammy begins talking about his “friend,” “Joe from China.”

“Next,” Maloney writes, “Sammy started locking himself in the bathroom for two or three hours at a time. He screamed and howled in agony. I lay curled on the floor outside the door with an unbearable pain in my own gut.

“My mother called. 'There's a medicine called Tenex,' she said. 'I read that it helps with tics.'

“It was about then that Dr. Drill and I began to discuss whether Sammy's behaviors might be 'consistent with' Tourette syndrome. Dr. Drill said that almost everyone with Tourette's has symptoms of OCD, although the reverse is not true. Perhaps it wasn't a serotonin issue after all. Maybe the problem was a different brain chemical: dopamine.

“'Tourette's?' I wondered. 'How on earth can he have Tourette's?'

“There was simply no family history of Tourette's anywhere to be found. I could extrapolate my need for an organized desk and a clean kitchen to signs that OCD was embedded in my genetic code. Symptoms of Tourette's, however, were nonexistent on either side of the family. The one positive thing that this possible diagnosis did was to absolve me of any and all guilt. I was willing to accept responsibility for almost anything. This one, however, was out of the question, and I stopped beating myself up for the move [into a new house, the same week when Sammy suddenly developed compulsive behaviors]. Home ownership could not be responsible for Tourette's. I knew it couldn't be responsible for OCD, either, but this finally flipped the switch on my needless guilt.”

Maloney's search for a cure for her son leads her deeper and deeper into the no-man's-land of psychiatric drugs (none of which helped Sammy, and all of which made him worse). She finally encounters a controversial diagnosis: “PANDAS,” which stands for Pediatric Autoimmmune Neurophychiatric Disorders Associated with Streptococcal Infection. “The theory of PANDAS is simple,” writes Maloney: “strep antibodies attack the basal ganglia, which is the area of the brain that controls behavior. In a nutshell, Sammy's brain was under assault.”

As the book jacket says: “[Maloney's] quest took her to the center of the medical community's raging debate about whether mental illness can be caused by infection. With the battle lines firmly drawn, Maloney searched until she found two cutting-edge doctors who answered that question with a definitive yes.”

After nearly two years of hell, countless medications, and complete determination, Maloney found two doctors who helped her find a strong antibiotic-and-drug-combo that effectively targeted Sammy's “asymptomatic” strep infection. His strep titer levels directly correlated with his compulsive behaviors. Almost immediately after starting these meds, Sammy's recovery began. After nearly three years of antibiotics, and still now, five years later, Sammy has virtually no traces of his “mental illness.”

This is an interview with Sammy, his mother, and his doctor: http://www.youtube.com/watch?v=50bQtkfiHvs

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When Sammy began to recover, he was absolutely determined to have his bar mitzvah before he turned fourteen. His speech was entirely self-written:

“I've had some problems for a while now. Stepping over invisible walls, holding my breath, and keeping things even were the first things.

“When we moved from our old rental house in Maine to a new house that we owned I had mixed feelings. One one level, I liked the nice house, and I could see that Mom was glad that she finally owned something in Maine. On another level, I really missed the old house. But the main problem with moving was that it seemed to intensify my behaviors after a little while.

“I've stepped over invisible walls for a very long time. I don't remember quite how long, I can see them somehow. I wish I could tell you when I started holding my breath, but I can't remember that, too. In the new house, there were more invisible walls, I had to hold my breath when going from the first to the second floor, and I could not go through the front door of the house. In the old house, the worst it ever got was me hating to look at bare feet. After we moved, sometimes I couldn't even leave my room. Couldn’t eat. Couldn't do much of anything. I was constantly having emotional breakdowns, and it was apparent that there was definitely something wrong. So I was heading to a doctor, a psychologist, hopefully he could help me.

“It's funny, you know, although I had all these problems I could never talk about them. I would stay in my room, locked up, never leaving. Boiling in the middle of summer with the windows closed, I would never tell anyone why I was doing this. The windows, well, that breeze, I just couldn't stand it. Somehow that breeze really disagreed with me. It was another thing that made it so I couldn't eat. It was becoming unbearable. I had to tell someone, but I couldn't, because the first and foremost rule was that I couldn't tell as soul. I couldn't eat when the windows were open, I couldn't eat when I saw bare feet, I couldn't even eat if the sounds of my eating corresponded with some other sounds. So I stayed in my room almost forever. That almost forever was really only a couple of months, but it seemed like forever to me.

“It was in July that we went to see the psychologist. It took me forever to get downstairs. I went to countless meetings with him, but it didn't help enough, I just didn't seem to get better. Then the psychologist suggested a new doctor, a psychiatrist, Dr. Drill.

“Drill suggested that I had obsessive-compulsive disorder and it was related to a lack of serotonin. He recommended Zoloft. He said this would help. This serotonin reuptake inhibitor, Zoloft, helped a bit but no matter how much we increased it, it could not solve the problem. I didn't know what to do. I was lost. It must've taken at least three months before Drill decided it was a dopamine situation as well. I hated the idea of adding a new medicine; I just couldn't stand it. Something was wrong. I could tell. When a person who worked for my grandmother said it could be related to strep, I somehow knew that was it. But Drill didn't know enough about it. Nonetheless, we decided to get a strep titer blood test. It turns out I had elevated strep levels; which meant it truly was related to strep.

“I'd been sick for a year when we set off to see a doctor in New Jersey. When we got to the hotel, it took me over two hours just to get into the hotel room. This was all related to touching a small squirt gun, which I despised, a week or so before. When my foot made contact with it, it instantly triggered a behavior where I always had to have both feet touching something, generally both feet on or off the ground. This wasn't always that hard but he hardest part was going over invisible walls, as you well can guess, I had to hop over them. The next day was equally hard. When we finally got into the doctor in New Jersey's office she gave me a full physical but didn't run any other tests. I didn't know it yet, but she was going to make things a lot better.

“In September, the doctor in New Jersey told us to see a new doctor, a Boston doctor. He happened to be a world-renowned doctor. On October 31st we were off to see him. When we first stepped into his waiting room, we were surprised at the size. It was a tad smaller than other waiting rooms. It had three chairs, and a very nice chandelier. The wait seemed like an eternity. When we finally got in, it looked like it would be worth it. I can't quite recall what he said in that conversation, but I know it was very comforting. He seemed to agree with the doctor in New Jersey and told us not to change anything. I left feeling quite good.

“Now, with hard work and help from the doctor in New Jersey, the psychologist, and the Boston doctor, I'm finally getting better. I don't know how much longer this will last. Things may have gotten worse in the middle. But I'm finally getting better. I feel like now I can take control of my life.”

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Several years after Sammy's recovery, a friend's child was diagnosed with PDD. (“Pervasive developmental disorders” are categorized as mental illnesses involving symptoms that affect virtually every area of a child's development. PDD is considered to be a disability on the autism spectrum.)

Maloney listened to the list of symptoms, and asked the mom whether her son had had any recent infections. Several weeks later, after treating for asymptomatic Lyme, the eleven-year-old began to recover from his “mental” illness.

Maloney writes, “My friend's experience has made me much less forgiving of the doctors who overlooked Sammy's infection. I had excused their oversight because of the 'newness' of PANDAS, but Lyme is a well-known disease and still doctors failed--more accurately, refused--to make the connection. And that's why, before any child is placed on psychiatric medication, we must ask the questions: Could this be an infection? Could it be a virus or bacteria?...”

“Historically, mental illness was linked with infection. When Georges Gilles de la Tourette first identified his syndrome in the 1800s, it was closely linked to rheumatic fever, caused by strep antibodies attacking the heart. In the 1920s, tics swept the population following an outbreak of encephalitis.

“Yet as mental illness moved under the dark cloak of psychoanalysis--and patients' mothers were often blamed--the door to finding an invasive cause was closed. The steadfast refusal of some doctors to reopen that door is disconcerting. Studies consistently report links. _Scientific American Mind_ reported in 2008 that schizophrenia has been linked to the flu, bipolar disorder to herpes, autism to Lyme disease, and OCD to strep. [Of personal interest to me: anorexia has also been associated with strep.]

“...[I recall] our pediatrician telling me about the many years it took for doctors to accept that stomach ulcers are caused by infections. I can't help but think about all those sick patients who suffered needlessly. And, of course, I think of my son. While I appreciate the patience of doctors who are exploring and researching, the bottom line is that my son and the children like him simply do not have time to wait.”

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And that's the bottom line, right? If our child gets sick, we want them better, and in most cases there are no big, multi-decade, double-blind, placebo-controlled studies to guide us toward effective, safe, sustainable treatments that work long-term. What should a parent of a mentally ill child do?

I am convinced that for now, our best bet is to seek out clinically effective ways to help our kids' bodies to do the crazy, complicated work that bodies have evolved to do: constantly regenerate, detoxify, and heal the complexity of themselves. I think that there are many reasons why PANDAS is a controversial diagnosis, including this: any particular, potentially pathogenic microbe is only one of many in a very complicated cascade. Strep or Lyme might be the domino that sets an illness in motion, but there are almost certainly other dominoes involved.

Mental health is not limited to activity that occurs within our skulls. A body's abilities to fight infections (or not), detoxify waste products and other toxins, and obtain nourishment, begins in the gut, which--along with its billions of beneficial microflora--is the foundation of the immune system. Our gut flora, without which we could not live, ideally fends off pathogenic invaders before severe infection ever sets in. These factors alone mean that we can't ignore the rest of the body when studying mental illness.

Then there's this, from Scientific American http://www.scientificamerican.com/article.cfm?id=gut-second-brain :

“[A]n often-overlooked network of neurons lining our guts...is so extensive some scientists have nicknamed it our 'second brain'.”

“Technically known as the enteric nervous system, the second brain consists of sheaths of neurons embedded in the walls of the long tube of our gut, or alimentary canal, which measures about nine meters end to end from the esophagus to the anus. The second brain contains some 100 million neurons, more than in either the spinal cord or the peripheral nervous system...The enteric nervous system uses more than 30 neurotransmitters, just like the brain, and in fact 95 percent of the body's serotonin is found in the bowels...”

And don't for get this: all the topics I discussed this this article http://www.lifeisapalindrome.com/articles/miraculous-possibility-hope , including this important point:

In 1998, a team of researchers lead by Dr. Andrew Wakefield took a number of children with autism, did small intestine biopsies on them, and discovered abnormally wide holes in their small intestinal lining--just like the holes found in patients with celiac, ulcerative colitis, etc. Wakefield postulated that the holes in these autistic kids' intestines were allowing proteins to leak from the inside of the bowel into the bloodstream, and that these foreign proteins were acting like neuro-toxins and interfering with neurological functioning.

How does a gut become leaky? There are probably countless causes, but one of the main players is disruption to our internal microbial ecosystem. Paraphrased from Dr. Tom Cowan ( http://www.sustainlane.com/reviews/the-gaps-diet-the-mother-of-all-diets... ), the basic process goes like this:

1. Each of us has millions of intestinal villi, which are tiny finger-like hairs projecting into the small intestine. These villi dramatically increase the surface area of the intestinal lining, making it a more effective semi-permeable barrier (meaning that unwanted things stay out of the bloodstream while nutrients can flow right through).

2. In order to do their job, the villi require a protective layer of mucus which in turn nourishes “good” microbial flora--some estimate a total of 5-7 pounds of millions of different bacteria, viruses, yeast, and other microbes--which reside in the human gut. These healthy bacteria are essential for a healthy human existence. They make vitamins, they digest food, they make antibiotic, anti-viral, and anti-protozoa substances to keep down pathogens, and they function as our immune system.

If there is a disruption in this exquisitely balanced microbial world, big and small problems can occur. Harmful organisms may proliferate, crowding out the beneficial microbes that normally help the small intestine to digest food and keep those gut walls sealed up tight. Once the beneficial microbes let down their guard, toxins can leak through a damaged gut wall--including heavy metals, undigested proteins, phenols, petro-chemicals, glue adhesives, agricultural chemicals, PCBs, personal care and cleaning product ingredients, plasticizers, by-products of the body's own metabolism, and many other harmful compounds. (Also, please check out this article for more information: http://www.lifeisapalindrome.com/content/part-two-gaps-and-autoimmunity-... .)

It would be so nice and simple, wouldn't it, if we could trace this mess back to one particular microbe, and eradicate it from our systems with a nice, simple pill? I wish this were a good long-term goal to keep in our sights, but I'm more and more convinced that it isn't. It's fantastic that antibiotics healed Sammy's infection--one would hope that his strep has been banished for good. But I don't think that these drugs are the answer for the skyrocketing number of kids who are getting diagnosed with mental illnesses. Since the 1920s, researchers have been hoping to isolate certain strains of bacteria that might be blamed for particular digestive and now mental illnesses--and then eradicate these from our bodies. No one has, to my knowledge, succeeded in this quest.

In part, this must be due our internal, small-scale, and yet extremely complex ecosystems. There's room for small populations of even highly pathogenic microbes in a normal, fully-functioning digestive tract that enjoys the symbiotic benefits of a full complement of hundreds of types of flora. But in a compromised gut, microbes like Candida or clostridia or countless others can wreak terrible havoc.
Antibiotics are often tried, but they have the undesirable effect of killing _all_ gut microbes, pathogenic or not--and during the several weeks or months it may take for healthy gut flora to regenerate after a course of antibiotics, there is plenty of time for--and few natural controls to prevent--opportunistic, pathogenic flora to proliferate in the gastrointestinal system.

Natasha Campbell-McBride, at the Wise Traditions conference earlier this month, spoke about the correlations currently being made between Lyme and autism. http://www.lifeisapalindrome.com/content/gut-and-psychology-syndrome-nat... . (Please read her lecture in full to understand the theories underlying the GAPS protocol, which allows the digestive system to heal so that the brain can, too. Also, here's a summary of how GAPS works: http://www.lifeisapalindrome.com/articles/miraculous-possibility-hope )

Campbell-McBride says, in part: A few years ago, lots of people were talking about mercury, and how mercury was a probable cause of autism. Medicine goes through fashions, and now we're on to Lyme. There are a lot of bugs, like Lyme, that might not harm a healthy individual. But when you're unhealthy, when your immune system is weak (and remember that immunity begins in the gut), then lots of things--like Lyme--become larger issues. There will be new things in five years that will be the latest fad, and then people will theorize that _these_ are causing the autism epidemic.

In the case of Lyme, many courses of antibiotics are generally given... Unfortunately, the Lyme bacteria is very difficult to eradicate, and meanwhile the antibiotics are damaging the gut flora directly. I would put my cards on our own immune system: build up the gut, and it will protect you from Lyme as well as hundreds of other parasites that we haven't studied as much but that can cause at least as much damage.

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Despite the differences between Sammy's story and treatment, and our little family's less-dramatic ongoing saga and the GAPS protocol, there are many, many parallels. I know, as surely as someone can know what another person is feeling, the desperation Maloney writes about at the beginning of Sammy's illness, as she helplessly watches him slipping away.

I knew it on the day Ben was born. Something Was Wrong. I shoved this intuition away as often as I could, since he was growing and developing _almost_ entirely “normally”...except for all the ways in which he Wasn't. There was his non-acceptance of physical affection, varying levels of rigidity and inflexibility that often culminated in hours' worth of explosive screaming fits, near inability to interact with people outside the home, speech delays and bizarre speech patterns and repetitive questioning, no apparent desire for peer interaction, severe reflux/”colic” as a baby, digestive issues all along, obsessive toileting habits, picky eating verging on severe anorexia, periodic awful stomach aches, inability to play independently, apparent lethargy/depression, tiny stature, bloated belly, compulsive smelling of objects, shirt-chewing, anxiety attacks, wanting to be next to a family member at all times, skin rashes...

All these symptoms and many more made it pretty difficult to get through many days. But sometimes there would be marginal improvements--or genuine maturation--just enough so that we could say, “Oh, it's just a stage. He'll just grow out of it.” We'd watch, and try to appreciate his intelligence and creativity, which, while substantial, were often overshadowed by his incredibly challenging “disposition.” And then he'd regress again. “We need accept Ben where he's at,” I'd think, “and not try to turn him into somebody he isn't.” And onward we would stumble.

It took me nearly seven years to realize that Ben's illness is actually an illness (and one which we will heal or I will die trying!). He was my first kid, I was in denial, and everything developed so insidiously, slowly, and non-dramatically. It took me a long time to stop thinking that my life sucked, or that I was a crappy mother, or that Ben was doing all these things to spite me or manipulate me. Things had just ramped up until Jeff and I didn't even realize how much our family life was centered around compensating for Ben's explosions and dealing with Ben's behaviors and trying to pretend that everything was okay.

We were doing the best we could, with the information we had, but the truth was, it wasn't just a stage. It wasn't okay. Ben had never been healthy, and although he never got as bad as Sammy, there were so many ways in which, as the years went by, he was getting worse. Maybe he would have “grown out” of his illness, but as of last April, when we started acknowledging how bad things were, and started GAPS, he sure wasn't showing any signs of doing so.

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Ben never had a diagnosis, and to hell with diagnoses. Even if we'd gotten one for him, it might have been “Asperger's,” or “Pervasive Developmental Disorder - Not Otherwise Specified,” or “Social Anxiety” or “Paranoid, Overparenting Mother.” What good are these labels? In what ways do they help a parent address the complexity of a child's mental and physical health?

Diagnoses of mental illness sometimes help parents get taken seriously. Maybe, in our case, it might have absolved me of vast amounts of guilt--which Maloney gave up around the point of Sammy's “Tourette's” diagnosis--somewhat sooner than later. But currently popular treatments for “psychiatric” disorders are, at best, notoriously challenging to get “just right” to positively affect a patient's brain chemistry; and often, at worse, they are completely ineffective or actually make the problems worse. Drugs also cause side effects. Occupational therapy might make sense for some, to offer basic compensatory strategies to help a person's brain iron out a few quirks. But an effective healing protocol for mental illness? Stories about complete recovery are mighty hard to come by.

I am an unschooler, born and bred. I don't believe in “normal,” in putting people into little boxes, and labeling them, and trying to make children into another person's idea of what a Child Should Be. And yet...a huge number of kids chronically behave in ways that aren't normal--in the sense that I don't think these behaviors _need_ to be happening, despite how common they suddenly are.

I often hear people discussing the “importance” of getting “services” for the growing number of “learning disabled” children (including those with autism spectrum disorders, ADD/ADHD, OCD, bi-polar, dyslexia, etc.). All I can notice is the increasing and wholesale breakdown in childhood development and health, and getting “services” for these kids doesn't even begin to address the problem. I'm making this sweeping generalization based on the rising number of kids who are getting diagnosed, receiving special help in schools, waiting for months due to shortage in available “services,” being medicated with psychiatric drugs, and plain old Not Functioning.

The astronomical rise of mental illness and “out of control kids” is not going away. We do not have an epidemic of bad parents. We have an epidemic of sick kids of every description, and parents who are overwhelmed and out of their league when faced with the task of coping, let alone healing their offspring.

As you know, I am absolutely convinced, based on current clinical research, that considering the role of gut flora is more essential than anything else in treating the root cause of mental illness--and “anything else” is what usually gets prescribed when childhood mental illness is diagnosed. So, when it comes to healing my own family, I know exactly where I'm placing my chips. No, I am not the world's best mother. Of course, I will make mistakes along the way, there is no absolute best diet for everyone, and I'm not trying to turn my son into some Perfect Robot Child. I understand that on some level, we all exist on a spectrum, on which nobody is entirely and completely sane. And yes, of course there are differences between people, and personality is not entirely due to our intestinal flora.

But healing with food is a whole lot more appealing than letting my child be a guinea pig for Big Pharma, or wasting any more time waiting for behavioral approaches to magically change his brain chemistry in a big way.

What do we do on an institutional/community/population scale? I have nearly absolutely no ideas, beyond getting Concerned. I want to reach other parents, and let them know that there are options way beyond those offered with a typical diagnosis of mental illness. Maybe Sammy's tale will be a call to action, pushing us to figure out a new paradigm, for the sake of our children.

I don't know what it will look like, but I the future sure isn't going to be boring.