Abigail Donovan and Laura Prager, pediatric psychiatrists and authors

The United States has more than 70 million children—and 7,500 child psychiatrists. That gulf between those who might need help and those trained to give it led assistant professors of psychiatry Laura M. Prager ’80 (right) and Abigail L. Donovan to clarify what happens to children with acute mental illness by writing Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service. They draw on personal experience: Prager directs that service at Massachusetts General Hospital; Donovan is associate director of the hospital’s Acute Psychiatry Service. Their book’s 12 composite episodes, crafted with “obsessive” care to protect privacy, bring lay and professional readers into the ER “when kids come to the brink,” sharing what that’s like for the child, physicians, and support staff. Their subjects range from children like “the whirling dervish”—“just as sick, or even more so” than peers with physical ailments—to those like “the astronomer,” suffering from social deprivation, not acute psychopathology. Most of the stories have no resolution, typical of emergency-room practice. Donovan stresses “the complexity of these kids, their families, and the systems in which they live.…Each individual case needs a lot of expertise.” Prager hopes “to expose a social evil: one reason children end up in emergency rooms is the lack of easily accessible outpatient care.” If we continue to “ignore the fact that children have very profound emotional and social difficulties,” she says, we will “end up neglecting our future: with kids whose difficulties weren’t addressed when maybe we could have made a difference.” With the book, she adds, “I think I can make a difference on the local and national level.”