Category Archives: adolescence

Riding the Rapids

We recently spent a few days hiking up mountains, camping and white-water rafting in Wyoming and Montana, because isn’t that what people who are afraid of heights (me) and can’t swim (yeah, me, again) do for fun? And it was fun. It’s good to push out of the comfort zone.

Most parents and the other adults who care for and work with children are quite serious about helping them get out of their supposed comfort zones and into a healthier lifestyle. Recently, I was speaking to a group of adults about the topic, “Raising Mentally Healthy Children.” We spent our time focused on what we can do.

One problem that arises in these conversations – whether in a group, one-on-one, or with a family, is that making time for change seems impossible. The days are packed, and nothing on the schedule seems negotiable. Yet, in reality, what’s not negotiable is what humans need to be healthy and thriving.

What most kids need, and what we need, too, is more appropriately divvied-up time. For example, children and teens benefit from a solid two hours or more of physical activity every day. They need time outdoors, in nature, for their immune systems, Vitamin D, circadian rhythms and even their eyesight development. The near-and-far variation in focus that being outdoors elicits promotes healthy eyesight in young children; kids are supposed to go from crouching down to study a beetle to peering across the field to see if that’s a hawk in the tree and then taking off running to make sure. Optimally, they’re outside for at least two or so hours every day – more on weekends.

Kids need enough sleep – probably 9 or 10 hours a night, with an absence of screens. Recent research links high levels of artificial light at night (ALAN) with increased rates of cancer due to disruption of the circadian rhythm. An immediate risk with insufficient sleep is the attention system. Sleep-deprived people are irritable, inattentive, forgetful, disorganized and generally not fun to be around. Sleep-deprived drivers test as impaired, much like those with alcohol and/or drugs in their system. Think about inexperienced and sleep-deprived teenagers driving to and from school and work, often in the dark.

Kids, and we adults, need unstructured time. Most of the adults present had a creative hobby or two, and we all agreed that it takes time to shift gears into that hobby. It’s hard to walk in the door after work and immediately pick up a paintbrush, or guitar, or journal, or woodworking tools, and be in flow. The segue into creativity requires a sort of almost boring downtime – something many adults and children avoid compulsively through electronics. 

I can’t tell people what sacrifices have to be made for their family to have a healthier life. It varies from family to family, and it is never easy. It might be simple or quite complex, but it is never easy. However – after the white-water part, when you aren’t on nature’s roller coaster, there are always some smooth, easy times ahead. Thank you to all the parents who go for it – who strive to be sure their children to have the range of experiences they need to grow up resilient, curious and confident.

Ouch! Hey! and, Yay!

It can be hard for parents to make the changes they see would be best for their families. Every good idea seems like a Sisyphean struggle.

Sometimes it’s useful to start very small. Let’s begin with a short, very simplified review of behavior modification from Psych 101. We’ve got positive reinforcement (YAY), negative reinforcement (also YAY) and punishment by application – life does something to you (OUCH), or withdrawal, when life takes something away (HEY!).

Let’s say it is noonish on a pleasant day, I have a break, and decide to take a walk outside. I will enjoy the breeze, the birds singing, a chance to move and clear my head. I will come back to the desk feeling invigorated. I have been positively reinforced. I did an action, or stopped an action, that resulted in something good (my uplifted mood).

A few hours later, it will be about 3 PM and I may have the beginning of a headache. I glance at my water bottle and realize I am way behind on fluids, so I drink a few glugs of water. In short order, the headache dissipates. I have been negatively reinforced: I did a desirable action, and something bad went away.

Punishment, on the other hand, is entirely different. If, feeling a bit bored, I decide to scroll through the news of the day, I might feel depressed and then realize I have wasted my break reading bad news (HEY!).  Or, I may notice the beginnings of a headache and, instead of a drink of water, start with a few chunks of delicious, smooth dark chocolate and then (OUCH) my headache may well get worse.

The point of this little meander through intro psych lessons is that, when making changes, maybe it will progress better if you find ways to start with positive and negative reinforcement rather than what will seem like punishments.

For example, let’s say you think that at least one weekend afternoon of family time without devices would be a good start. Teens and even younger children may not agree. Wrestling their phones and tablets away is feasible, but they will consider this HEY!, and their resulting dopamine withdrawal symptoms to be OUCH for them; their miserable behavior may be a big OUCH for you.  But if a family activity inherently means no devices and then everyone has fun, we now have a big YAY in place the OUCH and HEY! What might that include?

Being outdoors in nature, where devices may not work properly anyway. A movie outing. A museum that requires devices be silent and away. Physical activities. Someplace where there is no phone or internet signal. Or just take a deep breath and impose device-off mode around a slice of a day and spend it in actively doing things that would not be improved by device distractions. Have fun. Don’t lecture about how fun it was (that’s an OUCH). If your kid mentions it was pretty fun, you can agree and take that as YAY – an invitation to repeat as possible.

Hard Changes

Most of us have some changes to make. And most changes are not so easy. That’s why people postpone them, or poke at the edges, or just pretend the problem will go away by itself. Sometimes people convince themselves there isn’t even a problem, really; that it just depends how you look at it. Maybe so. But maybe there’s something that needs changing.

Let’s say you have a teenage child, or a child approaching the teens. S/he is cranky, sullen, uncooperative with chores, sulks during family meals and resists being on time for school and other appointments. S/he wants to spend time alone, in the bedroom, with electronics. The child is depressed and/or anxious and/or obsessive and/or perpetually angry. You know the situation will change, one way or the other. Everything changes. If you do nothing, you are gambling that your child will continue down this road and somehow, at 18 or 19 or 20, wake up, shake themselves off like a wet Golden Retriever and come out of their bedroom, smile and say, “Wow! How could I have been so wrong?!”

Yeah, I doubt it, too.

If you have this situation and need to take it on, it can be hard to know where to start. Here’s a suggestion: if the situation is not a crisis, then the most practical first step may be to start with yourself.

You will have to change. Perhaps you have to start the change process by being sure that all the adults in the house are on the same page in your expectations. Perhaps you need to get yourself on the right path.

You go first. You get enough fresh air, and time in nature, and sleep, and healthy nutrition, and balanced physical activity. You strive to do interesting and challenging things in what little free time you have. You will, quite naturally and incidentally, spend less passive screen time. You’ll be leading from strength rather than being a target for adolescents’ favorite criticism: that we adults are hypocrites. You’ll be in a much better stance to steer positive changes for your tween or teen.  

Not another horrible day

A different day, another awful situation. 

A child, or teen, or young adult has been struggling with emotional turmoil and is tumbling into danger. They confide in a friend, or maybe a few friends.

They may have “met” someone in an online chat and now this person is their “boyfriend” or “girlfriend,” and they are planning to run way to meet this person.

Perhaps the young person has been “sexting” with someone they know personally, or “met” online, and now are being threatened with “sextortion,” that the images of them will be spread around, unless they meet some demand. This has recently led to many teen and young adult suicides.

Perhaps the young person shares that they are a victim of abuse.

Or, perhaps they stumbled upon, or were led to, the terrible misinformation that hurting oneself is a useful way to cope with painful feelings. The young person proceeds to experiment with self-harm, and posts online about it.

So-called friends hear the plan, listen to the horrible stories, or see the images of scratches, cuts or burns, and fail to turn to an adult for guidance.

Every parent I’ve ever spoken to is under the impression that their child would, of course, come to them if a friend were in grave danger. And sometimes that is true, but an awful lot of the time – in almost any of these kinds of incidents I’ve ever encountered in clinical practice or consulted on, as it happens – that was not the case. The case was, almost every time, that other young people knew about the plan to run away, or the abuse, or the self-harm, and did not seek the guidance of an adult.

Sometimes these “friends” have an unflagging alliance, suddenly, to keeping promises (unlike the promises they have made to you, dear parent, about everything from cleaning their room to homework being done well to treating your automobile with respect). Sometimes they believe they are better equipped to help than an adult would be, although they cannot arrest an abuser, drive someone to the emergency room or help them connect with a mental health professional for counseling, and their capacity to manage extreme distress is probably not much better than the troubled friend’s skills. Sometimes they dread social disapproval for breaking the rule that you keep adults out of it, whether the “it” is someone self-harming, or sharing that they are a victim of abuse, or are planning to run away from home to meet up with the “boyfriend” they “met” online.

I urge you to have frequent, open conversations about these topics with your young people. Make them age appropriate; be calm and encouraging. If you are too stressed out, you may be misread as “angry.” Remember that adolescents go through a stage where their brain interprets almost every non-happy facial expression as “angry.” If that happens, the conversation will probably be a complete failure.

Be calm, be matter-of-fact, and be sincere. Ask questions, too:

How do the people you know handle things like a friend telling them this kind of stuff?

If this was your friend, what would you do?

If it were (fill in the blank for some close friend or family member), what would you want their friends to do in this type of situation?

Why do you think people are reluctant to ask adults for help with this?

What would make an adult seem safe to go to with this problem?

Don’t lecture; have the conversation. It may be a conversation that occurs for a few minutes at a time over an extended period. That’s okay; sometimes a few sentence and letting it simmer is what’s necessary.  

You may, without knowing it, be setting the groundwork to save a life.

Loneliness can kill you…Part 1

According to new research from the journal Nature, Human Behavior published on January 3, 2025, loneliness and social isolation lead to molecular changes that, in my simple terms, seem to set the body up for serious problems – increased risk for dementia, depression, cardiovascular disease, diabetes, stroke, and early death.  The researchers’ recommendations include routinely asking about loneliness and isolation, the way a health professional asks about sleep habits, alcohol use, and drug use.

If you are lonely on an ongoing basis, this is for you.

Loneliness can strike through no fault of one’s own.

Losing your spouse, for example, or a best friend, will almost inevitably lead to a long stretch of deep loneliness during the initial year or so of grief, and can continue beyond, as the bereaved person struggles to outsource some of that emotional, intellectual and spiritual intimacy to other relationships. In a healthy marriage, you share all sorts of confidences with a spouse that you simply might not share with anyone else – fears, dreams for the future, spiritual insights and struggles, and the warmth of shared memories that are no one else’s but the two of yours.  Somehow, some of that must be extended to others, and depth built over time. It an absolutely monumental task to parcel out these small slices of the immeasurable depth of a healthy marriage.

Moving, alone, to a new city, for a new job, can be exciting, but the reality can include aching loneliness when everyone at the new job goes home to their lives and you go to your apartment and try to figure out how to build a life. Developing the big, and small, connections that make a place feel like home can be daunting, and for most people, it takes longer than they had ever anticipated.

Loneliness hits other people, too. Those who are living primarily second-hand, separated by screens and trying to substitute electronic connections for human ones, are often intensely lonely. Some people interact with others in person, but the conversations are shallow, guarded and therefore nearly empty of connection and meaning. This type of loneliness can be even more painful, because it seems inexplicable; how can a person live with family or a partner and yet feel deeply lonely?

So, what to do? Unfortunately, the impetus is mostly on the lonely people to do something differently.

Here are some suggestions I would give to a client in such a situation.

  1. Go to church or synagogue. If you are grieving, try to go back to your own – but if that’s painful, go somewhere else, at least for now. If you are new to the area, just find a place that seems like a possibility. Then go to the hospitality time afterwards. Introduce yourself, and invite people to tell you about the faith community. Do not stand around with your cup of coffee and wait for people to notice you. Set a goal: perhaps that you will introduce yourself to three people, get their names, and ask a little about this community. See what happens. Try to focus on the other person; make the conversation a chance to get to know them and about their community – not about you. If it goes fairly well, go back the next week, greet those three people (and anyone else you met) by name if you can, re-introduce yourself without taking them forgetting your name personally, and see if you can meet a couple of other people. Within a month, you will have some acquaintance with a dozen or more people and have a solid idea if this community offers activities for education, worship and service for you to join.
  2. Even if you usually like to do things solo join at least one activity – one exercise class, one art class, one talk at the local bookstore, etc. – on a regular basis. Get to be a regular. Greet other people.
  3. Volunteer in your community. Do this with others. Doing good solo is beautiful, but if you’re not getting out of your head and focused on others in an interactive way, you are missing part of the point.
  4. Be friendly but don’t try to bully people into being your friends. For example, if you are new to the area, don’t wear out your welcome with the neighbors who came over to introduce themselves on moving day.
  5. Please do not use alcohol or other substances, or resort to hanging out having drinks as a way to cut loneliness.
  6. Be patient and keep trying! Think of these steps as experiments. Track what happens over time; be willing to change to a different experiment if the first one isn’t working after a month or so.

As you can see, the remedies for loneliness all include getting out of your head and into the world. Focusing on others, in small ways (such as greeting them and showing interest) to big ones (such as volunteering), is a critical part of overcoming loneliness. This can be really hard, because loneliness tends to make people even more withdrawn, more insular – it is a self-perpetuating problem unless you boldly step out, even with small but courageous steps, into focus on others.

More about connecting with others in Loneliness can Kill You, Part 2, coming soon.

Are we now voting on mental health?

Here in Florida, we have a process in which citizens can gather enough signatures and put an initiative on the ballot to alter the state constitution.

I vote no, even if in principle the idea seems good, because I don’t think that a majority vote is the way to treat a constitution. I would vote no, even if the amendment proposed to preserve, in perpetuity, the tax-exempt status of dark chocolate due to its obvious necessity to life. The whole idea of a constitution is that it sets forth basic principles: natural law, the essentials. All other laws and rules get held up to it to see if they fit within the boundaries of that constitution.  

In the upcoming election, Floridians will be asked to vote on a proposed amendment that would legalize non-medical marijuana for adults age 21 and over in Florida.  My libertarian side doesn’t much care what people do until it impacts other people. People who mess up their brains with drugs often seem to feel entitled to drive; ultimately, they demand their healthcare be paid for by other people; they clutter up emergency rooms, and do all sorts of other things that do impact others, making drug use a social, not a merely personal, issue.

Professionally, this deserves a resounding “no.” Not just because popular votes are not the way to treat a constitution; but because there is so much information not being openly and clearly presented on this.

To begin with, it is fairly laughable that there is so much so-called medical use of marijuana, when the research is sketchy for even the handful of possibly legitimate uses.  Anxiety? Insomnia? Marijuana is practically a recipe for anxiety, and in fact, can lead to very severe anxiety, especially among younger users.

Secondly, most people have been effectively shielded from information on the impact of marijuana on mental health, physical health, and crime. Why? Whose interest is served by hiding the number of ER visits for psychosis, panic, and/or hideously violent vomiting due to marijuana or other forms of THC use? Whose interest is served when the impact of THC in criminal activities is hidden? There is evidence that use of the modern, stronger forms of marijuana is leading to substantial increases in psychosis, self-destructive behavior and violence against others. Most people seem quite unaware of this. Did you know that the emergency room visits due to marijuana use – psychosis, panic and/or “scromiting” (screaming and vomiting) increased 53 to 400% in the first few years, from city to city? Or that even in Europe, the rate of marijuana psychosis slipping into schizophrenia has increased between 300 and 400% in the past twenty years?  In Colorado, a tragic experiment in progress on pot legalization, emergency room visits related to marijuana use increased 500% in the 5 years post-legalization, with severe psychiatric symptoms including psychosis and panic attacks. Then there is the pain and terrifying projectile vomiting typical of cannabinoid hyperemesis syndrome.

Critically, marijuana is not safe. It is prescribed medically (despite the evidence being rather variable and inconclusive) with a shrug: “well, the possibility of benefits outweighs the risks.” Fair enough; no reasonable person is worried about someone who needs appetite support or help with pain while in treatment for cancer or AIDS having long-term effects from marijuana; the possibility of benefit outweighs the risks.

That doesn’t make it safe. In 2021, about one-third of high school seniors were using marijuana in some form. We ought to be very worried about the effects on teenagers and young adults, whose brains are still in development and whom, evidence shows, will have long-term impacts years after they have stopped using marijuana. That, of course, assumes that they stop. About 17% – 1 in 6 – of people who start using marijuana in their teens will become addicted. The addiction rate is about 9% for adults, and that is old data from 2015, and thus trails the upticks in use and in potency.

The increased risks, especially for young males, for unremitting anxiety, psychosis, and a lingering apathy and lack of initiative ought not be brushed off or laughed off with stories of the late 1960s. Then, the available marijuana caused hallucinations for many people and was far less potent that modern varieties. In the past 40 years or so, the potency has increased about 4-fold.  For adolescents, the rate of suicidal ideation triples in those with cannabis use disorder; the rate of depression nearly triples; truancy, fighting, poor concentration all increase markedly with regular cannabis use.

Interestingly, we are urged to accept psychiatry when it comes to destigmatizing mental disorders and treatment, but this enthusiasm for psychiatric expertise melts away when it comes to legalizing weed in all its forms. The American Psychiatric Association still officially opposes the use of marijuana, noting it is not research-supported for psychiatric diagnoses and bears substantial risks for psychiatric side effects. The experts are discounted on this one thing. What could possibly drive that behavior?

Stepping back and gazing at these points – and I am sure there are others – I ponder why there is so much interest in promoting this particular amendment.  Is it because, as the old Judas Priest song goes, “Out there is a fortune, waiting to be had”? Is it really the case that so many people who are enthusiastic about bossy rules about the size of people’s American flags, house colors or the time people roll out their trash cans are libertarian on this one thing? How will they feel when it is their son or daughter who slips away into depression, relentless anxiety or psychosis?

The argument is made that legal marijuana will be pure – not laced with fentanyl or other deadly substances. Assuming this is the case, and that there arises no underground market to avoid taxes – moonshiners versus revenuers, remember? – the question remains as to whether the risk is worth it in terms of psychiatric and gastric impacts.

Who will pretend, later, to not have known how dangerous what will no doubt be called something like “Big Weed” really was, and rush to sue because of brain damage, the loss of loved ones to suicide or cancer? What about those whose death is due to initiating violence while “high” and being killed by someone in self-defense? What class action suits will emerge to right the wrongs of mass hospitalizations for psychosis and its long-term medical management? Will it in fact be the same ruse of not-knowing used against tobacco, despite its having been referred to as “coffin nails” even in the 1800s? And beyond these major effects, what about the many lives and talents wasted by indifference and ennui as the years-long lingering apathy steals young adulthood and early middle age?

What would make sense:  this proposition as a possible law, not as an amendment, with publicly available hearings and testimonies from all sides: those incarcerated for years for petty possession charges and those whose loved ones spiraled into psychosis and suicide.  Let’s hear sworn testimony and evidence from medical experts on both sides and statisticians who can break down the data on crime and medical impacts.  Then, having heard the information, we can, through the legislative process, pass a law that adheres to the principles of the state constitution and best suits the facts of the situation.

Social Contagion

(This post mentions eating disorders, self-harm, substance abuse and suicide. Please reach out to your local emergency services if you or someone you know is struggling with any of these!)

When I was in 9th grade, I unwillingly, and briefly, attended our parish’s very small Catholic Youth Organization meetings (CYO.  The group comprised mostly boys, all altar servers, who played ping pong and pool with our associate pastor, a well-meaning middle-aged priest from Poland. The only other girls were the type of enmeshed best friends that are normal at that stage of life. Their shared passion was Bay City Rollers. They put together, in that era of typewriters with ribbons and no internet, a monthly fan newsletter with some success.  Life would have been oh, so easy, if only I could have mustered enthusiasm for the boys from Edinburgh.  I tried. But, despite the social costs, a Dylan fan I remained.

Go ahead, laugh. But you have faced the challenge of social contagion, too. You may even now be wearing a style of clothing you don’t actually even like. It’s just what’s “in.” As a teenager, you wore the right clothes, or pined after them; you strove for the right hair style. You wore the trendy colors even if they made you look ill, and were anxious for the approval of your peers.  It’s not just kids who follow the crowd; every married person knows that when your spouse’s friend circle comprises mostly divorced people, there may well be trouble ahead.

Over the years, we’ve seen waves of societal concern about the risks of contagion. Were young people teaching each other to cut or burn themselves (1990s), how to purge or starve themselves (ongoing since at least the 90s), how to get a so-called “high” from household items? Could a teen’s suicide lead to copycat attempts?  The answer to all of these is, yes.

Children now are not gifted with preternaturally adult-style brain development. The ability to sound sophisticated by parroting what you’ve read or heard is not the same as an adult brain with a well-developed executive function – something that takes into the early to mid-20s to acquire.  Your kid is not any more resistant to peer pressures of even the subtle type than you were when you were screaming in excitement over a band because all your friends were.  As it happens, they are more vulnerable, because peer pressure can surround them wherever their cell phone works. Odds are, you were free – as soon as you were off the school bus, there was some space for other influences to counterbalance the noise of adolescents striving to show their individuality by being as much like their desired group as possible.

Notice the vagaries of the teenage years: they move from music star to music star, aesthetic nomads in lockstep. No one wears jeans; then they all wear jeans. The games, the accessories, even the car you drive falls under the anxious eye of a child who wants to fit in.  It’s important for all of us to be attuned to the various social pressures to conform, because we want our young people to survive, and thrive, throughout these very turbulent times.