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.

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.

Cutting off Mom and Dad, Part 3

…and now we come to the final installment (so far) in my
wonderings about this strange phenomenon of parent rejection by adult children.
So far, I have tried to spread the responsibility around: the infantilization
of young adults by many institutions, the culture at large, and parents. Now it is the young people’s turn.

It is my observation (granted, limited to some review of the
literature, professional trainings and clinical experience – over a quarter
century) that it is not usually the abused children who grow up and cut off
their parents. This seems odd, doesn’t it? If a child who was tortured decided
to cut off contact, we could understand, even support the healthy distancing.

It is much more typical for the young person who simply does
not want to be bothered to cut off the parent or parents. Quite often it seems
to be one parent; a widowed mother, typically, which makes me suspicious that
the possibility of some sort of responsibility drives the distancing. I am sorry to be that cynical, but so it
sometimes seems. Other themes seem to be
that the parent doesn’t just pat the child on the head for every decision, or
the parent has different political opinions, or religious beliefs.

If you are an adult, then surely you have developed the
capacity to tolerate the presence of people different than you; it appears to
be a matter of pride to young adults, especially, to be open-minded about
people’s differences, to refuse to allow even stunningly foundational
differences in values to be barriers to mutual respect. If that is the case, if
you think of yourself as tolerant, then surely you can tolerate the fact that
your parents, or grandparents, or aunts or uncles or other relatives, no doubt
have different ideas than you (and from one another). It may come as a surprise
to you that your parents, whom you may see as some monolith of monotony,
actually disagree with one another. A lot. The research indicates married
couples disagree on about two thirds of the stuff of life, or more; they just
have figured out, I hope, how to live and let live on these disagreements and
how to work with the few that are pretty significant areas.

Are you afraid? Afraid that you cannot properly defend your
own positions, operationalizing your terms and pointing to data, rather than
feelings, and that interacting with your parent(s) will be an exercise in
losing an argument and feeling like a fool?

Are you afraid to simply listen to try to understand more of
their opinion, meaning the information and experiences that support that
stance?

Are you afraid that staying close to aging parents will mean
being stuck with them, having to take care of them, when you are carefully
curating your life to minimize responsibility?

Are you afraid you will die of boredom if you have to listen
one more time to their ramblings about the events of their lives, which may
actually not be any more ennui-producing than your own (have you wasted a chunk
of your life bingeing a fictional series lately or playing video games?).

Are you afraid that they will keep trying to get you to
change and you are tired of explaining to them that your
job/partner/reproduction plans are not up for discussion?

Are you afraid to set boundaries, including the boundaries
of discretion? Surely you do not talk about everything with every friend; in
the same way, it can be very wise to discern what topics to discuss with whom.
If your definition of family means “people who have to accept and agree with
everything about me,” then even something as simple as dietary differences (the
omnivore and vegan siblings, for example) will necessitate cutting off a family
member when all you had to do was not rave on and on about the great steak you
grilled last weekend or stop talking about murder when you are sharing a meal.

Cutting off family without very strong grounds to do so is a
red flag. If your friends have done so, consider their reasons; if this is how
they treat the people who sacrificed for them in ways they may not yet
understand, exactly how solid is the rock you stand on with these friends? Can
you really count on them to be there, helping to clean up after you have
vomited, for the zillionth time, during chemo? To show up for you when there is
a death, or a birth, and in the long months of change and bewilderment
afterwards? To take a day off and drive you to and from having your wisdom
teeth out, or a colonoscopy, or whatever else has to happen – and the medical
office will not release you to a ride share service?

The family cut-off is a tragedy, under the best and most
reasonable of circumstances. The dangerous parents might need to be cut off,
for the sake of their children and grandchildren. It is heartbreaking that life
had to come to this, but it may be necessary. That is not something to be done
lightly, indifferently, or without serious reflection of how this decision will
play out in the decades to come.

Thanks for reading –

Cutting off Mom and Dad, Part 2

As previously explored, the culture undermines parent-child relationships. One way is the manipulation of expectations of normalcy. Young adults are frequently told to believe that anything less than absolute, craven praise and approval, of anything, is some sort of miserable toxicity and not to be borne. The relationship must be severed, even with parents.

On the flip side, many parents feel that their position as parent gives them license to offer criticism, advice, and endless commentary on their adult child’s habits, clothes, parenting, etc. If you are financing an adult child, then I would suggest you tell your child what you will do – not what the adult child will do. You can’t make them do anything, but you can control yourself. A self-sufficient adult who lives on their own, paying their own way, and raising a healthy, well-adjusted child does not need unsolicited advice or undermining, either.

If you’re thinking, reading this, that you jolly well can make them do something – well, actually, no, not without force. We parents specialize in saying things that can’t be enforced, silly things like yelling at a toddler, “You’re going to get in there and go to sleep right now!” The average three-year-old has figured out you can’t make her go to sleep; and if you do anything that forces sleep, and I find out, I will report you to Child Protective Services. A three-year-old is portable: you can pick them up and transport them to their bed, over and over, but the command to sleep is just a waste of syllables.

Sometimes, fellow parents, you may be grieving. You had your child, and you had dreams. You imagined a long future, that child’s adulthood, and the ideal fantasy of whatever your engagement with that child’s future life would be. I was hoping for a shared private practice (we had discussed this, to be fair!) and lots of hands-on times with grandchildren and spent a couple of decades amassing cookie cutters and art supplies that seldom needed, and given away with much grief, grief not for the things but for the unfulfilled dreams. Instead, I have an adult child of whom I am immensely proud who lives many hours away, and that means her husband and their lovely child are far away, too. I don’t get to impose my dream, or a guilt trip about my unfulfilled dream, on them. Doing so would be foolish and unfair, and reduce the likelihood I can enjoy what I have, which is far more than many people have, and a situation that those who are involuntarily childless would envy.

So…this set of posts on family cut-offs doesn’t solve anything. I don’t have any big, smart solutions or a therapy intervention that will take away the pain of alienation from the very people for whom you would willingly die. Perhaps it can open up some ideas for reflection, or conversation. If you are an adult who has cut off a parent, please reconsider, seriously and prayerfully, on whether their behavior warrants that wall of silence. If you are a parent, wondering what you have done, perhaps there is room to change the ways in which you try to influence or even make demands on someone who does not belong to you. Perhaps there is nothing to be done except wait and pray, which comprise tremendous power in the long run. What to pray? I do not know. I can tell you how I pray, across all relationships: family, friends, clients, students, our leaders, our enemies…that both the other party, and I, be open to becoming who God wants us to be. Amen.

Cutting off Mom and Dad, Part 1

We were talking about families, generally, over breakfast.

“I don’t know why family therapy isn’t held in greater esteem,” my husband commented. “Look at what things are like for families…people are really struggling.”

I agreed with the struggling. And, yes, it would be nice if family therapy were more respected. It is rich with the integration of lifespan development, evolutionary psychology, personality, temperament, and culture. Family psychology and family therapy seem to be the neglected child in the world of mental health. Yet every theory of development, and most personality theories, see the family and early life experiences as foundational to the development of the adult person. How we attach to others, the ease of trust, our expectations of the world, are all rooted in life experiences, particularly those early life experiences most often lived in the context of family.

Well, of course, if we emphasize family then we are saying family is important, pivotal, vital. And that, it seems, flies in the face of much of the mainline culture.

I will take one small slice for now: the bizarre movement to cut off parents who were not, and are not, abusive, neglectful, cruel, or so otherwise dysfunctional that remaining in active relationship with them would be endangering to one’s safety and/or sanity. There seems to have been, over the past few years, a growing movement in this regard. I have spoken with people, and read books by professionals, on both sides of these issues: the grieving parent and the disgruntled adult child; the professionals who attempt to help parents bridge the gap or, if that is impossible, to heal from the grief, and the therapists whose main lens is the toxic relationship that will only hurt you until you extricate yourself.

Are there cruel, abusive and destructively manipulative parents? Yup. And, likewise, selfish, cold and manipulative adult children, too. And my somewhat limited professional experience (I’ve been in this field about 30 years) is that sometimes children who cut off parents did not have abusive, cruel parents. Sometimes, people cut off parents who did not do what the child wished, did not read their minds, did not feel obliged to agree and praise everything their child did.

And here we come to a piece of the culture guaranteed to undermine the family: the demand that people validate and accept whatever one thinks, feels, and does as indisputably “okay” because it is how we “feel,” etc. Well, now we have a problem that any family therapist could easily explain.

Mommies, generally, give children the majority of early care. They provide unconditional love and approval because, as Dr. Jordan Peterson often points out, infants are “always right.” If the baby is crying, the baby is right: something needs attention, swiftly, lovingly and gently! That loving care must come even if baby is colicky, pukey, poopy, or otherwise quite disagreeable. The baby is, after all, always right. However, this stage of life passes, and then Daddy’s influence increases: Daddies specialize in unconditional love with conditional approval. “I love you, and the room is a mess. Get going on it, kid. Here, I’ll give you a hand.”

This coordinated approach works great: it prepares children for the real world, where people have expectations and you can’t just do “whatever” and then complain it’s how you feel, and have everyone act shame-faced, shrug and say, Oh, OK. If that’s how you feel. Whatever. Children benefit from the solid backing of both parents’ love, and the experience that disapproval of how I behave does not mean I am not loved. It means my behavior probably needs improvement.

The world, or the part of it to which children and young adults are often exposed, plays another tune. The modern message is that the relentlessly approving gaze of a nursing mother ought to be the perspective of parents forever, across all circumstances. That is a set-up to disrupt and undermine the family.

And it appears to be working terrifically.

A child goes off to college and is enlightened about…it matters not. Politics, nutrition, whatever. They realize their parents are abject idiots. Worse, their parents may be bad and ill-intentioned because, look! A younger sibling is being raised in a religious/liberal/conservative/omnivore/vegetarian/whatever home. Big sibling becomes disrespectful towards the parents, dismissive, and undercuts them in an attempt to rescue little sibling from the fate of growing up in the same family.

Or, a young adult who is apparently sliding along, perhaps in perpetual adolescence, shifting from goal to goal, engaged with street pharmacology or alcohol, resents the parent who dares express concern and perhaps even the intent to turn off the money tap. Anger, resentment, and accusations flare; the young person demands parental fealty, blames the parents, and the parents, afraid of losing the relationship, are tempted to cave and pretend that a ten-year cycle of major changes in undergraduate school is just okay. It wouldn’t be okay even if the young person was the one financing it with their series of so-not-serious jobs; it would still be a waste of talent and youth.

In short, the mainstream culture offers the illusion that new-mommy bottomless approval is what is normal for adults. Do parents contribute to the problem of parent/child alienation? Absolutely; and that will be a story for another day.

I could tell you #3: Screening the Screens

#3 in a series: I can tell you, but you’re not going to like it.

Once again, I’m the fun-killer, offering information for your recreational purposes that you might not like hearing.

Thus far, I’ve discussed getting more sleep and more physical activity as ways to help children who seem restless, unhappy, unable to focus (except for electronics, usually). If you have been experimenting with those changes – perhaps for your children, perhaps for yourself – and a few weeks have gone by, I suspect you have noticed a few changes.

You may be sleeping better and waking up more rested and alert. You may be naturally less reliant on caffeine and high-sugar foods to wake up or to get through your day. If you were tracking it, you might also notice that you are spending less recreational time with electronics. If you were managing these changes for a child, you experienced some degree of pushback, possibly to the level of an addict being denied their drug of choice, because the brain becomes addicted to the rewards of social media, video games, etc., and it will take time to replace that addiction with healthy patterns. If you were able to persist, within a few weeks you probably noticed positive changes in mood and behavior.

Some studies have supported the approach of adding positive changes before taking things away. For example, if a person needs to quit smoking, eat healthier and exercise, success is most likely to accrue if exercise is added first. This becomes an additional reward and incentive, and can help buffer the withdrawal from nicotine as well as withdrawal from addictive, highly processed foods. In that spirit, it seems it could be easier to have begun helping a child heal from the cultural damages that contribute to anxiety, depression, attentional problems, etc. by adding positive things (sleep, exercise and play) before directly taking away negative things (specifically, the largely unsupervised world of the online universe).

If your child has any unsupervised screen time, it is almost guaranteed they are seeing things you do not know they are seeing or want them to see. End of story. You think you have adequate controls, and firewalls; and somewhere far away, people with far more expertise in technology than most of us are busily creating pathways to circumvent parental controls.

As I have shared in other columns, one of my little escapes in a long work day may be a two to four-minute clip off the internet of some old movie: a dance scene from Mary Poppins, a short scene from Much Ado About Nothing, a few moments of Branagh’s Henry V, the latter not cheery but stunningly well done and quite grounding, as examples. These are my typical fare: dancing penguins, singing suffragettes and Shakespeare, but sometimes up will come next some horrible thing – R-rated, violent, hideous – so terrible that even shutting it down immediately is too much exposure. From this I hypothesize that if you think your kiddo is happily watching perfectly clean children’s videos and do not supervise, you don’t know. You do not know whether some horror or corruption that was carefully created and marked with the right key words to intrude on that corner of the market is slipping into the stream.

Under the best of circumstances, if it were an hour or two of tap-dancing penguins, it is on too much time to surrender to passive entertainment without being selective. Most people will not just absent-mindedly pick up any book and read it for a couple of hours and then look up, surprised and resentful, when interrupted for food or water or homework. The internet, however, is something else: the endless parade of “talking” kittens, so-called “influencers” and worse contrive to steal time every day from many people. It’s not all bad, of course; I listen to educational lectures when I’m on the stationary bicycle six days a week. I’ve encouraged people to watch “The Chosen.” I’m in favor of well-researched educational programming. I’ve done car repairs under the tutelage of a mechanic on Youtube and am still stumbling through beginner Spanish with the internet, too.

If you are unconvinced about the use of the internet, watch the documentary, “The Social Dilemma.”

Cutting back on tech time is hard. You’re probably not, initially, going to like it, and odds are your child will fight you – hard. We’re talking about your child’s well-being: their physical health, mental health, intellectual development and social skills. It’s worth the trouble. Try adding the deliberate reduction of entertainment with electronics to the improved sleep and physical activity habits. Then see what happens.

If this were my kid…

Advice-giving: some therapists claim it should never be done; therapists-in-training are eager to leap in with advice before they know enough about a situation to offer it. The stance on advice-giving has its roots in various philosophical approaches to therapy.

For those of a more psychoanalytic bent, it is the role of the therapist to push for deeper self-exploration and understanding, with that “a-ha!” process leading to more responsible, better-informed decision making. Insight leading to action is a vital part of maturation; the alternative is an adulthood of adolescent reactivity and self-absorption.

Psychoanalytic insight may not do a frustrated parent any good at the moment they are figuring out how to handle the upside-bowl of cranberry sauce on the floor. Again.

In solution-focused brief therapy, the emphasis is on searching for times when a problem is absent or much reduced and breaking down the details of those situations, especially in regard to clients’ behaviors. This process empowers the client to realize that s/he is already equipped to deal with much of the situation(s) at hand and develop plans to do more of what already works.

This is a very helpful process, but sometimes people want a little more guidance.

Psychoeducation – teaching, basically – is different than telling a client specifically what to do. It provides information, refers to scientific data, often linking particular actions to help with problems. Education is part of holistic counseling approaches to many concerns, including depression, anxiety, eating disorders, and problematic insomnia.

All of which brings us back to the question of advice. I am not a new therapist, and people are not coming to see a therapist with 25+ years’ experience and some white hair so I can look vaguely concerned and steeple my fingers and murmur, “Hmmm, how do you feel about that?” when they express anger and shame over their inability to get a five year old to comply with bath and bed routines.

So, I am, at least for the moment, breaking the invisible fourth wall – the wall first broken in literature by Charlotte Bronte in the final chapter of Jane Eyre – and say, straight out, “If this were my kid…

“I would take away all electronics for at least six weeks. Maybe longer. Not even any television/movies unless a responsible adult is with them.”

Yes, they are going to be bored. They will be angry. If they have been playing video games, they may become aggressive and destructive – be prepared for this. If they have been using pornography, it could be even worse. Fists and feet have gone through drywall over losing access to video games and phones. If your child becomes hostile and aggressive (not just normally angry), it is evidence you are doing this late in a problematic process. What are they going to do? Play other games. Make art. Play the instrument that is gathering dust. Exercise. Do chores. Read. Libraries offer books, puzzles and games to borrow: no cost, little effort. Try a family book club to introduce them to a broader range of reading. Help them learn how to have a conversation in full sentences, complete with eye contact. The possibilities are boundless.

If they need a device for school, it can be carefully monitored and programs to limit access (such as Covenant Eyes) are available to try to control what is going on.

“I would have them do chores. No, ‘school is their job’ is not a good idea. Do you want to be married to someone who goes to work, comes home, and expects to be waited on, because they did their job?”

By 13, an average, healthy child should be competent at all the basic skills of housekeeping. That means, able to clean any room without having to call in HazMat; sorting, washing, appropriately drying (read the tags), folding and putting away laundry (I give everyone a pass on fitted sheets, and yes, that reflects on my clumsiness); plan, execute, cheerfully serve and thoroughly clean up simple and nutritious meals; do most of the tasks of pet care; be able to handle trash, recycling and compost duties. Would you want to be roommates or married to someone who can’t do these things as a young adult? Your future daughter- or son-in-law will appreciate it.

“I would have them get an hour or two more of sleep, every night.”

According to the CDC, children age 6 to 12 need 9 to 12 hours of sleep per night. Teens need 8 to 10. Odds are, your child is not getting enough sleep and you are already saying this is ridiculous and impossible; how are you supposed to do this?

Insufficient sleep has an almost immediate detrimental effect on brain structures and functions critical for focus, memory and mood: factors that teachers and parents spend a lot of time complaining are deficient in children. You know what you’re like when you don’t get enough sleep; foggy-brained, irritable and looking around for caffeine and sugar. Your children are like that, too, except you are probably keeping the little ones away from triple-shot lattes. If your teen has to be up for school by 6 AM, then they have to be in their room without electronics sometime between 8 and 10 pm. The math is easy; accepting that something has to give is the hard part. Make it an experiment to accompany the electronics question and see what child you meet after a few weeks.

“I would have them learn to use a planner.”

Unlike the early years of school, and even a lot of secondary classes, real life – adult life – requires strategic planning. By middle school, students should be learning how to break down tasks into manageable, realistic chunks and follow those plans, adjusting as necessary. That means writing down “Social studies test tomorrow” Thursday night is not good enough. It means figuring out how much review needs to be done each night of the week to be adequately prepared, and adding that to Monday through Wednesday’s plans. Even outside of school, the skill of planning is useful.

For example, many people get into power struggles/arguments/endless debates over dinner. The frequency with which this particular power struggle erupts in therapy would astound non-therapists. I do not understand the surprise that dinner must be had. Name a date in the future – any date – and if I am not deceased, unconscious or doing colonoscopy prep, I will expect to eat. The need for a meal at night will never catch me by surprise. Yet this recurring surprise is apparently part of the annoying texture of life for many families. Model the benefits of planning. Get the week’s meals worked out, and streamline evenings. There is an immediate benefit: instead of arguing about “what to do” and wasting two hours around it, have a quick, planned meal and then have time to do something fun, like watch a parent-approved movie together, fold that pesky laundry, and push around more pieces on the 2000-piece puzzle of a Tiffany window that seemed like such a great idea at the time.

I’d make some good memories, I’d say, if this were my kid.

Every parent’s nightmare

All good parents – and most not-very-good-at-it parents – want what is good for their children. They would like them to grow up happy and healthy, to have a comfortable life, stay out of jail, etc. A few grandchildren and regular calls and visits would be nice.
Often unspoken, but definitely there, is the desire that their child not be what they might call “crazy.” It’s not my word – I’d use depressed or anxious, or having a psychotic episode – but for parents, one of the greatest fears of all is that their child grows up to be mentally ill, with hallucinations and delusional beliefs – to be out of touch with reality, to be, in short, psychotic.
Psychotic doesn’t mean “violent and crazy,” as it is so often misused. It means to be out of touch with reality, often with some sort of hallucination (hearing voices, seeing things that aren’t there, or some other sensory misinformation) and/or delusional beliefs (paranoia, which may mean being persecuted or it may mean an unrealistic arrogance, belief in one’s special powers, or that one is in fact someone of great power and importance).
And, it turns out, psychotic symptoms are a risk factor for two common substances in the lives of young people: methylphenidate, a commonly prescribed drug for ADD/ADHD, and cannabis.
The research on methylphenidate has been ongoing, in some cases for decades, and while you cannot do experiments to “prove it” (who would volunteer to try to have their child rendered psychotic just to see about a drug’s effects?), researchers scour multiple studies following up on children and teens prescribed methylphenidate, and find that 1 to 2.5% develop psychotic symptoms. That’s up to more than one in 50. The latest meta-analysis was published this summer in the Scandinavian Journal of Child Psychiatry and Psychology, using multiple studies with over 77,000 young people in all.
The link between cannabis and later psychotic symptoms, as well as anxiety, for young people has been known for years, but often studies began in the mid- to late-teen years and it was difficult to determine if those who were prone to mental disturbances were more attracted to cannabis than healthy teens, or if otherwise healthy teens were developing psychosis as a result of cannabis use. With studies beginning earlier – in 7th grade – researchers feel confident asserting there is an increased risk for psychotic symptoms within a year after a teen begins using cannabis. This is for all teens, not just those with family histories of psychotic illnesses such as schizophrenia.
What should parents and other caregivers do?
If your child is being treated with methylphenidate, work closely with the prescribing physician to monitor side effects, be honest about what you observe, and do not panic. Remember that counseling and neurofeedback, provided by experts, can help someone diagnosed with attention deficits develop skills and neurological adaptations to reduce symptoms. Seek a referral from your child’s physician.
In terms of illegal drug use…assume no “safe” amount of an illegal substance. The fact that many states have legalized or decriminalized marijuana has misled many people to believe it is “safe.” It is not. The American Medical Association and the American Psychiatric Association both have published strong positions warning about the use of marijuana.
Parents and caregivers also need to be mindful that the drugs used for ADD/ADHD, and methylphenidate as an illegal substance, are popularly misused, sold, or shared among young people. According to studies published as recently as last autumn, 5 to 10% of high school students and 5 to 35% of college students use, or have used, prescriptions for ADD/ADHD illegally as “smart” or “study” drugs. This may be regular use, or may be occasional to get through end-of-term crunches with minimal sleep. Side effects include sleeplessness, agitation, anxiety, dizziness, headache, sweating, appetite loss, elevated blood pressure, and psychosis.
Be alert for subtle changes in behavior and do not be afraid to be assertive about this. Your child’s physical and mental health may depend upon it.

Go and Do, for Me and You

Verbs, like “go” and “do”
In a recent on-air segment, Jamie and I (he’s the afternoon radio talent for Spirit FM, the local Catholic radio station/Christian pop music station where I’ve been volunteering since 2009) were discussing various social protests. He had asked me how to handle the flood of social media, with people posting/re-posting/re-re-posting, and the pressure to have some sort of opinion/assert some stand on perpetually protesting celebrity.
I try, but don’t always succeed, in preferring action verbs. Like, “go” and “do.” I don’t much care for meetings. I don’t like sitting around talking about how we can help the homeless and severely mentally ill. I went and did (full time work, almost 5 years). Jesus didn’t say, sit around and have lots of committee meetings. He said, pretty much, Go… (He also had something to say about babbling on and on, so I will move along.) I would rather teach than talk about teaching, do art than sit around talking about art…you get the idea.
So my thoughts are, go and do. It would be far more helpful – if, for example, we are talking about the real and obvious pain in poor neighborhoods – to go and do. Mentor a kid. Be a Big Brother/Big Sister. Organize a community watch organization. Do pro bono work in your field. Provide free tutoring. Be a Guardian ad Litem. Etc., etc. Go and do. Standing around getting attention for taking a public position that costs nothing seems a little self-serving.
It reminds me of the time a woman I knew criticized me for failing to wear red on some arbitrary date publicly announced to be the day to wear red to support women’s heart health. The only woman whose heart I have much influence over is my own. I had already exercised, gone to church, had good conversation with my husband, eaten a healthy breakfast – in other words, it was 8 AM and I had done all I could for THIS woman’s heart health. Nothing I was going to do, besides pray and try to set a half-decent example, would help anyone else.
It also brings to mind the big test for reports of visions of the Blessed Virgin Mary. Such a report requires much evidence, but a primary benchmark requires that Mary points towards Jesus. There is no credibility if the reported vision does not direct people towards Jesus. Such an experience is not something from the Good side. It might be a well-intentioned, innocent delusion, but it is not Mary. Mary doesn’t showboat.
So…if terrible injustice moves you, go and do something concrete, specific and clearly helpful for one particular person. Keep the meme to yourself.
…and more on “Go” and “Do”
Teen and young adult mental health took a drastic, terrifying turn for the worse beginning in 2007 – and the stats keep worsening, especially since 2012. This, according to a lot of research, can be traced back to the smart phone, according to San Diego State University professor, researcher and author Jean Twenge. Her recent book, “iGen: Why Today’s Super-connected Kids are Growing Up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared for Adulthood – and What that Means for the Rest of Us,” provides the results of not just her original research but meta-analysis of generations of data on the pattern of mental health and activity for youth.
It seems like constant connectivity has led to less “go” and “do” and more detachment and isolation. It’s a double-dose of negative: the ineluctable distance created by screen-based communication and a deficit of direct experiences. We were not designed to sit and click; we are made to go and do.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

Posts are for entertainment and not meant to be construed as treatment or professional recommendations. If you need mental health assistance, please contact a licensed professional in your area.

Plan B

I am very, very hopeful that, when I leave the office this evening and get into my Ford Fiesta, it will start when I first turn the key and that all four tires will be inflated. It gets regular maintenance and I expect it to start. My plans, including the amount of time I schedule for various commutes, revolve around the expectation (Plan A, as it were) that the little car will be ready to roll.

Sometimes, she is NOT ready to roll. She might have a flat tire, or a dead battery (Florida heat is rough on batteries). So, just in case of various emergencies, I have a jack, spare tire, some tools, a can of tire-inflator, a quart of oil, some water, jumper cables, a fire extinguisher, an owner’s manual and my AAA card. I also have a Bible and Rosaries for other sorts of emergencies. I would vastly prefer not to resort to any of these Plan B’s alone in a parking lot at night, but every so often I have been happy to have them readily available.

On a much more critical scale, military and police personnel have to have plan B at the ready in case of a worst-case scenario. Let’s say you are a special operator and you and your comrades are supposed to slip in silently, extract an American hostage or two, and slip out with the same seamless, silent efficiency. That would be Plan A: no one on your side gets hurt and maybe not even too many of the enemy. If enemies have to be hurt, they cooperate by succumbing very, very quietly. Plan B, entailing air support and extra personnel and a whole lot of messiness, is far from optimal. Plan A is effective if nothing goes wrong. If anything goes wrong, then you need Plan Bs. Plan Bs have a higher likelihood of success in the case of an uh-oh situation than Plan A, but are far less desirable.

Most of us don’t have to worry about extracting hostages or inflicting deserved mayhem on an enemy. We have to muddle through, discerning our purpose and doing our best to live rightly. Do we, who don’t have any expectation of being caught in a gunfight, need a Plan B? It’s become quite popular, especially in the business school world, to assert that a Plan B is an excuse to let Plan A fail.

I would argue that Plan B is part of the backbone of successful planning. Consider, for example:

You have promised your small children that, if everyone cleans up their bedroom by 9 AM Saturday, you will all go to the zoo! Yay! You had better have a Plan B already presented to them, too, in case of rain (as in, if it rains, we will postpone the zoo and have lots of fun doing “X” at home). You do not have control over whether or not it rains on your zoo day, but you have control over creating alternatives that account for circumstances beyond your control. Would you rather have Plan A – a sunny, fun day at the zoo? Absolutely; but if it’s wet, cold and dreary, kids who are able to be disappointed but know that all is not lost are easier to deal with than children who are whining because “you promised we could go to the zoo,” and claim they care not that it is raining and all the animals will be hiding inside, out of the weather. You promised.

There are thousands of possible examples: the college application that is Plan B if the desired, and worked-for, scholarship at your Plan A school doesn’t materialize; the back-up work plan if it takes longer to get a job in your field than you’d expected; the gift you will get for your child if the most popular toy that holiday season is out of stock. Would you rather get a full scholarship to an Ivy League school, a great job that starts exactly two weeks after graduation and be able to score Tickle Me Elmo, the latest Transformer AND the talking pony? Yup, yup and giddy-yup…but those are not all within your control.

The business school model against Plan A, very interestingly researched by Doctors Shin and Milkman, focuses on short-term goals with brief time periods. One test, for example, was that some participants were asked to consider a Plan B if they failed at the brief task while doing the brief task. If you have 10 minutes to unscramble sentences, and the reward for success is a free snack and some are warned up front that, hey, you might want to think about where else on campus you can score some free food in case this doesn’t work out for you, those participants might be a bit distracted from the task at hand. You have given them two tasks. That doesn’t mean they were not motivated for Plan A (the free snack) but rather they had to do two tasks at once: the task for the free snack and figure out where to get free food if the buzzer went off before they finished the first task. This is one of several experiments in their research. Other business writers have emphasized the belief that asking people on a project to have a plan B is like giving them permission to fail at plan A.

This is an interesting perspective and very narrow in its focus. There are risks in over-generalizing the findings of any particular piece of research, something Doctors Shin and Milkman know. Unfortunately, readers who see a non-academic’s cheerful, “Hey, if you develop a plan B you plan to fail,” misstated summary of Doctors’ Shin and Milkman’s work might leap to the conclusion that Plan B means Bad Plan. That is not what the researchers concluded.

I would propose that there are a few common reasons for a bias against adequately thinking through a Plan B when preparing to execute Plan A. These are by no means comprehensive –

“I have done everything that success requires and so I am entitled to success.” Ah, the entitlement myth, in which a benign and biased-towards-you universe bestows what you have earned even though there is far less of whatever you want available than there are hard-working and deserving candidates. Hundreds of people might apply for that scholarship, and all of them have great GPAs, hours of non-mandated community service and glowing endorsements from their local Mother Teresa. Yet the committee (and its computer program) can only give the scholarship to one applicant. Scholarship, job, internship…failing to achieve that one, ideal Plan A doesn’t mean you personally failed. It means that you didn’t get Plan A, probably for many reasons outside of your control.
“I am terrified of not meeting the expectations of those close to me (parents, often) and so most pour everything into Plan A. Anything less than absolute success means I have failed them – and myself.” This speaks to the narcissistic parent (“I am a perfect parent and you, my ought-to-be-perfect child, are the Exhibit A in proof of my perfection”) projecting the need for boundless success and admiration onto the child. Spouses can do this to one another, and children might fall victim to Pygmalion coaches or teachers.
“If I have a Plan B, it will surreptitiously make me turn into a lazy slug who will fail to put in the effort required for Plan A.” This is the, I can’t trust my own strength of character theorem, and one can only say in response to this, “Know thyself.” However, lack of a Plan B is not going to singlehandedly turn an unmotivated sloth into a laser-focused, goal-oriented powerhouse. If you know you need to work on your intrinsic motivation strength, now would be a good time to start.
“Plan A is my heart’s desire and I cannot bear to consider life without it…so I will just not consider the fact that Plan B might be necessary.” This is idealistic and romantic, and if you are not a good-hearted male under age 21, you probably need to accept a teaspoon of reality. If you are a good-hearted male under age 21, I will cut you some slack. That is the healthy age range for passionate idealism with a dose of immortality myth. The rest of us have to deal with the reality that life changes constantly. Your robust good health, your vision and hearing, the career you love, your neighborhood…will all change. If there is not a Plan B, you will have the alternative of crushing despair on top of the burden of grief, time after time after time.

I began this essay, spurred by a friend’s report of an adult daughter who, failing to get the job she’d applied for after college, is moving back home without any particular plan. Apparently, there was no Plan B. This led to curiosity about the “Plan B” issue in general, and discovering Shin and Milkman’s research. Not long after I began this essay, the book Option B, by Sheryl Sandberg and Adam Grant was released. I am looking forward to reading Option B and have no idea of its contents other than it was born within the heartbreak of unexpected grief and the part of the grieving process that requires that we shift to an alternative vision of our future.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

drloriputerbaugh

Psychotherapist, Author, Teacher

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