Category Archives: mental illness

Coping with grief when a child attempts (or completes) suicide

Coping with grief when a child attempts (or completes) suicide
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In the US military, the Purple Heart medal is awarded to a soldier who is wounded in battle, or who later dies of those wounds.

In the years of writing this blog, I have shared practical information on behavior and treatment, and offered encouragement and hope for parents.  But hope and information cannot soften the impact of this horrible statistic:  The mortality rates of teens with mental disorders are 3 to 4 times more deadly than most childhood cancers, and the statistics only measure those deaths by suicide:  Mental illness more deadly than cancer for teens, young adults.

Death by suicide seems especially tragic because it appears to be a choice, and while we tell ourselves that mental illness is the cause, it’s not the same as a car accident being the cause or a tumor being the cause.  Unsuccessful suicide attempts are no less traumatic, like a cancer that keeps returning, because you can’t come to terms with a “maybe.”  A parent is held hostage by the anticipation of loss, a relentless moment-by-moment fear that your child will attempt again in the future until they are successful.  It’s an emotional ride one’s subconscious never ever forgets, and it becomes your PTSD.  You can carry it quietly with you for decades, until a sneak attack, when you find yourself overreacting to a news story, a scene in a movie, or a conversation with a friend.

My PTSD ambushed me recently.  I was attending an evening class when suddenly a person next to me slammed down her cell phone, exclaimed “Oh my God!” and quickly grabbed up her things and dashed out.  I followed to check on her and see if I could help with something.  As she speed-walked to her car, she said her daughter had texted that she swallowed a poison because she was upset, but is now sorry and wants help.  I got back to the classroom in shock, trembling, and completely unable to focus.  It had been many years since I had received a similar message, but it felt like it had just happened again that moment.

You are not alone if you’ve ever secretly felt it would be a relief if your child ended their life, bringing peace to you both.  (And you wouldn’t be a bad parent, either)

But death is more than self-inflicted suicide.  You face a death of hope when child with a serious mental disorder that takes a long slow trajectory through addictions, high risk behaviors, and unstable reactions to life’s many insults.  Families like ours bear witness but can’t intervene, or interventions don’t work.  All we can do is wait and hope and do what we can for our child, day by day, and banish thoughts of a different future.  I consoled myself with the knowledge that my child was getting by, and getting by was enough.

Another type of death caregivers face is the loss of their child’s “self” as they knew it, and their future as they imagined it.  A mentally ill child or teen can morph from a fresh young person in a world that is wide open to them, to a scary being we don’t recognize as our own and cannot understand–a stranger, a changeling, a flame snuffed out too soon.  It should not be this way.  It is unfair.  It is a tragedy.  You start healing the grief when you are able to make the commitment to do the best you can anyway.  YOU HAVE EARNED YOUR PURPLE HEART.

Any serious medical condition can devastate and traumatize a child’s family, but those with mental disorders impose a complicated trauma that’s hardly possible to resolve.  The following stories are actual examples.  Ask yourself:  how does one be a loving responsible parent in these situations?

–  When her daughter attempted suicide, an overwhelmed single mother discovered that her son had been sexually abusing and cutting her for 3 years, right under her nose.  The guilt she felt was quadrupled by the guilt laid on her by others.  She didn’t know how to go forward as a mother from here, after loving but failing both children.

–  A teen girl attempted to hang herself in a very public place, and many found out about it before her parents.  Their first trauma was the call from the emergency room, their second was from the shower of doubt others laid on them:  Where were you?  Why didn’t you help her before it got this far?  What did you do to drive her to this?  And it was unending.  The daughter threw these doubts back at her parents repeatedly.  There were several inappropriate people in the community who wanted to “rescue” the daughter, including a teacher, but undermined the parents’ authority completely, and their ability to get treatment for the girl.

–  One couple devoted themselves to raising a difficult boy they adopted when he was 2.  At 9, after years of problems, he sexually assaulted a playmate, and they found themselves disgusted and repulsed.  The brokenhearted mother said she had long ago accepted that her boy would never be normal, but this was different.  She didn’t want him anymore.  (I’ve heard parents talk half-jokingly about taking their offspring to Nebraska. *)

You are not alone if you’ve ever secretly wanted your child to be taken away to never live with you again. You are not alone if you feel you’re DONE.  (And you would not be a bad parent for thinking this.)

Consciously keep the good things alive.  Display photos of the real child you know or knew, the one without the brain problems.  Keep their writing or artwork or tests scored A+.  Other parents experiencing a loss do this, whether the losses are from death by disease, or death of self due to brain damage from an accident.  Speak often of the good things they were or are, as any proud parent might, keep the memories alive.

Get out of your trance and take yourself back to here and now.  When you notice yourself caught up in a train of thought and obsessing on your fear or paranoia, get back in the room—get back to driving that car or attending that meeting or straightening the house.  Get back to noticing the people you love, get back to making those helpful plans.  Central to the philosophy of dialectical behavioral therapy (DBT) is the concept of “Mindfulness.”

Remember this wisdom: take one day at a time.  You can handle one day, you can keep cool, do what must be done, feel accomplishment, in one day. Don’t think farther ahead.  Since you are the linchpin, the one holding up the world, you probably don’t have the luxury of taking a break, and may have to hold things together until there is time for your own healing.  The one-day-at-a-time approach is imperative.

When you’re leg is broken, you need a crutch.  When you’re heart and mind are broken, use the “crutch” of a medication for depression, anxiety, or sleep.  Do other healing things for yourself, whether exercise or therapy or asking for comfort from friends.  Acknowledge your wounds and admit this is too much handle.  You have earned your scars from bravery, so wear them as the badges of a hero.

A tragic event does not mean a tragic life.  I know a mother whose son completed suicide as a young adult in his 20’s.  She seemed remarkably cheerful and at peace with this.  She spoke lovingly of him often, and her email address comprised his birth date.  She continually did her grief work, was active in a suicide bereavement group, and often offered to visit with families facing such a loss.

— Margaret

How am I doing?  Please rate this article at the top, thanks.

*  In the United States, in 2008, the state of Nebraska enacted a “Safe Haven” law to reduce the tragedy of infant child abuse and neglect.  The law allowed anyone to anonymously leave a child at a hospital with the promise that child would be cared for.  But something unexpected happened.  Parents from around the nation drove hundreds and hundreds of miles to leave their troubled older children instead.  Nebraskans eventually amended the law with strict age limits for infants only.

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Filed under Grief, mental illness, mental illness, parenting, PTSD, suicide

The 12 Commandments for Parents of Children with Behavioral Disorders

The 12 Commandments for Parents of Children with Behavioral Disorders
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  1. Thou art thy child’s best and most consistent advocate.
  2. Thou hast valuable information about your child. Professionals need your input.
  3. Thou shalt put it in writing and keep a copy.
  4. Thou shalt not hesitate to contact a higher authority if you can’t get the help you need.
  5. Thou shalt keep records.
  6. Thou shalt seek out information on your child’s condition.
  7. Thou shalt have permission to be less than perfect.
  8. Thou shalt not become a martyr, thus, thou shalt take a break now and then.
  9. Thou shalt maintain a sense of humor.
  10. Thou shalt always remember to tell people when they are doing a good job.
  11. Thou shalt encourage thy child to make decisions, because one day, he or she will need to do so on their own.
  12. Thou shalt love thy child, even when they don’t seem lovable.

– – – – – – – This is a revised version of “The 12 Commandments…” published by the Pacer Center (Parent Advocacy Coalition for Educational Rights) for children with physical and medical disabilities. www.pacer.org.

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The blessings and curses of schizophrenia – A father’s view

The blessings and curses of schizophrenia – A father’s view
3 votes

This guest article is by Don Moore.

Some families are presented with the dual dilemmas of dealing with a child that is both gifted and troubled.  Such is the case with my daughter who in spite of her schizophrenia nearly ended up on the popular television show American Idol.

Most fathers would be quite pleased if children came with owner’s manuals.  Mind you, the great majority would not read the manual, but prefer to use their own experiences and logic to determine appropriate actions in parenting.  Owner’s guides would be a fine reference resource to look up how things were to be done after trying their own thoroughly contemplated actions before resorting to some sort of predetermined remedial action.

Particularly in American society, a Man’s perspective is to reason out and come up with solutions to problems they encounter or to follow a set of requirements at their employment to retain their job.  Sure, there are exceptions, especially for those who pursue artistic endeavors, but even these can often be reduced to techniques, learned, practiced and then applied.  (More about men’s approaches to parenting is here:  For men who raise troubled kids) 

Like many other parents and especially fathers, my work revolves around the repair of things and when I first encountered my daughter’s difficulties with life, I followed an approach of analyze, find a solution and apply a remedial fix to my interactions with her.

Much of Western medicine follows this thought process as well; study the problem, recommend a treatment and magically the problem will be gone.  The real problem is that this simplified view does not reflect the nature of the underlying problem with many mental health issues.  An especially difficult disorder to use this approach with is schizophrenia.  Because we define this illness as a set of behaviors and characteristics and each person can have or not have many of the characteristics, the approaches that I followed in dealing with my daughter’s situation were woefully inadequate as well as misguided.

In fact, most of my approach to dealing with my daughter would have been ineffective with just about any teenager, much less one suffering from hearing voices and disjointed thinking.

If the point of reference that you are using to deal with a child with schizophrenia is that the child is somehow concerned with what effect their behavior will have upon you, you are sadly mistaken.  This is precisely what I thought when I would painfully explain why some task had to be done, like load a dishwasher.  If she could not complete the task, it was obviously because she was trying to agitate me and I responded by becoming agitated and angry at either her lack of compliance with my instructions or the poor quality of her efforts.  As the behavioral difficulties became more serious my frustrations escalated accordingly.  The escalations were equally ineffective.

All of the difficulties came to a crisis point when my daughter left to attend a performing arts college in Minneapolis.  There her difficulties took on another level of seriousness and she returned home.  Under the care of a psychiatrist, some progress was made and my wife and I elected to take a class in dialectic behavioral therapy (DBT) for parents.  The class, in conjunction with some wise advice from her psychiatrist finally got me to see that her difficulties were from within her own mind and the best approach was to understand her behavior reflected her struggles to deal with her view of the world and were not based upon a master plan to disappoint or offend me personally.  DBT techniques allow you to understand the effect of delusions on the child’s behavior and instruct you to deal with the feelings that those delusions have on the child’s behavior. There is not an acceptance of the truth of the delusion, but there is an acceptance of how the person feels about the thoughts they have.  Having someone verify their feeling about the delusion (It must be frightening to believe the government is using thought control on everyone) without accepting the truth of the idea helps the person modify their response to the delusional thought.

Once there is an understanding of the thought issues facing the person with schizophrenia, there is hope that the narrative that their brain has created for their existence in the world can be refocused to include new ways of viewing the world and how they are to interact with those around them.  Proposing alternatives to how they see the world is a method of getting them to rethink the ideas that they hold and readjust to a new way of behaving.  It is by no means as simple as an owner’s guide, but progress is possible.

Tracy and Emmy winner Joey Pantolino

In my case, the treatments my daughter received helped considerably at first and she was able to make a journey to American Idol tryouts, meet the famous judges in person and come one audition from actually being on the television show.  You can see her story in the February 2006 SZ Digest magazine http://www.schizophreniadigest.com/e107_plugins/szproducts/images/articles/2006_spring_story1.pdf  or at my website, www.matersofthemind.info .

Another aspect of mental illness that seems to be misunderstood is the wide range of seriousness and variation with symptoms.  My family has been both fortunate and unfortunate.  My daughter has been blessed with a set of skills in singing that brought her national recognition for her efforts with American Idol, but did not ultimately reward her with employable skills or remediate her disease.  There are others with schizophrenia with truly exceptional talents who find jobs and recovery.  There are also those who struggle with more serious symptoms.  Whatever the course of your loved one’s illness, there is some measure of comfort in seeking and finding skills that will help in dealing with the issues that are confronting them.  Not the least of these skills are understanding the emotional turmoil that the person feels in dealing with their view of the world and helping them deal with the issues surrounding that view.

Tracy and Senator Gordon Smith (wrote and passed mental health legislation)

During her American Idol experience, my daughter wrote and recorded a song entitled “I am Not Alone.”   There is no reason that any family or person should be alone in their efforts to deal with their condition.  While it may sometimes feel lonely, seeking out resources and learning about the experiences of other people with similar challenges will help in your efforts to create not an owners’ manual but a guide to help you understand alternatives while you seek a better path to follow.  You may not cure the disease, but you can respond better to the challenges you face in your own journey.

–Don Moore

I offer deep gratitude to both Don and Tracy for sharing their remarkable experiences

Margaret

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Life at home is a war zone

Life at home is a war zone
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Homes with troubled children are war zones–very different from those with physically-disabled kids.   We can’t make things better for our child with wheelchairs or ramps or other specialized equipment.  We need serious fire power.  This story tells what it’s like to live with our child, seek mental health treatment, and find social and emotional support for ourselves.  It is inspired by, and much quoted from, Emily Perl Kingsley’s “Welcome to Holland,” about having with a son with cerebral palsy.  The original is at the end of this article.

Welcome to the War Zone

I try hard, often unsuccessfully, to describe the experience of raising a child with a brain disorder – to try to help people who have not shared that difficult experience to understand it, to imagine how it would feel.  It’s like this… When you’re going to have a baby, it’s like planning a fabulous vacation trip – to Italy.  You buy a bunch of guide books and make your wonderful plans.  The Coliseum, the Michelangelo David, the gondolas in Venice.  You may learn some handy phrases in Italian.  It’s all very exciting.  After months of eager anticipation, the day finally arrives.  You pack your bags and off you go.

Several hours later, the plane lands.  The stewardess comes in and says, “Welcome to Afghanistan.”  “Afghanistan?!?” you say.  “What do you mean Afghanistan??  I signed up for Italy!  I’m supposed to be in Italy.  All my life I’ve dreamed of going to Italy.”  But there’s been a change in the flight plan.  They’ve landed in Afghanistan and there you must stay.

They’ve taken you to a dangerous unstable place full of fear.  You have no way to leave, so you ask for help, and citizens offer to help but you must pay in cash.  Instead of help, they lead you down one blind alley after another.  You are afraid because you are different, you are a target because you stand out.  After spending most of your cash, you can’t ignore it any more–you are in very serious trouble–completely alone in a strange country, surrounded by people who don’t like you.  You won’t be rescued.  You can only think about hiding and praying and holding yourself together.

After a few years of ‘round-the-clock stress and isolation, you make a couple of connections, and arrange an escape across the border.  There are dangers in the next country, but your connections help.  Your escape seems to take forever, yet you finally make it home!  But everyone you know has been busy coming and going to Italy… and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.” And the pain of that will never, ever,  go away… because the loss of that dream is a very, very significant loss.  But… if you spend your life mourning the fact that you didn’t get to Italy, you may never feel the fulfillment of using your character-building experience to help others escape Afghanistan.

Margaret

– – – – –

“Welcome to Holland” by Emily Perl Kingsley – http://ourlifeinholland.blogspot.com

“I am often asked to describe the experience of raising a child with a disability – to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It’s like this….When you’re going to have a baby, it’s like planning a fabulous vacation trip – to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It’s all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, “Welcome to Holland.” “Holland?!?” you say. “What do you mean Holland?? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.” But there’s been a change in the flight plan. They’ve landed in Holland and there you must stay. The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It’s just a different place. So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met. It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around…. and you begin to notice that Holland has windmills….and Holland has tulips. Holland even has Rembrandts. But everyone you know is busy coming and going from Italy… and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.” And the pain of that will never, ever, ever, ever go away… because the loss of that dream is a very very significant loss. But… if you spend your life mourning the fact that you didn’t get to Italy, you may never be free to enjoy the very special, the very lovely things … about Holland.”

The Holland story has been used widely by organizations such as NAMI (National Alliance of Mental Illness), as a way to help parents with troubled kids accept their situation when their child is identified as having a brain disorder.  Holland just seems too nice, too peaceful, to relate to our situations.

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Naturopathic and holistic mental health treatment

Naturopathic and holistic mental health treatment
7 votes

This guest article is by a naturopathic physician in Portland, Oregon USA, who specializes in mental health treatment for children and adults.  Following is a summary and link of a podcast about the use of holistic/alternative medicine for the treatment of ADHD.

Addressing Mental Health Issues From a Holistic Perspective
Krista Tricarico, ND.  www.openmindmedicine.com

Holistic treatment

The health of the mind and body are intricately linked. Just as our thoughts strongly influence our physical health, our individual physiology affects our mental and emotional well-being. The foods we eat, our digestive health, the toxins in our environments, our hormones, lifestyles, experiences, beliefs and attitudes all play important roles in our physiology and biochemical make-up. As a philosophy, holistic mental health recognizes this beautiful web of interdependency.

Holistic approaches for adults and children can be used in conjunction with psychiatric medication, but unlike pharmaceuticals, holistic mental health treatments usually have the “side effect” of improved physical health and a richer emotional experience. Rather than suppressing or covering up symptoms with a drug, the goal of treatment is to address underlying causes and work towards integration and balance.

As a naturopathic physician, my goal is to support the wisdom of the body and mind and facilitate an individual’s inherent ability to heal. Naturopathic Doctors (ND’s) are licensed primary care physicians who have attended a four-year, postgraduate-level naturopathic medical school and are clinically trained in the art and science of natural therapies. In addition to conventional diagnosis, laboratory testing and pharmaceutical medications, the scope of naturopathic medicine includes nutrition, counseling, homeopathy, botanical medicine, physical therapies, and mind-body approaches. Naturopathic training does encompass the same basic bio-medical sciences as conventional medical training, but the approach to health and disease differs considerably. It is the philosophy of naturopathy that clearly differentiates this medicine and directs how we approach each patient.

Treatments

This will look different for each person and will be guided by conversation and individual interests as well as physical exam and laboratory analysis when appropriate. I have found the following therapies to be key factors in mental health recovery.

Counseling

Some patients see me primarily for counseling, and people with this focus are welcomed. Others are either interested in a blend of counseling and naturopathic approaches or seek care strictly for holistic medical support. A young person’s treatment needs and interests also change over time, so I meet a patient where they are at this moment. My counseling approach has a strong emphasis on self-awareness and mindfulness. Self-observation coupled with an attitude of curiosity, openness and acceptance allows for conscious insight and more freedom in the responses to the stresses and challenges a young person faces daily. Mindfulness-based therapies are a particularly effective approach for depression, anxiety and addiction issues, and can lead to increased clarity and a sense of contentment.

Nutritional Therapies

The foods we eat have a direct impact on the chemistry of our bodies and brains and, therefore, on our mood, thoughts and behavior. Our brains require the correct balance of amino acids, fats, vitamins, minerals and glucose in order to function properly, and individual needs can vary drastically. I work with all patients, children and adults, to uncover their unique nutritional needs through history-taking, diet analysis and lab testing, and then help individuals address underlying biochemical imbalances through shifts in their diet and nutritional supplements. Food allergies or sensitivities can play a significant role in mental health, as well, and the removal of these foods from the diet can have a profound impact on one’s healing. Orthomolecular psychiatry is a field of medicine that has applied these nutrition-based therapies in the treatment of conditions such as schizophrenia, bipolar disorder, anxiety and depression and has helped shape my naturopathic practice.

For more information about orthomolecular medicine, visit www.orthomolecular.org.
For more information about food allergy testing, visit www.usbiotek.com.

Homeopathy

Homeopathy is a gentle yet powerful system of healing based on the principle of “like cures like.” People have observed since ancient times that a substance that causes an illness or symptom can, in very small doses, cure the same problem by stimulating the body’s intrinsic healing ability. Through an in-depth interview, I strive to understand a child’s unique physical, mental and emotional experiences and, after careful study, select the appropriate remedy. Homeopathy offers a safe and elegant treatment that is a natural complement to counseling and can be used alongside conventional medications and other naturopathic treatments. As a truly holistic and individualized form of medicine, it is particularly well-suited to psychological and psychiatric concerns. Although identifying the effective remedy can sometimes require patience and perseverance, the results of successful homeopathic treatment are profound and long-lasting.

Restoring Digestive Health

Many mental and emotional concerns have their origins in the gut. It is important to identify and treat conditions such as hypochlorhydria (low stomach acid), candida overgrowth, gut dysbiosis (a bacterial imbalance in our digestive tracts), parasites, inflammation, leaky gut (increased permeability of the intestinal wall), and food allergies as they have direct effects on brain function. Imbalances in the gut play a significant role in many neuropsychological conditions. Conversely, our emotions strongly influence our appetite and digestion. The nervous system and the digestive system are intricately linked by a constant exchange of chemical and electrical messages including nutrients and neurotransmitters. Anything that affects one realm is likely to affect the other, and I have found that addressing gastrointestinal health is often foundational in one’s mental health recovery.

Blood Sugar Balancing

The sugar in our blood is called glucose, and this is the primary fuel for our bodies. Being one of the most sensitive and demanding organs, our brains require a constant supply of this glucose to perform its never-ending functions. A healthy body is able to regulate the blood sugar to provide a consistent energy source for the brain; unfortunately, this function is commonly impaired. Hypoglycemia is a condition in which the body can’t sustain constant glucose levels and can be a causative factor in attention and behavior issues, anxiety, panic attacks, rapid-cycling bipolar disorder, insomnia and addiction. Elevated blood sugar over time not only leads to diabetes, heart disease and obesity but also mood and behavior disturbances, decreased mental functioning and dementia. Many psychiatric medications put people at additional risk for blood sugar problems only exacerbating this problem. Balancing your blood sugar is an important component of disease prevention and general health and will also support your mood, energy, metabolism and mental functioning.

Amino Acid Therapy

Supplementation with amino acids can help optimize neurotransmitter levels. Amino acids are the building blocks of proteins that our bodies transform into neurotransmitters such as serotonin, melatonin, GABA, dopamine, epinephrine and norepinephrine. These are the messenger molecules that allow our nerve cells to communicate and have a direct impact on our mood, learning, attention, pain and pleasure perception, sleep, energy, and thought processes. Most psychiatric drugs manipulate our body’s ability to process these neurotransmitters in an attempt to alter the levels of these important chemicals. Instead of, or in conjunction with, antidepressants or anti-anxiety medications, we can give the body the amino acids it needs to make more neurotransmitters and avoid the negative side effects of the drugs. Neurotransmitter testing is available and can help guide the treatments. Targeted amino acid therapy is a powerful tool for addressing a wide variety of mental health concerns and provides a safe and effective alternative to these medications.

For more information on amino acid therapy, visit www.neuroassist.com.

Balancing Hormones

Our hormones are produced and controlled by our endocrine glands and include chemical messengers such as thyroid hormone, cortisol from the adrenals, insulin from the pancreas, and estrogen, progesterone and testosterone from the reproductive organs. As parents of adolescents who are entering puberty know, hormonal change has a profound effect on behavior. Imbalances or disturbances in any of these interconnected systems can alter the way our brain functions. For example, thyroid dysfunction is an often-overlooked, underlying cause of depression, anxiety, poor memory and fatigue, and PMS is a well-recognized cause of mood swings, depression, anxiety and sleep disturbances. Helping the body regain its delicate hormonal balance can have far-reaching effects for the mind.

Detoxification / Heavy Metal Chelation

We are exposed to an extraordinary amount of toxins through our food supply, the air we breath, and even our tap water. Toxic exposures affect the health of our brains. When the body encounters more toxins than it can effectively process, it stores these chemicals in fat cells, and our brains are largely made up of fat. Some people are good detoxifiers. Others with autism, ADHD, Alzheimer’s, Parkinson’s, depression, chronic fatigue, schizophrenia and bipolar disorder are often not. Supporting detoxification and the safe elimination of toxins can be a key component to mental health recovery. I assist patients with appropriate detoxification strategies whether that is a gentle cleanse, a more intensive detox protocol or heavy metal chelation.

Mind / Body Treatments 

Mind/body treatments engage the power of your mind in your own process of healing. I use therapies such as breath work, meditation, memory reintegration, relaxation strategies, and Emotional Freedom Technique (www.emofree.com) to help patients move towards a state of awareness and peace. Reflecting on and connecting with one’s own spirituality can also be an effective stress-management tool. Learning to consciously calm the mind and relax the body has a powerful effect on our neurotransmitters, hormones and immune system, and ultimately our health and sense of well-being.

Dr. Krista, www.openmindmedicine.com


Foods that support brain and mental health

  • Avocado
  • Walnuts, almonds, other nuts and seeds
  • Salmon, tuna, sardines, mackerel, herring, trout
  • Ground flax seed
  • Brightly colored fruits and vegetables – eat the rainbow
  • 70% cacao and higher dark chocolate
  • Green tea (stone ground from whole tea leaves)
  • Berries:  acai, blueberry, cranberry, blackberry

Herbs and other alternatives that support brain and mental health 

  • Fish, cod liver or krill oil (if you could only have one thing, this would be it)
  • L-theanine or kava kava for calming and reducing anxiety
  • Turmeric, curry and other antioxidants
  • B-complex vitamins
  • Magnesium
  • Light therapy, for improved mood and energy

Substances that are bad for brain health

  • Alcohol
  • Artificial food coloring
  • Artificial sweeteners
  • Sugars: cane sugar, soft drinks, corn syrup
  • Hydrogenated/partially hydrogenated fats and trans fats (fried foods). Saturated fats are fine, it’s the hydrogenated and trans fats that are bad.  I actually highly recommend organic coconut oil
  • Nicotine, Marijuana, all other controlled substances

How do you like this article?  Please rate it at the top, thanks.

Integrative Management of ADHD – What the Evidence Suggests
By Richard Balon, MD | January 6, 2011

The use of complementary and alternative medicine treatments by children and adults with ADHD is the rule rather than the exception…more than half of parents who have children with ADHD treat their child’s symptoms with vitamins, dietary changes, and expressive therapies—but only a small minority tell their doctor. And roughly 8 out of 10 patients who use these treatments regard them as their primary therapy.

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On psychiatry and stigma

On psychiatry and stigma
2 votes

When parents complain about psychiatrists, it’s often due to them judging the parent as being the reason for child’s problems; one might call this a bad “bedside manner,” but with huge consequences for the family.  If parents aren’t listened to, or are talked down to, they can’t help, nor live with, their incredibly stressful child.  Yet poor customer service is not unique to psychiatry; the medical field has lots of practitioners who aren’t helpful or people-friendly.  What’s different about psychiatry is that The Rest Of The World often thinks it is sinister and evil.

Our Own Worst Enemies
Nada Logan Stotland, MD, MPH

“Oncology manages to cloak the most primitive possible treatments—poison and burning—with elaborate protocols. Yet the mention of psychiatry conjures ECT, and ECT conjures images of the snake pit.  …We are the only specialty with our own dedicated hate group. We shouldn’t be our own worst enemies.”  May 18, 2010, Blog @ www.psychiatrictimes.com

o        Dr. Stotland, above, mentions ECT  (electroconvulsive therapy), or “shock therapy.”  It reboots the brain and is the only thing that keeps some people alive and eases their suffering.  So how is ECT worse than shocking a stopped heart with a defibillator–two paddles on the chest and BOOM!  Which is more barbaric?

o        In the TV medical dramas, there’s this common scene:  a patient is in a hospital bed surrounded by doctors, and the patient is bleeding, or screaming in pain, or convulsing.  Somehow this is acceptable in prime time.  What if the scene was different.  Instead, an agitated, hallucinating patient is being restrained, and injected with a drug that immediately calms and relaxes them.  My guess is the public would find it sickening and unethical.

o        When a sweet-looking child loses all of his or her hair after being poisoned by chemotherapy, it evokes sympathy and compassion.  But if this same  child’s hair was lost while taking a psychiatric medication, then it would be seen as a barbaric side-effect of forcing drugs on children to send them to zombie-land.  Cancer treatment is forgivable,  treatment for brain diseases is not.

This public attitude must change.   It victimizes the victims who live with mental disorders, and their providers and families.   Mental health treatments are no more barbaric than those of other medical illnesses, but the stigma manifest in blame, prejudice, and ignorance of brain function are cruel–can’t people see we are doing the best we can to get help for sick people?  Let the dialogue be about improving lives instead of finding fault with doctors, sufferers, and families.

mp

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Use IQ sub-scores to guide your child’s future

Use IQ sub-scores to guide your child’s future
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The IQ of a child or teen does not predict their success or failure in the world, nor their chances for a meaningful life that’s full of well being.  But in very practical terms, your child will need to function as an adult someday, and take care of themselves, which means getting a job and getting a life.  What’s the best job or future path?  What isn’t?  If you know how your child scored on different parts of the battery of IQ tests, you can guide them to a future that rests on their best scores, and this is especially important for young people with behavioral disorders.  Let me explain.

A person’s IQ is the average of the scores from tests for different types of intelligences, and each test can be scored from a range of 0 to ~200.  From the Wechsler IQ Scale, used most widely in schools, there are six intelligence types. (There are many different IQ tests in use today, besides the Wechsler Scale.)

  • Verbal comprehension  Ex:  Measures the ability to write, work crossword puzzles, use words creatively or convincingly, tell interesting stories or funny jokes, debate an issue, explain things clearly, and use a large vocabulary.
  • Perceptual Reasoning  Ex:  Measures the ability to put puzzles together, appreciate of art or photography, use geometry, learn best with charts and pictures, draw, notice details.
  • Working Memory  Ex:  Measures the ability to remember strings of numbers or letters, lists, and subjects just observed or subjects recalled from a much earlier time.
  • Processing Speed   Ex:  Memory recall, speed of problem solving, recognition, and correlation.
  • Reading   Ex:  Measures the ability to read and understand different types of writing, to learn and draw conclusions from reading, reading speed, comprehend the meaning in written material.
  • Math Reasoning  Ex:  Ability to solve mysteries, solve logic and math problems, organize things, figure out how things work, use technology, appreciate and apply science.

Your child’s individual intelligence scores are better indications of your child’s strengths and weaknesses.  You should support interests that take advantage of where their best intelligence is, their high scores, to prepare them for schooling or a job.  On the other hand, if you know where they score low, you can arrange extra support for them before they become adults–or you can guide them away from a future choice (such as a career) where they won’t or can’t thrive.

The philosophy here is to help your troubled child use the best of what they have, and not require them to be well-rounded.  Pressuring them to do well in everything isn’t helpful for two reasons: 1. troubled children commonly have a wider range of low to high scores, and they aren’t or can’t be well-rounded; 2. your effort goes into weaknesses they struggle with, instead of  strengths that need nurturing and celebrating.  For troubled kids especially, self-esteem is critical.

A hypothetical case –  Take two very different children with very different IQ scores, yet both with the same behavioral problems in school.  They act out, pick fights, hit others and damage others’ things.  Sean is a 15-year-old boy with an IQ of 83, diagnosed with ADHD and Fetal Alcohol Effect (FAE); Katy is a 10 year girl with an IQ of 122, diagnosed with PTSD and ODD.  In the graph below, Sean’s scores are in red, and Katy’s are in blue.

 Sean’s score of 83 is misleading because his overall functioning is much lower.  In fact, three of his test scores are below 75, the level designated as developmentally disabled.  His special education teachers are surprised he does so poorly in school because he seems so normal on the surface thanks to his above average verbal skills.  He has lots of friends.  He communicates clearly, he listens to others, and he likes to tell good stories. What should Sean be when he grows up?

Half of Katy’s scores are above gifted, ~130, but her below average verbal ability prevents her from mastering essential social and communication skills.  Because she’s so intelligent, people are surprised that she continues poor behavior even though she is punished for it.  But Katy’s behavior comes from an early trauma.  And with lower verbal skills, she has a harder time communicating her needs, and experiencing the many little interactions that help us mature.  Katy can do anything, but what shouldn’t Katy do when she grows up?

To help people understand the implications of IQ, psychologist Dr. Arthur Jensen created a chart that he believed matched IQ scores to careers:

  • 89-100 would be employable as store clerks
  • 111-120 have the ability to become policemen and teachers
  • 121-125 should have the ability to excel as professors and managers
  • 125 and higher demonstrate skills necessary for eminent professors, executives, editors

“What is an IQ?” http://homeworktips.about.com/od/homeworkhelp/a/IQ.htm

From this chart, Sean’s IQ of 83 is too low for a store clerk, and yet Sean is able to function pleasantly and helpfully around people in structured situations.  He might do fine helping customers in the right kind of store.  He’s also good at tackling one day projects with groups of people.  Maybe landscaping or neighborhood clean-up is is meaningful to him and he thrives.

Katy could easily become the professor or executive in Dr. Jensen’s chart, yet her verbal skills might limit her to careers that don’t require nuanced interactions with people.  She might do best working semi-independently, possibly in technology, science, or engineering.  She might love a summer science camp where her intelligence would get the challenges it needs and shine.

What will your child do when he or she grows up?  You can’t make their decisions, but you can influence their choices.   Introduce them to situations they are predisposed to master.

“No IQ score should be considered an exact measure of intellectual ability…  It does not measure creativity, leadership, initiative, curiosity, commitment, artistic skill, musical talent, social skills, emotional well-being, or physical prowess – all components which can be included in definitions of giftedness.”
National Association of Gifted Children http://www.nagc.org/index 

How am I doing?  Please rate this article at the top, thanks!

— Margaret

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Life with a schizoaffective teen

Life with a schizoaffective teen
61 votes

I have first-hand experience raising a child with schizoaffective disorder.  Up until my child’s onset of the disorder in the ‘tweens’, I never thought I had much patience or backbone.   But one’s character strengthens with trials, and I learned I was patient and stronger inside than I thought.  Parenting my child entirely changed my life’s direction.

Farther down this post are practical tips and advice for raising your child.

Schizoaffective teens have both schizophrenic symptoms (thoughts disconnected from reality) and affective symptoms (unstable emotions and moods).  What an unfair combination of experiences to sabotage one’s brain.   My child had to persevere through intense feelings, excruciating anxiety, and thoughts that rarely touched on facts.  How could anyone maintain any semblance of normalcy during this?   The mental effort of holding oneself together was exhausting.

My child was often exasperated with me, as other teens are with their parents:  “Mom, you don’t understand me, it’s like the TV’s on, the radio’s on, the stereo’s on, you’re talking to me, and I’m trying to read a book, and I can’t not think about every single thing.”  Right, I couldn’t relate.  I could not imagine processing 10,000 inputs at once without going crazy.

Hallucinations feel normal when you’re in them

My child had a slow early onset of hallucinatory experiences beginning about 11 or 12, and was able to hide it until 14.  She considered the hallucinations and voices normal, and became accustomed to them.  Eventually, she noticed that others didn’t see or hear the same things:  the rhinoceros walking by; the sky turning green; words writing themselves on a blackboard.  To my child, here was proof of being special, magical, a traveler on the metaphysical plane.  Because there was proof, she felt superior to others and that she had special powers.

I have never had hallucinations, but imagine they are like dreaming wide awake.  My child’s audio hallucinations included something out of Monty Python:  two loudly arguing British ladies, with thick Cockney accents, relentlessly criticizing each other’s cooking and husbands.  She complained it was impossible to hear what the teacher said in class.  (Even today, during summers when she is happy, the stand-up comic voice visits and tells jokes throughout the day.  Our family witnessed many outbursts of laughter and giggling for no apparent reason, then started laughing contagiously.

My child’s visual hallucinations took fascinating forms:  stairs looked like a cascading waterfall, a living room chair continually rotated in space instead of standing still, moving objects left trails in space, like a series of images seen with a strobe light.

She awoke one morning with memories of life as a great queen for 1000 years, and talked about it in extraordinary detail.  Imagine her dismay when she discovered her mom now rules.

My child is the bipolar type of schizoaffective person.  While depressive types don’t have the highs or excessive agitation,  they still suffer with anxiety and paranoia.  When she was in a down cycle, she darkened her room and slept in a pile of bed-clothes on the floor.  She avoided things with negative symbolic meaning, such as certain people, certain streets, or certain names.   For some reason, sunflowers and Christmas were upsetting.  During depressive phases, she talked about suicide, or “caught” other disorders such as anorexia and PTSD.  I was often accused of abuse and endured many hurtful words.

Haunted by anxiety and paranoia

Anxiety and panic are torturous, and I wished I could have spared her from the pain.  She would obsess on a past emotional hurt and become horribly upset for hours, days, weeks at a time. (In my stress and ignorance back then, I yelled at my child unaware of how hard this impacted emotional memory.)  I had to apologize a zillion times.

My child continues to obsess on ancient hurts, now well into adulthood.  Any traumatizing experience can become a theme in the life story of a schizoaffective person.   They will refer to it and make connections to it for the rest of their lives.   Big issues with my child are about money (having money, people stealing money, having no control over money).   It’s common for her to interpret any event as the turning point when everything started to go downhill, “That’s when you took all my money, “That’s when you ruined my life.”

It may not be preventable.  It’s the very nature of schizophrenia spectrum disorders to find something to be paranoid about.  The point is for a parent to learn to avoid triggering the traumatic memories, and avoid reasoning or explaining what really happened.  Our children cannot reason once upset.  I had to learn to “de-escalate” my child, don a quiet and patient demeanor, affirm feelings, show empathy, and change the subject (“redirect”) etc.

Stalkers of famous people often have schizoaffective disorder

She did some reading and told me that people with schizoaffective disorder often believe they are connected to a celebrity’s life as lovers or confidantes, and some will stalk that person.  John Hinkley is a famous case.  He believed he was the boyfriend of actress Jodie Foster.  In her film, “Taxi Driver,” her would-be boyfriend attempted to assassinate the president to impress her.  Hinckley did the same, and attempted to assassinate then-President Ronald Reagan.  In prison, Hinkley was diagnosed with schizoaffective disorder.  The Beatles musician, John Lennon, was killed by Mark David Chapman, who believed he was the rock star and John Lennon was impersonating him–Chapman is another person with schizoaffective disorder.  I was amused that she realized, only then, that her ever-present (invisible) boyfriend was a famous rock star.

Partial complex seizures can simulate symptoms of schizoaffective disorder

Partial complex seizures of the left temporal lobe (temporal lobe epilepsy) cause, enhance, or simulate symptoms of schizoaffective disorder.  If your child has not had an EEG, request one.  If there is seizure activity, it can be treated by anticonvulsants such as Tegretol (carbamazepine).  This helped to reduce many of my child’s symptoms, such as intermittent bouts of terror, seeing auras around people, and color changes in the sky.  (See an abbreviated article with an explanation at the end of this post.)

Lessons I learned

  • Don’t challenge your child’s beliefs about their experiences, even if you think they are strange, focus instead on keeping your child functional: taking meds, attending school, engaging in safe activities, and managing personal care.  You will be better able to correct/redirect their thinking once they feel comfortable speaking openly with you.
  • Believe and act on any references to suicide or destructive ideas—this may be manipulation, but don’t take the chance.   If you believe your child is being manipulative or overly dramatic, ask them respectfully to stop.  Yes, just ask.
  • Allow your child to talk comfortably about their hallucinatory experiences.  You want to know what they are witnessing or monitoring in their head.  You want to know if a voice is verbally abusing your child, or telling them to hurt themselves or others.
  • “Inoculate” your child from cruel voices or messages–teach them to deny the power of the voice or not take it seriously.  Example:  “I know you can’t stop [this voice] from pestering you, but it’s OK to resist [him] or ignore [him].  [He] has no power over you.”  She was very upset once because her rock star boyfriend/ghost yelled at her.  I told her to tell him, “Stop it and leave me alone! Don’t talk to me that way!”  She did (somehow), and it worked!  The rock star guy stopped talking to her for a couple of days (as if he was sulking), and returned and was nice to her again.

Things you can do

  • Low stress is a priority. Create a low-key environment in the home, limit sensory input, use quiet or soft voices as much as possible.
  • Allow your child to avoid over-stimulation–crowds or energized spaces with too many things happening (parties, malls, sports events or activities, slumber parties, or whatever they say it is).
  • Don’t argue with them if something they say doesn’t make sense to you.  Listen attentively and avoid offering your opinions.  Let me repeat, don’t reason with someone who is inherently irrational.  Ensure they are safe, comfortable, and appropriate, and spend quality time listening like you would any other child.
  • Help them avoid anxiety-causing things or places.  Go out of your way.  Make a point of driving down a different road, or bringing them home from an event early, even if it’s inconvenient.  This is respectful and humane because they are  agonizing about something that you don’t experience.  You need their trust that you” protect them from their own mind.
  • Ask your child what they need to calm down or settle.  If they want to be in a dark room with the windows covered with foil, fine.  If they want to listen to loud ghastly music through headphones, fine.  Just watch.  It will be obvious if it settles them, or helps them focus and relax.
  • Allow your child to be weird at home as long as they adhere to basic rules.  “I respect your freedom to be who you want to be, but you must take showers and wear clean clothes.  Hygiene is the family policy.  This rule won’t change, but I am happy to help you with this if you want.”  No reasoning or justification, just a simple statement of the rules everyone follows.

You can ask for, and expect, respectful behavior

It is possible to ask your schizoaffective teen to stop disrespectful or harmful, inappropriate behavior, and it is possible to set a boundary if done in a respectful straightforward manner without justifying yourself.

Example of something I said to my daughter during a particularly dark period:  “I’m leaving the house and I’ll be gone about 2 hours.  Do not try to commit suicide, stay right here in your room and be calm.  I’ll bring you a snack when I get home.”  Note that this gave her a reason to wait until I came home.

Outcomes are poor with schizoaffective people, but statistics say they have a better long-term prognosis than those experiencing schizophrenia.  Perhaps it’s because their emotional awareness gives them the ability to form friendships and relationships, and talk about feelings (unlike many “pure” schizophrenics).  See article at the end of this post, “Social Interaction Increases Survival by 50%.”

Family Balance

Keep your energy in balance so you can maintain your family's foundation. Too much spent on your child affects everything else your family needs to survive.

Keep your energy in balance so you can maintain your family’s foundation. Too much spent on your child affects everything else your family needs to survive.

Now about you

You are in this for the long haul.  You will experience a roller coaster ride of emotions.  Pace yourself as if in a marathon.  There may be serious crises  (hospitalization) but these may space farther apart over time with treatment, and you’ll have respite.  Your child will settle into stable, repeated patterns unique to them, and you’ll learn which triggers to avoid, and to ignore what isn’t important.  You’ll also learn how to bring them back to positive states of mind, and set up a healthy environment where they choose to stay.  Have hope.  I lived this, and can attest to it.

–Margaret

How am I doing?  Please rate this article at the top, thanks.

Please add a comment about your experiences.  Your observations help others. 

– – – – – – – 

Complex Partial Seizures Present Diagnostic Challenge  (summary)
Richard Restak, M.D. | Psychiatric Times, September 1, 1995

Temporal lobe epilepsy (TLE), is now more commonly called complex partial seizure disorder. It may involve gross disorders of thought and emotion, and patients with temporal lobe epilepsy frequently come to the attention of psychiatrists.

A Dr. Jackson observed in the late 1800’s that seizures originating in the medial temporal lobe often result in a “dreamy state” involving vivid memory-like hallucinations sometimes accompanied by déjà vu or jamais vu (interpreting frequently encountered people, places or events as unfamiliar). Jackson wrote of “highly elaborated mental states, sometimes called intellectual aura,” involving “dreams mixing up with present thoughts,” a “double consciousness” and a “feeling of being somewhere else.” While the “dreamy state” can occur in isolation, it is often accompanied by fear and a peculiar form of abdominal discomfort associated with loss of contact with surroundings, and automatisms involving the mouth and GI tract (licking, lip-smacking, grunting and other sounds).

– – – – – – –

Social Interaction Increases Survival by 50%

Psychiatric Times. July 30, 2010

Theoretical models have suggested that social relationships influence health through stress reduction and by more direct protective effects that promote healthy behavior. A recent study confirms this concept.  Findings from a meta-analysis published in PLoS Medicine indicate that social interaction is a key to living longer. Julianne Holt-Lunstadt, PhD of Brigham Young University and colleagues analyzed data from 148 published studies (1979 through 2006) that comprised more than 300,000 individuals who had been followed for an average of 7.5 years. Not all the interactions in the reports were positive, yet the researchers found that the benefits of social contact are comparable to quitting smoking, and exceed those of losing weight or increasing physical activity.

Results of studies that showed increased rates of mortality in infants in custodial care who lacked human contact were the impetus for changes in social and medical practice and policy. Once the changes were in place, there was a significant decrease in mortality rates. Holt-Lundstadt and colleagues conclude that similar benefits would be seen in the health outcomes of adults: “Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also of survival.”

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Managing resistance: tips and advice

Managing resistance: tips and advice
3 votes


For those who raise resistant, defiant children or teens, this is the single most important piece of advice:  take care of yourself, your primary relationships, and the rest of your family.  Your child cannot take everyone down.  You have a life and so do the rest of the family members.  Protect your other children from PTSD – Post Traumatic SIBLING Disorder.  Schedule regular times for you and the others to relieve tension, and do something that takes you out of the home and brings you joy.  The time or expense is worth every bit as much as psychotherapy.

Before we get to the practical “how to” advice, make note of these facts about defiant and resistant children:

  • Physical age is not emotional age.  They act younger than they are.
  • The child lives in the here and now; they don’t think about the past or future.  They don’t see how their original actions result in a series of consequences.
  • The child does not notice their effect on others.
  • Their brain is easily overloaded, which explains their problems, but you can use this overloading problem to your advantage (see below)
  • They are inherently irrational and cannot follow your reasoning, so don’t try.
  • Believe it or not, you want your child to be resistant to the negative things they’ll face in life.  It is a strength to cultivate because it takes a strong will to face challenges.  YOU need to be resistant.

Managing resistant children is a balancing act.  If you go too far asserting authority you can draw more resistance, especially if you become emotional, so STAY COOL.  You’ll have to stand rooted and calm many times before they reduce their behavior, so embrace patience.  Patience is good medicine for stress.  Don’t get stuck believing you’ve lost patience… because you haven’t!

Practice ahead of time

Before you set a boundary on your recalcitrant child, practice what you will say in advance.  Play the dialogue out in your head—imagine their reaction to your request or rule, and plan a neutral-toned response.  Remind yourself that you are the authority, and you are more resolved and persistent than they are.  Your message doesn’t have to be rational, e.g. “Because I’m the mommy (or daddy) and I say so.”

THESE ARE PRACTICAL IDEAS, BUT NOT IRONCLAD RULES.  USE YOUR BEST JUDGEMENT.

Be a benevolent dictator

Since your home is not a democracy and your child does not run the household, they are not entitled to have all their needs fulfilled or opinions considered.  When they make a demand, thank them for letting you know their opinion, and explain how you will weigh their needs with those of everyone else.  Your child will find your decision completely unfair, but remind yourself that “fair” is not “equal.”   (It’s not desirable to treat everyone and every situation equally.)  Say it’s the best you can do for now.  As their accusations fly, dial back your interest, get busy with something else, and become distracted.

Allow some aggression

When it’s appropriate and safe, ask your child to do more of what they’re already doing so that they turn it around and defy you by stopping the behavior.  Example: your child refuses to take a direction and throws a book on the floor in anger.

Parent:  “There’s only one book on the floor. Here is another one, now throw this on the floor.”  (Child throws book down.)

“Here’s another one. Throw this down too.”  (Child throws book down.)

“And here’s another book, throw this one down, too.”  (Child becomes frustrated and angry, but stops throwing books down in defiance.)

Be a marshmallow

Show no resistance, instead, listen and respond to how they feel, not what they say.  Show them you are open to genuine talk later when the stress dies down.

Teen:  “I hate you, you f- -king b- -ch!”

Parent:  “Sounds like you’re really angry.”

Teen:  “Shut up you stupid wh- -e!  You c – -t!”

Parent:  “Can you tell why me you’re angry so I can do something about it?”

Teen:  “Leave me alone f- -k face!  Stop patronizing me!”

Parent:  “OK, I hear you don’t want me to patronize you, so I won’t.  I feel this is stressful for both of us, so I’d like to take a break and maybe talk about it later.”

Call their bluff

Child:  “I’m going to run away!”

Parent:  “OK, I’ll give you 50 cents to call me and tell me where you are, and I’ll bring you your stuff.”  (then walk away)

Reverse psychology

Parent:  “Oh my God, I can’t believe what you’ve done to your hair, that’s horrible!  What are people going to think?  That’s worse than tattoos.  You have to stop this nonsense!”

(One mother used this technique to get her daughter to stop her plans to make a homemade tattoo on her face.  After all, hair grows out, but facial tattoos can be forever.)

Overload their brain circuits

Give your child or teen multiple instructions quickly, and include things they do and don’t want to do.  It becomes too much work for them to sort out what to defy.

Parent:  “Keep up the yelling and close the door on your way out.  And be sure to get louder out there so all the neighbors can hear.  Dinner is at 5:30.”

(What happens?  The door is slammed maybe, but the kid is home at 5:30 for dinner.)

Actively ignore

As mentioned in a previous post* this works best with children 2 through 12.  They try to get a reaction by annoying you or threatening to do something you don’t want them to do.  Stay in the vicinity but don’t respond, look away, and act like you don’t care or can’t hear them.  Go into another room or outside, for example, and the annoying child will follow you to continue to get your attention with annoying behavior.  If they flip the lights on and off, or ring the doorbell repeatedly, or turn up the volume too loud, maybe you can switch a circuit breaker off and walk away… or if driving, you can pull over, stop the car, and get out and wait.   * Defying ODD: What it is and ways to manage

Mix it up

Be unpredictable.  Give a reward sometimes but not all the time, so the child keeps trying the good behavior to get the reward.  Instead of a consequence, use bribes to stop a behavior.  Allow them to do something they like to do, only with appropriate boundaries.  In my personal opinion, I think it’s also OK to manipulate a situation and allow the child to think they’ve “won.”  Choose your battles.  Let some things go if you’re too stressed.

Have realistic expectations

It’s easy to get stuck in rut—it happens to everyone—but you can climb out.  Remember,  it’s not the child’s fault and it’s not your fault.  Your child may not go through life the same as others, they may always have problems, but your job is to help them bounce back and learn from their mistakes.  If you can do that, you’ve wildly succeeded.  The best you can is the best you can do.

Bottom line

One must be a saint for sticking it out for their troubled child or teen, whether a bio parent, foster parent, grandparent, adoptive parent, or other family member.  If the child’s condition is serious, they may never make it in the world because of their disability, but you’ll know you’ll have honored them, lived your values, and loved unconditionally.

Hope

  • They have the ability to do better.
  • With treatment, children improve (e.g. therapy, exercise, medication…).
  • Things usually work out.
  • Help is out there.

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Marijuana and psychosis in teens

Marijuana and psychosis in teens
5 votes

Underside of normal brain. Shown area has blood flow.

 

It’s a myth that marijuana is safe.  While it has clear, proven benefits for certain physical ailments, the drug’s effect on those with psychiatric vulnerabilities, especially adolescents, can lead to psychosis and debilitating long-term cognitive impairment.  Marijuana should not be political or partisan, yet it is.  The research is international, which tends to refute the argument that concerns are political instead of medical.  Advocates use the term “safe herbal medicine,” but avoid mention of its horribly unsafe effects.  Like any psychoactive drug, there is serious risk of harm.

16-year old with 2 years regular marijuana use.

 

I was at a fundraising event once, chatting with a biochemist about brain chemistry.  At one point he turned and asked a friend passing by about his party the night before, and the friend said that everyone was so stoned they could hardly stand up.  This man then said he was sorry he missed it.  I asked the scientist if he was aware of the negative effect marijuana had on the neurotransmitter serotonin, and how it causes psychosis. “You’re joking!” he said sarcastically.  “What are you, some uptight ultra right reactionary?”  A person nearby overheard us and chuckled and said to me, “Where have YOU been?”  I’m just a parent who cares about kids, who is not buying the story out there.  And I’ve read the peer-reviewed research on marijuana going back 20 years.

18-year-old with 3 year history of marijuana use, 4 times per week

 

I share this story because I assumed that an expert in the biological chemistry would know we don’t fully understand the astonishing complexities of brain chemistry, nor the compounding effect of genetics on a person’s reaction to substances.  Why didn’t this man question his belief that marijuana is perfectly safe?

At the end of this article are summaries of  research studies that have been conducted worldwide since 2004.  All found negative effects of marijuana use on teens.

 “When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like… symptoms.”

 There are side effects.  We know some people cannot stop using alcohol once they start, and that serious addiction runs in families.  We now know that pharmaceuticals help some people, but have deadly side effects in others.  Why isn’t marijuana, with proven negative side effects, also considered a risky substance like antipsychotics or arthritis medications or statins?  Because it’s a plant, and not made by a giant corporation?  Because it’s popular?

I work with adolescents in the juvenile justice system.  A young man on my caseload grew noticeably depressed after starting regular marijuana use—this was tracked by weekly urinalysis.  He said that smoking helped him feel better.  I asked if he got depressed afterwards, and he shrugged.  I asked if he thought it was safe, and he said, “Sure, because it’s natural.  Everyone knows that.”

Pay attention, this is what teens think:  marijuana is natural and therefore safe. That’s what sellers tell them and that’s what they tell each other.  Advocates use the comforting term “safe natural herb.”  Did you know that commonly used herbs are NOT safe?

  • Comfrey is used in tea for arthritis pain, but causes liver damage.
  • Arnica is used for pain, but causes kidney damage.
  • Cinnamon bark is smoked by teens, and it causes disorientation, unconsciousness, and kidney damage.
  • Ephedra (ma huang) causes heart attacks.

Research into smoked or consumed marijuana is repeatedly linked to the onset of psychotic symptoms such as hallucinations, cognitive impairments, and schizophrenic-like symptoms, regardless of a person’s age, even if they don’t use other narcotic substances.  The risk is especially high for adolescents because they start using marijuana early.

A note on medical marijuana – The plant Cannabis sativa has two substances of interest:

  1. cannabidiol (CBD) – the molecule considered safe for a variety of treatments, and even approved by the upstanding American Medical Association;
  2. tetrahydrocannabinol (THC) – the molecule responsible for the high and the one that can produce psychotic symptoms.

Safe medical marijuana should not be the smoked leaf and buds, but as a dosed aerosol, and available by prescription, just as all other medications with possible negative side-effects.  Legalizing only this form makes sense. Otherwise, legalization is not about medical need but recreational use.

“Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.” (read more below)

 More than half the young people on my caseload have diagnosable disorders, or a history of addictions and disorders in their families.  They’re already in trouble with the law. The last thing they need is the means to self-induce psychosis.

Share this information with other parents.  This isn’t about keeping  medicine away from people who need it, nor is it a “righteous” ploy to pick on people who like to get high.  The danger for children is real.

–Margaret

How am I doing?  Please rate this article at the top, thanks.


Early Marijuana Use Heightens Psychosis Risk in Young Adults (summary)
John McGrath MD, Rosa Alati MD Archives of General Psychiatry, published online March 1, 2010,
MedscapeCME: Psychiatry and Mental Health

“Early cannabis use increases the risk of psychosis in young adults,” reports lead investigator John McGrath, MD, of Queensland Centre for Mental Health Research in Brisbane, Australia.  “Apart from having an increased risk of having a disorder like schizophrenia, the longer the young adults reported since their first cannabis use, the more likely they were to report isolated symptoms of psychosis.”

Investigators assessed 3801 study participants at ages 18-23 years, identifying first marijuana use and three psychosis-related outcomes:  non-affective disease, hallucinations, and the Peters et al Delusions Inventory Score.  “Psychotic disorders are common and typically affect 1 or 2 people of every 100” Dr. McGrath said, “…(I) was surprised that the results were so strong and so consistent…  We need to think about prevention.”

Results mirror those of another study conducted by Michael Compton MD, published in the American Journal of Psychiatry (November 2009), where investigators looked at 109 patients in a psychiatric unit and found that daily marijuana and tobacco use was common.  Of those who abused cannabis, almost 88% were classified as weekly or daily users before the onset of psychosis.

Emma Barkus, PhD, from the University of Wollongong in New South Wales, Australia, says other studies suggest that those who are engaging in risk behaviors about the age of 14 years are more likely to persist as they get older, adding further support to the role of cannabis use in predicting earlier psychoses.
– – – – –

Evidence Accumulates for Links Between Marijuana and Psychosis (summary)
Michael T. Compton, MD, MPH – Assistant Professor, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, 2008

Cannabis is the most abused illicit substance in the general US population, and the most abused illegal drug among individuals with schizophrenia.This literature reviewed studies that examined (1) associations between cannabis use and clinical manifestations of psychosis, and (2) the biologic plausibility of the observed links.

The initiation of cannabis use among those with psychotic disorders often precedes the onset of psychosis by several years.Cannabis use in adolescence is increasingly recognized as an independent risk factor for psychosis and schizophrenia.  Progression to daily cannabis use was associated with age at onset.

Study evidence also supported biological links between cannabis use and psychosis.  In the brains of heavy users, interactions with specific cannabinoid receptors are distributed in brain regions implicated in schizophrenia.  Other studies report elevated levels of endogenous cannabinoids in the blood and cerebrospinal fluid of patients with schizophrenia.  When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like positive and negative symptoms. – – – – –

Chronic toxicology of cannabis.  (summary)
Reece, Albert Stuart; Clinical Toxicology (Philadelphia, PA.)   vol. 47  issue 6, Jul  2009 . Medical School, University of Queensland, Highgate Hill, Brisbane, QLD, Australia.

 Findings: There is evidence of psychiatric, respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use.  Cannabis is implicated:

  • In major long-term psychiatric conditions including depression, anxiety, psychosis, bipolar disorder;
  • Respiratory conditions include reduced lung density, lung cysts, and chronic bronchitis;
  • elevated rates of myocardial infarction and cardiac arrythmias;
  • linked to cancers at eight sites, including children after in utero maternal exposure.- – – – –

Marijuana Use, Withdrawal, and Craving in Adolescents (summary)
Kevin M. Gray, MD, Assistant Professor in the youth division of the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina in Charleston.

Findings in the literature survey:  Initiation of marijuana use typically occurs during adolescence.  Recent data indicate that in the United States, 42% of high school seniors have tried marijuana; 18% have used it in the past 30 days; and 5% use it daily.  Among adolescents aged 12 to 17, 3.6% met criteria for cannabis use disorder (abuse or dependence) and 2% met criteria for cannabis dependence.

More than half (51%) of adolescents reported that marijuana is fairly or very easy to obtain.  Ironically, this ready availability may be a “reverse gateway” from marijuana use to cigarette use to nicotine dependence.  Earlier initiation is associated with problem-related marijuana use: “hard” drug use, poly-drug use, and academic failure.  Using marijuana once per week or more during adolescence is associated with a 7-fold increase in the rate of daily marijuana use in young adulthood.  Cannabis dependence increases the risk factors for impaired driving and delinquent behavior.  Chronic use is associated with impaired immune function, respiratory illnesses, cognitive problems, and motivational impairment. 

There is a debate whether marijuana use begins as “self-medication” for psychiatric disorders, or whether habitual marijuana use can predispose some individuals to psychiatric symptoms.

Social anxiety disorder in adolescence is associated with 6.5-times greater odds of subsequent cannabis dependence, and vice versa, frequent marijuana use during adolescence appears to increase the risk of subsequent development of anxiety and depressive disorders.  The prevalence of cannabis abuse is 2 to 3 times greater among adolescents who have major depression.  Also linked in both directions: conduct disorder predicts marijuana and other substance use, while early-onset marijuana use predicts conduct disorder.

Five treatment regimes were studied: motivational enhancement/cognitive-behavioral therapy (MET/CBT), family education and therapy intervention, a community reinforcement approach, and multidimensional family therapy.  All resulted in positive but modest outcomes, with MET/CBT and community reinforcement treatments being most cost-effective.

Emerging evidence indicates rewards for marijuana abstinence may be positive.  Multi-systemic therapy, an intensive approach that incorporates individual, family, and community components, has demonstrated effectiveness among delinquent adolescents.

Withdrawal: Marijuana withdrawal symptoms are a constellation of emotional, behavioral, and physical symptoms that include anger and aggression, anxiety, decreased appetite and weight loss, irritability, restlessness, and sleep difficulty, which result specifically from withdrawal of marijuana’s psychoactive ingredient, THC.  Less frequent but sometimes present symptoms are depressed mood, stomach pain and physical discomfort, shakiness, and sweating.  Onset of withdrawal symptoms typically occurs within 24 hours of cessation of THC, and symptoms may last days to approximately 1 to 2 weeks.

Craving: Patients’ craving of marijuana is evidenced after presenting them with cues associated with marijuana (e.g. sight or smell of the substance, films of drug-taking locations, and drug-related paraphernalia).   Exposure to cues leads to robust increases in craving, along with modest increases in perspiration and heart rate.  Cue reactivity can predict drug relapse.

Craving and withdrawal symptoms interfere with successful cessation of use and sustained abstinence.  In addition, medications are often used to target withdrawal from substances, such as benzodiazepines for alcohol dependence and clonidine and buprenorphine for opioid dependence. These medications could be combined with psychosocial interventions, or developed to complement concurrent psychosocial treatments. – – – – –

Legalization of Marijuana: Potential Impact on Youth (summary)
Alain Joffe, MD, MPH, W. Samuel Yancy, MD the Committee on Substance Abuse and Committee on Adolescence – PEDIATRICS Vol. 113 No. 6 June 2004, pp. e632-e638

Scientists have demonstrated that the emotional stress causedby withdrawal from marijuana is linked to the same brain chemical that has been linked to anxietyand stress during opiate, alcohol, and cocaine withdrawal.  THC stimulates the same neurochemical process that reinforcesdependence on other addictive drugs.  Current, well known, scientific informationabout marijuana shows the cognitive, behavioral,and somatic consequences of acute and long-term use, which include negative effects on short-term memory,concentration, attention span, motivation, and problem solving.  These clearly interfere with learning, and have adverse effects on coordination,judgment, reaction time, and tracking ability.  http://pediatrics.aappublications.org/cgi/content/full/113/6/e632 – – – – –

The Past, Present, and Future of Medical Marijuana in the United States (summary)
By John Thomas, JD, LLM, MPH, Professor of advanced law and medicine, civil procedure, and commercial law at the Quinnipiac University College of Law, Hamdon, Connecticut, January 6, 2010

Cannabidiol (CBD) is considered safe and has a variety of positive benefits, and this component should be legalized.  However, the other narcotic component in marijuana, tetrahydrocannabinol (THC), is responsible for the high, and too much may not be a good thing because it can produce psychotic symptoms in people. – – – – –

 Medical Marijuana:  The Institute of Medicine Report (summary)
Ronald Pies, MD, Editor in Chief – Psychiatric Times. Vol. 27 No. 2 , January 6, 2010

Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects.  However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other prescription medications. Cannabinoids can induce acute transient psychotic symptoms or an acute psychosis in some individuals… (but it is unclear) what makes some individuals vulnerable to cannabinoid-related psychosis.  There is a pressing need for more high-quality research in the area of medical marijuana and cannabinoid use. – – – – –
 
Link Between Cannabis Use and Psychosis Onset at a Younger Age (summary)
Ana Gonzales MD, Santiago Apostol Hospital in Vitoria, Spain, Journal of Clinical Psychiatry. August 2008

Researchers found a strong and independent link between cannabis use and the onset of psychosis at a younger age, regardless of gender or the use of other drugs.  The link is related to the amount of cannabis used.  “The clinical importance of this finding is potentially high,” Dr. Gonzalez-Pinto given that cannabis use is extremely prevalent among young people… estimates of the attributable risk suggest that the use of cannabis accounts for about 10 percent of cases of psychosis.”The findings showed a significant gradual reduction in the age at which psychosis began that correlated with an increased dependence on cannabis. Compared with nonusers, age at onset was reduced by 7, 8.5, and 12 years among users, abusers, and dependents, respectively, the researchers report. – – – –
Cannabis use and later life outcomes. (summary)
Fergusson DM, Boden JM, Addiction;  Pages: 969-76;  Volume(Issue): 103(6), June 2008

A longitudinal study of a New Zealand birth cohort tracked subjects to age 25 years.  Cannabis use at from ages 14-25 was measured by:  university degree attainment to age 25; income at age 25, welfare dependence during the period 21-25 years, unemployment 21-25 years, relationship quality, and life satisfaction.  Other indices were measured to adjust for confounding factors:  childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioral adjustment and cognitive ability, and adolescent and young adult mental health and substance use.The findings were statistically significant.  Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction. – – – – –

Doctors:  Pot Triggers Psychotic Symptoms (summary)
May 1, 2007
Aetna Intelihealth – Mental Health

 LONDON — New findings show physical evidence of the drug’s damaging influence on the human brain.  In some people, it triggers temporary psychotic symptoms including hallucinations and paranoid delusions. Two of the active ingredients of cannabis: cannabidiol (CBD) made people more relaxed.  But second ingredient: tetrahydrocannabinol (THC) in small doses produced temporary psychotic symptoms in people, including hallucinations and paranoid delusions. According to Dr. Philip McGuire, a professor of psychiatry at King’s College, London, THC interfered with activity in the inferior frontal cortex, a region of the brain associated with paranoia. “THC is switching off (a chemical) regulator,” McGuire said, “effectively unleashing the paranoia usually kept under control by the frontal cortex.”In another study, Dr. Deepak Cyril D’Souza, an associate professor at Yale University School of Medicine, and colleagues tested THC on 150 healthy volunteers and 13 people with stable schizophrenia. Nearly half of the healthy subjects experienced psychotic symptoms when given the drug.  Unfortunately, the results for the schizophrenic subjects was so much worse that researchers scrapped adding additional schizophrenic subjects to the study.  The negative impact was so pronounced that it would have been unethical to test it on more schizophrenic people.”One of the great puzzles is why people with schizophrenia keep taking the stuff when it makes the paranoia worse,” said Dr. Robin Murray, a professor of psychiatry at King’s College in UK.  She theorized that schizophrenics may mistakenly judge the drug’s pleasurable effects as outweighing any negatives. – – – – – 

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