mental health

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Navigating The Senior Prom: Tips To Help Parents Cope

From left: Zack Beresin, Sophie Manning and Glennon Beresin (Zack's twin sister) before their senior prom (Courtesy of Gene Beresin)

From left: Zack Beresin, Sophie Manning and Glennon Beresin (Zack’s twin sister) before their senior prom (Courtesy of Gene Beresin)

By Drs. Steve Schlozman and Eugene Beresin
Guest contributors

The recent fatal stabbing of a 16-year-old girl in Connecticut have understandably cast a dark shadow over prom night.

Attacks like the one in Connecticut are rare, but these events receive massive attention and can thus obscure the more common tribulations characteristic of the spring dance.

In no way do we want to make light of the seriousness of recent events, but we also do not want to miss the opportunity to explore the more common hand-wringing of this yearly ritual.

So, consider the following scenario:

It’s late afternoon on the day of the prom. Your son ambles downstairs in his tuxedo, silently seeking approval. Your younger daughter giggles: “What’s that thing he’s wearing?” she asks.

“That’s a tuxedo,” you say.

“I know what that is, Daddy, but what’s that big black belt?”

“It’s a cummerbund,” you reply.

But you are wrong, according to your daughter’s analysis. “It’s morantic,” she says. “I think he looks morantic.”

That’s how she says romantic. It usually cracks up your son when she says this, but not today.

“No,” you respond. “You look very distinguished.”

He’s still not pleased. He’s 18, after all, and not ready to be distinguished.

And as his date arrives, you have this sinking recollection: they are preparing themselves for a night that can’t possibly live up to expectations.

Then you start to worry about the sharp turn that can separate the glamour of the dance itself from the potential debauchery of the post-prom festivities. No dress-up clothes then, no contrived formalities…just hanging out with friends and staying up all night, with possible cut-loose celebrations (read: sex) or unfettered over-indulgence (read: drugs).

For all those parents out there who are planning to launch their own kids into this great Western tradition, we would like to opine from our vantage points as child and adolescent psychiatrists, and as former prom attendees, and, for at least one of us, as someone who has seen four kids attend proms. Here are a few tips:

1. Don’t use the “S” word

When your daughter emerges in her prom dress, don’t fuss. Tell her that she looks great, or that she looks beautiful, but don’t say sexy. Continue reading

Mom’s Memo To Schools: Please, Make These Random Half-Days Stop

May I share with you the delights of my children’s April school schedule? They get out at 12:40 because of parent-teacher conferences on these days sprinkled through the month: Tues., April 1; Weds., April 9; Tues., April 29. Oh, yes, and just when you thought it was safe, one more on May 7. (Plus they’re off April 18-25 for spring vacation.)

That’s in addition to our new regular Friday early dismissals at 1:40. When we got word of that, one mother I know said to the superintendent, “You must really hate parents.”

I don’t think the administration hates us, but I do think that perhaps we haven’t spoken up loudly enough about the logistical stress these half-days create. And they’re common around the state, from year-round early-release Tuesdays in Newton to April half-Wednesdays in Westwood.

They’re an old tradition. Many of us remember the joys of occasional half days from our own school years. You know, back when our mothers were mostly housewives. Now, virtually all mothers work, and I venture to say that virtually all working parents wish that all our public schools provided universal, affordable after-school care.

(Photo: Rachel Zimmerman)

(Photo: Rachel Zimmerman)

Or at the very least, reliable after-school care on random half-days. At our school, a team of mothers has created a “half-day matinee,” gathering all the children who need looking after for a movie that runs until the normal 2:30 dismissal time. But their altruistic efforts are in danger of being overwhelmed by demand: More than 200 children have been coming to the movies this month, straining even their heroic volunteer powers.

“First-world problems,” you may say, and I’d agree but go a step further: This is specifically a first-world middle-class problem. Continue reading

Newton Deploys Relaxation Experts To Help De-Stress Community

Screen shot 2014-04-07 at 1.45.34 PM

As of today, the high-achieving suburb of Newton begins a new effort to combat stress in teens: helping their parents relax.

The town is hosting four seminars for parents to help them “relax and reboot” and learn some strategies to better take care of themselves and their stressed-out teenage kids.

In case you live in Newton and are thinking of attending, sorry. They’re already full. But the town is offering several related programs, including An Open Conversation on April 30 for parents to talk about “how we define success in a high achieving community and how that impacts the stress on our teens.”

National statistics suggest that teenage stress is at an all-time high, with kids apparently adopting adult-levels of stress, according to the latest American Psychological Association report on stress in America.

In Newton, the issue is particularly poignant because three Newton high school students took their own lives during the current school year.

But even before the suicides, Newton had decided to take a somewhat novel approach. It applied for and received a “mental health and well-being” grant — $30,000 over three years — to, in effect, allow students, parents and teachers to take a massive exhale and figure out ways, large and small, to take the edge off growing up.

One solution was to contract with the Benson Henry Institute of Mind-Body Medicine, based at Massachusetts General Hospital, and offer the stress-reduction sessions.

The town was already aware of its stress-related problems: Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

Mental Health Parity: If Not Now, When?

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, “ranging from depression to anxiety to sleep disturbance,” and in the midst of being evaluated for post-traumatic stress disorder.

If true, it’s a familiar story of a stressed-out soldier with mental health issues and easy access to guns: we’ve been here before.

Of course, we don’t know exactly what kind of care or treatment this shooter was receiving — and the VA system is generally better than others. Still, it’s worth reviewing the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

(ndanger/flickr)

The latest policy brief published in the journal Health Affairs, documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of “physical” medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still aren’t fully implemented today, despite widespread support, including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

…”Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders.

The supply and availability of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patients–more than twice the percentage who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with receiving mental health or substance use treatment. Eliminating the stigma and increasing the availability of high-quality providers are two keys to increasing access to care.

…Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, Continue reading

Understanding Aster: How Singing And Dancing Help Heal A Child’s Trauma

For the past four years, I’ve been involved with a local nonprofit, the North Cambridge Family Opera, which stages original productions featuring cast members age 7 to grandma, and with a range of abilities. In 2011, I wrote about how performing in the group’s opera helped children with autism. This year, I was struck by the story of how music helps heal the past trauma of one young cast member, 8-year-old Aster, adopted from Ethiopia after her birth parents died. I asked Aster’s mother to write a bit about their experience. Here’s her post:

By Marina Vyrros
Guest contributor

In the mid 1990s, I worked as a refugee aide in the Guatemalan rainforest.

Many people in that community — having fled horrific atrocities, like their villages being razed or worse — were suffering from post-traumatic stress.

Atrocities notwithstanding, a contingent of ranchero musicians somehow managed to lug homemade, oversized guitars to the camps and play music each night, often in the 100-degree heat.

While the NGO’s provided a valuable service — helping the people rebuild their external structures — the service that the ranchers provided, though perhaps less tangible, was invaluable. Their nightly gatherings, singing songs about their plight, helped the community to rebuild and heal internally.

Four years ago, when I adopted an almost 4-year old child from Ethiopia (who continues to recover from the trauma of having lost both birth parents during her formative, early childhood years) the lesson of the power of music was not lost on me.

Claudia M. Gold, a pediatrician, blogger and author of “Keeping Your Child in Mind: Overcoming Defiance, Tantrums, and Other Everyday Behavior Problems by Seeing the World Through Your Child’s Eyes,” explains what may be going on in my daughter’s brain:

“Severe meltdowns are common in children who have experienced early trauma, at the time when the higher cortical centers of the brain were not yet fully developed. Stress of a seemingly minor nature can lead the rational brain to in a sense go ‘off-line.’ The child will have access only to the lower brain centers that function more instinctively.”

Especially during her first few years in Cambridge, Aster’s meltdowns were epic, but music and dance have consistently provided the most important vehicle to help her regulate her emotions.

Before, she might bang on the walls, now, to relieve her frustration, she pounds on a djembe, an African drum, in an afterschool program; instead of crying over seemingly inconsequential things, now, to release her emotions she invents and belts out Whitney Houston-y type songs, tears streaming down her face. To release her energy — which is abundant — she dances around. Everywhere. It all helps.

Recently, over the past five months, Aster’s been singing, dancing and even acting with the North Cambridge Family Opera based in Cambridge. In this year’s production, “Rain Dance,” she and the other animals living on the South African savannah elect a Machiavellian lion in a desperate attempt to end the local drought. Trouble ensues.

All kinds of research suggests that music can minimize the symptoms of post traumatic stress and other types of trauma. A 2011 study found that guitar-playing can help veterans with PTSD drown out the traumatic memories of bombs blasting; and in 2008 researchers found some reduction of post-traumatic stress symptoms following drumming, in particular “an increased sense of openness, togetherness, belonging, sharing, closeness, connectedness and intimacy, as well as achieving a non-intimidating access to traumatic memories, facilitating an outlet for rage and regaining a sense of self-control.”

Dr. Ross Greene, author of “The Explosive Child” writes that “children with behavioral issues don’t lack the will, they lack the skills.” Continue reading

Coerced Sex Common For Teen Boys And Young Men, Study Finds

A few nights ago, unable to wind down, I was searching for something to watch and stumbled across the film “Adore.” It’s about a pair of lifelong friends (grown women) who end up having affairs with each other’s young, hunky, 19- or 20-year-old sons. My first reaction was the same as one Netflix commenter:

“…if this had been two pals and each other’s teen daughter; well, you get the point. The movie would not have been made, or if so, it would have had an entirely different hue-to say the least. DOUBLE STANDARDS.”

Or, as A.O Scott wrote in his New York Times review:

“It is worth noting that the same movie about a couple of dads sleeping with each other’s 20-year-old daughters would need, at a minimum, to confront the ickiness of the situation. Really, such a movie would be unlikely to make it into theaters, in spite of the commonness of real-life relationships between older men and younger women.”

(Dustin Hoffman, Anne Bancoft in "The Graduate"; Movie-Fan/flickr)

(Dustin Hoffman, Anne Bancoft in “The Graduate”; Movie-Fan/flickr)

The film isn’t about sexually coercion; but it is about boundary breaking, and I thought of it again reading this new study on the pervasive, but largely unexamined problem of sexual coercion among boys and young men.

The study, published in the journal Psychology of Men and Masculinity, found that coerced sex is fairly common for teenage boys and college-age men and can lead to psychological distress and risky behavior, such as sexual risk-taking and alcohol use.

From the American Psychological Association news release:

A total of 43 percent of high school boys and young college men reported they had an unwanted sexual experience and of those, 95 percent said a female acquaintance was the aggressor…

“Sexual victimization continues to be a pervasive problem in the United States, but the victimization of men is rarely explored,” said lead author Bryana H. French, PhD, of the University of Missouri. “Our findings can help lead to better prevention by identifying the various types of coercion that men face and by acknowledging women as perpetrators against men.” Continue reading

Study Ignites Debate Over Non-Drug Treatment For Schizophrenia

Antipsychotic medications (Wikimedia Commons)

Antipsychotic medications (Wikimedia Commons)

By Alexandra Morris
CommonHealth intern

Antipsychotic drugs are typically the first-line treatment for the roughly one percent of people who have schizophrenia — often in conjunction with psychotherapy. But for patients who are not helped by the drugs or cannot tolerate their side effects, what’s left?

Last month, the Lancet published a study looking at the effects of cognitive therapy on patients with schizophrenia who refused to take medication – and prompted a heated debate within the mental health community.

Cognitive therapy involves one-on-one meetings between a patient and a therapist to discuss ways to change thinking and behavior in response to their symptoms.

Patients in the study were randomly assigned to receive either treatment as usual — ranging from no treatment at all to psychosocial support and other methods — or treatment as usual plus cognitive therapy. The researchers found that by the end of the study, the patients who received cognitive therapy had reduced psychiatric symptoms as compared to those who did not receive cognitive therapy.

Sounds reasonable, no? But initial media coverage included headlines claiming that cognitive therapy was an effective alternative to antipsychotic treatment. The Guardian posted “At last, a promising alternative to antipsychotics for schizophrenia,” and Science magazine wrote, “Schizophrenia: Time to flush the meds?” BBC News reportedly posted a headline “Schizophrenia: Talking therapies ‘effective as drugs.’”

Shortly after the study hit the press, bloggers were off and running (from PLOS to The Mental Elf), highlighting the limitations in the study design, such as the small sample size of 74 patients and the fact that nearly a third of these patients dropped out of the study partway through. They urged readers not to generalize the effect of cognitive therapy on schizophrenia based on limited evidence.

In fact, cognitive therapy was never compared to antipsychotics in the study. Some patients were even prescribed antipsychotics during the trial as part of their routine treatment. Several of the media reports also failed to mention an important caveat – that the trial was conducted in a specific patient population: those with mild to moderate psychiatric symptoms, as compared to those with severe illness who require hospitalization. The findings therefore cannot be extrapolated to all patients suffering from schizophrenia.

Lead study author Dr. Tony Morrison of the University of Manchester attested to the high drop-out rate. Continue reading

Study: Soldiers Enter Military With Higher Rates Of Mental Illness

As suicide rates among soldiers climbed to new highs four years ago, researchers prepared surveys for the largest study to date of mental health risk within the military.

The study’s new findings, published as three papers in JAMA Psychiatry, show that soldiers who join the military come in with much higher rates of mental illness than the general public and that most suicides can be traced to these pre-enlistment conditions.

Researchers organized 327 meetings at Army installations across the country in 2011. A total of 5,428 soldiers — some in large auditoriums, some in small field offices — filled out questionnaires that they knew would be matched to their administrative records.

Almost 85 percent reported a mental health problem that began before they entered the military — with particularly high rates of impulsive behavior, trouble controlling anger and substance abuse.

Lead author Ronald Kessler, a professor of health care policy at Harvard Medical School, said many men and women reported developing new conditions while in the service. The soldiers’ anxiety, depression and PTSD were layered onto their existing problems. Continue reading

Study: Bullying Toll May Linger For Years, Leading To ‘Substantially’ Worse Health

(trix0r/flickr)

(trix0r/flickr)

Researchers at Children’s Hospital Boston report that children who have been bullied suffer not only the immediate blow of humiliation or worse, but that the toll of such childhood insults may linger for years — particularly if the bullying re-occurs — and lead to dramatically worse mental and physical health.

The negative impacts of chronic bullying may accumulate and snowball, researchers report, with ongoing bullying associated with greater depression symptoms in kids and lower self-worth over time.

From the study, “Peer Victimization in Fifth Grade and Health in Tenth Grade,” published in the journal Pediatrics:

We analyzed data from 4297 children surveyed at 3 time points (fifth, seventh, and tenth grades) in 3 cities. We used multivariable regressions to test longitudinal associations of bullying with mental and physical health by comparing youth who experienced bullying in both the past and present, experienced bullying in the present only, experienced bullying in the past only, or did not experience bullying.

RESULTS: Bullying was associated with worse mental and physical health, greater depression symptoms, and lower self-worth over time. Continue reading