Sullen and/or Uncommunicative

Kids – and especially teenage kids – can sometimes withdraw from family communication and particularly from communication with their parents. They may retreat in different ways. Sometimes they sulk around the house saying very little to anyone including family, friends and others. Sometimes they don’t say much to their parents while they maintain contact with other family members and/or they talk non-stop on the phone to their friends, text madly away or chat avidly online. Sometimes their mood is morose for just a few hours and then they’re “suddenly” all happy again. But sometimes they withdraw for weeks or months on end. These silent and sullen periods are confusing for parents; how can parents tell if their child needs professional help or if he or she is just being a kid who needs space?

If you are dealing with a sullen or uncommunicative youngster, consider the following tips:

No One is Happy and “On” All the Time
Neither children nor adults experience constant positive moods. It’s normal for all of us to feel stressed or low, off and on throughout a day. Circadian rhythms alone (our biological clocks) affect our moods and energy levels, as does our diet, our exercise (or lack of it) and the various life stressors that each day brings. It’s important to give kids space to be a little irritable or quiet; they – like the rest of us – may need recovery time. Therefore, there’s no need to panic when you see that your child is in a mood. Instead, note the child’s mood and ask if there’s anything you can offer. For instance, you might say something like, “You seem a little down. Do you want to talk or do you need a little neck rub?” If the child declines on both counts, you just say “O.K.” and move on. You have shown an appropriate level of interest and concern without being intrusive or annoying. However, if the child is normally pretty balanced and then enters into an unremitting low, sad-looking mood for two weeks straight, you should express more concern. “Honey, I’m getting concerned. You’ve looked really sad for two weeks now and this isn’t like you. Is there something going on that is hard for you to deal with or are you feeling sad for no reason in particular? I don’t mind if you don’t want to talk to me about it – maybe I’m not the right person. But if you’re having trouble getting into a happier place, I want you to know that Dr. So & So is very nice to talk to and she might be able to help.”

Normal Needs for Privacy
Mood issues aren’t the only reason that kids withdraw from communication with their parents. Sometimes they are just expressing a normal need for privacy. No one likes their life to be a completely open book. You don’t share everything with your child and your child doesn’t need to share everything with you. If you don’t give enough privacy voluntarily, then a child may take it by refusing to open up. One way to offer privacy is to avoid intensive questioning. For instance, don’t ask your child detailed questions like “Who did you talk to today? What did you talk about? What is Bobby doing this weekend? Were you invited? Why not? Have you spoken to Carey lately? Don’t you think you should?” and so on. Children subjected to such inquisitions often learn to give very little information about anything. However, even when parents don’t ask much, teenagers are notorious for wanting to keep a private life. They may have no noteworthy secrets; being quiet doesn’t always mean that the youngster is engaging in suspicious activities. It may just be a case of privacy for privacy’s sake (i.e. “I don’t tell my mom who I see on the weekend not because I have something to hide, but just because I don’t feel like telling her.”). Sometimes, of course, excessive secrecy does indicate a problem behavior. However, usually there are other behavioral clues that contribute to a suspicious picture (for instance: a sudden drop in school marks, red eyes, unusual irritability, strange behavior, a change in behavior and so on). A lack of open communication by itself, is not necessarily cause for concern and in fact, is considered to be pretty normal in adolescents.

Set Appropriate Boundaries
If your child is otherwise happy and well, it is fine to set boundaries for the expression of sullen and uncommunicative behavior. For instance, if your kid is able to talk nicely to his or her friends and others, then go ahead and ask him or her to speak nicely to the folks at home as well. Make sure, however, that you are being mostly positive and pleasant yourself – check your communication ratio. Are you 90% positive and only 10% in the criticism-instruction-discipline section with your teenager (80-20 with your younger child)? If not improve your own pleasant behavior first and then ask your child to do the same. There is no need to allow rude behavior in the home and doing so gives your child the wrong message that family members aren’t real people with real feelings. It’s fine to say something like, “You don’t have to have a long conversation with me if you you’re not in the mood, but when I greet you please just look up for a moment and say ‘hi.’ It’s not acceptable to completely ignore a person who is talking to you and especially,  your parent.” If the child continues to ignore you after you’ve provided this information, something deeper may be going on – perhaps there are parent-child relationship issues, discipline issues or mood issues that would be best treated with professional help.

More Serious Mood Issues
When a previously happy child suddenly becomes sullen and/or uncommunicative for an extended period of time, he or she might be suffering from an internal or external stress. Internal stresses include mental health issues like social anxiety or depression. External stress includes life events like marital breakdown, failing grades or bullying at school. In children and adolescents, depression often shows up as irritable mood rather than sad mood, and is accompanied by other behaviors like changes in eating and sleeping patterns, a tendency to isolate from people, excessive low self-esteem or insecurity, changes in energy and other symptoms. If you are concerned about whether your child’s behavior requires professional intervention, ask your doctor for a referral to a child and adolescent mental health professional with whom you can discuss the issue.

Turning School Failure Around

Kids don’t enjoy receiving failing grades. It leaves them feeling inadequate and incompetent, frustrated, disappointed and disheartened. It is so much more satisfying to succeed! Fortunately, there are ways that parents can help their kids turn school failure around.

If your child is struggling in school, consider the following tips:

Working Hard/ Working Smart vs. Being Smart
It’s important to help kids understand that failure is the result of many factors, inborn intelligence being only one, often relatively insignificant one! Assuming that a child is placed in an appropriate academic setting (whether that is a special school, a special class, a regular class or a gifted class), he or she ought to be able to achieve a passing grade and possibly even an excellent grade. Children should not be sitting in classrooms that are way beyond their intellectual or academic level. For instance, we don’t put a 6 yr old child into a university level physics class! If your child is in the wrong academic setting, take care of that first. However, let’s assume for now that the child is where he or she belongs. Academic failure under such circumstances is a result of insufficient effort. That insufficient effort might occur because of stressful circumstances such as divorce or death in the family, or poor attitude such wanting to party and socialize instead of studying. Regular study with proper concentration usually leads to passing grades and even good grades.

It’s important that you help keep your child from attributing failure to himself or herself. When kids internalize failure, chances are, they will not try again. On the other hand, attributing failure to a cause that’s external makes the problem workable. After all, someone can fix a bad study habit, but it’s virtually impossible to fix a defunct brain.

Bite Your Tongue
No matter how much your child protests that he or she doesn’t care about the failure, deep inside he or she probably does. The casual attitude is most likely just a front to protect his or her self-esteem. Since a failing child already feels bad; there is no need to make him or her feel worse. There certainly is no need to create punishments – failure is punishment enough. Refrain from saying things like “I work hard to send you to a good school and this is what you give me?” Instead, share what you feel. “I feel disappointed that this is your grade.” It’s okay for parents to feel sad, disappointed, frustrated and upset about the situation; it is NOT O.K. to make hurtful or abusive remarks.

Reiterate Your Support
It’s a difficult time for your child, so offer your support. Ask your child if he or she would like help of some kind – homework tips, study partner, tutor, extra help from the teacher or something else. Do whatever makes sense with the resources of time and money that are available. Your child will see that you consider school success to be a valuable asset. However, apart from offering help (or insisting on it, for younger children), do not emphasize the importance of schoolwork to the point where your child feels annoyed or nauseated! Refrain from lectures and simply offer help.

Figure Out How to Get Better Grades Next Time
Be future-oriented. While it’s alright to ask: “what do you think went wrong?”, you must also ask “how can you change for next time?” Explore possible contributing factors such as low motivation, poor time management skills, mental blocks, emotional stress, fear, overwhelm and other issues. See what adjustments can be made. If possible, provide support in the form of l tutors, educators, therapists or other people. Sometimes a helping hand makes a huge difference in the child’s ability to persevere and succeed.

Find Your Child’s Strengths
Your child may be an underachiever in one area, but he or she may have plenty of strengths in another. Discover what your child is good at. A special interest, aptitude or hidden talent may be what you need to help your more generally motivated. Success in one area often spills over into success in other areas as well. Even if it doesn’t it certainly helps balance the child’s self-esteem as he or she discovers competencies and abilities that spell “success.”

Reinforce Positive Changes
There’s no better way to turn a school failure around than to turn it into a school success, and when that happens, make sure to give positive feedback. Kids, like adults, go from strength to strength. Focusing on small successes along the way helps to ensure big successes further down the line. Reward improvement with praise, treats and privileges (“Wow, all that studying really paid of on your math test. Why don’t we go celebrate with an ice cream cone?”). Similar to a “bonus” for hard work at the office, concrete forms of acknowledgement are powerful motivators for more effort in the future.

Helping Teens Survive Heartbreak

First love is a wonderful experience, but also a risky one. Most “first” relationships end at some point and with the ending often comes a crushing heartbreak. How can parents help their child through the feelings of tremendous pain, shock and grief that can accompany heartbreak?

Consider the following tips:

Use Emotional Coaching
Listening is one way of providing essential emotional support. Listen for feelings and name them back to the child without trying to cheer up the teenager. For example, “It really hurts.” or “It’s quite a loss.” Be careful not to use the word “but” when listening – as in “Yes it hurts but you’ll soon meet someone even better.”  This too-quick attempt to make the pain go away only tends to prolong the agony.

Share Your Own Experiences
If you’ve had the experience of heartbreak, go ahead and share a little of it. Don’t take front and center – it’s not about you right now. Nonetheless, sharing your feelings can be therapeutic. Your child will feel somewhat better knowing that you suffered a broken heart and lived to tell the tale. He or she can see that you survived and went on to love again (hopefully); this can help ease some of the desperation he or she might be feeling right now.

Refrain from Diminishing the “Ex”
Although the relationship seems to have ended, you never know for sure – the two may get back together at some future date – weeks, months or even years in the future. This is true even if you think it shouldn’t happen. Therefore, don’t say anything that may come back to haunt you. Also remember that your grieving youngster may still have strong positive feelings for the young man or lady. Your insults are not likely to be well-received. Instead of talking about the ex-girlfriend or boyfriend, just support your child through the feelings of pain and loss by listening sympathetically. You don’t have to share all the thoughts that you have!

Suggest “Rescue Remedy”
Grieving heals with a listening ear and time. However, many people find that the Bach Flower preparation called “Rescue Remedy” can also help calm feelings of desperation, hysteria, panic, loss, confusion and overwhelming pain. Rescue Remedy is available online and at health food stores and some pharmacies. It is harmless enough to be used safely by infants and pregnant women and does not interact with other medicines, foods or treatments. However, if you have special health needs or any concerns about it at all, do ask your doctor before suggesting it to your child. Rescue Remedy is available in liquid form as well as candy and chewing gum varieties.

Consider Professional Help
If you are noticing signs of depression, hopelessness, addictive behavior, or loss of interest in friends and school, then consider taking your child to a mental health professional. Teenagers do not always handle heartbreak well; in some cases, it is the trigger for a suicide attempt or an actual suicide. Keep the doors of communication open and if your child tells you that life isn’t worth living anymore, acknowledge the pain and say something like, “I know it can hurt so much that it doesn’t even seem like there’s a future after something like this. But there are professionals who can help people climb out of the dark hole and into the light again and I’d like you to talk with someone like that. There’s no need to try to get through this all on your own.”

When Your Child is Sad

Dealing with sadness effectively is a skill that will serve a child all throughout his or her life. After all, loss is an inevitable experience in this world – whether it is the loss of a favorite sweater, a cherished pet or beloved family member. Sadness is the appropriate response to loss. It is an emotional signal that says, “something is missing.” We feel sad until we have somehow reorganized our inner world to sew up the gaping hole left by the loss.

Parents can help children move through sadness. Moving through this feeling is important because failing to do so – staying stuck in sadness – can lead to feelings of depression, anxiety and panic, among other reactions. Unresolved sadness can also manifest as bodily pain and/or illness. For instance, unexplained tummy aches and headaches can be fueled by unresolved feelings of sadness. Parental support and guidance can help move sadness through and out of the child’s heart.

If your child is feeling sad, consider the following tips:

Let Your Child Know That’s It’s Okay to Feel Sad
Many parents are so distressed at seeing their kids upset that they want to cheer them up, reassure them and if possible, replace their loss, immediately. However, this approach only teaches children that sadness is an intolerable emotion. Unfortunately, such a message not only fails to teach a child how to handle feelings of sadness, but also increases the likelihood that kids will eventually run to escape measures like addictions when sadness threatens. Therefore, the first and most important step for parents to take is to calmly and compassionately welcome feelings of sadness. A simple acknowledgement of sadness can suffice, as in “you must feel so sad about that.” A period and a pause is necessary in order to convey acceptance, before continuing to speak. Avoid the word “but” since that word rushes too quickly to “fix” the sad feeling without processing it (see below for more about this). Allowing a child to feel sad also means letting him or her become temporarily withdrawn, unhappy and moody when suffering a loss. Refrain from trying to distract a sad child and from telling him or her to “cheer up.”

Provide Emotional Coaching
Dr. John Gottman, author of Raising an Emotionally Intelligent Child explains that naming and accepting a child’s feelings helps the child to both manage and release painful emotion. Just saying something like, “that must make you feel sad,” or “it really hurts” or “that’s very painful” or “I know it’s very upsetting” can give a child a channel for acknowledging difficult feelings inside of himself.  When the child can acknowledge the feeling, half of it disappears immediately. The other half will slowly melt out of the child’s heart with the continued support of the parent. All that is required is to let the feeling be, without  minimizing it or trying to change it in any way. For instance, suppose a child is very sad because his best friend is changing schools. The parent is tempted to say things like, “don’t worry – you can still visit him and have a friendship over the computer and the telephone.” However, the parent who offers Emotional Coaching says things like, “Wow, that’s hard. It’s sad to lose a best friend. I bet you’re pretty upset.” The parent accepts whatever the child says, naming the feelings that seem to be present. Emotional Coaching often allows a child to go even deeper into the bad feeling before resurfacing with a positive emotional resolution. Perhaps the child in our example might say something like  “Yes I am upset! I’ll never have another friend like him! I hate everyone else at school. There’s no one I’ll be able to be friends with!” If this happens, the parent just affirms how awful all that must feel (“It’s such a disappointment that he’s leaving, especially when there’s no one else to take his place and you’re going to be all alone.”) Once the child hears his feelings being spoken out-loud, he usually self-corrects and starts to cheer himself up (“well, maybe I’ll spend more time with Josh Lankin”). If the child doesn’t pull himself out of the sad feeling, the parent who has provided emotional acknowledgement is now in a good position to help the youngster think things through: advice that is offered AFTER Emotional Coaching is often much more likely to be accepted. You can learn more about Emotional Coaching in the book Raise Your Kids without Raising Your Voice by Sarah Chana Radcliffe.

Provide Perspective
Parents can provide education and guidance AFTER providing Emotional Coaching. Trying to do it beforehand often backfires, as the youngster feels that the parent just doesn’t understand the pain he or she is experiencing. Without understanding, the parent has “no right” to start offering advice. After Emotional Coaching, on the other hand, the child knows that the parent really understands and accepts the feelings of sadness. Now the parent “has the right” to try to provide information or perspective on the matter. In a study of children with depression, it’s been found that optimism is one of the factors that help protect children from the effect of overwhelming sadness. Kids who experience intense feelings of sadness (e.g. the sadness that comes after parents’ divorce or separation), but remain resilient are those who believe that the sadness is temporary — and that tomorrow will bring better days. If you can teach your children to look at the next day as having the potential to bring a new beginning, then you can help your child manage sadness better. Some parents will be able to draw on a strong religious faith to bring this notion forward and some will draw it out from their own bright view of life. If you have neither, however, try looking at the writings of Norman Vincent Peale – the father of “positive thinking.” Peale wrote dozens of books on the subject of maintaining an optimistic outlook, but even a quick perusal of his famous “The Power of Positive Thinking” will fill you with a rich reservoir of ideas to share with your children.

Encourage Your Child to Seek Social Support
Friends are handy in all moments of grief! As kids grow older, they can look to friends as people they can trust with their innermost thoughts and feelings. Studies among children and adults confirm the value of social support when handling difficult situations in life. Encourage your child to always maintain a couple of close friendships and a couple of casual friends. Close friends can provide valuable emotional support through sad and troubled times and casual friends can provide welcome distractions. Model this practice in your own life.

Consider Bach Flower Therapy
Bach Flower Remedies provide emotional relief in the form of a harmless water-based tincture. A few drops of remedy in liquid (water, tea, milk, juice, coffee, soda, etc.) several times a day can help feelings resolve more rapidly. Star of Bethlehem is one of the 38 Bach Flower Remedies – it helps heal feelings of shock and grief. It can help kids deal with death, divorce, loss of a good friend and other serious losses. Walnut can help kids move more gracefully through changing circumstances. Gorse can help lift depressed feelings. Mustard can help with sadness that comes for biological reasons like shifting hormones, grey skies and genetic predisposition to low moods. Larch can help with sadness that is caused by insecurity and Oak can be used when excessive strain and effort leads to unhappiness. There are other Bach Remedies that can help as well, depending on how the child is experiencing sadness. Consult a Bach Flower Practitioner or read up on the remedies. You can purchase them at most health food stores and online.

Consider Professional Help
If your child is “stuck” in sadness and can’t get out of it despite your interventions, do consult a pediatric psychologist or psychiatrist. A mental health professional is highly trained to help kids move through sadness and get on with a happy, productive life!

Marijuana Use

According to recent reports, erectile one in fifteen teenagers is using marijuana on a daily basis. More 10th graders smoke marijuana than cigarettes. On the other hand, order other forms of substance abuse are declining among this group – including alcohol use and other drugs.

What are the Immediate Effects of Marijuana?
Short term cannabis use (marijuana/weed/hemp/pot/grass and other slang names) often stimulates feelings of relaxation and elevated mood.  Appreciation for art and music may be enhanced or at least artistic appreciation might feel enhanced! Ideas can flow rapidly and the user may become quite talkative as well. In fact, pilule cannabis users may experience a variety of effects upon intoxication, including becoming hungry, having the giggles, experiencing hallucinations, experiencing increased  anxiety, suffering impaired motor coordination, experiencing increased fatigue and lowered motivation. However, a user will usually appear more or less normal to outside observers, even when he or she is highly intoxicated.

What are the Effects of Cannabis Intoxication?
Intoxication (getting “high”) is a disturbed state that often begins with symptoms of mild anxiety that can later progress to feelings of panic and might also include distortions in time perception, impaired judgment, impaired learning and problem-solving, euphoria, social withdrawal and motor impairment. Marijuana can also increase feelings of depression. Marijuana’s negative impact on memory and learning can last for days or even weeks after intoxication. Regular users may therefore be in a state of continuous lowered intellectual functioning. Those driving cars while intoxicated on marijuana have slower reaction times, impaired judgment, and impaired response to signals and sounds. Impulsivity increases, as does risk taking behavior. Physical symptoms can include dry mouth, rapid heart rate, red eyes and increased appetite.

The most common untoward reaction to cannabis is the development of an anxiety disorder, but use of the drug can also lead to serious psychotic disorders in those who are vulnerable. Vulnerability is associated with early use of marijuana (prior to age 18)  – in which case users have 2 to 4 times the frequency of psychotic illness occurring by young adulthood.  Also, those who start taking marijuana before age 18 have a much higher incidence of becoming addicted to the drug. Lastly, it appears that adolescent users are susceptible to drug induced permanent brain changes that affect memory and cognitive functioning.

What are the Effects of Cannabis Withdrawal?
When addicted users go off marijuana, they experience unpleasant symptoms such as irritability, anxiety, cravings for the drug, sleeplessness and decreased appetite. The symptoms are unpleasant enough to make abstinence challenging. They peak at 2-3 days off the drug and then subside within a couple of weeks. The most likely people to become addicted to marijuana are those who have started its use while in their teens and those who use the drug daily. Addiction is characterized in part by continued use of the substance despite negative effects on relationships, work or school performance or  other aspects of functioning.

Treatment for Cannabis Intoxication
Treatment can range from in-patient hospitalization, drug and alcohol rehabilitation facilities, to various outpatient programs and individual drug therapy counselling. Narcotics Anonymous (twelve-step programs) and other such group support programs are also helpful treatment options.

The Role of Parents
There’s much that parents can do to help their children avoid experimenting with or seriously using marijuana. Here are some ideas:

  • Bring home education books from your public library and leave them lying around with other books. Alternatively, leave them in the bathroom for “reading material.” Books written for young people on this subject are appealing to the age group with lots of simple information, pictures and user-friendly guidance.
  • Talk about drugs and alcohol at your dinner table. Give your opinions and share your knowledge.
  • LISTEN to what your kids are saying – without criticism, negative feedback or judgment. You don’t want them to shut down and keep their thoughts (and actions) to themselves. Instead, show thoughtful interest and curiosity and try to relate what they are saying to your own adolescent and current life experience.
  • Teach your kids healthy ways of managing stress – don’t assume they know how to process hurt, anger or fear. Bring home books on stress management and emotional awareness and talk about these things at your table.
  • Offer your kids professional counseling when they seem to have too much stress or when they are withdrawing, very anxious, suffering from insomnia, seem to be in low mood or otherwise seem emotionally off balance. You don’t want them to discover the pleasure of “self-medicating” through drugs!
  • Strengthen the emotional stability of your family, the health of your marriage and the happiness of your home through education and counseling as necessary – a happier home environment is preventative as far as heavy drug use goes.
  • Use an authoritative style of parenting – have some rules and boundaries but emphasize warmth (see “Raise Your Kids without Raising Your Voice” for a balanced parenting strategy). Refrain from using too many rules, too much criticism or too much anger.

Do I Have Depression?

“It’s like I just don’t want to get out of bed; I can’t seem to get anything done  all day. Everything is just too much.”

“I spend a lot of time crying. I don’t know why.”

“I’m pretty incompetent compared to everyone else. I’m a failure.”

The voices of depression. Gloomy, hurting voices. Hopeless, sad voices. We’ve all had our share of depressed days – maybe it was during the postpartum blues or perhaps after a major disappointment or loss. Maybe it came on for no apparent reason. And then it passed.

Some of us, however, experience the pain of depression for longer periods of time, sometimes for months or years. The pain can be intense, even debilitating. Depression robs people of joy in living, wreaks havoc with family relationships and incapacitates its victims. Deeply depressed people, for example, may find it very difficult or even impossible to carry out their daily responsibilities at home or at work. They may feel constantly “down” and overwhelmed with their lives. What can be done? How does one get cured of depression?

The answer depends on what sort of depression one is suffering from. Those suffering from “clinical depression” or “major depression,” (the more intense kind) will benefit from a strategy different from those suffering from more minor or transient depressions. You may have a clinical depression if five of the following symptoms have been consistently present for at least a two week period:

  1. Poor appetite or increased appetite
  2. Loss of energy or fatigue daily
  3. Insomnia
  4. Excessive sleeping
  5. Restlessness, agitation or slowing down
  6. Reduced feelings of pleasure
  7. Feelings of worthlessness/low self-esteem
  8. Diminished ability to concentrate
  9. Less able to cope with routine responsibilities
  10. Depressed mood (sadness) most of the time
  11. Thoughts about death

If these symptoms cause significant distress or disruption in your social life (including family life) or in your work life (including household responsibilities or academic responsibilities) and if they aren’t caused by some clear condition (such as a drug reaction, a medical condition or a death of a loved one), then they can meet the criteria for depression. Such symptoms may last for six months or longer.

Although there is some controversy in the mental health field about the most appropriate treatment for this sort of depression, all professionals agree on one thing: it’s important to get help. Treated depressions heal more quickly and more completely, saving you and your loved ones from unnecessary prolonged anguish.

Not only are there different sorts of treatments for this condition, but there are also different sorts of professionals who may be helpful. Psychiatrists and medical doctors are the only professionals who can prescribe antidepressant medications. Both may do counselling as well. Psychiatrists have extensive training in psychological disorders as well as in medical disorders, whereas family doctors may have no training in psychology (although some are trained in counselling). Psychologists are exclusively trained in the diagnosis and treatment of psychological conditions. Psychotherapists and counsellors are trained in the treatment of emotional and psychological conditions. Social workers may also have training in counselling. Any of these professionals may treat depression.

Treatments vary according to the training and orientation of individual professionals. Some psychiatrists and doctors tend to treat almost all of their patients with antidepressant drugs whereas others may use a combination of drug therapy and counseling. Drugs may be particularly helpful when a person just isn’t able to fulfil his/her responsibilities, is feeling suicidal or is not benefiting from therapy. Other professionals choose from a wide range of therapeutic approaches in counseling – some very short-term and others more in-depth. They will often vary their treatment for minor depressions as opposed to major depressions. Most work in conjunction with medical practitioners when medication is prescribed.

There are new treatments being developed for depression as well. For instance, TMS (transcranial magnetic stimulation) is being researched and shows promise as an effective intervention for treatment-resistant depression. In addition, complementary therapies may be used along with more traditional interventions: exercise, acupuncture, herbal medicine, Bach Flower Therapy, mindfulness meditation, energy psychology (i.e.EFT) and many other treatments may help speed healing along and are especially useful when a person is weaning off of medication after effective treatment.

Many people want counselling to be a part of, if not the entire, approach to treatment. Counselling helps to correct the cognitive distortions that can lead to depressed  feelings. It may help remove emotional blocks to happiness. It can also help prevent  recurrences of depression in the future by treating underlying causes and providing appropriate coping strategies. Counseling can often help people get off and stay off medication eventually. When choosing a counselor, look for someone whom you trust and like. The relationship between the mental health professional and the client is  paramount in the success of treatment.

Depression is a very common condition even in its more severe forms. In fact, some professionals feel it is nothing more than the result of being human. However, it is a condition which is not to be taken lightly. It can be devastating even if it is common. There is no need to suffer with depression. If you think you may be experiencing depression, seek professional assessment. Relief can come sooner than you think.

Helping Your Child Deal with Death and Loss

Facing death is one of life’s biggest challenges. Inevitably, many children encounter experiences with death – ranging from the loss of a beloved pet to the loss of a beloved parent. How can parents help their child deal with death and loss?

Consider the following tips:

Children Handle Death Differently from Adults
Your child may act like everything is fine – he or she is playing with friends, chatting online, engaging in hobbies and after-school activities; everything looks “normal.” This is just the way children deal with trauma. In fact, traumatic events like life-threatening illness and death can be so overwhelming for children that they sometimes bury it deep inside themselves where it is locked away for later review – often decades later. Meanwhile, they carry on with life. Unfortunately, it takes a lot of psychic energy to keep deep feelings of fear, loss and grief buried inside. The child may become depressed, anxious, poorly behaved or highly distracted (see below). It’s much better if some adult can help the child deal with the feelings and let them out, little by little, so that there is no “pressure cooker” inside.

Types of Reactions to Loss
Some children react to death by “acting out.” This means that their behavior deteriorates. Again, they may seem to be unaffected by the death in that they’re not crying, they’re not acting sad or depressed, and they’re not wanting to talk about the death. However, they are getting into plenty of mischief at home and at school. If you notice this sort of behavioral change in your child, then professional counseling can help. Although the counselor may recommend cutting the child some slack for a short time, make sure that you do so ONLY for a short time (i.e. a couple of weeks). It is important to impose regular standards and normal structure for the child, including reasonable limits on behavior. Accept all of the child’s emotions, but not any of the child’s destructive, disrespectful or dangerous behaviors. Just because a child is distraught it is not O.K. for him or her to swear at people or destroy property or disregard the rules of the house. As parents step in to gain control of the situation, the child will actually begin to feel more in control as well. The limits can be reassuring, communicating that normal life does go on and the parents themselves are O.K. enough to do normal parenting. All of this helps the child to return to a normal baseline.

Some kids kids become very anxious after a death, suffering from bad dreams or nightmares, having trouble sleeping, developing fears of the future and phobias in the present and obsessing about the death, the dying process or the person who died. If your child develops intense fears that don’t clear up within a month, seek professional help. Sometimes these signs may be symptoms of a post-traumatic stress reaction that requires specialized treatment.

Children May Become Withdrawn After a Loss
Instead of acting OUT, they act IN – becoming sad and isolated. It’s fine to allow children some quiet time, a time in which to lick their wounds and slowly recover. However, if a child is still turning away from life several months after a loss, seek professional assessment. It may be that counseling can help speed the mourning process along and help the child return to his or her life.

Talk about It
Very often, kids will not initiate conversations about the loss. This does not mean that they don’t need to talk. It often means they don’t know HOW to talk about it or they’re afraid of causing the parent upset. Parents, therefore, need to try to initiate talk. If the child doesn’t want to join in, then give the child space. However, some kids will be very happy to have the input of their parents. You can talk a little (not too much, so as not to overwhelm the child) about your own sadness and loss, but be sure to show interest in the child’s feelings. “We’re all sad and missing Grandma. I used to talk to her every day and now I really miss that. How are you doing with it? It must be hard for you too.” This sort of sentence gives the child an opening. Some kids will take the opportunity to express anger. “Why did she have to die? I want her to be here with us!” Acknowledge the child’s pain BEFORE answering questions. “Yes, we’re all upset about it. We all want her here. I know how much you miss her. No one really knows why people have to die – it’s all part of God’s plan. For some reason we don’t understand, we can’t live forever here on earth. But when the body dies, the soul still lives and in that sense we never die… (explain death in whatever way you understand it).”

When you support your child through a grieving experience, your child learns that he or she can turn to others in times of crisis. This is a very important life lesson that helps to stress-proof your youngster.

Other Healing Strategies
Some children will cope better by drawing their feelings. In fact, there are art therapists who can help your child process grief and loss through artwork and this can be a very gentle and helpful process. Or, just have drawing time a couple of times a week and ask your child to draw his or her feelings on a blank page. It doesn’t matter whether the picture is “nice” or not – it is simply a channel for the expression of emotion.

Making a “memory book” of the lost person or pet can also be a helpful exercise. You can help the younger child and the older child or teen can do it independently. Stories, pictures, thoughts, photo’s – anything about the person or pet may be put in the pages of this special book designed to honor the departed one. It is common to cry and laugh while making such a book –  many feelings are released. The exercise is very healing and helps the mourner move forward, taking the positive aspects of the loved one forward with him or her.

Be Aware of Your Impact
Although grieving adults are often in too much pain to parent well, it is important to remember that your children are always watching you. Your reactions – at least the ones they can observe – teach them a lot about life and stress management. If you are too overwhelmed to function well, show them how you access professional help or family support. Let them know by your model, that you needn’t go through pain and deep stress alone. If you are so sad that you find yourself crying all the time, let the kids know that the tears are temporary and that they are your way of letting the sadness out of your body. If you are crying in front of them for more than two or three months, get professional help. Your intense emotion can alarm your kids and give them a feeling of helpless despair. Ideally, after the first few weeks, you can cry when the kids are in school or asleep or at other appropriate times. Keep in mind that people go to work after the death of a loved one and they are able to refrain from crying eight hours a day when they are being paid to function well. Functioning well at home is equally important as children are sensitive to and affected by their parents’ mood.

Consider Professional Support
If your child has changes in behavior that are of concern like chronic loss of or increase in appetite, intense behavioral problems or new behavioral problems, nervous habits, bedwetting, a new set of “bad” friends, suspicious behaviors, sleep disturbances, fears, low mood, new academic problems or any other behavioral or emotional symptom that worries you, get a professional assessment. Sometimes intense stress can trigger latent mental health concerns or cause complicated grief reactions that benefit from professional help. The sooner you can help your child, the sooner your child will return to normal functioning.

Bulimia

Bulimia is an eating disorder – but one that is not necessarily easy to spot in one’s own child. Other eating disorders are more visible. For instance, pills almost anyone can recognize obesity – a condition in which the sufferer is significantly overweight. People can also often recognize cases of anorexia nervosa – the condition in which a person is severely under his or her ideal weight (and may therefore look painfully skinny and boney). However, it is not possible to identify someone with Bulimia Nervosa just by looking. The sufferer of this eating disorder may be a perfectly normal weight. It is not the WEIGHT that is disordered in this condition, but rather the way in which the person maintains that weight.  A bulimic (one who suffers from bulimia nervosa) eats way too many calories in one sitting (for example, a number of grilled cheese sandwiches, a full tub of ice cream, a box of crackers, a bag of chips and a plate of waffles). This episode of overeating is called “bingeing.” It is normally followed by feelings of panic (about gaining too much weight), shame and guilt and an intense effort to “undo” the eating behavior by engaging in excessive exercise or using laxatives to empty the gut, or inducing vomiting for the same purpose. Episodes of bingeing and purging (over-eating and then “undoing” the calories somehow) can sometimes occur many times a day. On average, people with Bulimia binge 12 times a week, consuming as much as 11,500 calories. Foods rich in processed sugar and fat, such as pastry, ice cream, bread and donuts are the most common objects of binges.

Bulimia Nervosa is more common than Anorexia, and affects girls more than boys.

Signs of Bulimia
Although parents can’t tell from LOOKING at their child that the youngster is suffering from bulimia, they may be able to discern a problem by observing their child’s behavior. Those suffering from bulimia usually feel a lack of control when it comes to eating. While most of us stop eating when we feel full, those with bulimia keep on eating to the point of feeling pain.  This inability to control their eating can be very embarrassing and typically bulimics try to hide their binging and purging.  Some typical symptoms that may indicate bulimia are:

  • Wanting to eat alone
  • Eating very little in public
  • Frequent trips to the bathroom after meals
  • Disappearance of food
  • Hidden stashes of junk food
  • Eating large amounts of food without putting on weight
  • Excessive exercising
  • Using laxatives, enemas or diuretics

People with bulimia may also have physical symptoms caused by purging.  These include:

  • Puffy cheeks caused by repeated vomiting
  • Discoloured teeth caused by exposure to stomach acid when throwing up
  • Frequent fluctuations in weight
  • Calluses or scars on knuckles and hands caused by putting fingers down the throat to induce vomiting

An Impulse-Control Issue
Are sufferers of Bulimia Nervosa aware that their eating pattern is dysfunctional? Yes. However, they have difficulty controlling themselves; the act of binging and purging is a compulsion. In fact, many Bulimics report that they only stop a cycle of binging or purging when they feel physical pain. Otherwise, they can’t help themselves. They have a compulsion that is too strong for them to overcome, much like an addicts relationship to his substance.

Bulimia Nervosa has been linked to emotional stress as well as body image issues. Low self-esteem, a history of abuse, a difficult life transition, traumatic experiences and other stresses have been found to be higher in those suffering from Bulimia. In addition, there is a higher rate of bulimia in those who are drawn to a body-conscious hobby or profession like modeling, ballet, gymnastics or physical fitness training. It is not clear whether the activity and peer pressure found in the activity actually induces bulimia or whether those with bulimic tendencies (obsession about body image) may choose those activities to begin with.

A Serious Health Threat
Bulimia is a serious health issue. Chronic bingeing and purging can cause serious gastro-intestinal diseases. The purging (in the form of vomiting, laxatives, and diuretics) can lead to electrolyte imbalances, usually in the form of low potassium levels. Low potassium results in symptoms such as lethargy, confusion, irregular heartbeat, and cardiac and kidney dysfunction. In severe cases it can even cause death. Other effects of bulimia may include:

  • Weight gain
  • Constipation caused by chronic laxative use
  • Abdominal pain and bloating
  • Tooth decay
  • Chronic sore throat and hoarseness
  • Broken blood vessels in the eyes
  • Weakness and dizziness
  • Loss of menstrual periods
  • Acid reflux

Risk Factors
Bulimia generally begins in adolescence and 90 – 95% of those with the disease are women.  There is no single cause for bulimia but low self-esteem and poor body image are often contributing factors.  Some of the more common risk factors for bulimia are:

  • Dieting – people who diet on a regular basis are more likely to develop an eating disorder than those who don’t.
  • Involvement in professions/activities that emphasize weight control – the pressure placed on gymnasts, dancers, models, actors, and other athletes to maintain a certain weight can lead to the development of eating disorders.
  • Low self esteem – this can be a result of abuse, depression, a critical home environment, and a desire for perfection.
  • Poor body image – young women are often influenced by our culture’s glorification of thinness and beauty.
  • Major life changes – bulimia is sometimes a reaction to stress, which can accompany a major life change.  Examples of major life changes may be; moving away from home, puberty, divorce, and the break-up of relationships.
  • Biological factors – since eating disorders run in families there is likely a genetic component.  In addition, research indicates that low serotonin levels play a role in bulimia.

Treatment for Bulimia
Treatment for Bulimia should be a combination of a medical and a psychological program. At times, an in-patient weight management program needs to be implemented alongside counseling in order to address the two critical aspects of the illness. Most often, however, bulimia is effectively treated on an out-patient basis. People do heal from this disorder. They may have relapses occasionally but when they learn effective stress-management techniques they can usually prevent relapses over the long-run. Seeking counseling and using self-help strategies are both important for long term recovery.

Psychotherapy is the main form of treatment for bulimia.  Specifically, cognitive behavioural therapy is often used to break the binge-and-purge cycle and change unhealthy thought patterns.

Medication such as anti-depressants may also be used.  These help to reduce binge eating and treat the depression that is often a part of bulimia.

Suicidal Feelings

A certain number of people kill themselves each year, most of whom were suffering from severe depression. Fortunately, 90% of people with depression are able to live full lives while managing their episodes of depressed mood. Only about 10% will end their lives (this number depends on where a person lives – countries vary in their availability of effective treatments and support for depression, so there is a wide international variability in suicide rates).  The pervasive sad mood that comes with depression, as well as the increased tendency among the depressed to obsess on negative thoughts, makes them susceptible to the hopelessness and irrationality characteristic of the suicidal person. People do not “choose” suicide; they fall victim to it as part of their illness.

What are the Implications for Parents?
The link between suicidality and depression should serve as alarm bells when helping our children deal with mental health issues. If we have a loved one who is suffering from depression, it is always prudent to watch out for signs of suicidality. A depressed child is at risk for succumbing to suicidal thoughts; it is up to parents to help prevent this. Vigilant parents can be familiar with the warning signs of suicidality and take action. Moreover, they can do everything possible to get their child the right kind of help. In addition, they can work hard to reduce the other stressors in the child’s life – like school work (negotiate accommodations with the school) and conflict in the home. In fact, when the parents work on their own marriage and parenting skills to increase peace in the home, this can help tremendously.

What are the Warning Signs?
According to the American Academy of Child and Adolescent Psychiatry these signs are:

  • Change in eating and sleeping habits
  • Withdrawal from friends, family, and regular activities
  • Violent behavior or running away
  • Substance abuse
  • Neglect of personal grooming
  • Personality change
  • Difficulty concentrating, persistent boredom
  • Drop in academic performance
  • Marked personality change
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • Loss of interest in previously enjoyable activities
  • Speaking positively about death or romanticizing dying (“If I died, people will appreciate me more.”)
  • Writing about death, dying, or suicide
  • Engaging in reckless or dangerous behavior; being injured frequently in accidents
  • Giving away or discard favorite possessions
  • Saying permanent sounding goodbyes to friends and family
  • Seeking out weapons, pills, or other lethal tools

A child or teen  who is planning to commit suicide may also:

  • Complain of being a bad person or feeling rotten inside
  • Give verbal hints with statements such as: “I won’t be a problem for you much longer.”, “Nothing matters.”, “It’s no use.”, and “I won’t see you again.”
  • Become suddenly cheerful after a period of depression
  • Have signs of psychosis (hallucinations or bizarre thoughts)

The risk of suicide is high among those who have attempted suicide before, know someone who has killed themselves, and are pessimistic about the chances of getting relief from chronic depression. Also, teens who have a family history of mental illness and suicide are more likely to attempt suicide as are teens who have clinical depression or who suffer from active addiction. Teens who’ve already made a suicide attempt have a higher chance of committing suicide successfully. Vulnerable teenagers who suffer a serious loss (like the breakup of a romantic relationship) may try to stop the pain with suicide. A history of physical or sexual abuse, incarceration, alienation from parents and refusal to access mental health services all increase suicidal risk. Males have a higher “success” rate for suicide than females, but females make many more suicide attempts than do males. Also take note if your depressed child suddenly seems unusally happy. Sometimes this switch in attitude happens because a child has decided to end his suffering and he is actually experiencing a state of relief. Remember that depressed mood is a serious and potentially life-threatening condition and should always be professionally treated.

The American Academy of Child and Adolescent Psychiatry recommends taking a child’s suicidal statements seriously. If a child or adolescent says, “I want to kill myself,” or “I’m going to commit suicide,” ask him what he means. Don’t be afraid of saying the word “suicide.” You won’t be giving the teen an idea that he hadn’t thought about. Instead, you’ll help him or her think things through. Ask about depression, anxiety and unhappiness. Don’t just tell the child no to talk that way.  Show interest and concern and get your child to a qualified mental health professional (such as a psychiatrist or clinical psychologist).

Suicidal Behavior in Teens
Teenagers are a vulnerable group. They experience tremendous pressure from all sides: from inside their changing bodies, from their parents, from their schools and from their peers. No one can be perfect in every area and so everyone is doing poorly in something. But teenagers can feel isolated with their failures and setbacks, lacking the perspective that older people have that “we’re all in this together.” Teenagers are intent on fitting in, looking good, being acceptable. If the only group they can fit into is a violent, drug-ridden street gang, then that’ll be the group they might very well join, especially if they have little support elsewhere or few sources of success and strength.

Because the pressure is so intense, many teens do not cope well. Their survival strategies depend to a large extent on their genetic make-up and the strategies they learn at home. Some teenagers have “hardy” genes that help them survive and thrive under stressful conditions. They can laugh their way through almost anything or simply tough it out. Others are genetically vulnerable to bouts of depression. However, the depressed teen is more at risk than depressed adults. Teens are very focused in the present. They have trouble imagining that in a few years life can improve tremendously. Their impulsivity can lead them to put an end to it all right now because they just can’t see any way out.

What You Can Do
Parents can also help buffer teens from stress by keeping the doors of communication open. Make it easy for your kids to talk to you. Keep criticism to a minimum; instead, give praise and positive feedback generously. Have fun with your teenager and try to make your home pleasant, comfortable and safe. Keep conflict down with your spouse. Avoid drama. Take care of yourself and create a healthy model of stress management strategies for your kids to learn from. Create a positive atmosphere. Have a dinner table several times a week and use it to have discussions on politics, human nature, interesting things in the news or whatever—keep talking with your kids. Make your values clear. Bring tradition and ritual into your home.  Accept all feelings without correction or disapproval. Ask for behavioral change gently and respectfully. Never yell at your teenager. Never insult, name call, use sarcasm or any other form of verbal abuse. Instead, be sensitive to your teen’s feelings at all times. Discipline when necessary but only after you’ve warned a child that discipline will occur and only with mild discipline—never affecting the teen’s social life (see Raise Your Kids without Raising Your Voice for safe and effective ways of guiding teenagers).

If your teen demonstrates any of the symptoms of depression or suicidality, talk to him or her about what you are observing and arrange an appointment with a mental health professional. You can call suicide helplines in your area to get information about how to help your child. You can take your child for a mental health assessment. If your child is uncooperative, seek mental health guidance yourself. Since a suicidal person feels isolated and hopeless, any steps that family members take to address the situation can be powerfully preventative. Remember, too, that many parents have walked this road before you. Access on-line and community support if your child has been threatening suicide.

Types of Depression

“Depression” is a common mental health condition. However, the word refers to many types of mood issues, rather than just one straightforward condition. In fact, there are many types of depression, depending on symptoms, severity, cause and duration of the illness.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the following are some of the types of depression:

Major Depressive Disorder
When people use the term depression, they usually mean a Major Depressive Disorder. Unlike short-term feelings of sadness, which can be due to any situation that can cause one to feel rightly sad and upset, major depressive disorder is an intense and debilitating condition affecting many aspects of one’s mood, energy and physical functioning.

A person with Major Depressive Disorder can suffer from feelings of hopelessness and despair, self-incriminating thoughts, crying spells, fatigue, weight loss, sleep disturbances, lost of interest in activities and relationships, inability to work, and thoughts of suicide. Major Depressive Disorder, also called clinical depression, is diagnosed if the debilitating symptoms are manifested by the patient for at least two consecutive weeks and causes significant distress and/or impairment in functioning.

Dysthymic Disorder
A less severe form of depression is called Dysthymic Disorder or Dysthymia. The feelings of sadness and helplessness in Dysthymia are less debilitating, and are often merely aggravated by other physical or mental illnesses. Symptoms of Dysthymia come and go, and vary in intensity per episode. However, it can be a chronic disease that runs in families. Diagnosis requires at least two years of chronic low mood. People with dysthymia tend to underfunction at home and at work, due to low energy, low mood, chronic irritability and negativity, low motivation, sleep issues, low self-esteem and other symptoms. If left unmanaged, Dysthymia can progress to a Major Depressive Disorder.

Bipolar Depression 
Bipolar Depression, also called manic-depressive disorder or bipolar disorder, is a mood disorder that is characterized by cycles of extreme elevated moods (called mania) and depressive episodes. During the manic stage of the disorder, patients can exhibit symptoms like extreme alertness, difficulty sleeping, increased energy and erratic euphoria. But this “high” is often followed by an extreme low typical of a Major Depressive Disorder. Bipolar Depression comes in two types – Bipolar I and Bipolar II. The first is a very disturbed state in which manic episodes can lead to high risk behaviors, highly inappropriate behaviors and troubles with the law (picture a teenager standing naked on a neighbor’s rooftop singing at the top of his lungs). Bipolar II is characterized by more eccentric-looking behavior that is out of character for the person (picture someone enthusiastically filling her entire house with antiques that she’s thinking of selling in order to make an enormous fortune – even though she’s never done anything like this before).

Loved ones of people with Bipolar Depression often miss the illness in the patient, because the manic stage is mistaken for a sign of recovery. But note that the mania stage has a particular irrational urgency to it, and is not to be mistaken for actual happiness. In fact, a depressed person with Bipolar Depression is anxious, irritable and prone to self-defeating behaviors during their emotional high.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) refers to depression that only comes during particular times of the year. For instance, there are patients who exhibit symptoms of depression only during the cold winter months, but they are otherwise fine during the summer. In other cases the opposite is true; it’s the summer that brings in the blues. In tropical countries, the rainy season can be the most troublesome part of the year.

Psychotic Major Depression (PMD)
There are occasions when the depression is so intense; it causes a loss of contact with reality. A person with Psychotic Major Depression may experience hallucinations (sensing things that don’t really exist) or delusions (irrationally interpreting events and observations). Psychotic symptoms in PMD are often temporary, and will go away once the cause of the depression is addressed. The condition is not to be confused with schizophrenia, which can also cause depression.

Atypical Depression
A kind of depression that is difficult to diagnose and treat is called atypical depression. As the term implies, atypical depression is depression whose symptoms don’t always follow what is traditionally associated with clinical depression. The symptoms also appear to come and go, and can be lifted by positive life events. It is believed that atypical depression is primarily biological in origin, a product of chemical imbalance in the brain.

Symptoms of atypical depression may include loss of energy, unexplained and uncontrollable crying, insomnia or hypersomnia, irritability, unexplained aches and pains, difficulty concentrating and loss of interest in daily tasks.