Dr. Henry Paul, MD

Psychiatrist, Author and Educator

POLICE AND SCHOOLS PARTNERING TO BETTER UNDERSTAND MENTAL HEALTH ISSUES

February 9th, 2015

Police and school officials in Fort Wayne, Indiana, are teaming-up to understand the basics of mental illness in young people in an effort to cut back on arrests of children in a mental health crisis. This partnership is inspiring to see because it is through collaborative efforts like this that young people who are at risk will get the best help.

16579192_sThe greatest way to help young people who have mental illness is to get them treatment and not to incarcerate them. The problem is that the symptoms of a mental health crisis are mistaken for delinquent behavior, and that can lead to arrest and possibly jail time.

There has been an ongoing debate in the medical community for years about the link between mental illness and criminal behavior. So why do so many Americans associate mental illness with criminal behavior? Because that is what is in the media and that’s what people remember. Think Sandy Hook. I’m sure what comes to mind for many is that the shooter was on the autism spectrum.

Behavior disorders in young people are often disrupting and bothersome to parents and teachers. It is normal for parents of teens to worry about their behavior, concerned that episodes of “acting up” may be harbingers of future antisocial, sociopathic development, or that their teens are on the road to violent criminality, substance abuse, living on the “edge,” and ending up in jail or prison.

The reality is that most normal teenagers do act up from time-to-time, sometimes in very disturbing and destructive ways. Adolescence is a time of testing limits. In young people who are still developing it remains self-evident that abnormal behaviors are often part of normal developmental progression, and they are temporary. In other instances it can be part of a disruptive behavior disorder, and if that’s the case the most important thing to do is to get the teen the proper treatment.

Young people with disruptive behavior disorders such as ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD), do occasionally break laws, especially those young people with Conduct Disorder. If your teen’s behavioral problems have proven to be intransigent, they may suffer from a behavioral disorder that requires greater attention and more specific help. The upside is that these disorders in young people can more easily be treated than the adult syndrome of “Antisocial Personality” (the Psychopath), which is notoriously resistant to psychiatric intervention. Youth carries with it more hope of intervention and possible change. Thus schools, police and mental health professionals working together offer the most fruitful hope.

Click here to read about the partnership between police and school administrators in Fort Wayne.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

UNDERSTANDING ANGER IN TEENAGERS

January 31st, 2015

There are two main sources of anger in children and teens: one is the danger that occurs as a result of facing new daily challenges, and the other is interpersonal relations.

32793892_sFirst, for teenagers facing new challenges, anger is part of the process. New challenges include dealing with the bodily changes of puberty, sexuality and increasing independence from parents. They can also include new social situations that are baffling and demanding, school and peer pressures, college anxiety, and all the other awkward and anxiety-provoking challenges that the passage through adolescence entails.

Second, anger resulting from interpersonal relationships — primarily, the relationship between teens and parents and social stresses with peers – is usually because a teenager feels a sense of being unwanted or being treated unfairly. Neglect, broken promises, inconsistency, hypocrisy, double messages, being over-protective, teasing, and the arbitrary exercise of power are just some examples of what can lead to these feelings.

The degree of a teenager’s anger also varies according to his or her makeup and other things such as age and temperament and his or her ability to tolerate stress and situations that are around them. Their gender also plays a role. While most males tend to act out their anger aggressively, females – although more willing now to express anger outwardly than in the past – tend to subsume it in other feelings such as depression.

Because parents tend to misunderstand teenage anger; they frequently mishandle it. Mishandling it may include denying that the teen is angry at all, ignoring it, attempting to eradicate it by abuse of punishment, complying with it, resorting to bribery, or refusing to set limits. All of those responses result in impeding anger from serving its function; to communicate to the parent what’s bothering the teen. Understanding your teenager’s anger is the first step in dealing with it. Understanding your own anger is the second step.

Parents need to understand their own motives and styles of anger management. Questions parents should ask themselves: Are you confused about your anger? Are you trying to exercise excessive control over your teenager? Do you feel an unconscious identification with your child that interferes with good judgment? Are you afraid of your teenager’s anger, or applying a standard of “perfection” in which anger is not permissible? Dependency, egocentricity, martyrdom, vengefulness – these are all personality traits that parents need to address in themselves before they can clear the way to reacting to their teenager’s anger more productively.

Thus, while most anger is normal, when parents mishandle their teen’s anger because of their own non-comprehension of it, they can cause problems that otherwise would not ensue; they affect what I call an anger metamorphosis, in which the child begins to see his anger as a bad, threatening, and disruptive feeling and therefore goes to great lengths to repress it. When anger is repressed, it evolves into symptoms that we especially see in teenage years. It can become the fuel for generalized anxiety states, depression, school failure, conduct disorder and other behavior disorders; criminal-type behavior, drug addiction, and a host of other problems. These legacies of mishandled anger will only grow if parents don’t realize that the original anger was healthy to begin with – that it carries a message of need that must and can be addressed directly, without fear.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT TO DO ABOUT AN ANGRY TEEN

January 30th, 2015

10333221_sDealing with your teenager when they are angry or having a violent “anger emergency” is not easy. Here are some steps to take when an explosive situation turns towards violence.

If your teenager gets so angry that you feel threatened by an “anger emergency,” do all you can to stay with your child and restrain him whatever way possible. In this situation, try not to criticize, although you should employ whatever means necessary to protect yourself and any others present. When you feel threatened, you may need to call in extra help, such as another parent, or, in rare cases, the police. Remember, you do your teenager no good by allowing him to rant and rave uncontrollably, especially if he is physically violent. Restrain him but do not berate him.

Fortunately, most teenagers do not reach the “anger emergency” point. With most teenagers, the aim should be to understand what message the teen’s anger seeks to convey. Understanding cannot be achieved by lecturing, chastising, or intimidating, but rather by compassionate listening and questioning. You want to find out what is troubling your teenager and to locate the trigger for the anger. Some teens can tell you why they’re angry while others cannot. You may need to play detective, trying to piece together what you know from your child’s actions, activities, and friends. Try to come up with a working theory to present to your child about why he might be angry. Observing, listening, and questioning your child are key.

Your primary goal should be to relieve the teenager, to ease whatever situation has induced the anger in the first place. You might suggest a solution to his problem or offer direct assistance. You might have to look at your behavior and how you might be able to keep from triggering your teen yourself. You may have to intervene at school or with local clubs to mediate the situation.
Lastly, if your teenager’s anger just does not go away despite your hard work in trying to detect the cause and ameliorate the underlying causes, then professional consultation is warranted.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

ANGER IS NORMAL – VIOLENCE IS NOT

January 29th, 2015

Young people can be downright frightening when angry. But many teens can become violent particularly if they are suffering from a conduct disorder or a psychotic disorder with paranoid delusions. Drugs and alcohol can often cause dyscontrol (the inability to control one’s behavior) that leads to violence.

15852958_sWhile anger itself is a perfectly normal emotion, violence is not. No parent should ever tolerate violence coming from their child. It is dangerous for everyone including the child. Immediate emergency measures include calling 911, restraint if safe and possible or even escape if necessary. Make no bones about it a violent child is dangerous and should be evaluated by a professional immediately. Don’t be fooled into thinking that if the episode passes that reasoning and processing alone is enough. You need a professional’s opinion. Emergency room personnel has training for dealing with these types of emergencies and is a good place to start if you’re in a crisis.

Anger, in general, is a difficult emotion for parents to understand. Should it be expressed, repressed, or displaced into other areas? Part of why it is so baffling is that most parents themselves do not understand their own anger – what it means, and how to handle it effectively. They don’t know how to make sense of the confusing messages in the media that bombard them about kids and anger. Parents worry that angry teens might hurt somebody, hurt themselves, join gangs, deteriorate academically and socially, and end up in prison.

First, some reassurance: although a majority of teenagers commit at least one anti-social act during adolescence, it is rare that they become criminals later in life. More fundamentally reassuring: anger is a perfectly normal feeling. Defined as a sense of displeasure or distress caused by feelings of powerlessness and helplessness, it runs the gamut from mild annoyance and crankiness to actual rage and fury, all of which can be normal reactions. Along with guilt, love, passion, joy, sorrow and excitement, feeling and expressing anger are part of being human. Without the ability to express anger, children and teenagers would be badly endangered. Anger is a great communicator. It signals parents to know when and how to help their child. Angry feelings are reactions to frustration, helplessness, and vulnerability – an alarm that the child needs aid.

The most important thing to remember about anger is that it is a response to feeling helpless. It usually can be understood if parents take the time to try. Anger usually disappears when the sense of helplessness underlying it resolves. Anger leaves no damage when it passes. Since feelings of helplessness are usually temporary and anger, freely expressed, can elicit help, parents are best advised to see it as a constructive feeling, even a helpful and life enhancing one.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

OPPOSITIONAL DEFIANT DISORDER AND CONDUCT DISORDER

April 30th, 2014

In the group of disorders called behavior disorders, in addition to Attention Deficit (Hyperactivity) Disorder there are two other conditions: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).

Oppositional Defiant Disorder (ODD) is a characterized by:

  1. Negativism
  2. Rebellion
  3. Arguing
  4. Defiance
  5. Anger episodes
  6. Revenge
  7. Resentment
  8. Spite
  9. Annoying others
  10. Blaming others
  11. Irritability
  12. An overall passive aggressive stance (I will show my anger by not doing….”)

Conduct Disorder (CD), an even more serious behavior disorder, often related to the development of Antisocial Personality Disorder in adulthood, is characterized by:

  1. Persistent breaking of rules
  2. Aggression toward other people/animals
  3. Fighting, bullying, cruelty, intimidation
  4. Destruction of property
  5. Fire setting
  6. Lying
  7. Stealing
  8. Other law/rule breaking
  9. Running away
  10. Truancy
  11. Breaking curfew

Both of these serious behavior disorders are difficult to treat, necessitating a multimodal approach and sometimes the use of medication: stimulants in ODD and sometimes antipsychotics in CD.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.