Dr. Henry Paul, MD

Psychiatrist, Author and Educator

YOU’VE GOT IT ALL WRONG!

January 26th, 2016

“Most American parents are completely confused and going utterly in the wrong direction,” Dr. Leonard Sax

A new book out this month by family physician, psychologist, and author, Leonard Sax says that parents have this parenting thing all wrong! “The Collapse of Parenting: How We Hurt our Kids when We Treat Them Like Grown-Ups” looks at the major shift that has occurred over the past 30 years in American culture: the transfer of authority from parents to children.

Like Sax, I too, have been in practice for many years. I agree with Sax that we have become an obsessively child-focused society; the children today are running the show!

Sax talks about how parents ask their children to let the doctor look in their (the child’s) throat. The parent then offers to reward the child afterward if they “open up” and let the doctor look in their throat to see if they’re sick!

Another interesting parenting trend, check-out “Spoiled Rotten” in the July issue of Boston Magazine where parents are paying their kids for scoring goals and grades. The rationale behind the thinking of the parents is fascinating. It is also wrong!

Parents today give their children unwarranted praise, try to be their child’s best friend, and give them whatever they ask for. The ability for parents to see clearly when it comes to their children has gotten skewed. Families go into debt trying to give their kids things they shouldn’t. Does Johnny need the most expensive sneakers? Does Emily need an upgrade to her IPhone that is working perfectly fine? Should children receive a trophy just because they were on the team?

Children are used by parents to fill parental needs and thus have their self-realization derailed. Worst of all, this parental indulgence sends the message to kids that they are the center of everyone else’s universe. As a result, some kids grow up without a sense of limits and with a high degree of entitlement and a lack of compassion and with little empathy.

Parents need to assume the responsibility for the fact that today’s kids lack a sense of limits, humility and a decent respect for authority. Kids believe that the end justifies the means, and that process means nothing. Society models and exploits this behavior on television and Internet programs targeting children and teens. It is the parents and society that are allowing this to happen and they need to make changes. Kids didn’t get this way all on their own.

LINKS
The Collapse of Parenting
Spoiled Rotten

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.

THE BRUCE JENNER INTERVIEW

April 24th, 2015

There is a lot of speculation and curiosity about the highly promoted interview between Diane Sawyer and Bruce Jenner that is running tonight on ABC. I am sure that after the interview there will be a lot of questions. Many Americans do not understand what a life-changing decision it is for a person to struggle with gender identity. The lack of understanding leads to confusion, paranoia, and discrimination. What I hope will come from the Jenner interview is a national dialog that will change the stigma surrounding transgender people in the United States.

Elliot Fukui, TransJustice Coordinator at the Audre Lorde Project, a community organization in New York City, spoke with CBS News recently about some of the common issues and misperceptions facing transgender people today. He says that it is important to support a person’s right to choose their identity, and he suggests a number of ways to do just that. Click here to read the CBS story and Fukui’s recommendations.

I just wrote last week in my blog about the great job that the media is doing bringing transgender characters and actors to television. It is evident that the diversification of today’s TV characters has certainly opened up plenty of discussions. Tonight Jenner will only add to the discussion, and that’s a good thing. I hope tomorrow to wake up and find the national dialog has exploded on this issue. It will only help people to understand gender identity and the need to embrace those who choose to make a change.

Disclaimer

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.

First, 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

Dealing 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.

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.

While 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.

MY CHILD IS GAY! WHAT SHOULD I DO?

January 15th, 2015

Most parents love their children! That love is what will help parents to survive the initial shock of hearing that their son or daughter is gay. After a period of disbelief or denial, most parents can be counted on to be supportive. Here are some guidelines for parents to deal with their child’s homosexuality.

If your teen is gay or lesbian you should provide emotional support, despite the fact that you may have trouble accepting it.
Counseling and/or psychotherapy are suggested for teenagers who are uncomfortable with or uncertain about their sexual orientation. Therapy can help with adjusting to society in general. Make no mistake, sending a child for conversion therapy to change their sexual orientation has not been shown to work.
There are many local and national gay support groups (see list below) that can help a homosexual teenager to overcome some of the stigmatization and negative feedback that he or she gets.
It is extremely important that ALL teenagers understand the information about the risk for sexually transmitted diseases. Homosexual transmission of HIV is common and knowing the importance of condoms and other protection against such transmissions is essential.
A very large percentage, up to 95 percent, of LGBT teenagers report that they are often called names or threatened. As a result, they often skip school because they feel unsafe. LGBT teenagers are three-times more likely to be assaulted than their heterosexual peers. In addition, they are threatened and injured more by weapons. Additionally, lesbian and bisexual teenagers are more likely than heterosexual girls to be victims of rape or attempted rape.
Take care of yourself, too. Parents should make sure that they seek support, as well. Groups like PFLAG are available to answer questions and offer help. The most important thing for parents is to gain knowledge, be understanding, and most importantly be supportive.

In my next blog, I will discuss the STDs and Safe Sex for teenagers.

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.

HOMOSEXUAL TEENS “COMING OUT”

January 14th, 2015

In our culture, homosexual youths have to deal with a number of mental health issues. Ongoing discrimination fuels anxiety, depression and other stress-related mental health problems among LGBT people. In our culture homosexual youths have a higher suicide/mortality rate than heterosexuals. It is estimated that 30 percent of all youth suicides are gay youths.

Many gay youths feel guilty about their sexuality and painfully different from their peers; they worry about the response from their families, are often teased and bullied, worry about HIV infection and other STDs, feel discrimination when joining various clubs and other activities, and often are rejected and harassed by other teenagers. This leads to isolation and withdrawal, low self-esteem, depression, and sometimes trouble concentrating. An added distress for gay youths is telling their parents and the fear of rejection. (See my next blog about support for parents).

Often when teenagers become aware of homosexual stirrings they feel great confusion and attempt to deny and repress them. This leads to anxiety, sometimes causing a teen to “run” for treatment to get the problem fixed. They sometimes even make religious commitments to overcome the homosexual feelings thought to be bad or sinful.

“Coming out” is a popular term used when someone chooses to make their sexual preference known. In most cases, teenagers will “come out” when asked about their sexual preference. Over time, increased socialization with other gays tends to solidify the sexual identity of a homosexual teenager. This decreases the sense of loneliness and isolation. Some pride in being gay begins to develop. Eventually, positive relationships with other gays and lesbians result in positive self-identification and ultimate integration and acceptance. This encourages teens to be open about their sexual orientations without defensiveness. Increased awareness of homosexuality, and gay teens’ own growing self-acceptance and self-expression, hopefully will continue to reduce social prejudice against being gay.

Talking about your sexual preference or “coming out” is an uncomfortable issue for anyone. For homosexuals it is also controversial. Just look at the gay athletes who in the past couple of years have come out in the NFL and NBA. How has it changed their lives; particularly their careers? Homosexual teenagers see this and try to relate it to their own lives. Who should they tell – friends, parents, siblings their doctor or coach? The bottom line is that homosexual teenagers have to decide when and whom they are going to tell and how they are going to tell them based on their particular and unique families, friendships, and social adaptation.

It is not easy for teenagers to express their feelings, but in 2011, 183 teenagers provided their feelings to The New York Times “Coming Out” project. Click on the link to read their stories. You will come away with a much better understanding of what teenagers face and how they feel about “coming out” as homosexual Here is also a link to the May 2011 NY Times article that outlines the project; “‘Coming Out’ – Gay teenagers in their own words” by Sarah Kramer.

DREAMS OF THE DEPARTED MAY BE A WINDOW TO WHAT IS DEEP INSIDE YOU

November 21st, 2014

“Dad looked fine, except perhaps for a less-than-flattering white sweater he didn’t, in reality, own. In my dream — that’s what this was — I didn’t know that he had died.” Paula Span, NY Times blog, “Dreaming of the Departed” The New Old Age; Caring & Coping.

Last week Paula Span’s New York Times blog, “Dreaming of the Departed” raised the question of how often family members dream of the dearly departed and what the dreams might mean. In her blog, she focuses on her experience of dreaming about meeting her dad in a deli two years after he passed.

“Seeing Dad left me wondering how often deceased family members enter their survivors’ dreams and what we know about what — if anything — that means. So I called Alessandra Strada, a clinical psychologist and director of integrative medicine and bereavement services at MJHS Hospice and Palliative Care in New York. She has listened to patients talk about their dreams for 20 years.” said Span.

Dr. Strada responded to Span saying, “Dreams are quite a prevalent component of the bereavement process.”

In the blog, Span referenced some interesting statistics from the recently published study in The American Journal of Hospice and Palliative Care that surveyed 278 caregivers (mean age: 63), nearly 60 percent of whom reported dreaming of relatives who had recently died in hospice care.

Over the years, many of my patients have told me that after experiencing a loss that they often think of the departed. Sometimes they feel as if they heard the voice or had seen an image of the dead person. They very often dream about them.

As a medical professional, I can tell you that dreams have always been a center of interest in a psychiatric practice as they are the most sensitive markers of what is going on deep in our personalities. Sigmund Freud considered the dream the “royal road” to the unconscious. Karen Horney said that early in a therapy the dream was sometimes the best indicator of what the patient is struggling with deep down.

Most patients feel good about having a “visit” from the departed. Others feel different, especially if the relationship with the departed was conflicted. These dreams, when gone into in detail, often reveal a lot about a person’s past and present relationships. Having such dreams is not pathological and should be accepted as a natural and revealing process. Of course, if the patient is suffering from a serious mental illness and such dreams cause great anxiety and instability then they should be seen as signposts to areas that need to be explored as part of the treatment being offered.

Note: Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

AUTISM – WHAT IS REALLY BEHIND THE RISING NUMBERS?

November 7th, 2014

“The dramatic increase in the number of children diagnosed with an autism spectrum disorder is largely the result of changes in how the condition is reported,” Danish researchers contend in a study out this week, and I agree!

The Danish study says that the increase in numbers is due largely to the changes in diagnosing and reporting.

“As our study shows, much of the increase can be attributed to the redefinition of what autism is and which diagnoses are reported,” said lead researcher Stefan Hansen, from the section for biostatistics in the department of public health at Aarhus University in an interview with CBS News. “The increase in the observed autism prevalence is not due alone to environmental factors that we have not yet discovered.”

In the United States, the U.S. Centers for Disease Control and Prevention estimates that one in 68 children have an autism spectrum disorder. The reported prevalence of the condition has increased over the past 30 years, according to the new study.

In the same CBS News interview, Amy Daniels, the assistant director for public health research at Autism Speaks, a New York City-based advocacy group, agreed that a significant part of the increase in autism has resulted from changes in diagnosis and reporting.

“The findings from this study are consistent with past research documenting the role of non-causal factors, such as increase in autism awareness, changes to diagnostic criteria and the increase in autism prevalence over time,” she said.

Scientists aren’t certain about what causes autism, but it’s likely that a combination of genetics and environmental factors play a role, according to the U.S. National Institute of Neurological Disorders and Stroke.

I believe that autism is a neurological disorder and not an environmental one. There are plenty of new studies and research about Autism. I just posted a blog in September about a research study that indicates that children’s brains with autism fail to trim the synapses as they develop, and that if safe therapies can be developed to clear these synapses, there might be new hope for treating autism.

Now, the most important thing about autism is that people are talking about it. The medical community is stepping up its research, and medical professionals and schools are looking at treatment and accommodations to help those diagnosed with the disorder. We have a lot of work to do to understand and to treat autism, and that work has begun! Stay tuned.

For more on the Danish study visit CBS News “What’s Behind the Dramatic Rise in Autism Cases?” For more on autism visit my recent blogs:

Children with Autism Have Oversupply of Synapses, Says New Study
Shock Em’ Out of Autism
CDC Says 11 in 68 Children is on the Autism Spectrum – So What Does That Really Mean?

DISCLAIMER

CHILDREN WITH AUTISM HAVE OVERSUPPLY OF SYNAPSES, SAYS NEW STUDY

September 3rd, 2014

Study Finds That Brains with Autism Fail to Trim Synapses as They Develop — Now a new study suggests that in children with autism, something in the process goes awry, leaving an oversupply of synapses in at least some parts of the brain.

The finding provides clues to how autism develops from childhood on, and may help explain some symptoms like oversensitivity to noise or social experiences, as well as why many people with autism also have epileptic seizures.

It could also help scientists in the search for treatments, if they can develop safe therapies to fix the system the brain uses to clear extra synapses. The New York Times

This is a very interesting article showing some of the latest research on Autism. The study, recently published in the journal Neuron, involved tissue from the brains of children and adolescents who had died from ages 2 to 20. About half had autism; the others did not.

The study suggests that children with autism have an oversupply of synapses in some parts of their brain. These synapses are normally “pruned” during childhood and adolescent development so different areas of the brain can develop specific functions without an overload of stimuli. When that pruning does not happen, and there is a continued overload of the synapses, the research suggests that this might be the cause of autism. If safe therapies can be developed to clear these synapses, there might be new hope for treating autism.

What I find interesting about this study is that there has been an ongoing debate in the medical community for years as to whether autism is a problem of too little, too much or a combination of connectivity in the brain.

In the NY Times article, Ralph-Axel Müller, a neuroscientist at San Diego State University, said, “Impairments that we see in autism seem to be partly due to different parts of the brain talking too much to each other. You need to lose connections in order to develop a fine-tuned system of brain networks, because if all parts of the brain talk to all parts of the brain, all you get is noise.”

The research is very interesting. What needs much further study is rapamycin, a drug that has serious side effects, and which is being discussed as a form of therapy for this neurological finding. Finding the cause is the beginning of finding a cure. Best not to jump too quickly looking for a silver-bullet cure, however. Let’s all follow the research. I am sure this will open up a much wider debate on the cause of autism and how to treat it. Stay tuned!