Understanding Self Injury

Often, I’m asked why teenagers engage in self harm. “Isn’t it for attention?” “Aren’t they just copying what they see on TV?” “How can they stand to hurt themselves on purpose?” The behavior of cutting or other forms of self harm seems so far removed from normal human acts it seems unfathomable to many adults. To a parent, teenage self injury can be terrifying. It leaves caregivers feeling helpless, frustrated, and scared. Yet if we look back on history, civilization is full examples of intentional self-harm crossing into many cultures.

As far back as early Greek mythology, Oedipus pierces his eyes with golden broaches in punishment for his behavior. Today's adolescents express self-hatred, engaging in self injury after a perceived failure. One sophomore girl bit her arm so viciously I could still see the bite marks days afterwards. She believed she deserved it after a misunderstanding with a boy she liked. In ancient Greek times, a shamed Spartan leader asked for a knife after being placed in stocks. Grabbing it quickly he proceeded to slice his own shins. Self harm is not a new issue. There were so many women in the late 19^th century pricking themselves with needles, doctors called them the “needle girls”. Contrary to the prevalent belief self-harm is on the rise, recent research indicates it may actually have stabilized in the last five years.

In its infancy, the medical field has promoted the healing powers of self-harm as Hippocrates encouraged blood letting to cleanse the body. Scarification in African tribes was believed to protect oneself from diseases. Early common psychiatric practices, ironically, included the application of hot irons, purging, and cutting in the treatment of ‘hysterical women’.

Christmas Eve 1888, famous painter Van Gogh allegedly partially removed his ear lobe in a fit of rage. Angry self-harming teenager generally do not remove body parts but could relate to being enraged enough to carve on themselves. Even animals will engage in forms of self harm. Bored dog’s will lick until themselves they have an open wound. Stressed parrots over preen cutting their flesh. Agitated primates bite themselves. 

Religion has provoked much self harm. In Germany, Martin Luther, the founder of the protestant movement, for example, beat himself with a whip regularly. Hindu’s Lord Krishna enucleated his eyes to benefit his mind. Australian aborigine shaman candidates  mutilate and scraped their skin to promote their healing powers.

Mourning and grief have been motivators for self-harm In certain African tribes finger amputation is common in mourning; the more of the finger removed indicates the level of closeness to the deceased. In 2012, a large group of Shia Islamics cut themselves with razors commemorating the death of  a beloved leader. Today, loved ones memorialize their losses with tattoos.

Beauty can motivate self injury. Examples include ear piercings to tattoos to foot binding to plastic surgery. Other reasons include increased revenue for beggars and a soldiers quicker route home. Culture does much to dictate attitudes toward self harm, what is acceptable and what is not.  Shame has kept much teenage self injury hidden. While self harm is widespread in world history, it does not minimize the significance of a young person engaging in self injury. It is not a passing phase. As in many of the examples above, it is indicative of deep emotional pain. Consult professional help if you know a young person is hurting him/her self. Dialectical Behavior Therapy  (DBT) has proven highly successful at reducing/eliminating the behavior. Self injury is not resolved quickly but can take 3-12 months of counseling for progress to occur.

See resources below for further help.

http://www.mirror-mirror.org/selfinj.htm
http://www.fortrefuge.com/SelfInjuryBillOfRights.html
http://www.kristalmathis.com
http://www.Portlanddbt.com 

6 Ways How to Help Depressed Teenagers

     One of the biggest challenges adults face working with depressed teenagers is knowing how much to accommodate and how much to hold to expectations. If all rules are accommodated to keep the teenager less depressed he/she may never learn how to cope with the consequences of his/her actions. On the other hand, holding depressed teens to the same expectation as their peers, may result in spiraling failure increasing their depressive symptoms. Watching your teen fail time and time again can be heartbreaking. You want them to succeed. They want to succeed.
     Many adults fall into the trap of waiving their normal rules to avoid conflict or high risk behavior (i.e. cutting, running away). Done out of the best of intention, the teens may appear to stabilize but when confronted with other expectations they quickly deteriorate. Also, reducing expectations for one individual creates resentment and frustration for others in the family, class, or group. On some level, the lowered expectation reinforces the hurting teen's failure. Essentially they get perks from struggling with depression. This is not the message we want to be sending them. How will you know if there has been too much accommodation? Start with measuring your own resentment level. How much have you done v. how much have they done to help themselves out? If you are going to compromise on an expectation, what are they compromising? If you notice you're working harder then he/she is, there is too much accommodation.
     On the other side of the spectrum are adults who continue to expect exactly the same from emotionally troubled teens as they do from all the others. The result for the teen is often failing out of school, always in trouble, increased poor self-esteem and depressive symptoms, and finally, shutting down. These adults try to motivate assuming if the motivation is big  enough the teen will somehow manage to make changes. "If you pass all your classes this year, you can take drivers ed this summer." "If you don't get any more suspensions, I'll buy you that X-box game you have been wanting.". The teen may actually be motivated, get excited, and earnestly throw themselves into the appropriate behavior with vigor. Within a few weeks, sometimes days, he/she has had a failure. He/She may try to hide it or give up again resulting in everyone's disappointment. So what does the adult do? Unfortunately, the adult may try another motivator which ends up in another painful cycle of failing. Finding the balance of support and enabling can be difficult.

How To Help Depressed Teenagers:
1.) Review expectations together (i.e. be honest, all homework turned in). Having it written out limits confusion later.
2.) Put together reasonable short term consequences (no electronics for 24 hours). Too long of consequences reduces effectiveness as the teens learn to adapt without their privileges. Hint: the consequence time doesn't start till you see the behavior you want (for example, if John curses during his 12 hour restriction period for cursing, the time starts over). Let your teen know ahead of time what to expect.
3.) Reward small steps in the right direction so they can see their progress (i.e. a point for every assignment turn in on time or for a day without yelling). The small reward can work toward a bigger motivator (i.e. X-box game, driver's ed, eating out, sleepover). This reduces their discouragement when they make mistakes as they can always try again tomorrow and still have an accumulated amount of points from past successes.
4.) Follow through. Do not shorten the consequence once you have already agreed to a certain amount of time.
5.) Be available to validate emotions and  talk about problem solving. Just remember to still hold accountable for poor behavior. Depression, ADHD, anxiety, and trauma are not excuses for abusive behaviors or a lack of responsibility.
6.) Encourage them to seek help. Most teenagers have access to counselors and doctors through school, faith system, and/or parents. Put the responsibility on them to develop skills to cope while you support them in their process

Finding a balanced approach can be a struggle. Consult with other professionals or supports if needed. You aren't in this alone.

How is mental illness created?

The Month of May is Mental Health Awareness Month. The more neuroscience discovers about brain processing, the more the community is able to understand behaviors. Mental health issues are prevalent in our society and are sometimes linked to violent and unpredictable behavior. The more informed the community is about mental health issues, the more they will be able to help rather than fear it.

“An estimated 26.2% of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year.” Many adult disorders start in their youth. Almost 10% of teenagers (13-18) meet criteria for serious emotional disturbance including but not limited to depression, eating disorders, autism, anxiety, ADHD, and post traumatic stress disorder based on the DSM IV-TR. Based on the 2012 study, girls were more likely to have emotional issues such as depression and anxiety while boys were more likely to have behavioral problems like those associated with ADHD.

Many influences in our culture promote mental illness as a character flaw. One suicidal teenager recently told me “My dad tells me to stop being stupid.” There is this idea if a person just tries hard enough and makes all the right choices, mental illness will be avoidable. “Aren’t most mental issues self-created?” I was asked recently by a respected business man. While motivation and choices do play a part of treatment, a ‘pulling yourself up by the bootstraps’ mentality or blame will not cure mental illness. Rather it increases shame creating an additional barrier to treatment.

Most counselors, psychiatrists, and psychologists agree on two primary explanations for mental illness.

1.)    Genetic—just as we inherit coloring and facial features from our family linage so do inherit predispositions for many disorders such as ADHD, bipolar disorder, major depression, autism, and schizophrenia. Just as doctors request family history for illnesses like heart disease and breast cancer, the family mental health history is just as important in screening for mental health disorders.

2.)    Circumstances—Ongoing abuse, trauma, loss, isolation, and recurrent environmental stressors can trigger mental health illness. The intensity and duration of a situation play directly into the human reaction.  “It is sometime an appropriate response to reality to go insane.” (Phillip Dick) As humans we can only handle so much for so long without help. Take the example of holding out a cup of water. For awhile a person can hold the cup out successfully without it interfering or bothering or bothering he/she. But, if they are expected to hold it out for hours there will be pain and at some point arms will collapse unless support is given. The inability to hold the cup out for long periods of time is not a weakness of character but a limitation as a human being. The same is true cognitively and emotionally. We can only handle so much for so long.

For some, mental illness may be a life long disorder such as asthma or diabetes needing ongoing counseling and/or medication. For others, mental health illness will be a season of life if they are able to gain the tools they need to stabilize. For teenagers, effective treatment encouraged family involvement. Like having the flu or chickenpox, with the right support, mental illness can be treated successfully.

How Do I Improve Teenage Behavior?

One of the alarming red flags in any parenting program, is the assertion only their way is the "right" way. While there are parenting true principles, a guaranteed technique to work for all teenagers all the time is nothing more than an illusion.  If one technique had a 100% guarantee, parents and cultures would have come to a consensus  long ago.  But instead, there are many parenting classes from the infamous Baby Wise  to Attachment Parenting. Theories abound and vary from culture to culture and, in America, from household to household. Many parenting classes do offer important fundamentals such as increased consistency and structure. How do you know which one to choose? Which one is true to your values? Which one(s) will your teenagers respond to the best?

Start by identifying your child's behavior pattern:

The Compliant Teenager
Very little action is needed in order to discipline the compliant teen. He/she responds to a look from across the room. Talking is the best tool to modify behavior. He/she depends on the adult's approval. Disappointing authority is one of the worst possible consequences for the compliant teen. If needed, taking away a privilege or two goes a long way. They may be moody at times, sometimes challenging authority but most of the time can be talked through conflictual situations.

The Independent Teenager
Most teenagers will push the envelope every now and then. They are learning how to be their own person which often translates into pushing against the boundaries set before them. They want to experiment with "adult" behaviors. Teenagers may explore risky behaviors. Using programs like Love and Logic or Total Transformation, parents train teenagers to think responsibly. They are held accountable for their behaviors but also learn decision making skills to cope with what life brings them.


The Challenging Teenager
Teaching a challenging teenager stretches and pushes the adults with whom they come into contact. Every day is a battle, every conversation an argument. Trust is minimal. For teens who insist on pushing every boundary given, authority would benefit from relinquishing the belief they can control behavior. However, they do have control over "the stuff" (aka everything your teen enjoys like their electronics, going out with friends, etc... ). Use this influence consistently and let the teen know how to earn back the privileges. Be up front about how long the consequence will last after he/she has complied. Utilize programs like Parent Project. They are "evidenced based" meaning studies have been researched on caregivers who have used the program strategies and the outcomes have been reliably successful. If needed, work with a counselor or another support since training a challenging teenager can be exhausting. You will need a cheerleader.

Whichever category your teen(s) falls into, know their decisions are their own. While parents, teachers, youth pastors, and other supports have a significant impact on teenagers, they do have a mind of their own. Some make great choices and others do not, no matter how hard we try. The best we can do is to educate ourselves, admit our mistakes, and demonstrate healthy love and boundaries as much as possible. The outcome is up to them.

Gangs in the northwest?

      One of the reasons I moved to a country suburbia neighborhood was for the walking trails. I love to walk and see the local wildlife, the tall NW trees, feel the breeze or the sun on my face. Being part of a fairly new neighborhood, there is always construction going on. As I passed a nearly completed house on my walk recently, I saw graffiti sprayed to the new windows and house siding. Upon closer inspection (becomes I'm curious), I found more recent spray on the side walk and another partially built home. It included pictures of male genitalia, gang symbols, racist comments, and foul language. Initially, I was surprised to find this in my neighborhood and not on the walls of inner city buildings.

      Seeing it reminded me how close we are to active gangs. Did you know local school have banned bandanas because of gang affiliation are identified by certain bandana colors? Did you know gangs from Portland use I-5 to gain access to other youth across state lines and in unsuspecting rural areas? "The U.S. Department of Justice indicate that every state has violent gangs and that there has been a dramatic increase in gang activity in smaller cities, towns and rural areas." Do not make the mistake of believing gangs are for big cities like Chicago, New York, or LA. Denial allows the problem to grow.

Why would teens belong to a gang? They are desperate for a place to belong. Teenagers need to have a sense of community and will get it where ever they can be accepted. For a youth with few safe relationships, who has been abused, who is isolated and/or bullied, a gang becomes the answer to their problems. If you want to gang-proof the teens in your life. Let them know they have a place to belong whether it be in your family, in the youth group, in clubs, Boy/Girl Scouts, choirs, drama, or sports. Help them find a safe place they can find acceptance.  Talk with the teen about consequences of joining a gang such as a criminal record, putting loved ones at risk, personal injury and/or death.

Signs a teen may be involved in a gang

• Skipping School
• Coming home with unexplained expensive items or cash
• Difficulty bonding with family
• Defiant towards all authority figures
• Drug Use
• Out at all hours of the night
• Sudden decline in grades

What to do if your teen is involved in a gang. Remember: The risks are high and the danger is real.

• Educate yourself on the gang signs.
• Minimize the teens idle time. There is truth to a busy teenager doesn't have time to get into trouble.
• Call local law enforcement/juvenile authority and ask about programs for youth connected to gang involvement.
• Call the police when you see graffiti signs, take photos, and cover it up as soon as possible as it attracts other gang members to the area.

For further help check out LAPD Tips and the Youth Booth.