The Oyster: Changing Pain to Beauty

Every once in awhile, I run across a story that must be shared. Nancy Davis, Ph.D. creates a story of changing identify from worthlessness to one of value. Its too good not to share.

The Oyster

Once upon a time an oyster lay on the bottom of the bay. Oysters are very rough on the outside and not very colorful. The shell of an oyster is often ground up into small pieces and used to make roads. People and vehicles ride and walk all over roads made out of oyster shells.

This oyster was no different. "I am designed to allow people to walk all over me because I'm just a yucky, ugly oyster," the oyster told herself day after day. "I was created for people to walk on me." The oyster had also heard that people sometimes become poisoned from eating oysters. So she told herself, "I'm really worthless; all I do is make people sick."

Often when oysters are served at restaurants, people remark, "Yuck, oysters are slimy, they're yucky. Why would anyone want such a repulsive thing?" So the oyster would say to herself, "They're right, I'm not worth anything, I'm slimy, people hate me, and I am worthless."

It was not surprising that the oyster was always feeling sad.  "Why couldn't I have been something different? Why couldn't I have been a diamond or a ruby? Why couldn't I have been a sand dollar or have a shell that could be made into earrings? Why, why, why?" the oyster asked, as she thought a lot about what she wasn't. She told herself over and over that she was ugly and awful and slimy and made many people sick.

One day a fisherman threw a net into the bay and caught this oyster in his net. The oyster was even more upset and cried out, "This is exactly what I was afraid of. Now I'm caught and everyone is going to discover just how ugly and repulsive I really am."

The fisherman had a different way of looking at things than the oyster. Finding the oyster in his net, he opened the shell with a knife. From deep within the shell, he pulled out an exquisite white pearl. This discovery surprised the oyster. She had paid no attention to the hard pearl as it grew within her. "Isn't it amazing that you can have something so valuable within you and not even realize it? How could this be?" asked the oyster. "How could I have this beautiful pearl inside me when I am so ugly?"

Because the fisherman had spent his life on the sea, he sensed the oyster didn't understand how a pearl is formed and he began to talk to her. "Long ago, when you were very little, there were things in your life that were very irritating and scary and sad and painful. To deal with this, you began to build a covering around your feelings. You wrapped and wrapped all your pain and sadness to protect yourself. This was really helpful when you were young and the pain was very real. What you did not realize and now you can see, is that you changed this awful pain into a valuable pearl. You found a way to take your pain and sadness, crystallize it and change it into something exquisite. this pearl was within, just waiting to be discovered."

"Wow", cried the oyster, "that's very surprising." Then the fisherman broke away the shell from the outside of the oyster because she didn't need that anymore. He removed the yucky, slimy part because she didn't need that anymore either. Then he polished the pearl allowing the beauty and luster to shine through. The fisherman gave the pearl to his daughter. She wore it on a necklace of gold and prized it dearly.

"Isn't it amazing?" the little pearl remarked to herself.  "I never realized that I am special. I was unaware that deep within there was a pearl waiting to shine like a jewel." As the pearl continued to think about life, she realized the most valuable jewels are often buried and are just waiting to be discovered and polished.

Davis, N.  (1996). Once upon a time...therapeutic stories that teach and heal. Burke, VA: Nancy Davis, Ph.D .

Handling "My therapist said...."

Have you ever had a teenager tell you “My therapist said….” followed by something bizarre, confusing, or conflicting with your values/rules? Even as adults, people will explain a change in behavior referring to a counselor's direction. And it is true counselors may say or ask clients to change thoughts/behaviors/emotions for a variety of reasons. There is an assumption if someone is in counseling, they want life to be different. This only comes with change. But what do you do when the “my therapist said…” statement challenges your values/rules? Without any context, it can be upsetting to have your values/rules challenged by someone who influences your teenager. Typically, therapists do not work to undermine parent’s/caregiver’s authority.

However, with teens, it is not uncommon for context to be excluded when talking about something their counselor said. Other times the original intent has been skewed for a variety of reasons.  Sometimes it is intentional. Other times it is accidental. While still other times, it is truly misunderstood. 

For example: In one session, Mary and I were talking about the importance of expressing her emotions in a safe way. One of the suggestions I offered was a password protected writing program (i.e. Microsoft Word). Later at home, Mary’s parents asked her for her phone password. Mary told her parents "My therapist said I should have privacy on my phone." and refused to comply. Naturally this was confusing for the parents. Mary had chosen to journal on her phone and consequently privacy should extend to her whole phone. Fortunately, the parents asked me about it and I was able to clear up the miscommunication while discussing with Mary alternate places to confidentially express herself (parents should have access to phone passwords with any minor in their care).

If you hear “my therapist said….” from your teenager and what follows does not keep with the family values, please clarify. Start by responding "Hmm...that sounds interesting. Tell me more about that." If what is relayed continues to be conflicting with values/rules even with more context, ask to talk to the counselor. Teenagers discover the therapist may hold a lot of weight with their parents and intentionally mislead them. Other times they may have misinterpreted the counselor’s intent. Teenagers may mistake validation as approval or agreement. To get the most out of the counseling experience for your teenager, good communication and clarification are vital.  

If your teenager will not let you talk to their therapist to clarify, let them know you will be unable to make or support any changes without clarification as it goes against family rules/values.  But, let them know you would be very willing to listen and clarify if you could talk with the therapist for one session or even half of one session. Some teenagers are more willing to agree if they can still be present with the parent and counselor.

Be careful not to bad mouth the counselor or contradict what they have said without clarifying because it undermines your teenagers therapeutic progress. If no resolution or clarification can be attained, respectfully say, "Everyone has a different opinion"  or "I'm not sure how that will work in our home." Don't let the counselors 'advice' become another area of conflict between you and your teenager.

A teacher once told her children’s parents at orientation “I promise not to believe everything they say about you, if you promise not to believe everything they say about me.” While counselors validate and accept what their teenage clients say, they also take it with a grain of salt. People have different perspectives and are entitled to their opinion. This is true with all clients not just adolescent ones. Counselors recognize they often are only seeing one point of view and encourage parental involvement whenever possible to more efficiently resolve the presenting issues. Ultimately, the caregivers/parents make the rules of the household not the counselor. 

The Science Behind Self Injury

Researchers have been studying non suicidal self injury (NSSI) for over 20 years. Only within recent history have they been able to look at the physiological and chemical differences in individuals who engage in self harm. It is an exciting time as the science behind the behavior can help clinicians and doctors learn to more effectively treat self injury. With more knowledge comes more understanding for parents, teachers, youth leaders, and peers who often feel confused and discouraged by the self-injury behavior.

The Brain

In the limbic system, researchers saw a hyper aroused state in those who engage in self harm. As the limbic system involves emotional regulation, in a hyper aroused state the individual is upset and may try to calm down. When the scientists applied a painful stimulus, they hyper aroused state came down. This appears indicative of NSSI as a coping skill for emotional regulation. In other words, the brain supports a common teenage assertion they actually feel better, calmer, release, and/or relief after engaging in the self injurious behavior.

The Altered Chemical Levels

Researchers have also found altered levels of cortisol response. They are uncertain if the behavior causes the altered levels or if the altered levels increase vulnerability for the behavior. Cortisol is associated with stress (Think of the commercials about cortisol/stress keeping us from losing weight.). It makes sense individuals engaging in self injury often have difficulty regulating their internal and environmental stress. We can see it in the altered cortisol levels.

They also found lower levels of endogenous opioids affecting pain perception and addictive behaviors. There have been rumors NSSI can be addictive. If the Endogenous opioid levels are lower, it is possible there is an addictive quality to some severe self harm. Also, if pain perception is altered, there is potential truth in someone who engages in NSSI stating they don't feel the pain of their actions. However, once the behavior no longer exists, the lowered pain perception does return. Others have suggested NSSI may increase serotonin or dopamine levels in the brain creating an addiction but research does not support the hypothesis consistently at this time.

Nutritional Deficiencies

Research has found successful treatment of self injury in increasing the Essential Fatty Acids (found in walnuts, leafy greens, fish, flax seed, etc...) in the diet. People who engage in self injury have lower levels of Essential Fatty Acids. In one research project, the control group was given a placebo while the other group was given Essential Fatty Acids regularly. After 12 weeks, the experimental group saw a marked decrease in depressed feelings and suicidal thoughts in comparison with the control group. Even adding a supplement such as Omega 3 and 6 capsules (fish and flax seed oil) increase the amount of Essential Fatty Acids in the body. I am continually amazed at how important good nutrition is to the overall health of the mind. While improved nutrition may not cure all diseases, increasing Essential Fatty Acids will improve depressed moods and suicidal thoughts based on some of the most current research.

Effective Counseling

Dialectical Behavior Therapy (DBT) is one of the most evidenced based forms of counseling treatment with self injury. Ask your teens counselor if they utilize DBT. If they don't, ask them if they would be willing to learn (by books or trainings). A counselor doesn't need to be a purely DBT clinician to be effective as long as they are familiar with the basic principles and can use DBT when needed to decrease NSSI. You want the counselor to be DBT influenced. Remember, even with the most effective counseling, NSSI is not a short term issue and there is no quick fix. DBT clinicians recommend preparing for 3-12 months before treatment is successful depending on severity, intensity, and duration of the NSSI.

Prevalence

Don't buy into the belief NSSI is increasing. Much of the literature supports a consistency in the prevalence of NSSI since 2005. It is possible we are more aware of the issue as teenagers open up about the historically hidden behavior. In the United States, up to 37% of high school students have engaged in self harm behaviors at least once. For more information on the research check out these websites:
http://www.suicidology-online.com/pdf/SOL-2012-3-24-32.pdf 
http://www.jabfm.org/content/23/2/240.full 
http://www.capmh.com/content/6/1/10

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.