Great Resource for Anxiety for People of Any Age

So here’s my theory about Lawrence J Cohen’s great book “The Opposite of Worry: The Playful Parenting Approach to Childhood Anxiety and Fears.” He wrote a book for anxious parents and then decided he would have more luck getting them to read it if he said it was for helping their kids be less anxious.

I love the title and for that alone is worth it; the absence of anxiety isn’t the opposite of anxiety. Feeling playful, full of creativity, joyful as when we are goofing around with someone we love that is the opposite of anxiety. Cohen really emphasizes parents and kids feeling connected rather than simply focusing on behaviour, something I really appreciate.

The book is full of great, practical approaches to anxiety that anyone can use. Hug yourself when feeling anxious, wrap both arms over the opposite shoulder, alternate pats or squeezes on the opposite shoulder. It feels warm and embracing, it requires a little cognitive and kinaesthetic work, so it takes us out of our anxiety, it is easy to remember for a person who is feeling freaked out.

It also contains a lot of wisdom addressed to anxious parents (a.k.a. the part of ourselves that might think other people’s anxiety is a problem but our own is absolutely reasonable and the only thing keeping us together.)

If you know you are safe, but you still feel anxious, then you may welcome a chance to lower your anxiety. If you believe you are in danger, however, then it would be foolish to relax. You need to be prepared to act at a moment’s notice. That’s why some highly anxious children angrily reject suggestions to relax. Abe [a] boy who was ... afraid of thunderstorms, once said to his mother, ‘three deep breaths are not going to stop us from being hit by lightning’

Finally, Cohen takes a very humble and humane attitude towards his clients, friends, family and himself in this book; he is definitely not the all-knowing therapist who understands clients much better than they can understand themselves. He learns from kids and parents alike about how to manage anxiety.

Friendship, kids and mental health.

A researcher from Ste. Justine here in Montreal, Mara Brendgen did a really interesting piece of research about friendship as correlated with depression in children.  You can read the article (if you have academic access) or a nice summary of it at BPS Research Digest by Christian Jarrett.   By studying kids who have an identical twin with depression and kids with a fraternal twin with depression Brengdan and her colleagues were able to identify kids who were genetically pre-disposed to depression but not depressed themselves.  Then she looked at those kids and looked at the quality and quantity of their friendships.

Genetic vulnerability to depression in girls was less likely to manifest if they had at least one close friend. Stated differently, the apparent protective effect of having at least one close friend was magnified in girls who were genetically vulnerable to the condition. This means that for girls there was an interplay between genetic risk and the protective effect of friendship.

There was a beautiful piece on This American Life last week about a girl who had something like Asperger's.  Her stereotypical conversation and poor social reciprocity get in the way of friendships.  But she still wants friendships.  Eventually she becomes angry and aggressive because she is so lonely.  Her moms take her to all sorts of specialists (a humbling note for those who work with kids with learning and/or developmental disorders) and none of it really helps until... she makes a friend, a friend who is interested in the same things as her.   (It starts at about 41:00 minutes)

A question I have about Brengden's research (or Jarrett's summary, not sure which) is cause and effect.  While kids who are genetically pre-disposed towards depression may have fewer friends or friendships they value less, is that a cause or an effect or are they related through some other factor such as personality type or attachment style? 

There is a correlation between people with schizophrenia and social isolation which has lead to the recommendation (here, for example) that people at high risk of schizophrenia make a conscious effort not to self-isolate.  But we all know that correlation doesn't mean causation or else we would all demand more importation of Mexican lemons until highway deaths were eliminated (link to this and other bizarre correlations). 

Nurturing a kid's positive friendships and encouraging him/her to view friendships as worthy of investing some time and energy in seems to me like a good idea whether or not they are at elevated risk of mental illness.  Of course, for a kid who is less good at friendship or less interested in it placing a lot of emphasis on making friends can backfire by making him/her feel more incapable.  Socially awkward kids often view friendship as an ability akin to drawing or music that relies on a high degree of innate talent (it is interesting that many kids who feel bad about their ability to make friends do so around the age of nine or ten when they also start to notice that other kids are way better than them at some things without having to try hard).  It may be true that some combination of genes and very early wiring can make a person better at social situations than others, but I tell kids that friendship is more like riding a bike than playing music; it is something you can learn at just about any age, something you can always get better at by persevering and something you will never be able to learn do by watching others.  You need to try it, fall down and try again. 

What "The Americans" gets right and wrong about families, deceit and violence.

I have been making my way through FX's "The Americans."  (Spoilers ahead!)  It is about a seemingly normal couple, the Jennings, who are, in fact, Soviet agents living in a Washington suburb and raising two children.  The politics of the show are complicated; the Soviet agents at the centre of the show, Philip and Elizabeth, are very sympathetically portrayed but the very idea that Russian-born Soviet agents were able to successfully pose as native born Americans seems more like post-millennial sci-fi paranoia à la Battlestar Gallactica than cold-war Tinker, Tailor, Soldier, Spy realism.  That aside, the appeal of the show is the marriage at its heart.  How can two people who are expert deceivers and trained to see deceit everywhere, trust one another?  Because they absolutely need to trust one another.  They are alone in enemy territory.  They are one another's only source of safety.


This is the dilemma at the heart of every relationship; No one can betray me like my lover and my lover is the only one who can heal betrayal.  The show manages this with great psychological realism.  Its creator is a former CIA agent. 

I have a serious quibble with the Jennings children though, Paige and Henry.  I am about nine episodes in so this may change but the kids seem ridiculously well-balanced.  This isn't meant to be an action-comedy like "Spy Kids" where the parents bring the diaper bag instead of the bomb disposal bag but the show can't shake the very American convention that to be likable, the spies need to be good, loving parents, with essentially lovable, if slightly troubled kids.  Paige and Henry hitchhike when the parents don't come to get them (because they have been abducted) and Henry smashes a beer bottle over the creepy driver's head to get away and the sibs pledge to keep it a secret.  They get mad and sullen when the parents separate.  This is the early 80s and by the standards of the time all this is pretty small potatoes as troubled kids go. 

Meanwhile Elizabeth and Philip are patient and present for their kids when they hurt over the separation and sneak into their rooms and give them loving looks at night.  These are the same people who stab, blow-up and shoot enemies of the motherland while living a double life as tour agents, people who have given up their pasts and country for an ideology they can never publicly avow.

I haven't worked with someone who lived a double life (any more than we all do).  But I have worked with families that have kept big, dark secrets.  I have worked with families where one or both parents are violent.  There can be protective factors that mitigate the impact of these things but their children are always impacted.  Granted, the Jennings kids' don't see what their parents get up to at night.  But it is very hard to shut off violence and deceit, to keep it hived off, prevent it from leaking out.  And the show recognizes that, plays with it... except when it comes to the kids. 

When Elizabeth and Philip tell the kids that they are separating, one of the kids asks, "Will you stop loving us?"  It would have been far more interesting (and chilling) to show how profoundly Elizabeth has been marred by years of constant deceit if we were offered the possibility of doubting her sincerity rather than seeing a model of connected parenting.  It would be far more interesting if, instead of staring off into space in class, Henry reacted to his parents' separation (and years of hidden violence) by becoming violent himself.  How would Philip and Elizabeth see their son -- and each other -- if Henry was beating the crap out of other kids every week?


It is interesting: The show's creator, Joe Weisberg, said in an interview that spy-parents usually have "the talk" with their kids at some point and let them know that they have been living a lie.  I suspect that if their parents are doing anything one-tenth as convoluted and violent as what the Jennings get up to, the kids already know.  "The talk" probably doesn't involve much listening by the parents or they would have learned that.  Like so much that has to do with children, we don't like to face the reality of the impact of lies and violence on them, so much so that a gritty show, all about the subtle, polyvalent impact of deceit and violence on human relationships, can't dare to get it right. 

Teen use of internet porn. When is it time to panic?

The ubiquity of pornography has got to be one of the biggest changes in society in my lifetime.  An acquaintance asked me what I thought the long-term effects of total access to porn would be for shaping the sexuality of kids growing up today and I really had no idea how to answer.  There is much heat and little light on the subject because sexuality in general and kids' sexuality in particular is such a fraught topic.  

On the one hand, today's nearly unlimited access to pornography via the internet is part of the demystification of sexuality which has been building steam over the last one hundred years.  It is connected -- at least in a six-degrees-of-fornication kind of way -- to changes which I view as absolute social goods, like decriminalizing miscegenation and homosexuality, allowing women (and everybody) a greater degree of control over reproduction and generally removing some of the shame from sexuality for everyone, male, female, gay, straight etc.  It is worth remembering that lynchings of non-white men for sex with white women, death by back-alley abortion and 'curbing' of gay people are pieces of North American history that happened within living memory (and are practices some would like us to return to).  The impulse to curb sexual freedom, including the freedom to view porn, can be an instrument of sexual repression and shame.  A lot of the conversation about pornography and young people -- any sexual topic and young people for that matter -- seems to smack of a old-person's cocktail of wistfulness and resentment ie. "If I can't have lots of crazy sex, then nobody should."  

On the other hand, pornography has to own some of the criticisms made of it; it is hugely male-oriented and at least some significant portion is downright anti-women.  It seems pretty intuitive that a barrage of woman-degrading porn would do anybody's developing sexuality harm.  More generally, porn is, by definition, commercial sexual objectification.  Young men and women who grow up viewing sexuality (and we are talking largely about women's sexuality) as an object for purchase or trade, rather than a subjective experience seem more likely to generalize some of those lessons to non-porn sex.  These are both arguments that can be made about any type of pornography.  There is also a particular techno-bent to some anti-porn writing that makes the argument that a quantitative difference of the internet makes for a qualitative difference. 

What happens when you drop a male rat into a cage with a receptive female rat? First, you see a frenzy of copulation. Then, progressively, the male tires of that particular female. Even if she wants more, he has had enough. However, replace the original female with a fresh one, and the male immediately revives and gallantly struggles to fertilize her.
You can repeat this process with fresh females until he is completely wiped out.
This is called the Coolidge effect—the automatic response to novel mates. It’s what started you down the road to getting hooked on Internet porn.

Digression:  Perhaps 2014 should be the year that nobody says "The area of the brain that lights up when..."  Regular readers will know that I am sceptical of some of the claims of 'brain science'.  The next post on "Your brain on porn" has fMRI images showing how sections of the brain "light up" when exposed to porn which proves that the subjects of the brain scans are addicted much as people get addicted to heroin. ( A primer on fMRI goofiness. )  Here is a picture of a dead fish in a fMRI with its brain lighting up when asked to imagine humans in social situations.


End digression:  There is a growing set of men who say that they are addicted to internet porn and/or incapable of erections with actual humans as a result of using porn regularly.  This is a tough claim to verify since it is so subjective.  Men may experience less frequent erections and attribute that to the use of porn; that doesn't necessarily mean that was the primary cause.  That is what is known as the post hoc ergo propter hoc fallacy.  It does seem to make intuitive sense that if you don't masturbate for a long time you are more likely to experience an erection in a particular circumstance.  It also seems like it would be pretty hard to look at a lot of porn and avoid masturbating, so the two do go hand in glove (as it were). There is a whole online Nofap community where people, mostly men, pledge to stop masturbating and/or viewing porn.  They support one another to achieve goals in days.  When does this shade over into shaming a normal and healthy sexual behaviour that has already been the target of a lot of shame?  I wrote a blog post a while ago about Marty Klein's argument that the term "sex addiction" is a way for people living in a sex negative culture not to address their sexual desires about which they feel incredible shame. 

There are a couple of things I am pretty confident about in all of this. 

1.  The whole "erectile dysfunction" piece of the conversation about porn and masturbation needs to get scaled way back.  Men are easily goaded into thinking that a rock hard penis is the only legitimate route to sex.  That's false and it isn't good for men's sexuality (or for their partners).  Start having sex without an erection and you may get one.  Keep having sex after an erection goes away, and it may come back.  But if you make having and maintaining an erection a prerequisite, that can mean a lot of heart ache.  Paradoxically, lots of porn and lots of nofap both seem to perpetuate the myth of no sex without an erection. 

2.  Porn is not sex education.  Teens need to know that what they will see in porn is not what happens between most people's sheets. Talking to teens about what porn is and isn't is part of the job description of every parent, and that needs to go beyond telling them it's bad or women-hating.  Porn:Human Sex::2Fast2Furious:Driving.  A fantasy. 

3. Teens will try to make their own porn.  Not every teen but plenty of them.  Maybe not your kid but plenty of kids your kid knows.  As Dan Savage has pointed out, smart phones are -- among other things -- mobile porn production and distribution suites.  And parents hand them over to kids without thinking about or talking about that.  If you must give your teen a smart phone, disable the camera.  Tell your kids you will search through the contents of their phones and then follow through.  Millions of adult Americans use their phones this way, should we expect teens to act any more maturely? 

Important Parenting advice! Ignore Parenting advice!

When did "parenting" become a word?  When a publisher realized that there were millions to be made from telling anxious, well-off parentingers about all the things that can go wrong with kids.  (And a guy named Stan, in marketing, suggested they move away from the term "child rearing").  Nobody ever sold a book called "If You Can Afford the 30$ to Buy This Book Then Your Kid Is Doing Better Than 99% of the Humans Who Ever Lived."  21st century Canadians live in an age and place where most of us can provide our children with nutritious food, shelter, education, clothing and medical care that most of our ancestors (and many people around the world today) would have been delighted to be able to give to their kids.  That and love will go a long way.  We live in an age and circumstance of tremendous blessing.  So why do we consume parenting advice books and lectures by the SUV-load?

I work with a lot of families in difficult situations and I have seen some pretty bad parenting (by today's standards).  I can tell you that very little of what I have seen happens because people didn't read a book on parenting.  Occasionally, I will meet parents who honestly did not know better.  I tell them to stop and, usually, they do.  Twice in my career I have told parents not to threaten to hit their kids with a belt.  These parents felt overwhelmed by out-of-control kids and thought that threatening such a beating was better than actually following through.  I told them that, for a kid, the fear of such a beating can be almost as devastating as the beating itself.  They thought about it and saw that what I was telling them was probably true.  We brainstormed some better ways to deal with their kid's behaviours and they never resorted to that kind of threat again.   

I see parents who want to stop doing things they know or suspect are bad for their kids but they can't because they have mental health issues or are struggling with the ghosts of their own past or trouble in their present.  Just about everybody knows that parents should keep their marital acrimony away from their kids.  There are dozens of books that will tell you that.  But I have seen a lot of parents who tell me that in their particular circumstance, because their soon-to-be-ex wife/husband is such a poisonous viper, it is absolutely critical for the kids to know everything.  Or they make every effort to hold back only to find themselves pouring out all their hatred to a kid who is caught in the middle.  A book may help re-inforce a message in such a circumstance but I think that person needs supportive friends, a caring community and probably counselling.  

The people who buy books on parenting are often the worried well; parents who lack confidence in their own ability to parent.  That is where I have the biggest issue with the parent-advice-industrial complex.  By turning something that humans have done pretty successfully for our whole history into a gerundified 'parenting' with classes and manuals and DVDs, it makes parents feel less confident in their own judgement rather than more confident.  Ron Taffel wrote a wonderful piece in Psychotherapy Networker a few years back called "The Decline and Fall of Parental Authority... and what therapists can do about it."  He wrote about some of the forces undermining parental confidence and what that does to people's lives.

[A] chronic sense of being held hostage by kids and the culture at large helps explain why parents so often show up in our offices looking and sounding like spineless wimps. With so little time to bond with their children, parents are afraid to take even one step that could drive them farther away, undermine their already shaky school performance, and ruin their chances for social success when little else seems to matter. Not surprisingly, a multibillion-dollar public and private enterprise monetizes these insecurities by selling a raft of social modules and remediation services—including tutors and homework helpers for the well-heeled and supplemental educational materials designed to jack up reading and math scores. The issue isn’t just parental abdication, but what I call the “merchandising of childhood,” based on a deep-rooted fear of failure.

Taffel sees economic difficulties as the driving factor in parental lack of confidence.  I would go one step further;  I think we live in a fear culture.  We are encouraged to be fearful rather than generous and open towards people and the world around us and we are especially encouraged to transmit those signals to kids.  Engagement in community organizations has plummeted in North America over the last 50 years.  People don't join clubs, religious institutions civic organizations.  In Robert Putnam's famous phrase, today people are "Bowling Alone."  And people are 'parenting' alone as well.  Living in a more mobile, deracinated society that is fearful and highly individualistic means people don't have great social networks for parenting.  There are fewer norms for parenting and the norms that exist are harder to learn than they once were.

That makes for a lack of what social scientists call self-efficacy among parents; basically the feeling that you know what to do and are able to do it.  That is a problem because self-efficacy in parents correlates highly with good outcomes for kids.  (Obviously, if you are convinced that the way to deal with a kid is by threatening to hit him/her with a belt or to dis your ex to the kids, that's not good.  But it is better to parent with confidence than to parent without confidence, even poorly, and parents who feel confident in their parenting are less likely to parent badly.)  Researchers don't know exactly why that is the case, whether confidence comes from success, or if it comes from shared norms and those things generate success in parenting or maybe that kids perceive confidence in their parents and feel a sense of safety because of that.  Or a combination of those things.  But it is clear that feeling that you can manage being a parent without getting post-doctoral training in child development and arts and crafts is good for families.  

This doesn't mean that parenting books can't be helpful for everyday kinds of problems with kids.  I have mentioned "How to Talk so Kids will Listen, How to Listen so Kids Will Talk" before which I think is great.  But I actively discourage parents from trying to anticipate and preparing a fully developed response to every potential disaster of childhood and adolescence.  Now if you'll excuse me I have to go work on the next chapter of my parenting book.  The working title is "1001 Things That Will Definitely Go Wrong With Your Kid That Only This Book Can Fix."        

Poverty, Families and Mental Health

A great blog post called "5 Stereotypes about poor families and education" in the Washington Post a few days ago quoted extensively from a book by Paul C. Gorski titled Reaching and Teaching Students in Poverty.  The excerpt offers a lot of research to dispel some common negative myths about poor people that impact the way schools and educators tend to approach them and how that impacts their experience of school; poor people don't value education, poor people are lazy, poor people are more likely to be substance abusers, poor people are linguistically impoverished and -- the biggy -- poor people are ineffective parents.  

This is a tricky subject because some things about poverty can have an impact on kids' school performance as well as physical and mental health.  Well-intentioned governments and schools generally want to respond to those negative effects in order to ensure that kids growing up in poverty have the best opportunities they can (or say they do, at any rate).  But as Gorski points out fuzzy thinking about how exactly poverty does or doesn't impact kids and families can be deleterious on a classroom or a public policy level.  

Stereotypes can make us unnecessarily afraid or accusatory of our own students, including our most disenfranchised students, not to mention their families. They can misguide us into expressing low expectations for poor youth and their families or to blame them for very the ways in which the barriers they face impede their abilities to engage with schools the way some of us might engage with schools.

The WP post doesn't discuss the tings we do know about the ways in which poverty (or things that are highly correlated with it) impact kids and families though I am assuming the book will do just that.  Paul Tough wrote a great piece a few years ago for the New Yorker called "The Poverty Clinic."  The article looked at a medical clinic which used the findings of the Kaiser Permanente Adverse Childhood Experiences study to treat poor families.  The upshot of the study and Tough's article is that childhood trauma is a huge risk factor for both physical and psychological illness both in childhood and in later life.  Since poor people are much less well insulated against trauma, they are, on average, at greater risk.  Trauma both intensity and frequency are a great predictor of difficulty in school and later life, but not poverty per se.  

The other piece of really interesting research about differences in family style between poor and middle-class families and how that impacts education that Gorski alludes to in the extract, but that doesn't get a lot of play is Anette Lareau's distinction between middle-class "concerted cultivation" versus poor and working class "accomplishment of natural growth."  While not contradicting Gorski, Lareau does portray the poor/working class families in her study as less organized around talk and less at ease with certain kinds of parent involvement (Gorski says that poor families may want to be involved but may feel turned-off by the ways schools invite participation, which tends to be geared towards middle-class parents). 

Finally, one of the things that Gorski doesn't address in the blog post is varieties of poverty.  Because poverty itself is not the cause of academic failure or ill health or family dysfunction, but certain things that are often associated with poverty are risk factors for all those things, we should look at and think about the way differences between poverties impact those factors; for example, not every poor community increases exposure to trauma for kids.  Some poor communities are better at insulating their young against trauma than some wealthier communities.

Most disasterous parent-child sex talk ever?

Talking with kids about sex can be tough for parents even when we think we're ready for it.  Julia Sweeney gives the best (or worst) account of having the sex talk with a child ever. 

I actually think listening to this is a great way to prepare yourself for talking with kids about sex.  Once the topic comes up, kids, especially young kids may ask all sorts of questions that we might never expect, but that are pretty obvious if you take some time to consider it from their perspective.  After all, everything about sex seems pretty unlikely to an eight year old. 

Also her account is loving and humorous and sort of makes the point that we all make mistakes when we talk about sex with kids, and if we have a loving relationship with our kids, we will get lots of chances to go back and talk more.  The importance of having an ongoing dialogue with your kids about sex was demonstrated by a 2008 study done by researchers at Ste. Justine hospital, here in Montreal.  That study found that while parents assumed their adolescents looked to friends and celebrities to shape their attitudes towards sex, teens (the study was of teenage girls) report that it is their parents who are their most significant role models, but that despite that they do not feel comfortable talking with them about sexuality.  So take heart, your child will look to you more than peers or the popular culture for her ideas about sexuality but you should start laying the groundwork for conversations about sex early.   

When do kids 'get' irony?

The ability to understand that other people have different ideas and information about the world from one's self emerges in most kids by around four years old.  This ability that most of us share is really nicely illustrated by this video.  According to psychologist (and brother-of-Borat) Simon Baron-Cohen, kids with Autism Spectrum disorder have a much harder time with tasks such as these.  A recent study in Frontiers in Psychology found that empathy and the ability to understand irony are correlated in kids. 

Empathy was strongly associated with several aspects of irony comprehension and processing, suggesting that emotional reasoning abilities are important to development of irony comprehension.

Makes sense.  Irony is a disconnect between what a person says and his or her inner state.  By around eight years of age most kids can 'get' that disconnect.  The authors point out that these are both areas that are difficult for people with ASDs.  Empathy and reading irony both require projecting one's self into another person's inner experience; Theory of Mind.  In the case of irony, one has to do that while swimming upstream, as it were, against the current of the literal message.  I have noticed in my practice how hard and frustrating it is for kids with ASDs to read and irony.