Students Face Challenges When They Return Back from Mental Health Out Placements

link to Hechinger report

Past Trauma May Cause Both Behavioral and Health Changes

Article by Harvard Woman's Health Watch

"Past Trauma May Haunt Future Health" (link)

Behavioral changes resulting from trauma. People who are suffering from traumatic memories may try to escape them by participating in risky behaviors such as drinking, smoking, drug use, or even overeating for comfort. "Those can all be used as a coping mechanism, a way of dealing with emotional dysregulation that occurs when someone has been traumatized," says Roberts. These habits, in turn, lead to health problems.

Physical effects related to trauma. The problem goes beyond unhealthy habits. Experts believe that there is actually a direct biological effect that occurs when your body undergoes extreme stress. When you experience something anxiety-provoking, your stress response activates. Your body produces more adrenaline, your heart races, and your body primes itself to react, says Roberts. Someone who has experienced trauma may have stronger surges of adrenaline and experience them more often than someone who has not had the same history. This causes wear and tear on the body — just as it would in a car where the engine was constantly revving and racing, she says. Stress responses have also been demonstrated in people who have experienced discrimination throughout their lives. "It ages your system faster," says Roberts.

Chronic stress can increase inflammation in the body, and inflammation has been associated with a broad range of illness, including cardiovascular disease and autoimmune diseases, says Roberts. Early trauma disrupts the inflammatory system. This can lead to long-term aberrations in this system and chronic health problems triggered by constant inflammation. Typically, the more trauma you've experienced, the worse your health is.

Changing Destructive Behaviors: Origin Stories

From HBR article “Getting to the Bottom of Destructive Behaviors,” by Ron Carucci 

If you, or someone you coach, has struggled to change chronic destructive behavior — anything from angry outbursts to freezing up in high-risk moments to asserting excessive control under stress — uncovering their origin stories may help you break through and make way where other approaches have failed to.  The process involves four steps.

1) Write down the origin stories.

I ask my clients to recall scenes from their formative years, usually between the ages of five and 20, in which the importance of the behavior in question started to appear.  Take the case of my recent client, Andy, the division president of a global accounting firm. He was affable, articulate, with an infectious energy that earned him high regard. But these positive qualities were counteracted by a defiant need to be right, crave the spotlight, and talk incessantly. I asked Andy to write down stories from his formative years centered around times he learned that being both right about, and central to, so many issues became critically important to him. I wanted him to uncover why being wrong or on the periphery was threatening to him. My hunch was that Andy only felt safe when he was talking, and that having his views questioned triggered a sense of inadequacy and shame. The question I told him to try and answer was this: When and how was this behavior learned?    

2) Identify the inner narrative. 

The origins of destructive behavior are almost always attached to well-formed narratives. These narratives serve as templates, or biases, through which we make sense of the world, and often manifest in reaction to experiences we faced earlier in life — or our origin stories. Unless we rewrite them, we spend our lives recreating conditions that reinforce them. But we can’t rewrite stories that we can’t even name. That’s what this step is about.  One of the stories Andy wrote was about the social struggles of changing schools when he was ten. Andy was both a severe stutterer and suffered with ADHD. His new school required him to attend “special education” classes in the middle of the day when everyone else was at recess. For two years, Andy’s daily walk of shame past jeering peers to what they called the “stupid classroom” set the stage for a defiance and shame that would manifest as the behaviors he now couldn’t change.  Andy learned that to prevent being seen as “stupid,” he needed to be highly likable, articulate without stuttering, and consistently demonstrate how smart he was to others. To him, being smart meant being right. I asked Andy to identify in one sentence what that vulnerable season taught him. The narrative Andy wrote down was: “Unless you can prove otherwise, everyone will see how stupid you are.”  His interpretation is starkly revealing. Andy didn’t believe he had to prove he wasn’t stupid. He believed he had to hide the fact that he was. Those years of ritualized public shame caused him to conclude he was inadequate, unintelligent, and therefore, had to adopt sophisticated behaviors to conceal that “truth” from others.  But his abrasive behaviors ended up doing the opposite — pushing people away and replicating his childhood experiences of rejection. Consequently, he had to acquire others’ acceptance and admiration using upbeat energy and brilliantly articulated ideas. Andy realized he’d spent his entire life perfecting a cycle that, while made him feel momentarily safe, yielded the very rejection he sought to escape.

3) Name the need the behavior is serving. 

The anchor that holds troubling behavior in place is the need it serves. This step is about figuring out what that need is. Chronic, destructive behavior is usually an attempt to resolve the painful experience that initiated it. When I asked Andy to tell me what he ultimately wanted, he said, “I want to feel like I belong just by being me.” The problem was that he learned early in life that he couldn’t both “belong” and “just be me.” As a result, he chose to concoct a new version of himself.  Andy and I discussed exactly what this meant: To counter his feelings of self-contempt and shame and purchase others’ acceptance, he made sure others believed he was an affable, articulate guy, especially at his place of work. His unconscious need to reinforce his own belief that he was stupid and unlikable is what made him resistant to change, despite cognitively understanding he should in fact change.  While he freely acknowledged the negative consequences of his behavior on others (cognitive) and desired to actually stop (motivation), the unaddressed pain of those formative years (trauma) was simply too formidable to be more than momentarily counteracted by his will or his acknowledgement. This cycle had set a destructive pattern into motion.

4) Choose a new narrative and alternative behaviors. 

Once someone has identified the deeper needs that that their troubling behavior serves, no matter how irrational they seem, they can begin the process of change.  To start my clients off, I always ask them to take a stab at writing down a new narrative. For Andy, the prompt was: What would happen if you really were smart and didn’t need to purchase other’s approval with your enthusiastic energy or by using your verbal mastery to appear intelligent? Do you think others would still admire you if you were quiet? For his new narrative, Andy wrote, “I am liked, smart, and safe even in silence.” It’s common to dismiss formative stories as mere parts of our past. A divorce, a loved one’s fatal illness, being bullied, surviving a natural disaster, and many other experiences, can leave lasting marks that shape who we become.

Increase in Teen Suicide and What We can Do about it

Richard A Friedman in the NYT.
"Why Are Young Americans Killing Themselves?" (link)

"After declining for nearly two decades, the suicide rate among Americans ages 10 to 24 jumped 56 percent between 2007 and 2017, according to data from the Centers for Disease Control and Prevention. And for the first time the gender gap in suicide has narrowed: Though the numbers of suicides are greater in males, the rates of suicide for female youths increased by 12.7 percent each year, compared with 7.1 percent for male youths.

"At the same time, the rate of teen depression shot up 63 percent, an alarming but not surprising trend given the link between suicide and depression: In 2017, 13 percent of teens reported at least one episode of depression in the past year, compared with 8 percent of teens in 2007, according to the National Survey on Drug Use and Health.

...

"To start, we need a major public campaign to educate parents and teachers to recognize depression in young people and to learn about the warning signs of suicide — like a sudden change in behavior, talking or writing about suicide, and giving away prized possessions. We should have universal screening of teenagers at school, with parental consent, to identify those who are suffering from depression and who are at risk of suicide. And we have to provide adequate funding and resources to match the mental health needs of our young people.

"Every day, 16 young people die from suicide. What are we waiting for? 

See also the Pew Educational Trust study.

Most U.S. Teens See Anxiety and Depression as a Major Problem Among Their Peers

Pew Trust shares an article about how teens are stressed.  (link)

Here's the beginning of the article:

"Anxiety and depression are on the rise among America’s youth and, whether they personally suffer from these conditions or not, seven-in-ten teens today see them as major problems among their peers. Concern about mental health cuts across gender, racial and socio-economic lines, with roughly equal shares of teens across demographic groups saying it is a significant issue in their community.

"Fewer teens, though still substantial shares, voice concern over bullying, drug addiction and alcohol consumption. More than four-in-ten say these are major problems affecting people their age in the area where they live, according to a Pew Research Center survey of U.S. teens ages 13 to 17.

"When it comes to the pressures teens face, academics tops the list: 61% of teens say they feel a lot of pressure to get good grades. By comparison, about three-in-ten say they feel a lot of pressure to look good (29%) and to fit in socially (28%), while roughly one-in-five feel similarly pressured to be involved in extracurricular activities and to be good at sports (21% each). And while about half of teens see drug addiction and alcohol consumption as major problems among people their age, fewer than one-in-ten say they personally feel a lot of pressure to use drugs (4%) or to drink alcohol (6%).