Teen Shrink Talks Teens

Many of you have asked, “Hey Teenshrink, this is all well and good, but what about teens?” The question is understandable given the name of this blog. But patience, there is method to my madness. In order to make sense of teens, I felt the need to set the stage. Adolescence only really makes sense if you understand the foundation it is built on. Hopefully I have shed some light on this foundation so far.

Teen transitions

Adolescents sit perched on the gateway between childhood and adulthood and it is in these years that an astounding array of mental health difficulties have their origins. Roughly half of all lifetime mental disorders, in most studies, are found to start by the mid-teens and three quarters by the mid-20s. The peak age of onset for all mental illnesses is 14 (according to the National Comorbidity Survey). It may come as little surprise therefore that many parents are overcome by a strange pessimism at the mere thought of parenting their children through these ages. But with some insight into the brain and soul of the teenage years it should be possible to reduce such pessimism.

Eric Ericson was one of the first theorists to extend the theory of development out of childhood. This was unlike Freud and many of his early disciples who seemed to have difficulty looking beyond early childhood. According to Ericson’s theory, basic interpersonal patterns of trust, cooperation, autonomy, mastery and sensitivity to shame and guilt may have been established by the time of adolescence, but the challenges of identity formation and integration into the broader community await the teenage years.

Adolescence has been defined as beginning with the onset of puberty and ending with the establishment of an independent role in society. However that timespan seems to be expanding in our western culture. The average age of puberty has been decreasing (for reasons that have not been established), and the age of establishing an independent role in society has been getting later. With the age of social media upon us, this time period has become ever more complex and tumultuous!

The Teenage Brain

So what is going on in the brain during these years? Although the brain has achieved 90% of its size by the age of 6, the amount of white matter in the brain continues to increase into the thirties. White matter is the part of the brain that acts like highways. Meanwhile the houses in the city of the brain are the gray matter. The gray matter begins to decline through middle adolescence. This has been referred to as synaptic pruning, but occurs inconsistently across various brain regions. The prefrontal cortex is one of the areas that fully matures through this time period. With its increased differentiation and interconnection the teenager becomes able to think more abstractly and experience greater self-awareness than ever before. This leads the adolescent to begin to ask him or herself the question “Who am I and where do I fit in?” in ways that younger children cannot yet do. The answer to this question for us, among the most social of mammals, has been incredibly important to our survival.

The Social Brain

Perhaps for this reason the teenage brain appears to demonstrate a heightened sensitivity to social stimuli such as facial expressions. The medial frontal area of the prefrontal cortex used by adolescents to decode facial expressions is more actively linked to the emotional brain than the superior temporal area used by adults for similar tasks . Therefore, the job of decoding facial expressions is much more tightly linked to the emotional brain in adolescence than it is in adulthood. For this reason it seems that non-verbal signals are more likely to lead to powerful physical and emotional reactions in adolescence than at any other time of life.

Male and female development, of course, take somewhat different trajectories. Male development in adolescence is associated with increases in the hormones testosterone and vasopressin, which act synergistically and result in increased intermale competition, while female development is associated with increased estrogen and oxytocin, which result in an increased tendency towards female relational bonding, which as we know can result in painful exclusion when it goes awry. (See Panksepp's "Archeology of Mind")

Of Peers and Parents

Strangely as a culture it seems we in the “western developed world” have gone down a rather strange road when it comes to how we approach this critical time of adolescence. In their book "Escaping the Endless Adolescence", psychologists Joseph and Claudia Worrell Allen note that teenagers in the US spend just 16 hours per week interacting with adults and 60 hours with other adolescents. One century ago it was almost exactly the opposite, as it continues to be in more traditional societies. The implications of this may be very significant.

Gordon Neufeld and Gabor Mate argue convincingly in their book, "Hang Onto Your Kids", that this environment, devoid of adult influence, increases the pressure on peer relationships and interferes with the parent child attachment bond that remains an important tether for the ongoing development for the adolescent. With weaker parent-youth bonds, youth are more likely to turn to their much more available same aged peers to meet their ongoing needs for nurturance and guidance. With the increased power of technology and social media this becomes seductively easier, and many parents unwittingly encourage this. Unfortunately, the results for the parent-teen relationship can be devastating. Once teens have tuned out parent for their nurturance needs, and tuned in their same aged peers, parents lose their natural parental authority and peers take over this powerful mantle of influence. The guidance these teens tend to receive from other adolescents rarely encourages the long term goals and values that adult caregivers would be likely to encourage. This shift in focus to same aged relationships is something that is almost taken for granted in our culture, but it inevitably leads to frustration among parents who find their offspring beyond their influence. Often parents either throw up their hands in defeat, or alternatively turn to harsh punishments which can result in further estrangement and resentment and breakdown of trust.

The Rising Tide

As adolescence proceeds, we see an increase in the incidence of depression, suicidal ideation, substance misuse, eating disorders and psychosis. Families and children face many pressures, such as illness, divorce, financial and personal upheaval which can accumulate and place strain on parent child bonds. With few alternate adults to turn to, youth often turn to their same age peers during these challenges, for a time often coming across as carefree and unaffected. However the world of peer relationships is unstable, many peers are struggling with their own problems, and hostility and rejection are everywhere to be found. As these pressures accumulate and as peers turn to one another, or turn inward, the chances of mental health issues reaching critical levels increases steadily. Drugs, self harm and disordered eating can serve as powerful ways to avoid pain and modify stress in the short term, but can quickly turn into compulsive patterns that are difficult to change, complicating long term social problems. Suicide looms as an ultimate "way out" that all too many youth consider. As parents find their influence on their troubled teens waning, their frustration and stress level naturally rise, and parents are themselves often under-supported in this world of ever decreasing social capital. (See Putnam "Bowling Alone")

Turning the Tide

Hopefully, with our greater understanding of neurobiology and of the developmental importance of the attachment relationship, we as a society may come to rethink our approaches to our vulnerable youth. Rethinking our approach to isolating youth in same age cohorts and instead integrating adolescents more successfully into integrated, age stratified, social contexts would certainly be worth considering. Perhaps by doing so we may see some reduction in the rates of adolescent mental health problems, violence, substance abuse and relationship problems that have come to dominate our news sources in recent years.

Trauma and Brain Body Interactions

Interpersonal Neurobiology Conference

I have returned from my conference in LA, which was truly inspiring. I followed this with a family vacation where I finished reading Robert Scaer’s book – 8 Keys to Brain-Body Balance, which I highly recommend to any of you interested in the Brain-Body interface or developmental neuroscience in general. Robert Scaer has been himself deeply influenced by the work of Peter Levine, who presented at the conference, and whose work I found deeply moving and inspiring.

In this post,  I would like to cover some of the key points that have hit home for me over the course of this conference, focusing on some of the overlaps between presenters and, in particular, some of the key insights from the work of Peter Levine and Robert Scaer. (Scaer unfortunately did not present at the conference).

Here's a great interview with Robert Scaer by Dr. David Van Nuys. click here

Windows of Tolerance

 

 

 First, I would like to refer to a concept that was raised repeatedly at the conference. This is the concept of “windows of tolerance”. What this concept refers to is how we develop a range of emotional and physical responses over the course of development. In this process our nervous system and our physiological responses become integrated and we develop a changeable set-point (sort of like a thermostat). This occurs through a very complex interaction of our genetic make-up and our lived experiences. Many of the key points of this development I have referred to in my previous posts (Allan Schore's work). Through these repetitive and rhythmic interactions in the womb and in the first 2-3 years of life, our physiology and nervous system may develop a broad range of flexible arousal which allows us to adapt to many different situations in our environment (i.e. a wide window of tolerance – see figure 1). Alternatively we may find ourselves with a narrow window of tolerance, outside of which we experience disruptive reactivity or paralyzing immobility (see figure 2).

Figure 1

Healthy attachment and attunement, in the context of a stable environment and community, lead to wide and functional windows of tolerance. Alternatively expressed genetic factors and or environmental factors, that interfere with this development, lead to narrow windows of tolerance. A narrow window of tolerance may lead to strategies to avoid extremes, resulting in rigid patterns of behavior, or alternatively, a tendency to experience extremely chaotic emotional states.

Figure 2

 

 

Brain Body Interactions

Robert Scaer has proposed a robust theory of body-mind interactions that expands on the physical implications on this brain body balancing act. He explains the implications of being is a state of chronic high arousal. When the thermostat is set too high, into the chronic arousal state at the top of the graph, the body releases cortisol which over a long period of time can result in chronic health problems, such as high blood pressure, obesity, diabetes, stroke, and suppression of the immune system. High cortisol also results in damage to the hippocampus which I have explained in a previous post is responsible for memory and learning, therefore causing memory impairment and learning difficulties. In the extreme, these high arousal states can result in paranoia and psychosis. On the other hand when the thermostat is set too low, low arousal states can lead to problems with chronic fatigue, heart irregularities, irritable bowel, asthma and  overactivity of the immune system.

When Trauma Strikes

 

A key factor that can lead to narrowing of our windows of tolerance is trauma. A traumatic experience is any experience that at the developmental stage of the individual (which varies accross development and with experience) pushes them completely out of their window of tolerance, with no expectation of safety. Scaer goes on to explain that when we have a traumatic experience we may enter a freeze state. The key brain area that assesses our environment and engages the freezing response is the amygdala. The amygdala is active from the third trimester of a fetus' development, and therefore, Scaer points out, we are susceptible to trauma even prior to being born. Traumatic memories are not encoded in the part of our brain that encodes ordinary memories. Those ordinary (explicit) memories are encoded by the hippocampus, which does not come online until the second to third year of life. In trauma, the hippocampus is disabled, as are the parts of our brain that control language.  When this occurs the motor movements and sensations that we are engaged in just prior to this are stored in a form of memory called procedural memory. If this state of action and sensation is not “discharged”, which requires entering a state of calmness where we can return to emotional state prior to the trauma, these motor and sensory memories remain active and the traumatic state is stored in a sort of "perpetual present". (Scaer himself had a facial tic which was a remnant of traumatic incident he experienced at the age of 4.) Motor memories can lead to chronic changes in posture, tics or stutters. Sensory memories can lead to chronic pain conditions, an example of which is the phantom limb phenomenon.

Peter Levine has developed a therapy which he has named Somatic Experiencing which engages the client in gradually accessing the stored motor and sensory memories of trauma, while deactivating the amygdala by careful attunement and providing resources to the patient that establish safety and empowerment.

Summary

In summary, the brain and body exist in a complex relationship with one another. Various life experiences can contribute to healthy and flexible brain-body interactions and others can lead to rigid or chaotic brain-body states. With a deeper understanding and appreciation of these patterns, we in the healing professions may be capable of profound healing. Without this understanding, we run the risk of perpetuating or even worsening these imbalances. In general, our health care system remains ignorant of these interconnections and we continue to treat the brain and body as strangely disconnected. Hopefully as the neuroscience and physiology of these interconnections becomes better understood, we will become better at improving the brain body balance in ourselves and in those we care for.

Divided Brain, Divided Soul

This post has been inspired by Iain McGilchrist's book, “The Master and his Emissary”. This is a visionary work which explores the lateralization of the human brain. By lateralization I am referring to the fact that the human brain is divided into two hemispheres or halves. Specifically I have just finished listening to Dr. David Van Nuys' latest interview with Iain McGilchrist which I highly recommend. http://www.shrinkrapradio.com/2013/02/28/340-brain-lateralization-and-western-culture-with-iain-mcgilchrist-md/

Left Brain, Right Brain

 

It has become a part of pop culture to refer to the right and left brain, ever since the “split brain” studies of the 60s and 70s. In these studies patients who had their brains surgically divided with a surgical procedure to control epilepsy were subjected to psychological tests to evaluate the differences between the hemispheres. This led to a popularized stereotype of the hemispheres that McGilchrist debunks in his very comprehensive survey of this topic, while bringing the most up to date neuroscience to the table. In this way McGilchrist synthesises a very new construct of the important differences between the two hemispheres of the human mind.

2 Ways of Knowing

McGIlchrist takes an evolutionary look at how this specialization of the hemispheres developed, pointing out it’s origins in birds and mammals. McGilchrist posits that this lateralization evolved because of the adaptive advantage of having two kinds of attention that we can use at the same time. The left hemisphere attention system is narrowly focussed, predictive and exclusive, making it ideal for predatory, scavanging, or tool making and using tasks, while the right hemisphere attention system is wide ranging, inclusive, integrative and less predictive making it ideal for being on the look out for surprises, unexpected dangers or opportunities. By dividing itself in two, the mind can run both processes simultaneously which has massive and obvious survival implications. With social birds and mammals the hemispheres also specialized in their social functions. The right hemisphere taking on the role of holistic appraisals of the social world and it’s opportunites and dangers while the left using more practical strategies for manipulating social situations and presenting a social “persona” to the world.

The main point here is that the left hemisphere tends to ignore context, which is both it’s great strength (separating relevant information from the whole, so as to manipulate it more effectively) and it’s weakness (losing sight of the forest for the trees).

Birth of the Brains

Developmentally the right hemisphere is the earlier developing hemisphere. It stores the implicit learning of attachment experiences and it learns the implications of non-verbal information in our environment. It connects our social world to our physical world of stress responses, motivations and behaviours. This learning is chiefly organized by the subcortical brain structure known as the amygdala, which becomes active before birth. This right brain learning is implicit (unconscious) and enduring. The left hemisphere begins it’s growth spurt later (from 18 months or so), and it begins it’s process of naming and analyzing the world and developing more explicit (conscious) connections and strategies. The chief subcortical region that encodes this learning is the hippocampus, which comes online later and is more vulnerable to stress and injury.

The Rise of the Left Brain

 

 

 McGilchrist’s thesis includes the argument that the western world has come to highly value left hemisphere knowing while undervaluing right hemisphere knowing. He argues that western culture tends to be reductionistic, glorifies factual knowledge and is dismissive of experience or context. I would agree that our modern approaches to society and child rearing have reflected and influenced this bias. We have tended to devalue communities, sacrificing them to the conveniences of parking lots and personal sanctuaries. We have also undervalued the developmental window of the right hemisphere, namely the first 18 months to 3 years of life with inadequate maternity leaves and insufficient support for at risk mothers, with the result that infants all too often are raised in crowded daycares or  in front of screens watching “Baby Einstein”.

Integration 

 

 

Hopefully, with the vision of new influences such as McGilchrist's this new era of neuroscience will bring a deeper commitment to the knowing of the right hemisphere. The right’s hemisphere’s inculsive nature is naturally empowering of the left. Mental health is not a contest between the hemispheres. The goal of all mental health work, ultimately, involves the healthy integration of both ways of knowing.

Interpersonal Neurobiology and Shrink Rap

Yes, I know...

I have been away for the blog now for some time. :(

However, I have been continuing my exploration of the world of Interpersonal Neurobiology and how it is shaping our view of human development and mental health.

One fantastic source I have stumbled across is Dr. David Van Nuys podcast, Shrink Rap Radio. I have posted a link to his webpage at the bottom of the left sidebar and I recommend it to all, clinicians and non-clinicians alike. Dr. Dave, as he calls himself, is a psychologist who has taken it upon himself to interview thinkers and practicianers in the fields of psychology, psychotherapy, mental health, spirituality and neuroscience. I have been very impressed with his interviews and the selection of his guests. Thank you Dr Dave!

I agree with David's recent musings that we are seeing a grand integration in mental health theory that is being lead by advances in neuroscience. This is very exciting. We may soon see a day where the various theoretical schools of psychology, social work, psychiatry and healers of all disciplines will be able to find scientifically supported common ground and find grand unifying mechanisms in the work of healing and recovery.

I am looking forward the 2nd Annual Interpersonal Neurobiology conference I will be attending in LA. Let me recommend Dr. Dave's interview with Daniel Siegel that I just listened to. This conference is Dr. Siegel's brain child and his grand vision of the workings of the mind is one I certainly ascribe to. Let me quote his definition of the mind for you. "The mind is a relational and embodied process that regulates the flow of energy and information within an organism." It is in the concepts of "relational" and "embodied" that we are making the most headway in developing new understandings in neuroscience in the last decades.

I see that we are entering a new paradigm where neuroscience is escaping the age old trap of reductionism. By understanding the mind and neurobiology as relational and embodied we can understand the transcendant aspects of mind and self. This is the key to great improvements in cooperation and wellbeing.

I look forward to updating all of you on my experiences at the conference.