Adolescence: A Built in Second Chance for the Brain

Humans are complex. We have intricate networks of specialized cells, organized into specialized machinery called organs, conducting the daily business of maintaining life. Humans can adapt to a wide range of environments and use learning to express the local language as well as the customs of social behavior. The design is elegant.

However, as impressive at is may seem to observe the uniqueness and complexity of the human design, what’s even more impressive - if you think about it - are the built in second chances. Our adaptability comes in spurts, which if harnessed, make rapid growth and change possible.

As a clinician, I have always enjoyed helping people with the big transitions in life: puberty and the start of middle school/high school, young adulthood and leaving home for education or career, marriage, divorce, retirement… Among the big transitions, puberty and young adulthood are aided by nervous system change, making these the most delightful stages* to support. (I’m always shocked when other professionals dislike treating teens and young adults! How could anyone disagree that they are the most fun? When the brain is in the midst of change, how wonderful to help things along the right path!)

Puberty is a second chance. At puberty, diseases can abate and new abilities can spring up. And most impressively, puberty offers a second chance to the developing brain. Brains learn rapidly for a window of time beginning around puberty, changing disease disposition, especially in mental health. The brain is actively changing for a window of a dozen years. A once anxious child may emerge from adolescence without much anxiety thereafter. The problem seems to take care of itself. A distracted elementary school student may morph into an attentive high schooler, college student, and adult contributor.

When parents, educators, and mental health professionals can harness the active change in the brain during adolescence, we can support lasting change in the nervous system, and wire in better health. When a teen starts seeing a counselor for anxiety, and she learns a new way to think about her fear along with a set of strategies for coping, those new ideas take deep root in her brain.

Embracing adolescence as a time for learning helps us see what an opportunity it provides for growth and healing. Wouldn’t you agree?

 

 

*Actually, puberty through young adulthood is one long stretched out stage of brain development, not two separate stages as we have been taught to believe.

Posted on May 1, 2017 by Melissa Deuter.

Why I Want to Hear From Your Mom

Jim comes into the clinic waiting room and plops down with his mom seated next to him. She nervously clutches her handbag, a look of worry evident in her eyes. When I call him into the interview room, his mother’s eyes dart from me to him and back. Does she have something she wants to tell me?

“Why don’t you come back with him, just for a few moments,” I say to the mom. Jim huffs at her. I smile cautiously at him and wait for his mom to follow.

Inside the room, door closed, I ask Jim if it was his idea to come for the evaluation, or someone else’s. He tilts his head toward his mother and rolls his eyes. He says, “I’ve been a little bit anxious with school and everything, that’s all. I’m fine. I went to a holistic herbal shop and got some new supplements. I don’t need to be here. She’s just hysterical, as usual.

I turn to address Jim’s mom. “Can you tell me why you wanted him to come for the evaluation?”

She glances over at Jim from the corner of her eye to see him lean back in his chair and look up at the ceiling. “Jim hasn’t slept in several days. We hear him upstairs during the night, in and out of closets and boxes. I don’t know what he is doing up there, but he seems agitated at night and moody all day. He peels out of the driveway recklessly when he leaves the house. Jim has always been calm, quiet, and easy going. He has always slept 10-12 hours a night. He has never been like this before.”

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People seek psychiatric evaluation for any number of reasons: anxiety, depression, inability to sleep, changes in behavior, substance use. They sit down in a chair, answering questions about their inner experiences and trying to explain a hidden problem. They offer a peek inside their minds and hearts.

But I always want to hear from their families, too.

In healthcare, we refer to the information obtained from significant others “collateral reports.” I want to hear as many collateral reporters as I can find. Not all healthcare professionals agree with this view. They worry that involving family members can bias the clinical picture, or that somehow privacy will be breached by asking questions of the wrong family member. Still, I am adamant about the value of an outsider point of view to make things clearer.

Maybe you are a healthcare professional, or maybe a patient reading these words, and perhaps the idea that family should be directly involved in your healthcare evaluations seems to cross the line. If so, hear me out.

Psychiatry is the medical discipline that treats mental health problems, or lately referred to as “behavioral health” problems. “Mental” and “behavioral” health are the purview of my field of medicine. “Mental” = internal, thoughts and feelings hidden out of view, on the inside. “Behavioral” = external action, on display for others to view.

·      Only the patient himself can tell me his mental state.

·      And I can rarely rely on a patient himself to accurately describe his own behavior problems.

The patient describes his first person perspective on how he feels and thinks. Families give information about what happens on the outside, the changes in behavior visible from their perspectives.

In mental health, we have to hear from Jim’s mom. Otherwise, we will be operating with bad information, treating the wrong problem.

Posted on April 24, 2017 by Melissa Deuter.