Trigger Warning: This article includes mentions of self-harm with details of cutting.
With the advent of spring, mental health awareness continues to remain strong as we kick off the month with Self-Injury Awareness Day on March 1st. More frequently judged than treated, people who self-harm often do not receive the proper treatment they need to regain a healthy mindset but are bullied for their scars and labeled ‘attention seekers’ instead. Self-harm is the act of deliberately harming one’s own body through cutting, scratching, burning, self-hitting, inserting objects into the skin, and more.
In my experience, when scrolling through social media, there are often more judgemental comments than supportive ones when a stranger online has the courage to ask for help. I’ve also seen hate comments on posts/videos regarding healed self-injury scars, with unfriendly sentiments comparing cuts on one’s wrist to a barcode on grocery products. However, there is always hope in the darkest crevices of the Internet and life as supportive communities spread awareness regarding self-injury and break down the surrounding stigma and social barriers.
It is reported that around 15% of teenagers have reported some form of self-injury with skin cutting being a prevalent method (Mental Health America). Self-harm is often a last resort for many people as they try to process negative emotions and the downhills in life through an unhealthy coping mechanism. Although people who self-harm may be suicidal, the majority are not as they seek temporary relief and fall victim to a self-destructive cycle of self-injury. By engaging in self-injury, a person believes they gain control over their body when everything else in life is uncontrollable.
As with all mental health issues, self-injury causes many problems to one’s health in the short and long term. Physically, it may cause permanent scarring, uncontrollable bleeding, addictions, and infections. Mentally, it can exacerbate negative emotions such as guilt or shame, lead to avoiding friends/family, cause more interpersonal difficulty in close relationships.
Starting a conversation with those around you on this topic is often very difficult to initiate. After setting a serious tone for the discussion, make sure to create a safe space, allowing others to express themselves and offering emotional support when needed. Remember to listen and not judge. If you believe a person you know has been harming themselves, you can look for these warning signs and direct them to treatment:
Unexplained frequent injures (ex: cuts & burns)
Difficulty handling feelings
Problems in relationships
Unstable work/home environment
Keeping sharp objects on hand
Statements of hopelessness/worthlessness
Professional and self-made treatment options for those who self-harm are abundant, but often hard to access due to socioeconomic status, inability to ask for help, uncertainty regarding resources, etc. Ensuring that everyone knows that such treatment exists makes a difference, so here are some examples of beginning the road to recovery:
At some point or another, we have all had to make a tough choice. We may think, ‘do I want to major in biology or chemistry?’ or ‘should I rent or buy this house?’; when faced with difficult decisions such as these, we tend to begin panicking.
In situations like these, one of the most common pieces of advice heard is: “sleep on it.” Yet, is this just another excuse to procrastinate, or is this actually a good idea that helps our mental well-being?
Truth is, this saying is one of the most accurate phrases one might say. In fact, a good night’s rest is an essential part of a healthy lifestyle, improving attention, behavior, learning, memory, and overall mental and physical health. Sleep deprivation, on the other hand, can have horrible effects on one’s health.
Executive director of sleep medicine at Harvard University, Russell Sanna, Ph.D., believes that sleep and its importance cannot be overstated in the slightest. “If you’re having a problem in life or at work,” he tells WebMD, “analyze the problem and its possible solutions, [then] sleep on it before making a final decision.”
Unfortunately, sleep is often overlooked, especially among adolescents. In between extracurriculars, calculating our GPA, worrying about chances of getting into a college, developing social status and studying – for the SAT, ACT, AP Exams, finals and so much more – we also need to spend time eating, breathing and sleeping. So, which one do we cut out when we become swamped with work?
Well, cutting down on eating or extracurriculars will just save a couple of hours of the day. But sleep? If we cut down our sleep from the suggested 9 hours to about 4, we are gaining a whole 5 hours to work! Many students have admitted that they just need time for work: in the debate between time versus sleep, time often wins.
This is where the problem lies: the lack of sleep may gain you some time here and there — but in the long run, you’re actually taking away precious time in your future. Sleep doesn’t just help you feel good tomorrow but helps our brain and body function as a whole. While you are able to gain an extra 5 hours to work every day without sleep, you are actually impairing yourself in the future — the lack of sleep has been proven to lead to major physical health issues. According to the Center for Disease Control (CDC), the link between sleep deprivation and chronic diseases has grown significantly — including a connection to diabetes, cardiovascular disease, obesity and Alzheimer’s disease.
A lack of sleep doesn’t only affect one’s physical state, but the mental state as well. In fact, sleep deprivation leaves your brain exhausted, prohibiting it from doing its duties well. During sleep, your brain is rejuvenated; pathways between neurons in the brain form — allowing you to remember what you’ve learned — while REM sleep stimulates areas of your brain essential in spatial memory and learning. In fact, according to a study conducted by Harvard Medical School, out of 10,000 adults, those with insomnia are five times more likely to develop depression or anxiety. Additionally, they were also 20 times more likely to develop panic disorder.
A lack of sleep is not something to take lightly, having many negative effects on physical and mental health; we may be thinking in a short-term way because we want success now rather than later, but we should also look into taking care of our future.
The next time you are planning your day, try scheduling everything before a certain time to ensure that you are sleeping on time. The next time you are swamped with work, take a breath and manage your time properly. The next time you are faced with a hard decision, take your time to listen to one of society’s best advice and sleep on it.
There is one specific quality in humans that gives us the power to achieve sky-high goals. The one virtue that emperors over millennia have manipulated to cause the downfall of many empires. This, my friends, is the power of self-esteem, the evaluation of one’s self-importance. It is one of the few qualities that is easily broken, but difficult to rebuild.
Self-esteem, in a way, can be thought of like trust. When someone takes advantage or lies, the bond of trust between two individuals is broken, and hence, it is hard to believe the person again. Similarly, due to disturbing experiences, one’s self-worth can diminish, and this can create a wall of sorrow and misery. In order to conquer this dejection with bliss, it is of utmost importance to understand the two main qualities that contribute to self-esteem, which are confidence and self-respect.
As I stated before, throughout history, many kings and rulers intimidated their enemies with unfriendly letters, malicious threats, and rumors. This caused the ruination of many big empires, since the subjects’ and soldiers’ morale decreased, therefore letting their emotions get the best of them. Mind games were played and self-esteem crashed.
Likewise, experiences in life do the same with us. They attempt to destroy our confidence and self-respect by causing anxiety and stress and making our minds heavy. The natural human response would be to just keep tolerating all of it until the difficulty goes away. But how long can one face the same problems again and again?
There is always a limit, and to reduce the stress on the mind, several methods exist. The most popular is meditation. Unique styles of meditation are taught, such as mindfulness, spiritual or transcendental. From my experience, the most effective has been spiritual. It aims to silence the mind and send vibrational energy (comes from your mind and thoughts), to each of the chakras, or power points of the body. Being easily done, an individual does not have to sit in a specific posture but can do it while doing everyday work. However, the ideal way is to sit, close your eyes, and turn on some peaceful music.
Imagine all your tension flowing out of you like water from a fountain, and your mind emptying all its thoughts into that “flowing water”. Power is being filled within you, as you send positive energy to your mind and organs. Finally, as you open your eyes, try to maintain that stage of silence, and watch as your day goes by blissfully.
Personally, my work gets done quicker after meditation, and I feel less distracted. Other forms such as mantra meditation involve chanting or praying. These methods of de-stressing yourself help boost confidence, and hence self-respect. These two “sub-qualities” make up what is known as self-esteem. So, if you often feel inadequate or demoralized or have low self-esteem, try meditation and work on your thoughts and feelings to achieve this peaceful state of mind. You can do it!
February’s most celebrated holiday, Valentine’s Day, is (now) a heartfelt honoring of love as couples exchange gifts mainly centered around chocolates and flowers. Just one week after Valentine’s Day, however, is a week dedicated to National Eating Disorders Awareness (NEDA), taking place from February 21 – February 27, 2022. The official campaign sloga, See the Change, Be the Change, signifies the era of activism and awareness that is changing the public’s perception on eating disorders as well as accessibility to helpful resources for those with eating disorders.
Eating disorders are a serious mental illness that affect a person’s internal relationship with food and body image, often leading to serious effects such as unhealthy weight loss/gain and intrusive thoughts. These disorders can affect people of all ages and backgrounds, but researchers have found that eating disorders more commonly impact teenagers and young adults. On average, almost 3 years pass before those experiencing eating disorder symptoms seek help.
Types of Disorders:
There are a multitude of eating disorder classifications, but here are three common types:
Anorexia Nervosa (AN): Characterized by unhealthy weight loss and distorted body image, people with anorexia restrict their intake of food, often not noticeable at first glance as one does not need to be underweight to be struggling. Both thinner and plus-sized individuals can be diagnosed with Anorexia Nervosa, which is classified with two subtypes: restrictive and binge-purge. AN can be fatal as suicide is the second leading cause of death for people diagnosed with AN.
Restriction of energy intake
Intense fear of gaining weight even though underweight
Disturbance in the way one’s body weight/shape is perceived
Symptoms: Dramatic weight loss, developing food rituals, denying feeling hungry, limited social spontaneity, concerned about eating in public, sleep problems, dry skin, muscle weakness, etc…
Bulimia Nervosa (BN): Bulimia Nervosa is characterized by a cycle of binging followed by compensatory behaviors such as forced vomiting and fasting. Individuals diagnosed with this disorder can be any weight. Recurrent binge-and-purge cycles affect the entire digestive system, leading to chemical imbalances in the body that affect other organ functions, which can cause fatal consequences such as cardiac arrest.
Recurrent episodes of binge-eating
Recurrent inappropriate compensatory behavior to prevent weight gain
Episodes and behavior occur at least once a week for three months
Self-evaluation influenced by body shape/weight
Symptoms: skips meals or takes small portions of food at regular meals, disappears after eating often, drinks excessive amounts of water, teeth are discolored, self-injury, calluses on back of hands from self-induced vomiting, unusual swelling in cheeks, etc…
Binge Eating Disorder (BED): One of the most common eating disorders in the U.S. and one of the newest eating disorders formally recognized in the DSM-5, BED is characterized by recurrent episodes of eating large quantities of food, a feeling of loss of control, and not regular use of unhealthy compensatory measures. Unlike BN, BED is not followed by compensatory measures so individuals with this disorder are often overweight.
Recurrent episodes of binge eating
Marked distress regarding binge eating is present
Occurs at least once a week for 3 months
Not associated with recurrent use of compensatory behaviors
Symptoms: frequent diets, having secret recurring episodes of binge eating, disruption in normal eating behaviors, feelings of disgust/depression/guilt after overeating, eating alone out of embarrassment, stomach cramps, difficulties concentrating, etc…
Avoidant Restrictive Food Intake Disorder (ARFID): Another new diagnosis recognized by the DSM-5, AFRID is similar to anorexia as individuals who experience both limit their intake of food. However, those diagnosed with AFRID do not feel distress regarding their body’s appearance (body dysmorphia). AFRID can stall the growth and weight development of children and results in psychological problems as well. Children with a co-occurring anxiety disorder, habits of picky eating, and diagnosis of autism/ADHD are more likely to develop AFRID.
Eating/feed disturbance result in one of four effects
Does not occur exclusively during course of anorexia/bulimia
Not attributable to concurrent medical condition
Not better explained by lack of available food/ cultural practice
Symptoms: dramatic weight loss, only eat certain textures of food, fears of choking/vomiting, consistent/vague gastrointestinal issues around mealtime, limited range of preferred food becoming narrower, menstrual irregularities, muscle weakness, impaired immune functioning etc…
Other eating disorders include Pica, Rumination Disorder, Laxative Abuse, Orthorexia, and more.
If you or anyone you know is suffering from an eating disorder, contact the Eating Disorders Helpline at 1(888)-375-7767 for treatment referrals and support/encouragement. Eating Disorder Hope has also compiled a list of websites available for those struggling with certain eating disorders both based in and out of the U.S.
If you would like to raise awareness and join the fight against eating disorders, you can take action on the official NEDA website where you can share your story, register for a spring 2022 NEDA walk, represent NEDA on your college campus, volunteer as a landmark photograph, and plan a NEDAwareness Week Event.
There’s a common phrase that says, “In a world where you can be anything, be kind.” And for the Taarika Foundation, kindness — in any form through any medium — matters.
This year, Random Acts of Kindness Week is from February 13, 2022, to February 19, 2022, according to the Random Acts of Kindness Foundation — a week to reflect on the positive impact of kindness.
With the period of uncertainty — the Pandemic — we have been and still are facing, it seems appropriate to take any chance we can get to make someone else smile; we do not know what others may be facing in a time like this, and we can only hope that our presence brings a positive aura anywhere we go.
How can we do this?
You guessed it: random acts of kindness! Random acts of kindness provide a way to release positivity into any environment. They bring the community together regardless of background — lifting people’s spirits while making you feel good in the process of helping others.
What’s more, according to UC Berkeley’s Greater Good Magazine, researchers have found that witnessing kindness also inspires people to be kind, a phenomenon referred to as “moral elevation.” Ultimately, random acts of kindness act as a medium for people to offer kindness to others regardless of socioeconomic status, disability, race and more.
Why Random Acts of Kindness?
Kindness is shown frequently in the world we live in — a reality easily overlooked by many. Large or small, these acts of kindness are common, even if we may not always be aware of them nor their positive effects in the community; and while kindness is often covered by the shadows — going missed by many — its beneficiaries are tenfold.
We all should strive to make kindness more noticeable in society; kindness has the power to make a difference — random acts of kindness shown to strangers and friends alike have the influence to bring more smiles to more peoples’ faces.
Why do Random Acts of Kindness Work?
Random acts of kindness have been proven time and time again to make both the recipient and giver of kindness feel an elevated sense of contentment. According to UC Berkeley’s Greater Good Magazine, it has the power to not only make one think more highly of themselves but also become “more aware of positive social interactions.”
According to a research paper published in Oxford Handbooks Online by Kennon M. Sheldon, Julia Boehm and Sonja Lyubomirsky, variation in kindness is the key to happiness. To avoid the feeling of redundancy with kindness, an approach that includes various ways to express kindness to different people can help with enacting positive change in the community. Random Acts of Kindness are one of these methods we can use to help make a change in whatever environment that surrounds us.
Moreover, according to a study conducted by Sheldon et al. published in the Review of General Psychology, a significant increase in happiness was measured in participants who performed five random acts of kindness for six weeks consecutively. Random acts of kindness have the ability to bring change to anyone and everyone’s lives regardless of past history.
How to do Random Acts of Kindness?
It’s time to look outside the box and express your kindness. Kindness matters — it can be as small as a smile and holding the door open for someone or as large as protests, delivering food and raising awareness for mental health.
Random acts of kindness are a venue to show your kindness. Regardless of whether we know the recipient or not, the kindness expressed at random intervals — with no forthcoming — allows for a way to bridge the community together and ultimately make multiple people feel good.
The Random Acts of Kindness Foundation even offers a list of diverse Kindness Ideas to refer to. I hope everyone takes the time to look at the list and express kindness in their communities!
Aesop once said, “No act of kindness, no matter how small, is ever wasted.” I like to think kindness has a ripple effect: your kindness doesn’t just make you feel good, your kindness spreads to others as well. Then their kindness spreads, and so on until we get a communal kindness movement.
Ultimately, kindness is a universal value that will unite people — it is an avenue upon which everyone can agree on. So, whether it be a simple random act of kindness in a community or anything else, we should all start enacting kindness in our communities, looking beyond differences and instead recognizing the underlying humanity in each and every one of us. I’d recommend starting by showing a random act of kindness to someone near you right here and right now; whether you know them or not, kindness can make anyone smile.
Taarika Foundation(TF) Krupa: Welcome back to another episode of Mindful, Beautiful, and Thriving. Once again, I’m Krupa,
TF Anisha: And I’m Anisha! Today we’ll be continuing our podcast series on Body Dysmorphia and Eating Disorders with an interview with a therapist who specializes in eating disorders and family based therapy.
TF Krupa: Today’s guest is Nan Shaw. Nan, thank you so much for speaking with us today!
Nan Shaw: Me too. Thank you!
TF Anisha: So first off,
Would you tell us about what kind of therapy you provide for youth, specifically, with an eating disorder?
Nan Shaw: Yeah. So primarily when working with teens with an eating disorder I offer family therapy, and specifically family-based therapy(called FBT), which is a very specific kind of family therapy that is designed for adolescents with eating disorders. It’s an outpatient therapy that takes 6-12 months to complete. Sometimes it can take longer, sometimes less time, but that’s basically generally how it goes. And another part of that and how I work is also working with teens. I work with doctors, dieticians, and the family therapist, and as part of the family therapy I meet with the teen and the parents together. And sometimes the siblings too. And then if there are situations where a family can’t be involved, let’s say a college student that lives far away from their family, I sometimes also work with the teen/adolescent only, that’s called adolescent-focused therapy.
TF Krupa: That’s super interesting, I didn’t actually know you work with the family as well as the child. So [since] you specialize in family-based therapy,
Could you elaborate a little bit about what working with a patient’s whole family is like, and family involvement is important?
Nan Shaw: The working with the whole family I personally think is wonderful, I came and do this work as a family therapist anyway, and I particularly like that because really the whole family is involved in the illness, I think it’s important to involve the whole family in the recovery, and everyone is sort of in on it and everyone in the family also deserves to have the education, the support, the tools to help the teen with the eating disorder get better. But the primary focus really is getting the teen better. Family involvement is important because at its core an eating disorder is considered an illness that is keeping the teen from eating enough to survive or feeling out of control maybe with eating too much or purging and it’s the nature of the illness that the teen can’t change this by themselves let’s say. So who better to help than the parents. And also I just want to say when I say parents I also mean caregivers, maybe whoever is caring for the youth whether it’s a parent or someone also in charge. And the other reason I think it’s important to include the family is that by the time an eating disorder has been identified in a teen, they’ve been struggling by themselves for quite a while, and it’s scary and exhausting. So I think of it as sort of when they’re getting the family involved, so like the cavalry has arrived and they no longer have to do it but themselves.
TF Anisha: Right. I’d just like to say that that’s really eye-opening to me and something I didn’t know before. So we actually previously talked with a teenager who did struggle with an eating disorder and they talked about how it helped them open up to their parents a lot more. So I think on that topic,
Would you be able to talk about just what common challenges you come across when you work with teenagers and teenagers’ families?
Nan Shaw: So that’s a great question actually. Probably the first one I think of is that for the teen, even a teen that wants help, this type of treatment, family-based treatment of really any eating disorder treatment, can initially feel like things are being taken away. Whether it’s the diet they’re interested in or an exercise they want to do, that suddenly parents and other people such as myself are all involved in that. And it can feel, particularly I think to teens who are more independent and doing more by themselves to suddenly have professionals all in their business and parents all in their business, can feel both insulting and threatening and of course that’s not the goal. And because the illness by definition creates a situation where a teen isn’t eating enough or is purging too much and can’t intervene, we have to do that. But it can feel like something’s being taken away.
Another thing I think teens often [find] challenging with eating disorder recovery is if they’re dealing with anorexia and have to gain weight, that’s a hard thing. I mean we live in a culture where losing weight is always honored, and we have no idea when someone’s losing weight, and gaining weight is always judged or at least it feels that way. And so hearing from a teen in and saying “Guess what you have to gain weight,” that can be a hard thing to sit with comfortably.
Two other challenges I think of, another is that there’s sort of a belief in this treatment that all life stops until you get better and that is to prioritize recovery over everything else. And so teens that are heavily invested in their academics, studying for the SAT, or loving their soccer team, suddenly everything is “Wait, hold up, you can’t do this, you’re gonna have to leave school early” or you know “Soccer’s on hold.” That can be really hard and scary. In truth we have to “All life stops” until you get better. And then I think the last challenge for teens is they can feel pretty ashamed of what’s going on and isolated, maybe not talking to their friends, not wanting to go out and have pizza with their friends because they’re having a hard time having pizza, feeling really out of step with their peers.
TF Krupa: Yeah that was perfect. I didn’t really know any of that before, and I’m glad that we could talk about this because I know a lot of teenagers, they have these kind of like isolation issues and things about missing out on their teen years in general. And I feel like having an eating disorder would amplify that so much through recovery. I know everyone’s experience must be different, but just a follow-up question:
What advice would you give to youth dealing with an eating disorder, or for their parents?
Nan Shaw: So, let’s start with the youth with the eating disorder. I’d start with hope, that people get better, that there’s treatments out there that have been shown to work. FBT has been found to be quite successful, it’s the most successful treatment, considered really the first one. So, not to give up hope, and then [they’re] not in this alone. I would remind them that things that are being taken away or ways that the therapists or the parents are intervening are just for now, that’s sort of the hallmark of family-based treatment that we often end every sentence with, and that’s just for now. Because that’s true, [as] soon as a teen is feeling better, weight restored, eating more appropriately, we want to give all these things back. That’s the goal of treatment. So “for now” is a really important concept.
I think I would also advise “Tell somebody.” It’s an illness of secrecy, an eating disorder thrives in secrecy, and so the more open and honest a teen can be with those around them where there’s friends, parents, teachers, the better [the] chance for recovery.
And an eating disorder can’t live where there’s openness and honesty,
Dr. Nan Shaw
so I would say tell somebody, and then recognizing that recovery is hard, treatment is not all that comfortable, and that it may be hard and it may feel a little worse before it gets better but it absolutely gets better. So I would also want to say “Hey, this gets better. Hang in there.”
So for parents, I would have different advice. Some of it is similar, things like hope and “You’re not alone,” and “This is just for now,” are all important concepts for the parents, who can feel kind of bad and weird to suddenly be making sure you’re home for dinner, things like that. So “For now” is really important for the parents to know as well.
The other thing I say to parents is often by the time an eating disorder is recognized, it’s really just the tip of the iceberg, that what you can see above the water is just a little bit. You kind of go, “Huh, my kid’s struggling a little bit,” but often what’s beneath that and once treatment starts there’s a whole bunch of stuff going on underneath and that the eating disorder might be much more powerful on the teen than parents ever realized. So I’d like to prepare the parents for that, that maybe what you’re seeing is just the tip of the iceberg, and because of that, parents [who] do the quicker success to recovery goes to parents who basically kind of drop everything at the start and really focus. So they may have to take off from their work to really focus. So it’s, say, all hands on deck, giving all you got as soon as you find out about it. And you can’t overreact. I often tell parents, because parents say “Well I don’t wanna overreact, do I really have to keep her from camp,” and I might say “Well you can’t overreact, because you’re trying to save your kid’s life.” So maybe she could have gone to camp or he could have gone to camp, but why not keep them safe if you need it?
And the other thing, it’s really important for parents, is this idea of prioritizing their child to get better versus feel better. Getting better means hard stuff like eating a meal or completing a meal you don’t want to, or gaining weight if you don’t want to, or not being able to use the bathroom after a meal if you wanted to. And both for teens but also for parents, it doesn’t feel good if your kid is uncomfortable. You don’t want them uncomfortable. And yet recovery is in the analogy we often use, you may have heard this before, is imagine – and I’ve worked with parents before who use this for children children who’ve had cancer for example, and chemotherapy tends to be pretty uncomfortable, and yet if a child was struggling to go do that, the parents don’t go “Ah you can skip it today.” They will say, “I am so sorry,” and “I know this is hard,” and “I’m with you every step of the way, we’re going to get through this.” Feeling better would be to skip it right, but getting better would be to go but doing it lovingly. So that would be what I would say to the parents.
TF Anisha: Thank you for all of the advice you just gave, I think it was really helpful and I really hope that it does resonate with anybody in the audience. And so, kind of I think this was a perfect segway for the next question, because on the topic of people silently struggling with eating disorders, I know that me and people and in my community and both Krupa and I, we’ve seen people maybe start on that path to maybe a really difficult eating disorder or any sort of form of feeling body dysmorphia. And it’s an uncomfortable decision to have with a friend, so just
If you could give us any advice on how to make that better for everyone to kind of lovingly approach that sort of topic with a friend, that would be great.
Nan Shaw: That is a great question. And I guess the first thing I’d want to say is there’s no right answer. So feel free to do what kind of feels right. I guess I’d answer that two ways. If somebody that either – sibling or a friend – is not in treatment or you don’t know if they’re in treatment, I would suggest one, making it talkable. If not with a friend, you know you don’t feel comfortable talking with a friend, maybe just someone else. So you as the observer that’s worried can also go to another adult, teacher, school counselor, parent, your own parent, just say “I’m worried.” So, you could approach the friend or approach somebody else so you can get some help because being worried about a friend also creates its own anxiety.
If you want to talk to the friend, and again there’s no right answer here […] I like to recommend what I call
“Share the Dilemma.”
Dr. Nan Shaw
So, your question is even a dilemma. “What do I do, I care about this person I want to say something, is it my business? Will I hurt their feelings?” It’s a dilemma. So a great way of approaching dilemmas from my perspective is you share. And you go to this friend [and say] “I have a dilemma. I care about you, I’m worried about something, and I might be completely off and I also don’t want to upset you or make you mad. But I wanna ask you if you’re okay.” […] So you share the dilemma, and most of the time that goes really well because you’re not coming at it “I know and I know exactly what needs to happen and I’m worried.” But you’re like “I don’t know what to do here but I know I care about you and I’m worried and this is what I’m seeing.” So that’s […] if somebody’s not in treatment and you’re worried they’re not getting help.
If somebody is in treatment, and you’re worried about them, for whatever reason, one of the things we say in family-based treatment, the friends and siblings, in particular, the role of a friend and a sibling is just to do that, a friend and the sibling. So you say “Hey let’s go see a movie” or play a game or if you see them struggling with a meal, distract. Talk about the most recent episode of Grey’s Anatomy or something. You just play the role of a friend and a sibling in a distracting way, it’s not your job to make them feel better or feel responsible for their recovery, to just be a friend or a sibling.
And the other really cool thing friends and siblings can do is practice what a lot of recovery is, which has to do with body compassion, body acceptance. So you yourself don’t get involved, even if you want to, but you just don’t get involved in conversations about the latest fad diet or your own negative body comments, if you’re feeling that way, or any kind of judgment about body, […] size. And it could be good for the friend or sibling to also not engage in that, it’s usually not really very helpful. It doesn’t help our self esteem to bash our own bodies so it can be a very powerful difference just to not engage or if a friend says “Hey do you know how many calories are in what you’re eating?” you go “You know what I really just don’t care,” even if you do care.
TF Krupa: Thanks so much for that, I know it’s definitely going to be helpful for our listeners, and as Anisha said, both of us have seen people kind of start to go on that negative trend and I know that it will also helpful for us if it ever escalates for them. Thanks again for joining us on this episode of our series on eating disorders and with that comes the end of this interview. See you guys next week!
A scaly snake slithers slowly around my body, constricting me. With each breath I take, I feel myself slowly, but surely, suffocating. The pallid brown walls of the bathroom stall begin to blur, and the dirty white tiles and stray pieces of toilet paper left on the floor seem to merge. I can’t breathe. I can barely see. The tears that fall from my eyes seem to have no end, as they caress my face in its sticky warmth, leaving trails of wet mascara running down my face. I don’t want to step out of these confines of the tan bathroom stall. Although miserable and pungent, this seems to be the safest option for now; however, I cannot stay here for long – I have to get back to my class.
Bullying – the systematic abuse of power that often happens to many students right under their teacher’s noses. Unfortunately, I am no stranger to being bullied, and neither are the majority of students in America. 1 in every 5 teens in America have reported being bullied in a survey taken by StopBullying.gov, and as bullying continues to gain awareness from the general public, researchers have started to pay closer attention to it as well. An increasing number of studies have proven that there are serious psychological risks associated with being bullied including being put at a greater risk for panic disorder, anxiety disorders, generalized anxiety, depressive disorders, PTSD, and agoraphobia as adults.
One of the most common and overlooked forms of bullying, especially in schools, is name calling. Ranging from small insults to slurs, the impact of a build up of these aggressions is detrimental to a person’s well being. But how can you help and be more aware? One step you can take comes from GLSEN(Gay Lesbian and Straight Education Network), an American education organization against discrimination and bullying based on sexual orientation or gender identity and expression. They started No-Name Calling week, a week during mid-January where students and educators reflect on name calling in schools and the hurtful impacts it causes. Though the week has passed and was from the 17th to the 21st, it is still applicable to our daily lives. How often have you heard common insults thrown around over and over at a person, stifling them and making them feel shame for simply existing?
Taking part in stopping the bullying and harassment done to youth is vital to both their mental and physical health, and is something that you can start working on by reflecting within yourself. By doing so, we can open up a discussion about damaging effects of bullying and help eliminate name-calling in our communities.
My name is Sania, and today I have with me Dr. Vidhya Krishnan, who is a child psychiatrist. We will be talking about the treatment of depression using biopsychosocial interventions.
Before we do that however, would you like to introduce yourself, Dr. Krishnan?
Dr. Krishnan (DK): Sure. Thank you, Sania, for having me today. As you already mentioned, I’m Dr. Krishnan and I’m a child and adolescent psychiatrist. For my day job, I work at the Children’s Health Council in Palo Alto where I’m the head of adolescent mental health services.
What are the different ways you treat depression?
DK: So depression obviously is a mental health condition. It is the language we use for the condition called major depressive disorder, and a few other depressive conditions. Whenever we try to address a mental health condition, we try to come at it from very, very different directions.
So, we try to address the biology of the condition which is what is happening from a chemical, neurocircuitry kind of a standpoint, and psychological, which is the way the brain thinks and processes information, and then we come at it from a social standpoint, but I want to include that to say both social and environmental.
The reason I break it up into these three parts is because [the biological umbrella includes interventions like medication]. The psychological part would be therapy. The various kinds of therapies one might use includes “talk therapy,” one of the more popular kinds.
[However] there are other kinds of therapies people use to treat depression [that address] the social or the environmental factors include things that people do: what’s happening in school, and in a person’s family life, friend circle, even things we do on a daily basis, what we eat, how we sleep, the level of activity we do. So what I would like to say is overall, the treatment of depression includes a wide umbrella of things that basically touches every aspect of a person’s existence.
TF: That’s incredibly interesting to know. I knew that there was therapy and medication, but I didn’t realize that there was such a wide variety of ways that depression was treated. And so that leads me to my next question, which is,
When do you recommend a child’s depression be treated with medication in terms of their age and severity?
DK: So as far as the age goes, there is no particular cutoff. […] There’s not an age below at which we will not treat depression and there is not an age above which we will not treat depression. So I think the question, most importantly, is what presents in front of you. I think of two big categories when I bring up the idea of using medication to treat depression with my clients and their families.
One of them is the severity of the depression. If someone has what we would like to call a moderate to severe level of depression, medications automatically enter the conversation. Just because we talk about it doesn’t mean we always do it, but that definitely shows that things are sever enough that it should be talked about.
The other big factor is functional impairment, right? The way a child goes to the world, they have a family component of their life, a school component of their life, and a social component of their life. If the depression [has progressed] to a point where it’s affecting all or some of these aspects to a big degree where a child’s ability to engage with their school, which is their main job, or their family or their friends is impacted in a big way, we do consider the possibility of medications as one of the things we might want to do to help them get back on a sound footing in their life. So I would say severity and functionality are the two main criteria I use when making medication recommendations.
TF: So that’s very interesting. I didn’t realize that there is no age limit or age range in which it should be treated with medication, so thank you so much for telling us that. And I’ve also seen a lot of people with depression, that see therapists and take medication, but I never really understood how exactly the medication helps with depression.
So can you explain what medications do and why simply going to a therapist isn’t enough in some cases?
DK: For a combination of reasons! Depression, obviously, is a sum of many different factors, right? There is genetic vulnerability, on top of which, there could be medical conditions or life circumstances, which conspire with each other to basically tilt the needle towards the person’s emotional health responding through depression, sometimes in triggered situations where there are negative life situations. Either within someone’s control or not, but sometimes depression can happen for no reason at all. Due respect to why a person becomes depressed at a particular point, there always are neurochemical and neurocircuitry kinds of changes that are observable in the brain, that is easily discernible through PET scan and various other functional metrics of analysis.
Like if you took a picture of someone’s brain who’s depressed, you can see that the various cells in the brain are not talking to each other as well as the like for them to, and the various parts of the brain also, at a bigger level, are not communicating with each other as effectively or efficiently as we’d like to.
And this is obviously a very big challenge because that is a big barrier to being able to experience benefit[s of treatment]; If you think of therapy, [it] is learning new ways of teaching someone new ways for the brain to deal with the world outside of themselves, or even in the way that we talk to ourselves inside of our head as we get prepared to deal with life or life’s circumstances.
The trouble is that when you have therapy alone and the level of depression is extremely significant, these large parts of your mind are not exactly working the way they’re supposed to. Even if the right kind of therapy is available, the barrier because of this lack of appropriate communication between the various parts of the brain is [such a barrier] that therapy alone cannot [provide sufficient support]. It’s almost like asking someone to jump over a wall that’s way too tall—it’s not possible to do no matter how much coaching or training you get. Sometimes you just need that ladder*. (*Note from TF: …and that’s okay!)
Sometimes medicine, if you think about it, is that ladder that you use to be able to climb over taller walls. Someone can coach you on how to climb the ladder, how quickly you can climb it, and how easily you can get over the top. But if you think about it that’s kind of the role it does it makes these parts of the brain have the chemicals necessary in the tank to be able to be available when the right messages come in, so the message is able to go through but also the same time allows for these various parts of the brain to talk to each other a lot more efficiently. It’s almost like it greases the wheels.
TF: That makes a lot of sense, so medicine is kind of like a booster that can really help you get out of your depressive phase or kind of, you know, ease your depression. And so, the next question is,
Once one of your patients starts taking medicine for depression, how long do they need to take it to see results and when would you eventually stop or taper down on the medication?
DK: So the medications, because of what I just explained as what the medications need to do, create this tank of chemicals that needs to be there in your brain so that, you know, […] various parts of the brain are able to communicate with each other more effectively. But eventually, the job of the medicine is to help the body build its own tank of chemicals. And for these effective communication roles that you have developed, almost like information superhighways, to kind of work of their own volition without the aid of medications. What ends up happening though, is this whole process of the brain becoming self-sufficient without the need of this external booster, like you said Sania, […] it takes the brain a while to get into this new habit if you will.
So number one, for the medicine to just start working to build the original time, it can take anywhere from four to six weeks, which is a long period of time and I understand. But given how long [treatment sometimes lasts], six weeks in that scheme of things does not feel like a large amount of time. But once we have found that the medicine is helpful or effective, the treatment of what we call an episode of depression needs to usually last somewhere in the order of about nine months to a year or a year and a half.
The reason for it is it takes that long to shore up the body’s defenses to undo some of the problems that have happened because of the brain being in a depressed place because certain parts of the brain to grow it the way they’re supposed to. It’s almost the same way you think of is you know when a child’s body is malnourished, they don’t grow tall, they don’t put on weight, their body is not able to do the various age-related tasks its due. Similarly a brain that is under the influence of depression doesn’t grow the way it’s supposed to grow and doesn’t do all the tasks and activities that it’s supposed to do for that age and stage of life. So you need to have that regrowth and that catch-up happens before you’re able to get out of that episode of depression. And that takes time, which explains the nine months to a year, year and a half timeline.
One of the things I always talk about is the window of time that we are using medications to address the symptoms of depression. It’s a great period of time to kind of combine that with the therapy because as the brain is growing back, like I said developmentally catching up, right, because depression has almost been like a pause button. What is happening is therapy added in at that particular point can accelerate that process significantly. So to be able to successfully get to that year mark are nine months or a year and a half mark and be at a place of readiness to be able to stop the medicines requires the person to be able to have caught up and keep up with all the things that have happened in that particular time and so I would say three things right?
Giving the brain enough time and space to do the growing it needs and the catching up it needs to do but also modifying the various thinking changes that have happened because of depression by the combination of therapy, is what gets somebody to a place of readiness to see both results and be at a place where you’re ready to stop the medications and kind of move on from that phase of treatment.
Though one other other point it would be useful to add here is that everything that I said right now is valid when you’re looking at someone in their first episode of depression or for the first instance of treatment. But it is important to remember that not everybody responds to the first medicine or the first treatment they take.
And not everybody’s in the first episode of depression. Sometimes this is maybe the second time or the third time someone’s struggling. But in those instances, the answer is a lot more customized and it is something that one should discuss with one’s doctors because once you get into further episodes of depression or more longer duration of illness, other variables start to matter in terms of how long it takes to see results or when a person is ready to stop [treatment].
TF: Yeah, that makes a lot of sense. I like how you said that that it’s, you know, it’s not like a one-size-fits-all type of thing, right? Not all patients will respond to the same medication the same way. And I think it’s really important for people to know that just because the first one didn’t work doesn’t mean the ones after that won’t work, you know?
TF: And so my last question to you is, just to tangent off of that,
How do you deal with suicidal thoughts or tendencies of patients that have depression?
DK: So one way to think about it is, at least as far as people with depression or concern, you want to think of suicidal thoughts or suicidal tendencies as a part of the depressive profile if you will, right. For many kids and including adults, it flows from the symptoms of depression in the sense that “I don’t feel like my life was worth living, I don’t feel like I’m able to help myself or either good enough light that feels meaningful.” And many people without even consciously realizing it slipped into a phase where they start to say, “I don’t matter’ or “My life doesn’t matter.” “What’s the point anyway, I wish I was dead.” “Nobody would be sad if I died.” And sometimes this goes into a place where they start to think that, you know, “I think I’m a burden, I think I am not of value, and what does it matter if I die? Nobody will miss me.”
First things first, I always say that one should not fear asking these kinds of questions if it’s [to] a family or a member or a loved one because it’s a very common thing we see in people with depression, even if they’re not at a point where they’re going to do anything about it. This kind of negative thought pattern is actually very core to just the symptoms of depression themselves, and many of the people who are […] stuck in this thought pattern find that when the depression lifts, these thoughts also get better and go away.
So I think you want to first start by thinking of it as a part and parcel of depression, and not be fearful of asking or checking in [with loved ones] about these thoughts if a person does have them to see hey if you have them because it might be a great sense of relief for someone to share this with somebody and now somebody knows, which means somebody can help, which means somebody can point you in the right direction of what can happen next. And so that is the first thing, asking, checking in, and knowing about it is extremely important.
The other thing that is also important is there are studies out there that show that there may be a very, very small, but nonetheless, important thing where when you start treatment, whether with therapy or whether with medication, there can sometimes be a change or a worsening of these thoughts initially.
That does not mean that the treatment is not working.
Dr. Vidhya Krishnan
Sometimes what ends up happening is treatment makes a person be able to see where their life is a little bit more clearly, and what they see around them may not be something they like because of how much damage depression has done to their life and their circumstances and it can be very disheartening, to begin with. That’s exactly the point where we need to let somebody know that help is on the way, that there is light at the end of the tunnel and holding their hand.
So, instilling a sense of hope and knowing that they have people who are in their corner, people who are rooting for them (who know what they’re doing and who are able to help can preserve that sense of fullness), almost a “substituted hopefulness,” which comes from the outside until the actual treatments for the depression are able to kick in. So there is a period of vulnerability where we might know about these thoughts and feelings but we are not quite in a place where we are able to fully address them, which is when the external help a friend, a colleague or parent or relative, a doctor or a therapist can be so important and so valuable in supporting someone through that particular phase. But most times, as the depression improves, simultaneous to that we also see an improvement in these thoughts and feelings, automatically.
But if that’s not the case, and you’re not seeing those changes, therapy can play a significant role. Because sometimes these suicidal thoughts are almost a, I wouldn’t say a maladaptive coping, it’s felt like “That is the solution to my problems.” And so finding alternative solutions in conjunction with a really good therapist can replace these thoughts and feelings with other, more helpful thoughts and actually have a good chance of being able to help these thoughts and feelings.
So I think you want to think of suicidal thoughts and tendencies almost lockstep with the depression in your treatment of depression, as one of many things we try to address the same way we might try to address sleep or difficulties or appetite difficulties, and this is just one more of those things that we deal with.
TF: Yeah, that’s super helpful to know. I think it’s really nice to know that it’s not something that’s uncommon for people with depression, and it’s, you know, something that happens and it’s something that can be treated and something that can be improved with medication and with therapy. So that is an amazing thing. And thank you so much for joining us today in this interview. I learned a wealth of information, and I’m sure a lot of our listeners did too. So thank you so much.
At the beginning of each new year, January signifies change and turning over a new leaf as many create New Year’s resolutions such as having a balanced diet, dedicating time to hobbies, working out at the gym, or even arriving at school on time. With the prioritization of work and education in many people’s lives, self-care takes a backseat to hustle culture as we are pushed to our limits.
However, with many awareness campaigns promoting January as Mental Wellness Month and National Mentoring Month, the importance of caring for our mental wellbeing while helping others is slowly becoming normalized. Mark the following dates on your calendar so you can follow along and stay updated as well!
Mental Wellness Month
Mental wellness affects all aspects of our lives; from how we act and make decisions to how we are feeling on a certain day, maintaining a healthy mindset is key to living a healthy life.
As the American Mental Wellness Association suggests, health can be improved in four dimensions of our life: the biophysical, social, spiritual, and psychological. For a New Year’s resolution, you can choose any of the following fields to improve upon as there are a myriad of suggestions available.
Improving biophysical health can consist of adopting a healthy diet consisting of correct calorie intake and receiving nutrients from all five food groups to help reduce excessive stress and avoid physical illness.
Other ideas: Regular exercise, Restful sleep, Avoiding illegal substances
Improving psychological health can consist of practicing self-care, which is divided into seven categories: sensory (taking a hot shower), pleasure (watching a movie), spiritual (meditating), emotional (journalling), physical (stretching), social (volunteering), and mastery (cleaning). It is recommended to perform self-care for a minimum of half an hour per day. Self-care will look different for everyone, so engage in an interesting activity you would enjoy!
Other ideas: Avoiding burnout, Avoiding perfectionism, Mindfulness
Improving social awareness can consist of surrounding yourself with an active support system that will provide stability, encouragement, and advice when you are in need of it. Support systems can include anyone, but always remember to reciprocate the support that you receive!
Other ideas: Maintaining a positive environment, Committing to a sensible number of events
Improving spiritual health can look like having a set of healthy, realistic dreams and aspirations that keeps you motivated and encourages you to keep moving forward. Don’t be afraid to re-evaluate your current goals when they feel like they are unrealistic!
Other ideas: Good set of morals, Belief in a higher being
For more ideas, check out The American Mental Wellness Association » Staying Healthy.
Taarika Foundation (TF): What exactly is ADHD and how does it affect people who have it?
Leah Anderson (LA): ADHD is also known as attention deficit hyperactivity disorder and it affects the ability to concentrate and to sit still. It generally affects children and manifests itself in impulsive behaviors and being overly active. It causes people to have an inability to sit still for a long period and to focus on a task for more than a few minutes.
How can ADHD make studying and school challenging?
LA: With school, obviously you have to sit through school for 45 mins. My classes are 80 mins which is even longer to sit still and focus. It is harder to sit down and take a test or sit down and study for a long period or to focus during school.
Is there a way to teach people to cope with their ADHD so that it has little to no effect on them?
LA: For mental disorders such as ADHD I have learned that the most important thing is coping skills. Coping skills in this context mean figuring out the ways to learn that work for you. Some people with ADHD can sit for 15-20 minutes while some people with ADHD can only sit for five minutes. The biggest thing for me is to have enough breaks so that I can walk around and move, and learn how to focus myself in a way that I can learn.
What help/treatment have you received for ADHD? Has it helped?
LA: So I take medications to help with my ADHD, but unless there is an effort put in, for me to realize that I have this hindrance, the most important thing for me is to use my skills because the medication can only do so much. I have a learning specialist to help me with the things that I have issues with like essays and taking a test.
What advice would you give to the teens who have ADHD?
LA: The most important thing is getting tested, and knowing that you have this diagnosis. If you know you have this diagnosis you can go to your school and talk to them about accommodations which for me, have been very helpful in the past. Another thing is to take breaks and learn about yourself. It is not about how well your classmates learn and how your teacher teaches you, it is learning how you can best take in information and sit for longer periods of time. Talking to a psychiatrist is also helpful because they can prescribe medications to you that can help lower some of the effects of ADHD.
TF: Today, we interviewed Leah Anderson, a senior at Harker High School. We learned a lot about ADHD and how it can affect study habits and skills. We also learned how you can cope with your ADHD to form good study skills and to be mindful. Again, special thanks to Leah Anderson for helping us with this podcast. We are from the Taarika Foundation, and you are listening to Mindful, Beautiful, and Thriving. Be sure to stay safe and stay home.