3 questions for the ‘program kid’

September 10th, 2017

Why don’t you like doing the things you once loved? Why do you shut down over seemingly basic things? Why does the GPS say 30 minutes but it takes you 45? These are questions I sometimes hear people ask me. The answers lay deep rooted in the long history of my life.

My name is Tom and I am a “program kid”. Over the past 11 years of my life I have been in over 20 residential settings, and over 15 schools. Some of them were good, some of them I can’t even begin to explain the trauma that has come from them. I won’t get into details, names, or locations. Though I hope to answer 3 questions I am often asked.

Question 1: “Why don’t you like doing the things you once loved?” When you arrive at a placement, they will try and get to know you and the things you enjoy. The first few times that was an easy question to answer. By the 7th or 8th program I didn’t want them to know me, and I didn’t want to know them. I’d had enough times doing the things I enjoyed and either being punished for it or judged. Unfortunately this only made me feel worse. I do enjoy the same things I once loved, but for much different reasons. I still love going fishing, for example. Not because I can be with my dad, but because I can be alone, in a quiet and peaceful environment. I still like wind in my hair because the white noise created by it rushing past my ears distracts me from the countless triggers around me.

Question 2:  “Why do you shut down over seemingly basic things?” You see, hear, and experience many things in program life. Most of it can be scary for a 7+ year old. So, when I hear glass breaking in the distance, “suddenly” my face goes ghost white and I can’t answer any questions. And when I hear someone scream or yelp in pain yet I’m the one in shock.

The best way to explain these happenings is with what I call a “time machine day dream” or better known as a “flashback.” It is as if I am picked up right out of my seat and placed in a program where glass shattered all over you and blood is everywhere. Screaming at night when a strange man walks in your room, but to no avail. I am barely able to write this, let alone experience it daily. This is why these seemingly basic things set me off.

Last, Question 3: “Why does the GPS say 30 minutes but it takes you 45”? The roads you take, I have been down. I will not, and cannot drive past that broken home one more time. The railroad tracks that are a simple non-occurance for you, remind me of a time I wish would be wiped from my memory. That pond over there? I almost drowned in it. This, and my photographic memory, consequentially make me extremely good with directions. I may be late, but I show up in a good space and ready to achieve the purpose of my visit.

I hope that these questions, one day, I will not be asked, and if so, my answer will be a simple, I do, I don’t, and I took 28 minutes, not 30. Until that day slowly comes, I hope that this gives some insight into how I live, and why.

Thomas Stewart is a member of Youth MOVE Massachusetts who enjoys creative arts and helping others.

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Pain that frays the ties between us

August 22nd, 2017

“I can’t feel it, I can’t feel it,” my son wailed.  He was nine and just coming out of a meltdown.  He had cried and screamed, knocked over furniture and hurt himself, but that was the least of it.  His eyes had changed and when I looked at him, the boy I knew had disappeared.  He could hear me, he could talk but he was overwhelmed with his psychic pain.  It was like he was lost somewhere inside himself.

As the meltdown came to an end, I held him as I always did.  Touch worked far better than words but I spoke anyway.  I told him I was there and loved him.  He cried as he often did, “But I can’t feel it.”  My mother’s heart was breaking. At times like this all I could do was love him through it.  If the medications and therapy and all the rest weren’t working, I hoped that would be enough get us through it.  But, would it, if he couldn’t feel it?

Some mental health problems in children (adults too) fill them up so completely with pain that it overwhelms them.  I understood that.  But that inner pain could also sever him from me and everyone else at times.  You could see his eyes change so that even the visual connection was broken. His everyday self simply disappeared. Without that emotional connection, no matter how frayed it feels, you feel helpless and I felt helpless then and many other times. In those moments, I worried that I would lose him completely.

It’s common to say that someone is “suffering from mental illness” but we don’t use the word suffering in our family.  We do talk about pain, however We also talk about what we should do next or how much we love each other.  We recast psychological pain as a temporary thing (even if temporary lasts for months) that will respond to new approaches and cannot erode our constant connection to one another.   When he was nine, I knew that children and teens change often, outgrowing and leaving behind yesterday’s mood, whim or obsession and I hoped that time and change would be on my side

Physical pain gets far more sympathy than psychological pain. We wince or gasp when we see terrible wounds or injuries yet often look away from someone’s emotional suffering. Doctors are more comfortable when you come in with a medical problem, asking you to rate the pain on a scale of 1 to 10.  There is no such scale for psychological pain.

The McGill Pain Questionnaire, created in the 1970s to help people talk about their pain to doctors, provides lists of adjectives. Pain can be described as throbbing, tingling, suffocating, agonizing or flickering, to list just a few options.  Many people use this language of physical pain to describe the pain of psychiatric illness. It’s helpful, I think, once your child is older and their vocabulary grows.

My son’s pain during these childhood meltdowns was like a tsunami, overwhelming him and separating him from friends and family.  He would feel a constant, lower level ache or sadness or even despair, then an earthquake would come along creating jagged rifts in his life.  Afterward, he would often be limp and exhausted as he slowly came back to himself. He always did come back, almost as an act of will since I couldn’t tug him back through feelings he couldn’t feel.  I would watch him closely, worried he would remain separated and adrift. Worried that I would lose him.

He had bruises afterward though.  Bruises I couldn’t see, even though I could see them slowly healing.  The meltdowns, outbursts and emotional storms leave wounds and after effects just as real as a car accident or an awful medical illness.

Psychological pain still doesn’t get the serious acknowledgement that physical pain does.  David Biro writes in his article, “Is There Such a Thing as Psychological Pain? and Why It Matters” that science often relegates “psychological sufferers to second-class status” largely because scientists and doctors who study and treat pain “consider the experience a strictly physical phenomenon, in the sense that it can only be caused by injury to the body.” Yet people who have experienced both physical and psychological pain frequently say emotional pain can be far worse.

Some studies show that the same part of the brain lights up when we feel psychological pain as when we feel physical pain and something as simple as taking a Tylenol can lessen mental hurt.  I’m not too sure that would have been the answer for the kind of pain my son experienced, but it’s good to know.

Children and teens (who are we kidding? adults, too) express their feelings through behavior more often than through words.  They rage, withdraw, weep softly, sob hard, lash out, hurt themselves or put up walls to deal with psychological pain.  As my son’s mother, I felt his pain keenly and constantly.  It hurt, but it was part of our connection.  Those times when it overwhelmed him and separated us were the hardest times. Pain can isolate but, if we are lucky, love and support builds bridges and keeps those bridges strong.

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Including parents should be part of effective trauma therapy

August 2nd, 2017

Some mornings as I drive to work, my mind wanders through my family memories.  I often wonder if my life is at all like other people’s lives.  I always think about my children first and then think of the many families and young people I have supported as they needed it. At times I think about all the kinds of therapy, services, supports and various medications that I have tried out. I think of the binders filled with IEPs, treatment plans, timelines and photos that I have taken to remember it all, and wonder if I remember all the facts. It can be hard with three children.  They are all unique and different but share one  thing – trauma.

Trauma is now looked at more and more with children (and adults) and there are lots of conversations about new supports, new research and new ideas. I have tried the Trauma-Focused Cognitive Behavioral Therapy approach, Eye Movement Desensitization and Reprocessingsensory dietAttachment Regulation and Competency and therapy after therapy. And you know how it works best? Including the family, especially the parent.

My child has received therapy in the residential setting and the community but when I have not been taught and included in the treatment, it really hasn’t worked most effectively.  Many therapists told me to focus on my trauma and they would focus on my child . The reality has always been that my trauma has already been worked on and the PTSD that I have incurred from going through the ongoing issues with my children has been just as hard.  The reality is that the one therapy where I was included resulted in both my son’s greatest gains and his ability to maintain his skills and improve in his journey.

Trauma has turned out to be so common that it is something more and more systems are identifying and seeking better outcomes. Is anyone noticing that when you include the parent, the treatment improves? Are we making sure the skills are taught to the parent so that the approach can be done during home time, day trips, holidays at home and more? Do people see the parent as an investment or a problem?  I would love to see more outcomes that look at how including parents helps the child. I absolutely know that improvement for the child is very much tied to the connection to the parent.

An underlying piece of the onion that no one sees and no one wants to understand continues to be the things many parents and caregivers do to make it feel safe for their child. It takes patience, understanding, empathy and sometimes just someone to show that they hear the parent and see them as the expert.  It has been the one area in my children’s life that has been a mystery to figure out.

As the brain develops things change, memories change, and behaviors to deal with it change too. My oldest son and I talk now about what memories we have and how we continue to feel lucky to be able to talk about it and how we are going to deal with it. Trauma comes up when you least expect it.

For us the biggest trigger is fire.  We remember a house fire that we were in. We are triggered by seeing the burnt house we drive by, a candle burning in a house, smell of smoke, a fire alarm and at times just people lighting a grill. It comes up and each of us deal with it differently. I approach it with a mindful approach, my middle son using the Attachment Regulation and Competency approach and my oldest using the Trauma-Focused Cognitive Behavioral Therapy approach. They are all correct and all okay- but without my understanding and embracing what works for them it would not work.

I appreciate being asked about trauma and talking to people about their approaches. It doesn’t go away. It is not the last peel of the onion for us– it is actually near the outside.

My last suggestions are the following:

  1. Include parents in your treatment model- teach them and include them
  2. Ask the parent what has worked and not worked
  3. If a parent asks for assistance to get outside support for trauma, help connect them
  4. Talk about positives that are possible so that parents know it gets better
  5. Remember that it doesn’t matter how large or small – if people use the word trauma LISTEN

Let’s change trauma to something we talk about and help.

Meri Viano is our guest blogger.  She is the parent of two sons and a daughter who continue to inspire her blog posts.

 

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Why do we still say the same things to transition age youth?

July 18th, 2017

My then-17 year old son went to bed the night before his birthday and woke up an adult the next morning.  At least that’s what everyone told him.  Neither of us could see too many differences.  We had often played a game about birthdays while he was growing up.  Just before his 8th birthday he said, “When I’m 8, I am going to like sprinkled cheese on my spaghetti.”  And he was sure, (picky eater that he was) that he would and, so he did. Before he turned 12, he told me, “When I’m 12, I will get over my fear of roller coasters.” And he was determined and made that happen.  I’m still not sure how.

Turning 18 was different.  He couldn’t declare, “When I’m 18, I will have all the skills and knowledge to make my life happy and be able to navigate the mental health system to boot.”  Just because someone proclaimed him an adult, he didn’t actually have all the wisdom and tools he needed.  Because he had a mental illness, there was a lot to know, a lot to manage and a lot of complicated decisions to make.  Saying, “When I’m 18….” didn’t make that happen, whether he said it or a provider said it.

Yet, lots of the time the people working with young adults tell them things like, “You’re 18 now and can make that decision for yourself, “ or “You don’t have to share this information with your mom or dad.”

The Pew Research Center has a lot of data about millennials (ages 18 to 36).  36% are living at home and 59% get financial support from their parents.  Only 25% are married (compared with 30% in 2007) and 48% say their parents most influence their voting.  They account for 20% of all same sex couples in America and 74% say they appreciate the way other cultures impact the American way of life.

Kind of an interesting group, aren’t they?  This data includes all millennials, whether they have mental health issues or not.  Here is what the norms for their age group are not: to get out of the house at age 18, find a spouse, start a family and don’t listen to others.  Yet, in the mental health world, that is often the party line.  Our young people are provided with a version of “normal” that’s often based on outdated data.  Wouldn’t it be great if our starting point was what is “normal” for this generation and then individualize that?

I really like the data on how many young adults say their parents influence their voting.  My son and I have lively conversations about the ballot questions each election. They’ve ranged from charter schools, to humane treatment for animals to “death with dignity.” This last election he had strong opinions on marijuana legalization, but he wanted to hear mine, too.  I don’t think I changed his voting but he got better explaining his stance the more we talked.

We live in a complicated world.  My father carried around cash most of the time and he pretty much knew where each dollar went.  It was visual and even tactile – he could see and feel it being spent.  My son’s bank account, on the other hand, got hacked recently.  Some unknown person went into his account and withdrew and withdrew until everything was gone.  He knew what to do because we’ve talked about and rehearsed this kind of thing before (did a walk through on something minor)  and he went to his bank and filled out fraud forms.  But he needed to get that knowledge before he could perform the action.  This is true for most young people.

Parents can – and usually do – take on a lot of roles.  We can be insurance advocates, emotional supporters, medical historians, the local ATM, encyclopedias, life coaches, navigators, experts on benefits and often, advice givers.  Some of us are better at some of those roles than others.  We can also tailor the information and help to our child, because we’ve been doing it for a long time.  What I don’t get is why many who  support young adults don’t automatically assume that parents have some pretty good stuff to offer.   If you find out they don’t, take it from there.  But don’t make that your starting point. Parents can have a variety of roles which is not pointed out often enough.

When my son turned 18, I asked him what roles he wanted me to play.  He hated the idea of having to call insurance for a prior authorization.  He liked the idea of being in charge of his treatment, but having me on speed dial for medical history (yes, I still have a list of all the meds he’s tried).  This was our conversation, not one with providers, though it could have been.  We made it clear for ourselves where we wanted to start and we agreed that not everyone knows everything they need to know.  And that’s okay.

It never goes smoothly.  There were times when I was bossy and times when he was determined to reject help.  There were times when we both couldn’t figure it out.  There were times when I had a hard time giving up my old roles and there were times he didn’t want to take on any new ones.

We kept figuring it out and still are.  What made it harder were the times his providers said, “You don’t have to talk to your mom” or “You need to make this decision,” without asking him if he wanted it that way and letting it be okay whatever he chose.  Young people with mental health needs become independent, but their path can be full of curves, needing comfort one day and distance the next.   It might include getting advice and support from their parents, just like the rest of their generation.  Nothing wrong with that.

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Ramblings within a month-long depressive episode

July 4th, 2017

I’ve been wondering recently what it’d feel like to work in one of those call offices for suicide hotlines. I know the pay is crap and that shouldn’t matter but you must be pretty strong to help someone after they shatter.  The thing I love though is that the people who actually call those are trying to put their life back together.

I’ve been on and off suicidal for as long as I can remember. I’ve never attempted. I smile. I laugh. I lend every helping hand I have. My depression is caused by demons of my past that I almost got away from but they’ve caught back up to my present. I look to my past and see nothing but haunted houses and ghosts. I look to my future and see a vast, empty desert with no road. I am lost and I am scared. Imagine looking to your future and seeing nothing. Nothing but a death trap. I live in a house I fear I will never escape and the worst part is…it’s not actually that bad.

I learned how to be independent at a young age. With a father who was busy working so the family could have money, a mother who was all talk and no action and an older sister who never felt or acted older. I had no choice. I don’t remember when I first started questioning who would miss me. I knew my dad would be devastated and my mom would blame herself. My sister might try to follow me as well because I’ve always set an example. My best friend would feel like she lost everything and as much as we jokingly say we want to die to each other, I think she’d be upset she didn’t take me seriously.

I got a new therapist recently. She’s nice but when we talk I discover walls I never realized I built and don’t have the strength to knock down. I haven’t figured out how to vocalize my feelings yet and it’s much easier to write this thinking no one will be reading it. But people have to read it. I want people to know that it’s a good thing I’m scared to kill myself. I’d much rather a car hit me or a shooter shoot me. Although in some sense it’d be pointless because I believe in reincarnation.

I’ve been on medication since I was 8 and it really messed with my hormones and nervous system. People have suggested I look back into them but they honestly scare me. They messed me up so bad. They messed me up because my depression was situational. My depression isn’t caused by a chemical imbalance in my brain. It’s caused by me living in a city, a state, a place I hate. The real question is, though, Where do I like?

I have spent my entire life living because other people seem to think I should. I live to stop my family and friends from crying. I live because what if I actually am supposed to marry the kpop star Choi Minho in the future, I can’t leave him alone. What about the kids I haven’t adopted? What about the cats I haven’t pet? I live for all these reasons but none of them are actually for me. If you asked me what I want to be when I grow up I’ll probably lie. My real answer would be dead…or somewhere I feel alive.

The author would like to remain anonymous, but has been a long-time member of Youth MOVE Massachusetts and offers their support to other peers who may also be struggling.

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