Who says, “Weed is safe?” Teenagers, beware!

Here is a study which was carried out using magnetic resonance imaging on 799 adolescents who used cannabis (weed).  It shows that cannabis use was associated with accelerated age- related cortical thinning form 14 to 19 years of age in predominantly prefrontal regions.  This means that cannabis use adversely affects brain development during adolescece.  So everything that is legalized is not safe!!

Association of Cannabis Use During Adolescence With Neurodevelopment

Matthew D. Albaugh, PhD¹; Jonatan Ottino-Gonzalez, PhD¹; Amanda Sidwell, BS¹; et al

“To our knowledge, the present investigation represents the largest longitudinal neuroimaging study of adolescent cannabis use to date. We report evidence of an association between adolescent cannabis use and altered cortical thickness development in a longitudinal sample of youths. The spatial pattern of cannabis-related thinning was associated with a PET-derived map of CB1 receptor availability as well as a map of age-related thickness change. The findings underscore the importance of further longitudinal studies of adolescent cannabis use, particularly given increasing trends in the legalization of recreational cannabis use.”

It is certainly difficult to see a loved one go through difficult times, mentally and physically.

What can make the situation even more challenging?

Supporting a loved one through something you have never experienced before or know little to nothing about.

So here are 8 things you can keep in mind when caring for or supporting a loved one going for counselling/therapy:

1. It’s okay to check-in after a session.

It is perfectly alright to ask how their counselling session went. It just means that you care. This however does not mean that the person will always feel comfortable or want to share all that transpired in the session, and that should be respected. 

Should your loved one choose to share what happened, be completely present, listen and be open to the possibility of them being vulnerable. 

Should they choose not to divulge details, don’t push or force them to discuss. Pushing them to talk about the sessions when they are not comfortable might eventually interfere with the therapeutic process.

2. There could be some distress.

While counselling eventually leads to healthier coping mechanisms and overall growth, it may not be a smooth sailing ride all the time. During the course of counselling, one might have to deal with uncomfortable feelings and unpleasant memories. This can be tiring as well as distressing. Each person deals with this differently. While some might ask for space post a session, some others might want company.

3. Commend their decision to prioritise mental health

Confronting one’s unpleasant emotions and breaking maladaptive coping mechanisms week on week can get upsetting. Commending their decision to seek counselling from time to time might help your loved one feel supported and choose to continue with the process even if it gets uncomfortable sometimes.

4. Changes don’t occur overnight.

Working on any kind of issue takes time. The timeline differs for each person depending on the problem at hand, their circumstances, etc. Moreover the counselling process involves going through various stages such as trusting one’s counsellor, learning about yourself before you can actually start making changes. Hence, restraining your expectations and being patient with the process can help a great deal.

5. Help out with homework.

Sometimes counsellors may give tasks or activities to do between sessions as means to continue self work. Offering to help with these tasks (within limits) or simply being there for them while they carry them out can make a lot of difference. Although, forcing them or constantly monitoring their homework is not advisable.

6. Be open to interaction.

At times some counsellors may invite you to join a counselling session. It would be nice to take up such opportunities and participate. Such interactions may prove beneficial and help your loved one bring about the changes they desire to make.

7. Acknowledge the positive changes.

Speaking of changes, acknowledging positive changes during the course of the therapeutic journey can help a lot. Not only does it help your loved one notice the changes that they may not have realised, it is also an indication that you are looking out for them and encourages them to carry on working on themselves.

8. Read up.

It is always a good idea to educate yourself about your loved one’s mental health condition(s). 

Chances are your loved one’s counsellor may take an entire session on this matter. If not, you can always ask for resources or do your research. Doing this will definitely help empathise better and aid in navigating through your caregiving journey.

Bonus: Consider getting support yourself

While it is really good that your loved one is getting professional help, it can sometimes put pressure on those in their support system to be present all the time without receiving any help themselves. Build a support system for yourself or you can try going to therapy yourself. Make sure you are getting adequate physical and emotional nourishment. Remember, you can’t pour out of an empty jug!

“Aaaeeeee…..” , the child screamed and then there was a loud bang followed by sobs then “please…please….do it na- only once….makes me feel better. Don’t you love me to even do this much”……more sobs. This child sounded very very disturbed. And as this recorded voice clip played on the mother’s phone, she was crying while the father stared stoically out of the window. This voice clip was recorded at home when Milesh (not his real name) 10 years old had spent about 2 hours scrubbing his feet, followed by both parents having scrubbed his feet a few times. But Milesh was not sure the ‘germy germs’ had gone and wanted Mother to scrub a bit more, just to be sure. Milesh had obsessive compulsive disorder.

How does OBSESSIVE COMPULSIVE DISORDER (OCD) start ?

Obsessive Compulsive disorder typically begins in childhood or late adolescence. The sufferer begins to experience repeated unwanted thoughts, images, impulses or doubts. The themes evoke shame and secrecy- sex, blasphemy (religious), harm to loved people, dirt and contamination. The person very well knows that the thoughts are irrational but can’t understand what is causing them- and feels guilty or abnormal. The person tries to reduce the discomfort by doing some rituals- but their intensity progressively increases causing more trouble. At such time the quality of the thoughts or intensity of distress causes the person to become extremely unhappy, to the extent of provoking suicide. 

How o family members get caught in the symptoms

Family members are the first to know the problem. It seems to them that just reassuring the person or doing some rituals takes a few minutes of their time, but makes their loved one feel better. So out of love they do it. Soon enough they are spending more and more time just doing things or saying things (that are basically unnecessary) just to keep the peace and harmony at home. They have become involved in Obsessive Compulsive Disorder. At this stage, family members realize something is wrong and is not going away- they need help.

What can family members do to help?

As a family member living with a person with OCD (Caregiver), it is important to first dis-entangle oneself from the symptoms first. Gently but firmly one refuses to engage in the rituals (compulsions) demanded by the sufferer. So if a patient is seeking reassurance for a doubt….do not answer it; because that makes the symptoms worse. Show your love by being gentle, being there, using comforting words and being patient while the sufferer deals with their emotions in the form of an outburst or a heartrending wail or even suicidal or violent threats. Sometimes one may have to function as a co-therapist and supervise OCD therapy at home. OCD therapy provokes much distress and patient tends to avoid it. So as a caregiver, again one has to learn to be gently assertive and motivate the patient on a daily basis with your words and actions- that ‘this is required for you to heal’. 

Keeping a record of a patient’s behaviors and reporting them to the treating team is important. Among all mental health issues, OCD is one disorder that takes a lot of time and effort for recovery. It also requires higher doses of medications; almost to the edge of tolerance. Hence the caregiver of a person with OCD has to have extra hope and fortitude- sometimes for several weeks there is no change; plus the patient has to be constantly kept engaged in therapy by keeping the spirits up (whew!). 

Your take home message

 OCD is treatable and the period after recovery is surely worth the trouble. Make sure you remain fit to enjoy the lovely days that await you after the patient improves- don’t let the stress of the disease and caregiving wear you down. It is useful to maintain a calm and watchful countenance. Coordinate closely with the treatment team and follow their advice. Give them feedback if something is not working. Seek help for your own emotional turmoil as it is very difficult to witness the suffering of a loved one. Treatment of OCD is difficult, not impossible.

Asha and Avinash took a seat, saying ,”we are advised by the doctor to take counseling.” Both aged around fifty five years, were married for about 30 years. 

Avinash presented the problem as, “she is feeling depressed. She has started prescribed medications.Nothing is helping her. ” He added, “I was in a relationship, I am out of it, I have accepted my mistake.I have promised to not repeat it. She remains sad all the time. How to assure her? “

Asha took over, “this is the fourth time, and I can’t believe in his promise anymore”.

Both were feeling hurt, helpless and desperate. Years of energy and emotions were invested in their marriage and both wanted a solution to this interference. 

I decided to understand each one’s perspective by talking individually before having a joint session. 

Asha unburdening 

Asha spoke details of his four affairs. She described how accidentally she discovered them.On confronting him he had accepted his mistake and she restored her trust in him. She said, “this time I cannot trust him. What if he does it again? “

Asha had been too kind in the past and now was feeling sad, helpless and had suppressed anger. 

“Do you feel like you’re being taken for granted? ” I asked. 

“Absolutely.”

Her self respect and dignity were at stake. She had crossed all her limits of being considerate. She did not know how to restore them without breaking the marriage.In order to not disturb her son and daughter, who were around age 25/27, She maintained outward calmness regarding her husband’s extra marital relationship. 

Avinash starting to know himself

Avinash said, ” I am feeling very bad and guilty since she doesn’t believe in my promise and she is so sad and depressed” He looked down upon himself. 

I said, ” You have been four times into such relationships. Every time you didn’t want it and yet it happened”.

” Yes, I am very regretful and guilty about it. “

” Maybe you are aware of your thoughts and not in touch with your feelings and sensations. This is similar to a person with diabetes who overeats sweets in spite of the knowledge of its harmfulness. “

“Yes.I see such a possibility. And what can I do? “

I suggested a process through which he could get in touch with his emotions at the onset of each relationship. He accepted the homework. 

Asha anchoring into personal strength

Asha complained, ” In spite of taking medicines given by the doctor ( psychiatrist) I continue to feel disinterested in everything. I don’t cry but neither can I smile.” She looked unable to overcome her grief. 

Asha could be helped with” the  Journey ” technique in which she journeyed through her deeper layers of  feeling states. Diving deeper she touched an unshakable calm state. With this calmness she floated up wiping clean all her disturbing feelings of hopelessness, anger, distress. At the end of the process Asha had collected her inner strength and clarity. 

After two more such sessions Asha regained her smile and interest in general. 

Avinash developed insight into his driving emotions

Avinash could identify the emotion that pushed him into a relationship.He shared, “my work involves interacting with people in need. When a woman during such interaction shares her intimate experience, I feel highly regarded and I get involved with her. This has happened all four times that I got involved. “

This indicated his low self-esteem causing him to make a choice he regretted. 

I said, ” maybe you feel small in general. You may observe your thoughts about yourself for a week, and we shall review it”

Avinash agreed to it and returned the following week. 

Transformation to self acceptance. 

Avinash looked very sad and disturbed. He said, ” I am shocked to see how always I try to hide my smallness and try to project my superior abilities. It is disturbing me. This whole week I was restless and unhappy. ” He pointed out his defensive behavior hiding his feelings of inferiority. 

Avinash needed to accept himself without comparing himself to others. To help him do so ‘ the journey ‘ technique helped him too. 

Through the journey technique he could get in touch with his intense feelings of inferiority, below it the layers of anxiety, fear, sadness, unhappiness. Just when he went further deep into his feelings he got in touch with serenity and self acceptance. He could wipe off and replace the upper layers of discomforting feelings with peace and self acceptance. 

Avinash experienced great relief, stopped judging himself, and could concentrate better.

Asha getting ready to act

After undergoing two sessions of ‘journey’ Asha felt strong enough to plan her future approach. Asha identified her concern regarding Avinash getting into another relationship in future. 

I helped Asha to consider informing Avinash that she could leave him if he gets into a relationship again. 

Asha pondered and said, “although it is difficult, I am capable of managing it. I would get my daughter married before taking such a step to protect her future. “

Asha felt her self respect and dignity restored with this thought. Then Asha prepared a kindly worded letter informing Avinash about her present forgiveness and future condition.Letter was safer than talking so that she could convey precisely. 

Now both Asha and Avinash were ready for communication in a joint session. 

Joint session. Realignment. 

Asha read out the letter prepared in advance to Avinash. Both had tears rolling down. Avinash conveyed apologies to Asha for the pain he gave her through previous years. He wholeheartedly accepted her future condition. 

Lower self esteem, undue compromising, suppressed anxiety and fear left unresolved can have such devastating effects in marital relationship.

The epidemic of suicides

The last few academic years would be remembered for the alarming number of reported suicides among school- going children. It almost appeared like the outbreak of an epidemic.  There was a flurry of programmes on TV channels, in the community and in schools and colleges immediately following this outbreak. Theories were postulated.  Blame games were played. Helplessness was voiced on different levels. Mental health authorities were interviewed by the media.Tall claims were made by school authorities regarding the status of mental health of their schools. Concern was showered on children. The media glorified the issue as usual.   The wave seems to be over now. The same indifferent silence will prevail among people until some other disaster gets reported in the media. 

Cause, or just a precipitating factor?

Most of these suicides, though seemingly a result of some incident in the child’s life, were not “because of” that incident.  Not getting to participate in a competition, failure in an examination, being denied some materialistic thing such as a cell phone, being scolded by a parent or a teacher cannot be “causes” of successful suicides in a child.  They can, at the most,  precipitate the disaster in a child who is predisposed.  The crux of the issue is how to identify these children who are prone to suicidal attempts so that they can be helped in time.  

Some facts and figures

It is widely believed that childhood is a time which confers a relative immunity from the risk of suicidal behaviours.  This belief is based on two notions: childhood is largely free of problems, and that children lack the developmental maturity to think of  or act upon suicidal thoughts.  However, recent research has shown that by std III (age 8-9) children have a good understanding of suicide.  A Canadian study indicates that 229 children between ages 5- 14 committed suicide during the period 1993-1997. Two of these suicides were by boys under 10.  Of the remaining 227 children, 155 were boys and 72 were girls.  Highly lethal methods like hanging and firearms were used by 90% of children.  There are no adequate Indian studies regarding suicides among children.  However, the typical Indian scenario reveals an increasing competition among students, undue importance laid on examinations, a rise in the number of overanxious parents and unempathetic teachers, increasing commercialisation in the field of education, devastating influence of media on children and thoroughly inadequate facilities for help towards children in distress.  

Who is at a high risk of suicide?

Factors which may place children at increased risk of suicidal behaviours are psychiatric disorders such as depression, poor social adjustment, emotional, sexual and/ or physical abuse, problems in the family, chronic health problems and poor coping strategies in general.  The basic difference between adults and children with respect to their emotional problems is their ability to express them.  Children cannot express their emotions in words, unlike adults.  Very often they get expressed through their behaviours which can be picked up by sensitive adults who deal with children.  

Case 1–  

Asha (name changed for the purpose of confidentiality), a 12 year old girl, basically a chirpy, talkative child, was remaining quiet for the past one month.  She had stopped answering questions in the class, had stopped mixing with her friends and would be found to be lost in her own thoughts.  She would keep drawing black clouds in her books.  One fine day she did not report to school.  The school received a news that she was hopitalised in a nursing home because she tried to kill herself by consuming some sleeping tablets (which her mother used to take).  A note was found on her bed which said, “ If I am the cause of problems in my mother’s life let me leave this world.”  Further probing into her family background revealed that there was severe disharmony between her parents.  Her father was an alcoholic and used to beat up his wife when drunk.  Her mother had left the house with Asha twice before but had returned after a few days “for the sake of Asha”.  The mother would often remark that  she was staying with her husband just because Asha needed “a family” to stay in. Asha would often wonder how she could help the situation.  That day the father assaulted his wife once again.  Asha could not see her mother in a distressed state any longer.  She persuaded her mother to leave the house and go to her parents’ house.  But the mother kept saying, “I don’t want to do it just because you will be in trouble.”  Asha took the blame on to herself which finally resulted into a suicidal attempt.  

Case 2–  

Anmol (name changed for the purpose of confidentiality), an eleven year old boy was found missing from home after his father refused to give him a mobile phone.  After about 20 hours he was found sleeping on a railway platform.  He was reluctant to come home and had to be coaxed into coming back. When he came into treatment some details of his background became evident.  He was average in studies.  However, both his parents were highly educated and would expect a higher percentage of marks, a target which he was not able to achieve.  His parents would pressurise him for studies, would criticise him for his low marks, would keep demanding a good performance from him.  They had drastically cut down his hours of play.  They showed no appreciation for his talent in music.  He had lost interest in studies.  His work in school would remain incomplete for which he would get punished by teachers.  His parents used to be called to school very often for the same complaint.  Anmol was feeling sad and he had lost interest even in activities he liked, such as music and sports.  He did voice his  feelings to his elder sister but she also could not help him much.  He was contemplating for a long time to run away from home and end his life.  One day he asked for a mobile phone from his father. His father not only scolded him but also beat him mercilessly.  In a frustrated state of mind Anmol left home. 

Early detection is the key

It is very clear from the above cases that children who have suicidal ideas are generally depressed for a long time and see no hope for further improvement in their condition and resort to a suicidal attempt as a way to escape from their suffering.  If their depression is detected early and if help is provided they come out of their depressive state. 

How to detect depression in a child?

Persistent sadness of mood, loss of sleep at night leading to daytime drowsiness, lack of interest in work and play, loss of appetite with loss of weight, deterioration in scholastic performance, lethargy, retardation of the child’s physical and mental functioning are observable signs of depression in a child. Sometimes, there can be vague physical symptoms off and on, such as headache, abdominal pain, bodyache etc. for which there is no physical basis.  A change in a child’s mood which is persistent for more than two weeks is an alerting signal and may indicate depression.  If such symptoms are present the teacher should communicate with the child and find out what is wrong and what the child attributes it to.  If there is a definite likelihood of  depression, the school counsellor needs to be informed, who can take up the case and follow up the matter with the child’s parents and refer the child to a psychiatrist.  In case there is no counsellor available the teacher needs to get in touch with the child’s parents and suggest a referral to a psychiatrist and follow up the matter further.  

Communicate with children

It is important for teachers to communicate with their students as a group about difficulties in life and healthy strategies to deal with them.  It is helpful to discuss with children  about various aspects of life. Children can express themselves beautifully when given an opportunity.   A sensitive, empathetic teacher can effectively communicate about almost anything with his or her students.  I can say this with confidence because I have seen such teachers.  

Teachers, it is high time..!

Teachers, it is high time you take a pause to find honest answers to some of these questions for yourselves….How often do I talk to my students apart from the subject that I teach? Do I know my students well? Do I have a good rapport with them? Do my students ever approach me with their difficulties?  Do I understand the “child’s point of view” in a given situation? Do I consider referring a child to a mental health professional important?  Do I feel that my students are a burdensome responsibility on me? Do I lack time…. or the inclination…..or the understanding…. or the sensitivity….or something else?  

TEACHERS, PLEASE TRUST THAT YOU CAN MAKE A DIFFERENCE! IT DOES NOT NEED GREAT EFFORT, JUST A LITTLE SENSITIVITY.

How Dopamine drives behaviour 

A) Dopamine and pleasure

Dopamine is a neurotransmitter responsible for pleasure. Not pleasure after receiving a reward but anticipatory pleasure. When we anticipate something exciting, dopamine is released which makes the chase more fun than the satisfaction of getting what we want 

But why did evolution design us to seek pleasure ? During evolution, resources were scarce and survival was important. Thus whatever helped us survive, made us feel pleasurable so that we end up doing things again and again. Example, carbohydrates, fats and salts were scarce during evolution. Thus whenever we would come across a sweet, salty or fat laden source of food like honey or berries we would experience a spike of dopamine and that would motivate us to repeat this behaviour again and again. Same thing would happen with drugs or sex. 

But if we chase those dopamine highs through food or drinks or drugs or sex, we eventually limit our behaviours to that activity. Our pleasure seeking becomes narrower and restricted to those activities. Eventually those activities also don’t give us the expected pleasure. Thus detoxification or fasting or deprivation helps to restore the dopamine levels back to baseline. Similar effect is observed during delayed gratification. If we delay our pleasures, we can savour them and save the best for the last 

B) Dopamine and novelty seeking 

Dopamine also spikes up during novelty seeking behaviours. Why does it happen? Again coming back to our evolutionary past, activities like hunting and foraging for food would spike dopamine levels. But after we get what we want, dopamine doesn’t stay high. Since otherwise we wouldn’t venture out to hunt or forage. Thus dopamine eventually goes back to the baseline. Sometimes it drops even further from the baseline, which further motivates us to eventually seek out more. 

Thus anything that we achieve in our life, motivates us to further achieve more to get more and more of those dopamine spikes. 

Example, once an athlete who wins a gold medal or a student who comes first in class is driven to achieve further to get more and more of the dopamine spikes. 

But there’s a flip side to it. After an achievement there’s a period of low which is associated with the drop in dopamine. This phenomena is seen in holiday blues or postpartum depression where after we endure a much awaited event, we experience sudden low mood giving rise to a sense of loss of purpose 

So in order to sustain this dopamine high which can also be pursued through real life achievements, we should have goals and pursue them and set bigger goals eventually. Thus positive addictions can be pursued which can lead to a natural high

C) Dopamine and rewards 

But pleasure and novelty are not enough to drive behaviour. Dopamine stimulates the reward pathway. If we reward ourselves with money when we do a particular behaviour, we become motivated to do more of that behaviour. But eventually rewards become predictable and expected after a certain interval. Thus they lose novelty and we start craving for more. 

Some of the most addictive behaviours like gambling become addictive because the rewards are variable and come at unexpected intervals. Similar thing happens with social media. When we access social media, there may be a notification or a like or there maybe nothing or suddenly there may be a bunch of pleasing comments. Thus when we’re rewarded intermittently, unexpectedly or with a variable quantity, we get addicted to that behaviour. Thus intermittent variable rewards actually boost dopamine which drives behaviour. 

Thus if we reward a child for studying with a bike or gifts, eventually he/ she will crave for more rewards and won’t be interested in studying or studying for the sake of those gifts. Thus gifts may drive his behaviour and not the interest in learning. When we give intermittent unexpected rewards like a praise or a drive or day spent outdoors which happens as a way of appreciating his efforts instead of the outcome of marks, rewards would be eventually sought in the activity itself. Thus the joy of studying and learning motivates a student which becomes a reward in itself 

Thus we see how a naturally occurring chemical neurotransmitter drives pleasure, motivation and drive and what we can do to stimulate it naturally.