Monday, September 26, 2011

Drama Can Lead to Tragedy

Thanks to Danah Boyd and Alice Marwick from Microsoft Research who really hit the  nail on the head with their article on last week's New York Times oped page entitled "Bullying as True Drama."

In my office not a day goes by without a parent, psychologist, teacher or student referring to "drama."  As Boyd and Marwick point out, though, "drama" is frequently a dangerous scrim for something much more real and harmful. Admitting to bullying, whether as a perpetrator or a victim requires "acknowledging oneself as either powerless or abusive." 

No adolescent likes to be on either side of this equation. "Many teenagers who are bullied can’t emotionally afford to identify as victims, and young people who bully others rarely see themselves as perpetrators,"say the authors of this article.  And they continue:

"Dismissing a conflict that’s really hurting their feelings as drama lets teenagers demonstrate that they don’t care about such petty concerns. They can save face while feeling superior to those tormenting them by dismissing them as desperate for attention. Or, if they’re the instigators, the word drama lets teenagers feel that they’re participating in something innocuous or even funny, rather than having to admit that they’ve hurt someone’s feelings. Drama allows them to distance themselves from painful situations."

Microsoft Research looks like a remarkable international collaboration of social science and technology that covers issues as varied as new speech recognition technology, astronomy, and using data to identify genetic factors in disease.  These are the big minds at work on the world's thorniest and most intriguing problems and part of their mission statement is to "examine social media practices through various methodological and theoretical lenses and provide insight into how social media is reconfiguring daily life."  It's a thrill that they are using their expertise in a manner that benefits some of the least empowered (and most technically connected) in our society, namely teens. 

So next time a student, patient, teacher, parent or even a therapist calls it "drama" think again about what the backstage reality is for the people involved.

image from

Thursday, September 22, 2011

Remember Haiti?

I just received an update from Partners in Healh about the ongoing cholera outbreak in Haiti.  Please click on it and read about this disease that is there to stay for the foreseeable future.
Remember PIH in your end of year giving.


Tuesday, September 20, 2011

LGBTQ Youth: Suicide and Depression

Youth who identify as LGBTQ (lesbian, gay, bisexual, trans, or queer) are at almost three times higher risk of suicidality compared to "heterosexual" youth. 

Let's say that another way: if your child (or one you know or care about) identifies as gay or is attracted to someone of the same sex, he or she is at much higher risk of depression and suicidal thoughts. It turns out that youth who identify as bisexual are at even higher risk.  Other behaviors and risks that run in LGBTQ youth (otherwise known as sexual minority youth or SMY) are: substance use, eating disorders, victimization (bullying) and interpersonal violence.

Although clinicians and folks who care for young people have known for some time that the suicide rates among LGBTQ youth are high, this recent study published in theAugust Journal of Adolescent Health  looked at 24 previously published studies of depression and suicide in young people to tease out some of this data.  They remind us that even in an age when LGBTQ/SMYouth are coming out at younger ages, the risks of doing so remain high.  If victimization gives rise to a feeling of hopelessness and if a child's environment is not a validating one, all sorts of behaviors from cutting to substance use and antisocial activities and school failure can be the result.

It doesn't have to be this way.

All youth should be screened at their "physicals" for their "mental" health as well.  That should include interviewing them about their sexuality.  For LGBTQ youth further queries about harassment, discrimination or lack of validation should be made and providers should be prepared to "provide appropriate care for  youth in need."

image from via

Thursday, September 15, 2011

The Period Tracker Plus

For many girls it is important to keep track of their periods.  For some it's a matter of avoiding a fertile time, for others (older we hope) it's the opposite.  For many of my patients who are young and have normally  irregular periods they should be aware of the intervals between periods. Of course for anyone having sex without protection or with imperfect protection a tracker can mean the difference between discovering a missed period before it's too late or having some options and choices shut down.

Today a seventeen year old patient showed me  "My Days", an app for android phones that allows women and girls to track their periods in as much detail as they might want.  It certainly makes it easier on the doctor when she asks: "So when was your last period?" and the young patient whips out her phone to show me this:
The same tool that helps a 14 year old discover how "irregular" she really is will also be perfect for the 30 year old who wants to know when she is most fertile and most likely to conceive.   My only concern is that the 14 year old (or anyone for that matter)will interpret those days as the only ones when she should avoid having sex or unprotected sex.  In terms of pregnancy prevention and STD avoidance it's not safe to have unprotected sex at any time.  Condoms at a minimum, and a second  form of contraceptive would be the best bet.  All month long.

A Google search of the best apps for keeping track of periods revealed that all of them have ovulation, mostly hitting it rather than avoiding it, as the goal.  I have not found a simple app that is appropriate to teenage girls.  Other concerns I have with the apps I saw online at this review are that they emphasize PINK and feel ridiculously girly-girl; they hover on PMS, moodiness, and other pre-menstrual symptoms in a way I am not sure is productive; and some of them even have warnings for men to avoid their partners during certain "times of the month."

Come on! Your "fertile window"? Yikes!

Anyone want to work with me on an app for teenagers that is more developmentally appropriate?  Kotex are you there?  I remember the pamphlet I read from you about periods in the 60's.  We can do so much better with technology in our hands.

Tuesday, September 13, 2011

Bridging a Gap

I just read Tom Brokaw's book, The Greatest Generation about people born in 1920 who experienced World War II during their twenties.  He notes over and over again that this generation was ready to sacrifice education, livelihood, time and family for the country and often gave their lives in the process.  The book profiles many famous folks from that time but also some remarkable unsung heroes.  One of the best chapters is entitled "Shame" where Brokaw reveals the lives and sacrifices of Japanese-Americans and black and Latino Americans who met with  dramatic segregation and hate during the war years.

Have we learned from the mistakes of that great generation?

Over the past week or so, a despicable YouTube video montage that purports to support the notion that Barak Obama is a Muslim was shared by a family member of mine.  It struck a cord in my children who have responded with poetic personal anecdotes.  As I read The Greatest Generation, I was struck by the possible subtext that in some way the current generation of young people is somehow deficient in patriotism, humility, sense of service and willingness to sacrifice. But my own family has come forward to show that this is not necessarily so.  The following email responses (printed with permission) to the video  were sent by my family members who decided to jump in the ring to show the global understanding and thoughtful, nuanced way they look at the world in the 21st centruy:

I have heard the call to prayer. I have been a guest in Muslim households. I currently have a Muslim housemate. And i have had Muslim boyfriends! BUt besides all of that, Obama is not Muslim. WAKE UP.

  I spent a year hearing the call to prayer too. I fasted during Ramadan (ok, for a day, but still), I ate a ritually slaughtered sheep during eid al adha, donned traditional Muslim dress, visited mosques, learned to speak Arabic, and I still don't eat pork. It doesn't make me a Muslim. More to the point though, being a Muslim wouldn't make me a traitor.
The call to prayer is a beautiful sound - I too heard it every morning in Indonesia, like President Obama, and I am no more Muslim than he. We need more people who appreciate the different cultures that make up this country, and fewer bigots who latch on to every divisive opportunity that presents itself. Inshallah -- God willing.

If the anniversary of 9/11 taught us something maybe it is that it'snot simple or straightforward.  Let us all engage in the complex efforts to understand the larger world and nurture the next generation of hope.

image from via Googleimages

Wednesday, September 7, 2011

Freshman Orientation-Chinese Style

I am not often accused of hovering over my children. In fact, I generally feel we have done a decent job of raising resilient, independent young adults.

But with my last two headed off to college these past few weeks, I have been hovering more than usual.  I have to stop myself from asking what time they will be home or where they are going or asking them to check in too often.   And once I dropped the first daughter off at school I was fine  with getting pushed out at 6pm after a rushed, but nonetheless teary, goodbye. Fine, that is, for about twenty miles when the flood gates opened up.

So it was particularly amusing for me to see this photo :
"Parents of newly arrived freshmen students sleep on the floor of the Youming Gymnasium at the Central China Normal University on September 3, 2011 in Wuhan, Hubei Province of China. The university opens its gymnasium for the parents who sent their newly enrolled students to the college in the new term. (Photo by Zhou Liangjiu/ChinaFotoPress)

The university set out mats for some 600 parents accompanying freshmen students on their first day of school, local media reported."  If you look carefully there are actually two adults on some mats. 
Maybe this should serve as a reminder of how we eventually take our children's places and they ours:
image from and via Googleimages