13
Dec 24

Your Teen’s Grief Over a Diagnosis

Teenager“Encourage your teen to learn as much about the illness as they can face.”

The word grief implies that there is a loss, and in your teen’s case, it may be a loss of the innocence associated with their health condition. Most teens never expect to experience mental illness; in many cases, they have never before heard of their diagnosis. The very word “bipolar” or “schizophrenia” may cause them to recoil. They do not want to be that person and they believe they cannot deal with this. The route from grief to acceptance is painful and difficult, but there are ways to ease the journey.

Addressing your Teen’s Stigma
Many teens carry a stigma about mental illness even if they were never before aware of it. Explain to your teen that stigma is the result of ignorance and is overcome through education. Encourage them to learn as much about the illness as they can face. This might include reading an autobiography or perusing articles online. There are some helpful magazines published solely for the benefit of people with, say, schizophrenia. This literature will help your teen to normalize the illness. Sz Magazine is an outstanding magazine for patients with schizophrenia. BP Magazine is also an excellent publication and is for sufferers of bipolar disorder. Your teen may be willing to volunteer at your local chapter of the National Alliance for Mental Illness (NAMI). This will help them to feel like they have control over their illness and they will meet other people who are helping the fight against stigma. You may want to volunteer for NAMI yourself to show your support.

Addressing your Teen’s Self-Image
If your teen feels that their diagnosis changes who they are, ask why. If they say something like, “Now I’m a person with bipolar disorder,” ask them to list how that makes them different from before the diagnosis. They may say, for example, that they are now a person who sees a psychiatrist and a therapist and who takes medicine; that they are a person who has fewer friends and has given up on an activity that they once enjoyed. Then ask them what is still the same; for example, they may still drive, attend school, enjoy the support of a loving family, take pleasure in music or reading science fiction, and more. Try to get this second list as long as possible. This may help your teen see that they are still the same person. Try not to let them focus on blanket notions such as, “I’m bipolar.” Having bipolar disorder does not comprise a person’s entire being.

Beyond that, remind your teen that people are always changing, especially during the teen years. Even if they had not become ill a year ago they would still have changed in some ways. See if they can identify something new that they would like to try. What would they like to accomplish and get out of the next year? See if you can get them to set some concrete goals. This will give them a sense of  control over their life.

Helping Your Teen Compartmentalize Grief
If you find that your teen is crying every day about the diagnosis, tell them you understand but then suggest to them that they choose a specific time of the day to grieve as deeply as they want and to fight the feeling the remainder of the day. For example, they may need to go to their room and cry for half an hour after coming home from school. This could be a helpful stress reliever. When they are finished, they should come out and do something that makes them feel better.

Helping Your Teen Maintain Friendships
A mental illness can temporarily derail a teen’s social life. If they find that they have lost ground in this area, now might be a good time to evaluate their friendships. Some of their friends who have drawn away from them may be worth pursuing and others may not. If they have been involved in a negative friendship and the illness has strained things, they may choose to let the friendship go. A life-changing illness can be just that, but the changes may be for the better.

If they are trying to keep up but do not have the energy to go out much, they may be able to use Facebook to keep up with friends. They may find it easier to go to a movie with friends than to the mall, which requires more conversation. If your teen finds themselves so changed that they can no longer relate to former friends, suggest that they embrace their new self. They are more sophisticated about life now and they will need to find teens with a similar depth of understanding. They may meet such teens in a yoga class or in the school’s drama club or newspaper. Encourage them to try a few things and to take their time choosing new friends. This will be especially important if they have been hurt or abandoned by former friends. Tell them that many people will want to befriend them and that now they have a good idea of what they are looking for in the people that they meet.

Helping Your Teen Understand the Right to Privacy
It may be in your teen’s best interest to hold off on telling new friends or acquaintances about their illness. After all, their illness is simply one part of who they are. Let friends get to know the other, more interesting, parts first. Till now, your teen may have never experienced the need to maintain privacy in an area of their life. Empower them with that option now. Let them know that they do not owe anyone an explanation for what they are going through and that they have nothing to apologize for in terms of the illness. It is an important step toward adulthood.

Helping Your Teen Deal with her Loss of Innocence
All of this talk of embracing change may seem positive, but your teen may still be struggling with the end of innocence. At some point, we all go through this, but in your child’s case, it happened brutally and unexpectedly. Suggest that they give themself some time to let their emotions catch up to what their mind now knows. For whatever reason, humans are able to understand facts quicker than they can feel okay about them. A useful nighttime exercise is to have them write down or think about five things that are good in their life right now. Do not be surprised if their therapist or psychiatrist is one of them. Gratitude has a way of soothing pain. Slowly, they will begin to see that life still offers them opportunities and that their illness will not be able to hold them back for long.

Meanwhile, encourage them to keep their schedule as full as possible. Busy people do not have time to dwell on things that are out of their control. Finally, reassure them that they have probably been through the worst part of the illness and that things can only get better. Let them know that as they continue to improve and their symptoms continue to subside, the illness will gradually become a smaller, less significant part of their life.


06
Dec 24

Stabilizing Mania or Psychosis in Your Teen

Teenager“Try not to challenge her. Listen, but keep your comments neutral and non-judgmental.”

It is distressing to see your teen suffering from mania or psychosis. The psychiatrist will make it a top priority to shut down the symptoms, but it may be up to you to get your teen through the days. Hopefully, you can be present throughout this time, even if it means working from home for a while. It is best to provide vigilant supervision since the teen’s behavior may abruptly change and worsen.

Stabilizing Mania

Teens with bipolar disorder often experience mania. The manic teen may have pressured speech in which you cannot interrupt them, or they may pace, not sleep, or carry on about ideas that do not make sense to you. They may overspend or indulge in some other activity to excess.

For now, remove your teen’s access to Facebook, e-mail, or any other media form in which they could write something they later regret. Hide all credit cards and debit cards. Since mania can lead to dangerous behavior, make sure their psychiatrist is monitoring their progress. Follow his orders and record your teen’s behavior every day so that you can give him specific examples of what you are observing. It is easy to forget incidents when you are in the midst of an emotional turmoil. A faithful record can also encourage you when you see that there is improvement.

One of the toughest features of mania is that it often feels good to the patient. For this reason, your teen may resist medicine. Remind them that a crushing depression awaits at the end of mania, if left untreated. Tell them that you are not trying to spoil their good mood but that you want to see their mood leveled out for the sake of their mental health. Try to avoid getting pulled into lengthy, circular discussions that do not lead anywhere. It is okay to say that you need to go do some work for the time being. If your teen wants to talk to you all day, designate a specific time for discussion, such as from three o’clock to four o’clock. If they have a lot going on in their head, encourage them to write about it in a journal. Do not allow your teen to exhaust you.

Managing a Psychotic Episode

Psychosis occurs when a person begins to lose touch with reality. It can include hallucinations (hearing voices, for example) or a delusion (believing that people are out to harm them, for example). It may be a symptom of bipolar disorder or schizophrenia, but it can also occur with depression. It can be brief or it may persist for years.

Some medicines can cause psychosis, so your teen’s doctor will ask for a list of any medicines your teen takes. Street drugs such as LSD and marijuana can cause psychosis. If your teen is paranoid one night and fine the next day, suspect drug use. Talk to them and let them know that if they continue the drug use, the paranoia may worsen and can persist even after the drug use is suspended.

Sometimes a teen becomes psychotic from using illegal drugs and even after they stop the drug, the condition continues and has to be treated with antipsychotic medicine. If your teen seems paranoid for any reason, or if they are saying things that do not make sense, they need to see a psychiatrist. During treatment, the doctor may prescribe an antipsychotic, and he may provide a benzodiazepine like Ativan for short-term use to briefly suppress the psychotic symptoms.

Meanwhile, you will need to deal with your teen, who may be frustrated with the effort to explain to you what is going on because you do not see reality the same way they do. Try not to challenge them. Listen, but keep your comments neutral and non-judgmental. Trying to convince them that they are seeing things wrong will make the condition all the more frustrating, making them feel desperate, misunderstood, and alone. They may decide it is necessary to hide their beliefs from you, and then you will not know if they are still experiencing psychosis.

Although you are listening to your teen, do not encourage them to keep carrying on about their belief. It will only further flame the delusion. Try to keep the environment calm and quiet. Turn off the television, since they may misinterpret what they see and hear. If they try to engage you in their thinking, you may find yourself walking a fine line. Do not indulge the delusion by saying things like, “It’s okay, honey. I’ve put this cross on the door and the aliens won’t be able to get past it.” Maintain a tone of neutral empathy. For example:

Your Teen: There are people out there who want to kill me.
You: I can see that you’re scared.
Your Teen: You don’t believe me, do you?
You: What matters to me is that you feel scared. It must be awful to feel this way.
Your Teen: But you don’t believe me.
You: I sympathize with what you’re going through.  I want to reassure you that your safety and well-being are my top priority right now.
Your Teen: Lock the doors! They’re coming. You don’t understand. Let me explain this to you again…
You: I hear you loud and clear. The doors and windows are locked, just as they always are at night. I know that the world is not always a safe place, so I take sensible precautions to keep our family safe.

Choose your words carefully, avoiding anything that could sound judgmental. Think before you respond. In their confused state, they will not notice any slight hesitations.

If the paranoia persists for months, you may want to make certain accommodations to make your teen feel more comfortable. For example, if they think people are out to kill them, they may not want the garage door open until they are safely inside the car. This is not the same as saying that you agree with the false belief. It is simply a courtesy to make life less stressful for them.

During auditory hallucinations,remember the following:

  • Your own voice will be a source of reassurance. When the voices are at their worst, your loving tone may cut through the nonsense.
  • During a lucid moment, ask your teen to list all the things the voices have said. It may comfort them to realize that the voices always lie.
  • Getting your teen to talk can refocus their attention and make the voices stop. Some people find that singing makes the voices disappear. If they say they will feel silly, sing along with them.
  • Hide anything that could be used as a weapon, including knives in the kitchen or tools in the garage.

Don’t wait until things become out of control. If you feel you are in danger, get out of there and call 911. Explain that your teen is in the midst of a psychotic episode and that you need an ambulance. The police will come too, but they will not arrest your daughter if they are clear on what is happening. Inform them if there is a weapon so that they are not taken by surprise.

If your teen is taken to the hospital, do not despair. Let the professionals take over. Afterward, avoid talking about the things your teen said at their worst. If they did something that now has consequences, such as over-spending, offending someone, or getting into trouble with the law, reassure them that there will be time and opportunity to fix it. For now, it is time to focus on getting well. After your teen is well, it is a good idea to work together on an emergency plan.

Recommended Books:
The First Episode of Psychosis, by Michael T. Compton, M.D., M.P.H. and Beth Broussard, M.P.H., C.H.E.S.
When Someone You Love Has a Mental Illness, by Rebecca Woolis M.E.E.C.