Saturday, October 21, 2017

On Anxiety

I just finished John Green's Turtles All the Way Down, which I read because he claimed it was his way of trying to put words around what it's like to live with profound anxiety, and then I saw this article asking "Why are more American teens than ever suffering from severe anxiety?". I was raised with most my sibs affected by some kind of mental illness or disorder, and now my children are in the same boat. Somehow, I've made it this far relatively unscathed by the ravages of anxiety, so I'm ever eager to really get my head around what it feels like from the inside.

Green's book is just what I was hoping for. There's nothing to read below the surface here, which might deny it any book awards, but it does an excellent job of giving us a clear and straightforward  first-hand glimpse of the inner thoughts that drive anxious behaviours. Like David Sedaris's Naked, a collection of hilarious personal essays about OCD, it can help the reader really get why anyone would do or think those things and then begin to empathize with that curious drive that all but obliterates their free will.

The NYTimes article discusses what to do with the rising number of teens trying to manage mental health problems. It offers some suggestions for treating anxiety in the schools:
"Too many [IEPs] are 'avoidance-based and teach zero skills.' She gave the example of a plan that allows a student to leave a classroom anytime he feels overwhelmed. Often, a teenager 'can go wherever he wants and stay there for as long as he thinks he needs,' she said. Instead, she argued, a school should have a policy in place for the student to seek out a guidance counselor or nurse and do some role-playing that helps the student 'externalize his worry' [. . .]  Then the student should return to his regular classroom as soon as possible. [. . .] In order to retrain the brain, in order to create that message that says that even though I’m uncomfortable I can do this, we need to stop treating these anxious kids like they’re so frail, like they can’t handle things. [. . .] Kids are being given some really dangerous messages these days about the fact that they can’t handle being triggered, that they shouldn’t have to bear witness to anything that makes them uncomfortable and that their external environments should bend to and accommodate their needs." 
It can be frustrating to watch the system foster behaviours that will not serve the kids in the long run. I have little power to affect that board-wide, but I do try to challenge kids to leave their comfort zone in my classroom. Letting them escape just trains them to find ways to continue escaping. We give lip-service to letting kids fail, but then are made to quickly clean up after them to avoid, I believe, any retribution from parents or any black spot on our school's image. If we want to let kids learn from failure, then failure rates need to stop being used as a marker of a bad school. Currently, teachers who fail a student who has produced no work all term will be courting their own trial if there weren't many varied and entertaining attempts at coaxing out some display of knowledge. For some students, teachers must provide all class notes instead of having them find their own homework buddy to get copies, and allow study sheets during tests with double the time limit, and develop alternatives to presentations because the kids are too anxious to demonstrate their knowledge, and won't pass the course without accommodations. Failing can make them leave school and not return, so we're to try even harder to get them their credits. But every extra chance, every bending of rules and standards, can tell them they're too fragile to fail, and maybe then that they're too fragile to try. Instead of, "Try again tomorrow; you'll get this!" we're getting sucked into, "Let me just do this bit for you." And that's not what teaching looks like.

The article hits on a key problem with current therapy methods,
“When we do give them therapy, it’s unlikely to be exposure. With a few exceptions, we’re not treating people with what actually works best.” Part of the reason is that exposure work is hard. Anxious people aren’t typically eager to feel more anxious. “It’s also uncomfortable for many therapists,” Whiteside told me. “Most people go into therapy or psychology to help people, but with exposure therapy you’re actually helping them feel uncomfortable. It’s not much fun for anybody. It’s much easier to sit in a therapist’s office and talk about feelings. [. . .] the more anxious a person feels going into an exposure exercise, and the more surprised he or she is by the result, the more effective it is at competing with an original negative association or traumatic memory." 
We feel their pain. Absolutely.

To what extent, I wonder, is our reluctance to let people struggle through to the other side of their issues really just a matter of our own cowardice in the face of this journey? We just want it to get better and be comfortable and easy. We need to be brave enough to witness this internal strife yet urge them forward. Just a bit.

And then a bit more.

The kids terrified of presenting are the very ones who most need to do that presentation. It doesn't have to be in front of the whole class at first. We can start with a couple carefully-chosen kids at lunch. And then a few more can join the next one, and then a few more. They can be cold called to read out the answer to the test question you know they got right and have right in front of them. But making an alternative assignment for them just reinforces that they may as well give up the fight; we don't believe they've got it in them to ever talk in front of people.

For available and easily accessible therapy choices they have talking and drugs, but I haven't seen any kind of exposure therapy like they describe in the article. That seems to just happen on TV or in $900/day treatment programs. We know what will work, but we're not willing to spend the money to make it the dominant treatment protocol.

Finally, the article moves home:
 "The million-dollar question of raising an anxious child is: When is pushing her going to help because she has to face her fears, and when is it going to make the situation worse and she’s going to have a panic attack?” Allison told me. “I feel like I made the wrong decision many times, and it destroyed my confidence as a mother.” 
Tell me about it! I just got through a year of cancer and surgeries and developing a affliction to be managed daily forever and coping with the death of my dad, and none of that was as difficult as watching my kid struggle to collect the courage to leave the house and make it through each day. Anxiety is a BUGGER! It's a devastating, crippling condition that saps the energy and voids the spirit. Between classes, my school day is punctuated with texts home to "Get yer ass outta bed!" and "It's okay if you're late, just go now!!" often ending with "Who cares if there's only an hour left of class, just get out the door!!" And then I get home and flood the place with compassion. My parental role is to push and comfort, push and comfort. It can be a feat of strength to struggle with a problem that I can't actively fix or soothe, and sometimes it gets the better of it. When it's a bad day, if there wasn't an obvious issue, like a forgotten pill, we scramble for the cause: dairy? bread? eggs? How I wish it were food-related! Maybe it's some sad news from somewhere else in the world? remembering a past event? something?? But the reality is, the cause is typically not findable. And then another day is great, and that doesn't make sense either. You can track all their eating and sleeping and thinking until all the ink in the world dries up, and sometimes it's just nothing. It just is.

As a parent, nothing has helped like immersing myself in Stoicism, Taoism, and Existentialism. Control your attitude and let go of the rest. Aim for courage, prudence, justice, and temperance in all things. Courage, definitely! I'm not so keen on temperance. Just be. Life is random and messy, but, every day that you're here, you've chosen to accept this mess. We must imagine Sisyphus happy, and all that jazz. And there's usually lots of good bits in the mix too! Life isn't always a drag.

When it comes to addressing the headline's question, the article takes a familiar path:

"Many are anxious about school and how friends or teachers perceive them. Some obsess about family conflicts. [...] in the last few years she has heard more kids than ever worry about terrorism. [...] When I asked Eken about other common sources of worry among highly anxious kids, she didn’t hesitate: social media. Anxious teenagers from all backgrounds are relentlessly comparing themselves with their peers, she said, and the results are almost uniformly distressing [...] round-the-clock responding to texts, posting to social media, obsessively following the filtered exploits of peers [...] it’s become this thing that we can’t live without but that’s making us crazy [...] they can also serve as a handy avoidance strategy [and we must also be cautious of] the “illusion of control and certainty” that smartphones offer anxious young people desperate to manage their environments. [...] But life doesn’t always come with that kind of certainty, and they’re never practicing the skill of rolling with the punches, of walking into an unknown or awkward social situation and learning that they can survive it."
As much as it's chided, looking at trends, it really appears it is the iPhones. We grew up with a hole in the ozone layer and the cold war. I sometimes suggest I did drugs and dropped out of high school because, when Reagan got into office, I was pretty sure we were all going to die. (It likely had more to do with falling in love with a stoner, but it makes for a better story.) The problems are worse now, for sure, but we also know about every single problem out there! There's no ignorance is bliss in the information age. Social media compounds the awareness of every blight in the world. And, on top of that, it has us all comparing ourselves to, what seems like, a mass of perfect people out there.

But to put the phone down is to deny ourselves the development and maintenance of relationships.  So this is a bit of a pickle. Just keep pushing and comforting, and tomorrow's another day.

So it goes.

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