Peek inside a classroom - What happened to Jasmine?

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When you look inside a classroom there are some things you can not see….

Jasmine was one of my favorites.

She was one of the shortest, scrawniest children in our second grade classroom. Maybe 45 pounds with her coat on. Her tattered backpack seemed as big as she was. Somehow the tiniest children can hold the most energy, the most emotion, and somehow they manage to get the most compassion from me.

When you peek in our classroom you may see Jasmine stealthily surveying the classroom for the child most likely to respond the most spiritedly when she gives them the “the finger”, or when she “gives them” a freshly sharpened pencil, in the side of the head, perfectly thrown from twenty feet away.

When Jasmine is unsuccessful in provoking a classmate’s response, she can get really amped. I have heard guttural profanity and I have been horrified to see her raise a school chair over her head and heave it at a classmate. More surprising, sometimes Jasmine targets someone twice her size. Sometimes she will even taunt teachers, naming one “Young Buck”. Once juking her way around him, beating him to the hallway fire alarm, and crisply setting it off.

Jasmine’s motivation is not related to anything we can see. It’s complicated. What we don’t see is “why”. Why would such a young child with such a lovable smile be so aggressive and confrontational?

Her teachers (including me) often see these behaviors as ‘disruptive’, which they most certainly are. Even seeing her as “bad”.

What none of us see is that the classroom setting is not necessarily related to Jasmine’s actions either. Jasmine’s confrontational behavior can already be in full swing before she even reaches the school. Sometimes she freely enters the courtyard looking for someone to suckerpunch, or to bait by verbally defiling their mother. The “best” candidate is the one who will respond aggressively. Jasmine wants a fight, not someone who will run.  She can’t “release” anything if they run. More than once, Jasmine has physically assaulted a teacher who intercepted her attempts to get physical with a classmate. Our school had no regular nurse and the counselor was on longterm leave. There was not even another room for Jasmine to de-escalate in.

Is Jasmine bad or is there something else? Why is her behavior so volatile; one minute so calm and so agitated the next?

Beginning to “see”
We have to ask questions. Carefully ask the right questions.

It’s NOT a question of what’s wrong with Jasmine.

It is a question of what happened to Jasmine. (See Foderaro, pg. 191 in ‘Creating Sanctuary’ by Sandra Bloom M.D.)

Most immediately what has happened to Jasmine is that she has been “triggered”. The trigger is “thing” that started her visible, physical “release”. You could peek in the classroom all day. In fact, you could look right at the trigger, and not see it.

Jasmine probably can’t identify the trigger either. It was very likely some sensory detail: something Jasmine saw, heard, smelled, touched, or even tasted. It’s locked in her (non verbal) memory and associated with a time of intense fear. It may have been as “innocent” as a ticking clock, or the nail polish color on a finger, an untucked shirttail, or even a backpack. The final memory that registered before abuse.

Meanwhile, as you are looking in our room, make sure you see the other 29 children with Jasmine. Her behaviors have ripple effects. You will see some of the 29 tense up and some may indeed become triggered themselves by something in Jasmine’s behavior.

So, it’s not necessarily the setting, and we can’t identify a trigger, and it affects the whole educational process. Therefore some may surmise that it’s an unpredictable and unmanageable situation. If you are intent at that moment upon relentless pursuit of academics, the situation will be unmanageable.

Back to Jasmine: something else you probably didn’t notice came earlier. Before her visible, physical “release” came neurobiological processes that put her into a hyper aroused defense mode.

Hyper arousal is one of nature’s perfectly logical defenses, in Jasmine’s case, to  a sensory memory embedded deeply in her brain (in her amygdala to be precise). Now in “fight-or-flight” mode from a terrifying memory, the brain is flooded with adrenaline and cortisol, preparing for action. When already in this state of hyper arousal, the slightest additional cue can detonate defensive action.

After hyper arousal (from the memory), and the trigger in the moment, the pent up traumatic energy (stress or fear) is released. That release is the defense that we can see.

“Defense against what?” you may still be asking.

Defense against something else that none of us see.

What none of us see is what happened to Jasmine.

Frustrated?

Welcome to the world of teaching children.

Welcome to the world of trauma-impacted children.

Public Health Research
Childhood trauma is the response of overwhelming or helpless fear, or terror. Specifically, it is a response to abuse, neglect, to a missing parent, or a household which includes violence, mental illness, or substance abuse. Other childhood traumas can include experiences with community violence, or ethic oppression, and many more. Let’s be clear. Trauma means things like rape. Like physical beatings, like relentless emotional destruction, or maybe complete disregard for basic physical needs. Total neglect of another human being. Often the trauma is inflicted by someone who is a “caregiver”.

The CDC’s public health research says that 22% of our children are trauma-impacted with 3+ categories of trauma, to the point of predictable, lifelong damage and early death. Yes, early death. Early death related to childhood experience. They call it “Adverse Childhood Experience” (ACE).

ace pyramidl
ACEs are no respecter of demographics, zip code or socio-economic status. The CDC researchers found that even in beautiful suburban San Diego, roughly one-fourth of the mostly middle class, mostly white, working folks with medical insurance had experienced 3 or more ACEs!

ACE rates in urban areas can be double the suburban level, but the 22% rate in San Diego is shocking in itself. Percentages translate to 6 to 7 children (6 to 7 “Jasmines”), severely trauma impacted with 3+ ACEs, in a class of 30, even in San Diego.

Three or more ACEs is significant because experiencing 3 or more ACEs correlates with doubled risk of depression, adolescent pregnancy, lung disease, and liver disease. It triples the risk of alcoholism and STDs. There is a 5X increase in attempted suicide.

Neuroscience Research
Neurobiology tells us that trauma’s impact is deep. Chronic, or complex trauma changes children’s physical brains, and impairs cognitive and social functioning. These injuries relate specifically to the prefrontal cortex and academic processes, especially executive function, memory and literacy

So, the children are not “bad” or sick, they are injured. See ‘Destroying Sanctuary’ p 135 by Sandra Bloom M.D.).

Neurobiology further informs us that cognition shuts down for trauma-impacted children who are overwhelmed by a state of chronic, or complex trauma: it is physiologically impossible to learn.

Trauma-impacted children can not equally access their education.

Another learning from neuroscience is that young children can not “just get over it”. In fact, the younger the child, the more immature the physical brain and the less practiced in social defenses, the greater the damage the more difficult to access and verbalize, and the longer it takes to heal, if ever.

Trauma Informed Education
There is an abundance of literature on the topic of ACEs and Trauma-Informed education. A successful education paradigm requires: a) explicit acknowledgement of childhood trauma, b) screening students, c) training teachers and d) creating “safety” across the learning environment. (See “Common Sense” for much more detail)

Crucial investments towards safety include appropriate class-sizes, with limits on trauma-impacted children per classroom. For example, one teacher alone will struggle to be effective aiding one ‘triggered’ student from among the 6+ who have 3+ ACEs, within a classroom of 30 kids, who are waiting to be taught. Additionally, dedicated appropriate space for children to de-escalate is needed, as well as on-site nurses and counselors; counselors, who build on-going relationships with the children and families.

What no one can see by peeking in the room: What happened to Jasmine?
When I had my first peek at Jasmine, she was in Kindergarten. Someone had confined her in the small, 4X6 entryway of the main office, in the narrow space between the registration counter and the wall with the bulletin board. The veins on her neck bulged and throbbed, as she lay on her back furiously kicking and screaming, her face smeared with tears. She’d already ripped the paperwork from the bulletin board. Why ? Her cousin “didn’t wait” so she could walk home with him… She now angrily refused to leave.

I could see the behavior.

I could not see the ACEs Jasmine was impacted by.

My eyes were opened only later when I sensitively started asking her caregivers” What happened to Jasmine?” Only then did I begin to “see”. I saw of the incarceration of her father. I saw the death of her mother. I heard her uncle’s anger at “having to take in his sister’s baby”. Still, the uncle “caregiver” rarely sees Jasmine because of his night shift work.

Earlier, when I’d walked Jasmine home that night from Kindergarten I was scared (as an adult) to see the squalor and dilapidated row house. The front door was hanging open to the street and it was dark inside. I know there is drug traffic and drug related violence on her block and the surrounding blocks. My alarm shifted to anger when the smell of illegal smoke wafted out the open door with moaning sounds of stupor inside. I was somewhat relieved when Jasmine’s cousin bounded out to meet us. But I have never forgotten what I saw.

Now, when I see a child with a backpack, I still trigger…

Keep in mind that Jasmine is NOT an unusual child. That year there were 9+ other trauma-impacted children in our classroom. See “Danny Goes to School” and “Failing Schools or Failing Paradigm?”.

Trauma-Impacted Students Do Not Have Equal Access to their Education
Our education systems are NOT trauma informed today. Districts don’t train teachers, children and schools remain unsafe, and trauma informed systems remain unfunded.

Preparing individual “Section 504” plans for individual children does not address system-wide needs and is not a practical option, given the scope: millions of students.

Education “reformers” focus on “Common Core” and standardized testing. They use phrases like ‘no excuses’ and ‘high expectations for all’ without providing appropriate accommodations for all. That contradiction is wrong. Morally wrong.

The system ignores the 22%+ of trauma-impacted children and their classmates.  In my urban district, the rate is even higher, at 45+% children with 3+ ACEs. “ACE-blindness” disproportionately penalizes urban districts impacted with doubled rates of trauma. That is doubly wrong. (See “Common Sense” ).

Instead of accommodation, punishment.  Punishment at the system level (much like punishment at the personal level).

The system generates wrong decisions, life-changing decisions, based on uninformed, misleading data.  Attempting to compare States’ or School Districts’ scores, and even individual schools, given the wide variations in trauma rates, is dangerously wrong. Then realize that the system continues this level of travesty at an even more deluded level: an individual classroom compared to another individual classroom. Even comparing those classrooms to year ago “scores”. None of the above get adjusted for radical variations in rates of trauma of as much as 100%!

An uninformed approach.

We still do not see.

Action Steps
We have the right to be frustrated and angry about what happens to all our Jasmines and her classmates!

Our own U.S. Department of Justice report,  “Defending Childhood”, calls childhood trauma a national crisis. The CDC says it is critical to understand. Becoming Trauma Informed is no longer optional. Let’s channel that anger into action.

Stand up and be heard by your politicians:

  • An immediate opportunity for action is lawmakers’ rewrite of national education legislation (ESEA), ironically known as “No Child Left Behind”. (See “Common Sense” ). The rewrite is already in House/Senate conference committee, so no time to waste.

    Click  this ‘OpenCongress’ link to get names of your Congress members. Click on a lawmaker and then find contact information on right side of screen. Email or call them today, or send them a link to this blog. Ask them to acknowledge and fund accommodations in ESEA for trauma-impacted children!
  • If you are in Pennsylvania, there is a second opportunity, maybe even larger opportunity for yo, with state lawmakers, detailed here (with contact information at the end).
  • If you’re not trauma-informed , read here, or  research childhood-trauma  or seek training, here,  here , here  or here.

Note: “What happened to Jasmine?”is a true story utilizing pseudonyms.

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Be sure to follow Daun Kauffman at lucidwitness.com

daun

Daun Kauffman has been teaching in Philadelphia public schools for 14 years. "I live, and work, and worship in the Hunting Park neighborhood of north Philadelphia, with students we’ve served. The Philadelphia Inquirer has described the neighborhood as 'a gritty, drug infested barrio'. Nevertheless, my neighbors and students are steadfast, creative and inspiring in the way they wrestle with many life challenges. They have taught me much." 

Dr. E. Fuller Torrey and Dr. Dennis Embry need to work together to promote the use of fish oil for the long-term prevention of psychosis

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embryNetwork faithful know that Dr. Dennis Embry (a member of the CMHNetwork Advisory Council) has long been promoting the use of Omega-3 fish oil for the long-term prevention of psychosis. One of the studies that Dr. Embry has often cited is one that was funded by Dr. E. Fuller Torrey several years ago, that showed promise in the preventable effects of fish oil. For as long as I have known Dr. Embry, he has been calling for Dr. Torrey to move forward with the study.

Lo and behold, last week, the Treatment Advocacy Center, which is headed up by Dr. E. Fuller Torrey, made the following announcement in their newsletter:

  • From the Treatment and Advocacy Center Newsletter
    torreyFive years ago, an international team of researchers reported that a 12-week course of omega-3 reduced the risk of early psychotic symptoms progressing to schizophrenia in a study of 81 high-risk adolescents and young adults. The study took place over the course of a year. But now the researchers report the preventative effects of the fish oil intervention may last even longer (“Longer-term outcome in the prevention of psychotic disorders by the Vienna omega-3 study,” Nature Communications).

    Only 10 percent of the individuals in the omega-3 group of participants went on to develop a psychotic disorder in a seven-year study period compared with 40% of the group receiving a placebo, say authors G. Paul Amminger et al.

    The omega-3 participants were also less likely to be prescribed antipsychotic medications or to meet diagnostic criteria for severe mental illnesses during the follow-up period. The majority of the people that received omega-3 were employed full-time at follow-up and no longer experienced psychotic symptoms at the end of the study period, according to the report. 

    “If the finding that omega-3 prevents transition to full-blown schizophrenia is replicated, this would be a major breakthrough in preventing this debilitating illness,” according to Treatment Advocacy Center founder Dr. E. Fuller Torrey.

    The Stanley Medical Research Institute (SMRI) funded the original study by Amminger et al. in 2003 as well as the follow-up study. SMRI currently is funding three additional studies of omega-3 in Australia and Europe and a trial of the use of omega-3 for individuals with bipolar disorder.

    SMRI is a supporting organization of the Treatment Advocacy Center, whose mission includes promoting the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

 Note to CMHNetwork readers: E. Fuller Torrey is the Associate Director of Research for the Stanley Medical Research Institute.

Okay, Dr. Torrey and Dr. Embry, time to move this forward. The Children's Mental Health Network is calling on the two of you to work together to get this treatment protocol listed on the National Registry of Evidence-based Programs and Practices. Collectively, you have a rare opportunity to show true collaboration between a prevention scientist (Dr. Embry) and a research scientist who has dedicated his life to treating individuals with the most severe forms of mental illness (Dr. Torrey).

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Julian Bond -- American Revolutionary

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Morning Zen Guest Blog Post ~ Rev. Dr. William J. Barber II, NC NAACP President, Political Action Committee Chair of National Board of NAACP

One of Julian Bond’s heroes, Frederick Douglass, died at 77 in his Washington, D.C. home, cared for by a loving wife and comrade. NAACP Chair Emeritus Bond died at 75. He leaves his loving wife, Pam, at their Washington home, along with his blood and Movement children, like me, across the nation, who have learned much from his example on the Long March for Justice.

Douglass’ (1818-1895) Long March began in the dangerous moral fusion abolition movement that led, in 1861, to the U.S. Government's organizing millions of Black and White families and soldiers to smash its sin and system of slavery in 1865. After a short period of exciting moral fusion advances in the 1st Reconstruction, Douglass watched with increasing frustration as southern states allowed racism to terrorize the new African American citizens with impunity. He joined the great cloud of anti-racism witnesses in 1895, and the next year the U.S. Government gave its full support to Jim Crow with its Plessy decision. Black southerners suffered egregious economic and social oppression for the next 58 years, until the NAACP knocked the legal legs out from under Jim Crow.

Julian was 14 when nine white men in black robes declared Plessy unconstitutional. The Warren court, and every southern politician,  knew this was merely the first step in dismantling America’s apartheid system of segregation and gross inequality in education, employment, housing and health. Taking on this 2nd Reconstruction necessitated a second war, less violent, with the U.S. Government’s commitment to this struggle decisively less unanimous than the Supreme Court’s. The anti-racism non-violent army of the south was led by citizen-soldiers who, like every army, were young. Julian Bond was 20 when he went to work with the Student Non-Violent Coordinating Committee—SNCC. Although SNCC had a few “elders” – Ella Baker, James Forman, and Robert Moses—in the main it was composed of young Black students from southern high schools and colleges. Hundreds of  courageous young Black students from the south, joined by a few white southerners, served as the shock troops in the first battles, waged in lunch rooms, bus stations, and courthouse voter registration gauntlets.

Young Julian’s political analysis, his serious demeanor, his understanding of White-Black southern history, and his command of English quickly won him the job of SNCC’s Communication Director. Thousands of news releases and political analyses flowed from the SNCC office in Atlanta. Since its field secretaries were continually being arrested, beaten up, and threatened with death, and they had sworn to forego the right to self-defense, Bond’s ability to alert national television and print media to where people were being attacked probably saved many SNCC activists and grass roots leaders.

When Black soldiers came home from from Vietnam home describing the atrocities they had seen the U.S. commit against the tiny country’s non-white peasants, it was not long for Julian and SNCC to begin protesting these atrocities. Soon the Georgia Legislature, dripping with the money being spent by the U.S. military across Georgia, decided Bond’s truth-telling could not be tolerated in the legislature and ejected him from his hard-won seat. Without skipping a beat, Julian and SNCC took the attack on him as an opportunity for turning the southern U.S. anti-racism movement into a southern hemisphere movement against the racist policies of the U.S. and European nations toward native, non-whites. With brilliant organizing and media work, complemented by a good legal strategy, the Supreme Court forced the legislature to seat one of the youngest state representatives in the country.

Americans are the targets of a conscious dumbing down by tea party extremists, who are dependent on their twisted versions of world events and history. Their cruel policies would be immediately rejected if our kids were taught accurate history in our public schools. This problem led to Julian's full support of the Eyes on the Prize film. But it also makes it necessary, I believe, to preface any comments about his contributions to the anti-racism movement with a review of certain historical facts, to contextualize and provide an evidentiary foundation for the statements of praise and thanks I want to make about my beloved brother. I know Julian would have it no other way.

After the 2nd Reconstruction was short-circuited by the Wallace-Nixon-Helms-Rehnquist southern strategy, Brother Bond, in 1998, was persuaded to lead 64 civil rights veterans who sit on the Board of Directors of the National Association for the Advancement of Colored People. Julian Bond never let us down in our efforts in North Carolina to revive SNCC’s strategy of non-violent direct action from the moral high ground. He gave us confidence to experiment with different ways to welcome our Brown and White sisters and brothers to the central struggle against racism. Yes, the “Black Power” slogan and its underlying theory was popularized by SNCC in 1966. But we knew it had been vulgarized by hostile national forces and media, and that SNCC itself always supported white allies, friends, and close comrades within the anti-racism movement.

In 2006 we began building the Historic Thousands on Jones Street Coalition and Julian attended several of these annual People’s Assemblies. He encouraged our State Conference to transform our once a year actions at the People’s House into once a week actions, which the media called Moral Mondays.

Now, Brother Julian, you get a well-deserved rest. You join the nine Emanuel Martyrs in the cloud of witnesses. We will keep alive your love, your humor, and your direct way of promoting justice, as we continue the Long March. You will be present within us as we walk in the NAACP’s Journey for Justice through North Carolina on the way to D.C. to demand a comprehensive Voting Rights Act, that five Justices—liquidating history—eviscerated a couple of years ago.  As the Journey passes ALEC’s offices in Northern Virginia, a factory of poisonous boiler-plates of cruel laws for southern states to pass against the poor, disenfranchised, poorly schooled, LGBTQ, labor, immigrants, women, and every group of people excluded from accumulating capital in the avaricious economic-political system that is playing its trump card once again, you will be with us. We can hear you saying from the clouds: AMERICA. Shuffle the letters and you get: I AM RACE.

Chairperson Bond. . . You are Present.

Julian. . . Presente’.

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barberRev. Dr. William Barber, II is President of the North Carolina NAACP and convener of the Historic Thousands on Jones Street (HKonJ) Peoples Assembly Coalition. The coalition is a broad alliance of more than 140 progressive organizations with over 2 million memberships to champion a 14 point anti-racism, anti-poverty, anti-war agenda. Dr. Barber and this coalition has aided in the passage of the Racial Justice Act of 2009, which allowed death row inmates to appeal their sentences on the grounds of racial bias in the court system; and successfully advocated for voting reforms such as same-day registration and early voting, and has re-framed marriage equality as a civil rights issue and helped mobilized black churches to support a ballot initiative in 2012.

In opposition to regressive policies pushed by the governor and state legislature including draconian cuts to Medicaid, unemployment benefits, and public education funding, Dr. Barber has mobilized the Forward Together Moral Monday Movement, a multi-racial, multi-generational movement of thousands for protests at the NC General Assembly the people’s house, and around the state. Hundreds, including Dr. Barber himself, have also engaged in non-violent civil disobedience to expose what the politicians in North Carolina are trying to do in the dark. Dr. Barber has written one book entitled, “Preaching Through Unexpected Pain”, and several articles and is currently working on his second book. He has been featured on Wall Street, CNN, MSNBC, the New York Times, Crisis Magazine, and has spoken, preached and lectured around the country.

Sharing your voice is easy - Just ask Laurie!

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Last week we shared the news that NIH was looking for input into their strategic plan. One of our faithful readers, Laurie Stahlecker, wrote in with the following suggestion. We are sharing our response to Laurie and the action we took to show all Network faithful that it really is easy to get your voice heard - and we will help you do that!

Laurie's note to the CMHNetwork:

  • "You need much more information on children with brain injuries. I have a child with a traumatic brain injury, and there is absolutely no help for him in Minnesota!!! I have worked with individuals that are unqualified and ignorant when it comes to TBI. Research is nil to nothing. Very disappointing." ~ Laurie Stahlecker ~

 Our response to Laurie:

  • Laurie - Thank you for being a faithful Friday Update reader and pointing out an area in the NIH strategic plan that could use improvent. The Children's Mental Health Network greatly appreciates your willingness to comment. We recognize that much more is needed to meet the needs of children with brain injuries, particularly their mental and behavioral health needs.

    Many other families express similar frustration about how little awareness there appears to be about brain injuries, particularly in the developing brain of a child, and how much effort it takes to explain the connection between the behaviors and the injury in order to get the most appropriate level of care and the services and supports that families need, no matter where they are on their journey or recovery and healing.

    Your comment inspired us to write a comment to the National Institutes of Health, calling for more research to be done on the behavioral manifestations of brain injury,  and for a faster transition of knowledge from the laboratory to the field where it can influence positive outcomes and quality of life for people living with brain injury and their families. We are encouraged by the NIH commitment to the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative and will continue to follow their findings and advocate for making brain injury and its behavioral health manifestations a research and awareness priority.

Here is what we wrote to NIH:

  • The Children's Mental Health Network strongly advocates for a concerted research emphasis on brain injury and related mental and behavioral health conditions.

    Recently much public attention has centered on the BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies) which is doing much to further scientific understanding of the human brain, and the many physiological, biological, psychological and behavioral disorders that affect it.

    Pursuing research programs that seek to translate the scientific findings of BRAIN projects into meaningful improvements in health outcomes for patients represents a compelling next step. A potential avenue through which these translational research projects could be implemented is in the area of brain injury, specifically as it relates to mental and behavioral health.

    There exists a critical disconnect in linking the incidence of any kind of acquired brain injury to cognitive, behavioral, psychological and emotional deficits. Health providers - with alarming regularity - fail to predict the long-term behavioral and psychological consequences of brain injuries. The result of this is that patients with brain injuries are only treated for mental and behavioral conditions, with little to no attention given to the potential organic causes of those conditions.

    The relationship between brain injuries and maladaptive behavioral conditions throughout childhood and adolescence has been well-documented, tracing back to the pioneering lesion studies of the 1990s up until projects falling under the umbrella of the BRAIN Initiative. The need arises to implement conclusions garnered from those studies, vis-à-vis imaging and diagnosis, risk factors, brain plasticity in development, and emotional, cognitive and psychological deficits, into substantive clinical treatment protocols that can have a tangible impact on the health outcomes of individuals with brain injuries.

    The association between brain injury and behavioral health represents a significant opportunity for bridging the gap between laboratory science and improved quality of life.

If you have something you want us to weigh in on something, let us know. This is the power of the collective voice. Let's use it!

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Where is the #hashtag advocacy for children’s mental health?

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Morning Zen Guest Blog Post ~ Lisa Lambert

hashtagsEverywhere I look, I see hashtags. They are on Twitter, Facebook, Instagram and other social networks. They help us find others who are share our interests – just look up #mentalhealthawareness on Instagram and browse through the images. Hashtags are used to promote awareness, too. “Look at this,” hashtags say, “I care about this and you should too.”

Hashtags have really caught our attention at key moments. In 2014, #BringBackOurGirls drew the world’s attention to the kidnapping of 276 schoolgirls by the terrorist group Boko Haram. Sharing #JeSuisCharlie let everyone know that you were standing with others for freedom of speech after the massacre of 12 people at the Paris newspaper Charlie Hebdo. Started in response to the trial (and then acquittal) of George Zimmerman, #BlackLivesMatter compels us to focus on systemic racism and police brutality and is one of the most successful hashtags. In our sound-bite society, hashtags can capture a thought, unify a public conversation and link us together.

But some are better than others. I am on the hunt for one that can springboard children’s mental health into everyone’s awareness. Sometimes, when families call with a heartbreaking story I think we should use #TreatmentWorksWhenYouCanGetIt or #FightingStigmaComesAfterFightingForCare. Then I realize we want to galvanize people, not sadden them.

Hashtags became truly popular after first being dismissed as too nerdy. Chris Messina, who introduced hashtags in 2007, was told by Twitter that it was never going to catch on. His original idea was to organize tweets and messages into groups so that people interested in #mentalhealth, for instance, could sort through other people’s comments and see only the ones they were interested in. It’s hard to think today of how we would do any of this without hashtags.

Using hashtags didn’t stop with grouping posts or tweets. Organizing messages is like library science. It helps us locate and gather information but then what? How do we move from informing to messages we can act on?

Almost 3 billion people worldwide are on social media every day. Some of us get our news and updates online while some simply keep up with friends and relatives. Smart, effective hashtags have a unique ability to reach tens of thousands with a quick, clear message.

Thousands have become hashtag activists, realizing early on that we can bring the public’s attention and empathy to a cause or circumstance that would have been unnoticed. Although this can create solidarity and visibility, there is debate about whether awareness can lead to significant change or move a sleeping giant. The jury is still out. What hashtag advocacy does is reframe the public conversation and perception. We have a chance to do this for children’s mental health.

We have a chance to change how people see our families – the parents and siblings of children, youth and young adults with mental health challenges. To me, they are all unsung heroes, hanging in there, innovating on some days, sighing silently on others. When NFL player Ray Rice was caught on video camera punching his then-fiance, many wondered why she didn’t leave him. Stories from domestic abuse survivors poured out on social media under #WhyIStayed which changed the public’s view.  Can we do the same for our families and create a hashtag that leads to an avalanche of stories? What about #WhyIWontGiveUp or #NotStoppingAnytimeSoon ?

Because mental health issues show up as behavior, many young people are judged, isolated and belittled. It breaks our hearts as parents to see them hurt for things they cannot (yet) manage or control. I remember having many conversations with my son’s therapist about the constantly moving line between “cannot” and “will not” and then realizing so much fell into the “cannot” category. I fervently wished I could make the light go on for others too. Can we try out #ItsCantNotWont or #WhyIWontEngage ?

Take a look at the top hashtags for mental health. Most are organized around diagnosis such as #anxiety or #ptsd. A few link to resources such as #suicideprevention. So far, organizing discussions by diagnosis and content hasn’t moved us forward. Messages have to be strong, compelling and clear. They also have to let others know that your issue should be a top priority. Does #mentalhealthmatters really make it matter more to anyone new?

We need a hashtag for children’s mental health. Even better, we need a succession of them so that when one fades away another will replace it. We need a hashtag that will change the negative media images of young men with mental illness doing violent things into an I-get-it-now moment. One that will catch the attention and energy of Americans focused elsewhere. After all, 1 in 5 children experience a mental health issue each year, which means just about everyone knows a child or youth dealing with these issues.

What’s your suggestion?  #LetsHearIt

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lisaLisa Lambert is the executive director of Parent/Professional Advocacy League (PPAL), a nationally recognized blogger on children's mental health issues, and a Children's Mental Health Network Advisory Council member. Lisa Lambert became involved in children’s mental health as an advocate for her young son in 1989 through the CASSP family network in California. After moving back to Massachusetts, she began supporting families whose children and youth had behavioral health needs. Her areas of expertise include mental health policy, systems advocacy and family-driven research.

Forgive me

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Morning Zen Guest Blog Post ~ Caroline Wolff ~

I set him up. I had promised to meet him for breakfast the next morning. In the throes of a mania so severe that it directed nearly all his actions, he somehow loved or trusted me enough to override his manic thinking and keep our breakfast date.

When the knock came on his door that morning before breakfast, it wasn’t me. It was the police. They had come to take him to a psychiatric hospital. He had told me he preferred not to go to the hospital; he had asked for more time to consider treatment options. I didn’t listen. After I called the police, I stayed far away. I made no attempt to see him. I sat outside the hospital on a curb, too afraid to face what was inside.

Several months later, a scene in a movie triggered thoughts of that day, and I began to cry. My husband guided me into the backseat of our car, where my crying intensified and spun out of control. I wiped at my face until my right hand became coated with mucus, thinned by tears and webbing the spaces between my fingers. He cupped my hand and clumsily flattened it against his lap, running it down the length of his thigh. “Here,” he said. “This is where we wipe our nose.” He didn’t recoil; he didn’t distract me; he didn’t tell me everything was OK when it wasn’t. Instead, he sat quietly and streaked his jeans with my hand, over and over. It was a gesture that convinced me that whenever I chose to leave that backseat, I could manage what came next.

The following day, I reread Leo Tolstoy’s short story “The Death of Ivan Ilyich.” In the story, a servant named Gerasim comforts a dying man throughout the particular horrors of his death. Gerasim is bright and cheerful and strong. He dresses neatly and smells good, like the outdoors. He doesn’t shirk from emptying the chamber pot. He holds Ivan Ilyich’s legs because the dying man feels better when he holds them. Gerasim accepts the ugliness of wretched illness and offers what he can to ease it because he would hope, he says, that someone will do the same for him one day. The only moments of comfort the dying man has are when Gerasim is there. 

I wish that on the day the police came, I had dressed practically but respectfully: a white button-up shirt and jeans; brown boots; a sensible, pretty watch; rose perfume—the scent the strongest woman I know wears. I wish I’d waited outside and averted my eyes at the exact moment the patient was brought out of his room. I wish I had ridden with him in the fenced-in backseat of the cop car: not staring, not pitying, not chattering nervously. Just sitting quietly, perhaps putting out my hand, now and then, to touch his arm. I wish I had walked beside him into the lobby of the hospital. Perhaps the patient would not have wanted me there. Perhaps the police would have refused to allow me to be there. But I had been too scared even to ask. So again, I will borrow from Tolstoy’s story and end, as he does, with this: “Forgive me.”

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Caroline Wolff is the author of one of the essays in the book Writing Away the Stigma.

'Defend Childhood’ to improve access to education and explicitly confront childhood trauma

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Morning Zen Guest Blog Post ~ Daun Kauffman

Millions of injured children whose pleas are not being heard are waiting at the intersection of the “Defending Childhood” Report from the Department of Justice (DOJ) and Congress’s rewrite of “No Child Left Behind” education (ESEA) legislation.

As one part of defending childhood, the children need a pivotal revision when the adults in the Senate and House work to reconcile their differences on ESEA.

While the children wait for help, other education efforts are ineffective.

Defending Childhood

The children’s injuries are captured in a term from neurobiology: “childhood trauma”.

Childhood trauma is not “poverty”.
Sometimes ‘trauma’ and ‘poverty’ are misleadingly used interchangeably. Yet, research shows that more than half of those living in poverty do not experience debilitating trauma. Poverty does have a myriad of impacts on learning to be sure, but they are not necessarily traumatic impacts.  

Childhood trauma is a response of helplessness, of being overwhelmed, even terror, from event(s) some call “Adverse Childhood Experience” (ACE): Physical Abuse, Emotional Abuse, Sexual Abuse, Physical Neglect, Emotional Neglect, Single Parent Home (due to separation, divorce, or incarceration), Household violence, Community violence, Household substance abuse, Household mental illness.

The magnitude is staggering. The DOJ Report described it as an “epidemic” back in 2012. Even earlier, back in 1979, the Surgeon General termed it a “national crisis”.   In spite of the stunning scope, and life altering power, children are still being hurt today. To them it must seem like a never-ending nightmare.

We do know how to help.

Instead, at this particular intersection today, where children attempt to “achieve” in elementary and secondary school classrooms, the nightmare continues, and can often be worsened.

Congressional contact info is linked at the end of this blog, for those who are immediately ready to speak for the children.

Wide Scope:   All Neighborhoods
Public health research
by the CDC reveals devastation that is no respecter of demographics, zip code or socio-economic status.  Specifically, researchers found that even in beautiful suburban San Diego, roughly one-fourth of the mostly middle class, mostly white, working folks with medical insurance had experienced 3 or more ACEs!

The wide scope varies in a shocking range from 22%  to  greater than 45% of children impacted by 3 or more categories of trauma — in many school districts the scope is greater than English Language Learners (ELL) or those with an Individual Education Plan (IEP). In some urban locations (pg. 17 map) the prevalence is greater than ELL and IEP students combined!  Each of those impacts is acknowledged and accommodated and funded.  Not childhood trauma.

Three or more ACEs is significant because experiencing 3 or more ACEs correlates with doubled risk of depression, adolescent pregnancy, lung disease, and liver disease. It triples the risk of alcoholism and STDs.  There is a 5X increase in attempted suicide. It doesn’t just go away. Later, if unaddressed, it results in work absenteeism and lost productivity, measured in billions of dollars. The CDC also found a “strong correlation between the extent of exposure to childhood ACEs and several leading causes of death in adulthood. . .”

 

 

 

 

 

 

 

Center for Disease Control

 

 

 

 

 

 

 

Deep Impact:   Life Changing
The deep impact of childhood trauma changes children’s physical brains, and impairs their cognitive and social functioning and ultimately their life trajectories.

The neuroscience is compelling.  Childhood trauma connects directly to education via its toxic stress effects on development of the physical brain.  When children live in a chronic, traumatic state of survival, the unresolved toxic stress damages the function and structure of their still-developing brains. These injuries relate specifically to the prefrontal cortex and academic processes, especially executive function, memory and literacy.

The physiological process also leads kids to distorted perceptions of social cues, which alter their social behaviors in response.  Eminently logical defenses in the midst of trauma (hyper-vigilance, dissociation) become ingrained habits, and then destructive, once the threat is extinguished, but the defense pattern remains.

Neurobiology tells us that for the 22% to 45+% of children who are overwhelmed by a state of chronic, or complex trauma, it is physiologically impossible to learn. “Equal Access” requires significant accommodations.

Without the accommodations leading to equal access, children risk having their traumatic experiences re-triggered and further embedded neurobiologically.

Instead of repair, more damage.

Frontline  Perspective From the Classroom
Schools could be safe and even restorative. Instead, the childhood trauma crisis disrupts all schools at times.

At best, trauma-impacted children are invisible in the data and analyses (Try asking for ACE-adjusted, test data). At worst the data is outright misleading, especially for our understanding of academic results including “standardized test” results. The results are a confused, meaningless “average”, including epidemic numbers of trauma-impacted students in defensive “survival” mode with muted cognition.

Pivotal decisions such as ESEA revisions are then based on these deceptive data.

Preparing individual “Section 504” plans for individual children does not address system-wide needs and is not a practical option, given the scope: millions of students.

A successful education paradigm requires: a) explicit acknowledgement of childhood trauma, b) screening students, c) training teachers and d) creating “safety” across the learning environment.

Screening students can be as simple as using the “ACE score” derived by counselors as part of annual school registration or re-registration. A wide range of other screening measures is available at the National Child Traumatic Stress Network website.

Confronting the learning impacts and the classroom impacts of trauma requires training. The most efficient approach is through teachers, “first responders” in the classroom, who see the children daily. Training must be an on-going requirement to: 1) deliver “safety”, 2) understand complexity of teaching trauma-impacted children, and 3) respond appropriately, including avoiding re-triggering old trauma.

Other crucial investments towards safety include appropriate class-sizes, with limits on trauma-impacted children per classroom.  For example, one teacher alone will struggle to be effective aiding one ‘triggered’ student from among the 10 who have 3+ ACEs, within a classroom of 30 kids, total, who are waiting to be taught. Additionally, dedicated appropriate space for children to de-escalate is needed, as well as on-site counselors; counselors, who build on-going relationships with the children and families in the school community.

“We must not look the other way”
A common sense revision to ESEA.

The intersection of childhood trauma and our educational system is the most accessible entry-point to this horrific national crisis.  Virtually all children in the USA traverse some school every weekday.

Traumatized children lose equal access to education without accommodations.

Further, “Childhood trauma” is the missing, macro factor in education which has been blurring our interpretation of results for all micro programs. Meanwhile, we continue pouring billions into education program “buckets” oblivious to the gaping trauma holes in the bottom.

Now, with the ESEA rewrite, we have a choice to ‘Defend Childhood’, to improve access to education and to bring clarity to results, by explicitly confronting childhood trauma. That, in turn, will lead to more equity in education, and better social and financial productivity for our nation.

Ask your Senators and Representatives to add this crucial factor in their revisions to ESEA.

Click the ‘OpenCongress’ link to get names of your Congress members. Click on individual name and find contact information on right side of screen. Email or call them today, or send them a link to this blog about revising ESEA.

Defending Childhood

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Be sure to follow Daun Kauffman at lucidwitness.com

daun

Daun Kauffman has been teaching in Philadelphia public schools for 14 years. "I live, and work, and worship in the Hunting Park neighborhood of north Philadelphia, with students we’ve served. The Philadelphia Inquirer has described the neighborhood as 'a gritty, drug infested barrio'. Nevertheless, my neighbors and students are steadfast, creative and inspiring in the way they wrestle with many life challenges. They have taught me much." 

Sure, Congress can “fire” SAMHSA Administrator Pam Hyde, but is it the right thing to do?

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Note: This Morning Zen post is part of an ongoing series that is exploring specific areas of H.R. 2646 that will need to be addressed in order to create a mental health bill that reflects the full range of needed services and supports to help those with mental illness thrive in the community.

~ H.R. 2646 (The Murphy Bill) attempts to address a management issue through legislation ~ 

For the past two years, there has been a constant drumbeat from members of Representative Murphy’s committee that the Administrator of SAMHSA had been a major obstacle to getting committee questions answered about how SAMHSA approaches its responsibilities. Read our review of the recent hearing featuring Administrator Hyde testifying in front of the House committee and you will get a good feel for the level of animosity expressed during the hearing. It is clear that there was no love lost on either side.

Unfortunately, this frustration with Administrator Hyde also shapes the structural foundation of H.R. 2646, creating an approach to mental health reform that, while full of claims of how the "broken mental health system" will be fixed with its passage, is woefully out of touch with the complexities of the mental health service delivery system at the local and state level. (Read our detailed analysis here.)

Frustrated as they might be, Congress can’t “fire” Administrator Hyde, as the separation of powers between the executive branch and the legislative branch dictates that while Congress has the authority to investigate and allocate funds, the power to replace senior leadership is the purview of the Executive Branch. However, there is nothing to stop Congress from abolishing the position of the SAMHSA Administrator. No position, no Hyde.

Assistant Secretary position
Here is the language in the bill that will effectively give Administrator Hyde her pink slip (H.R. 2646, page 14, line 12):

  • SEC. 102. TRANSFER OF SAMHSA AUTHORITIES. IN GENERAL.—The Secretary of Health and Human Services shall delegate to the Assistant Secretary all duties and authorities that— as of the day before the date of enactment of this Act, were vested in the Administrator of the Substance Abuse and Mental Health Services Administration; and are not terminated by this Act.

In the recent hearing on H.R. 2646, Congressman Murphy said the creation of the Assistant Secretary position would "elevate [the position] in terms of authority (2:28 mark in the video). However, the job duties of the proposed Assistant Secretary are eerily similar to those of the current Administrator. Attempting to further clarify both the rationale behind the creation of the Assistant Secretary position and plans for SAMHSA as an agency, Representative Collins (NY) stated that "no one is suggesting SAMHSA go out of business, but a rebalancing necessary."

Regardless of where you stand on the effectiveness of SAMHSA Administrator Pamela Hyde, addressing those frustrations by attempting to legislate a management issue is just plain wrong, bad law and bad practice.

It may be wrong, but precedence does exist
In 2006, the mid-term elections were coming, and there was mounting frustration with Secretary of Defense, Donald Rumsfeld. Politicians on both sides of the aisle were using him as political chum, and the calls for his removal were getting louder and louder. But, what could they do? During that tumultuous time, Michael Dorf, then a professor at Cornell University Law School, provided a beautifully concise description of how, with just a bit of sleight of hand, Congress could get rid of Rumsfeld. Dorf included historical context for this type of chicanery, going all the way back to the full-scale sacking of federal judges during the transition in power between John Adams and Thomas Jefferson.

  • "Still, there is a precedent for just this sort of end run. Following the defeat of John Adams and the Federalist Party by Thomas Jefferson and the Republicans in the election of 1800, Adams and the lame-duck Federalist Congress created new federal judgeships, and packed the courts with Federalists before the change in power. After they took office, the Jeffersonians simply abolished the new federal judgeships. With no judgeships to fill, the Federalists ceased to be judges."

Dorf concluded his essay in 2006 by questioning whether or not Congress should use such measures to appease personal frustrations with appointed officials in the Executive Branch.

  • "There's an irony for you. With the nation's security at stake, and with Congressional Democrats and Republicans increasingly united in their displeasure with Rumsfeld's conduct of the war, whether he stays or goes should be anything but a political question."

If the Jeffersonians could do it in 1800, why shouldn’t the architects of  H.R. 2646 do it now?
Building a bill from a frustration about the job performance of the SAMHSA Administrator narrows the lens of objectivity to one of partisanship and personal agenda. Ironically, should this bill see the light of day and pass, by the time it does there will be a new administration and Pam Hyde will have moved on to other, less headache-filled adventures.

The question we need to ask ourselves as advocates, and then ask our elected officials, “Is this the most prudent way to deal with a management issue?”  Do we need an “extreme makeover” because we are frustrated with the SAMHSA Administrator? Is this the way Congress should address frustration with Executive Branch management issues in the future?

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scott

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network

Gang abatement? Is it possible that school climate and the conditions for learning could reduce violence?

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Morning Zen Guest Blog Post ~ Kevin Dwyer

Is it possible that teaching social skills – combined with the other conditions for learning (CFL) such as connection and caring - could reduce juvenile delinquency, violence, gang membership and even radical affiliations with groups like white supremacists and jihadists? As yet we don’t know but this may be a logical hypothesis worth testing.  We know from long term research that SEL skills have life-long preventive and positive outcomes.  

A well publicized research article (see: Washington Post, July 17th, also highlighted on the PBS Newshour July 16th, and the NY Times July 24th.) one (Washington Post) titled, “Kindergartners” social skills may predict success” may give credence to looking at such potential longitudinal research outcomes. The researcher, Damon E. Jones[1] of Pennsylvania State University lists the social skills of kindergarteners as a good predictor of very long-term academic and social success. Kindergartners who demonstrated skills (as reported in ratings by teachers) such as empathy, listening, problem solving, cooperation and sharing in kindergarten - and the lack thereof, were followed for two decades looking at graduation rates, police records, reports from parents and self reports. Findings for the 753 subjects, controlling for numerous social/economic, ethnic variables, resulted in findings such as, “children who scored well (high) in social skills were four times as likely to get a college degree…”  These highly social skilled children also were more likely to be full-time employed and less likely to be arrested, whereas those with low social skill ratings were more likely to have lower employment and higher chances of being arrested. This study looked at naturally developed social skill mastery rather than a longitudinal study that involved SEL instruction.  The study does confirm the critical importance of social skill mastery for success. The authors of the study also suggest that the findings can identify early (kindergarten/preschool) students who could benefit from interventions to remediate their social skill deficits and reduce negative long-term outcomes for those children.

Outcome measures for social skill instruction have been shown to be positive in academic and behavioral results, including improved attention span, reading scores, attendance and, yes social skills (see the CASEL.org website).  

So, can SEL instruction and other resilience building CFL methods reduce gang affinity and violence? I don’t know, but there are some studies that imply “Yes.” Take lowered juvenile arrest rates of identified at risk students being lowered by participating a first grade classroom positive behavior game.  The decades long study of the “Good Behavior Game” [2](GBG) showed that this first grade classroom behavior management activity reduced the teenage arrest rate of participating students, who were already identified as having problem behaviors, when compared to similarly identified  students who did not experience this preventative intervention. In other words a simple classroom team structure that enabled first graders to compete at being “good” had a life-long positive impact! The boys in the study identified as behaviorally at risk in first grade were followed throughout their schooling and into adulthood. As young adults, they (males in the study) had significantly fewer arrests for violence than the matched control group that did not participate in the GBG or received added reading support. Further research showed that their drug use was also lower. One might suppose that they were less likely to be violent gang members as well but this was not measured. Other programs build on this strategy and replicated the positive outcomes, particularly for behaviorally troubled males. The GBG is an example of positive discipline and social skill development, and a components of the conditions for learning. The GBG study was a one-year, first grade intervention. Imagine the GBG combined with SEL instruction and other preventive, resilient-building interventions such as those that enhance connection and caring.  

Connection and caring are another condition that frequently is thought of as components of a “safe and effective schools.” Positive, active connection to school through participation in extracurricular activities has been known to significantly improve attendance, graduation and positive behavior.  Class meetings, advisories have also helped ensure connection and caring.

I am unsure if lowered gang membership or radical group affiliation have been outcomes measured in that research. Caring and connection have what we call “face validity” in that it makes sense that students who are known and are cared for (treated with respect and valued) are less likely to seek out affiliation with such radical groups.

Maybe someone is already doing this research. If not the federal government should be funding such important gang, violence and security measures. I would love to hear that we are looking at the long-term impact of connecting with our children and youth and giving them life-long social/emotional success!


References

[1] Damon E. Jones, Mark Greenberg, and Max Crowley.  (2015). Early Social-Emotional Functioning and Public Health: The Relationship Between Kindergarten Social Competence and Future Wellness. American Journal of Public Health. e-View Ahead of Print. doi: 10.2105/AJPH.2015.302630   

[2] The Good Behavior Game and the Future of Prevention and Treatment  Sheppard G. Kellam, M.D.,1 Amelia C. L. Mackenzie, B.S.,1 C. Hendricks Brown, Ph.D.,2 Jeanne M. Poduska, Sc.D.,3 Wei Wang, Ph.D.,4 Hanno Petras, Ph.D.,5 and Holly C. Wilcox, Ph.D.

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dwyerKevin P. Dwyer, M.A., a Nationally Certified School Psychologist, is an education and child mental health consultant. He recently served as a principal research associate for the American Institutes for Research. For over 30 years he practiced school psychology in public schools and held several local, state and national leadership positions in the fields of mental health and education, being responsible for the design, development, implementation and evaluation of programs and practices, for improving school climate, safety, and well being for the education, and mental health of children. He has helped school staff in many districts use data to inform decisions on improving caring and connectedness with students and professional peers.  His work, publications, presentations, and practices have influenced public policy and the development of efficient, family-focused collaborative child service systems. During his 30 years as a public school psychologist, he worked directly with over 10,000 children and their families as well as trained over 6000 educators. He provided psychological services to children, including those with disabilities and those whose anxiety and mental health problems blocked learning and adjustment. He assisted teachers and staff in supporting a caring, inclusive school climate for all children. In 2007, the Maryland Coalition of Families awarded Mr. Dwyer and his wife for their work in making schools more family friendly. He served as president of the National Association of School Psychologist and was given its highest honor, the Life-time Achievement Award. In 2000, he received the Tipper Gore “Advocacy award for improving the lives and mental health of America’s children” from the National Mental Health Association.

Winter Break

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Morning Zen Guest Blog Post ~ Lauren Shapiro ~

It was nine o’clock on Christmas morning, and I was putting on my bathing suit at the Rincón Beach Resort in Puerto Rico when my phone rang.

“Dad’s gone again,” my sister said. “He left another note.”

A tunnel opened up inside my head and began sucking up everything in the room: the torn gift wrap on the floor, the scattered toys, my husband, Kevin, who was struggling to get our one-year-old son into swim trunks.

“What did it say?” I managed.

“That it was no one’s fault.” I hung up and collapsed onto the bed.

“He’s going to do it this time,” I said, the tears coming on now.

Kevin paced the room. “The fuck were they thinking, calling you?” he yelled. He picked up his phone and began to text my sister.

“Stop, stop, stop,” I said, burrowing in deeper. The room was the tunnel, and I was part of it. The boundaries of objects evaporated.

 “We’re two thousand miles away! It’s Christmas!” he said. “What the fuck do they want you to do? Sit and cry in a hotel room?”

“He’s doing it,” I said. “I know!”

“No, he’s not. He doesn’t have the balls.”

I was suddenly aware of our son, Javi, half dressed and clutching a pacifier in each hand, staring at us. Had I ever cried in front of him? I wiped my face.

Because there was nothing else to do, we went down to the pool.

***

Our friends Dan and Becca, just married, had joined us for Christmas, along with my in-laws, who live in Puerto Rico. Kevin’s parents had divorced, but the birth of Javi, their only child’s son, seemed to have brought them closer together. The resort was small, a hotel really, but the pool sat right next to the beach and featured a small and very infrequently staffed bar. There was a kiddy pool, a hot tub, a giant chess board, a ping-pong table without paddles.

The place was almost empty, save for another family that I recognized from yesterday. Kevin had pointed out their little girl, roughly four years old, who’d refused to let Javi play with her toys. “That girl will grow up to be what we call a comemierda,” he’d said, “a spoiled brat. Just look at her.” She was dressed similarly today: a sparkly pink bathing suit, matching water shoes, elaborate hair bows, a glittery star sticker stuck to her cheek. And she was surrounded by intricate water toys: boats with removable plastic people and doors that opened and shut, large dolphins and whales that squeaked and spouted water, a floating island with palm trees and a treasure chest. I set Javi down next to his own paltry selection: a cheap plastic boat, a few squirt toys. He immediately went for the girl’s dolphin.

“Mami, no! It’s mine! He can’t play with it!” the girl whined in Spanish, looking at her mother and pointing at my son. My phone rang. I let Kevin deal with Javi.

***

“He’s alive,” my sister said matter-of-factly. “Dan found him on a ledge at the top of the Air Rights Garage. He pulled him in and held him until the police arrived.”

I pictured my slender twenty-six-year-old brother dragging our father over the concrete divide of the garage and pinning him to the asphalt. Less than a month before, on his previous attempt, my father had gone to that very same spot. He’d left a note at home then, too, and while Kevin and I and the police raced around New Haven—looking for his car, trying to track his phone, texting and calling him endlessly—he was trying to find places from which to jump: the bridge (under construction), an icy lake, and finally the ten-flight Air Rights Garage. After nearly six hours, something—I can’t imagine what—must have clicked off in his mind, and he turned the key in his car’s ignition and descended the ramps out of the garage. When he got home, he stumbled out of the car with a Ziploc bag in his right hand, his wallet sealed inside it. He’d be committed to the very hospital where he worked as a pediatrician. They’d only keep him for three nights.

Kevin and I had just moved from Madison, Wisconsin, to Hartford, Connecticut, and it was a move I was beginning to regret. After a few difficult months of living with my parents, we’d rushed into buying a house we couldn’t afford; Javi was not taking well to daycare; and I was busy teaching at a local college and working through the final edits on my first book. Our move to Hartford had been influenced, in part, by the idea of being closer to my parents after Javi’s birth. But distance had perhaps led me to minimize the depths of their issues with mental illness, and I soon found myself thrust suddenly into this caretaker role, striving as best I could to bring an elusive happiness and order to their complicated psyches. My siblings, both of whom live in California (“I wonder why!” Kevin would joke), had come to Connecticut for the holidays so we could take a break. For the past five months, I’d been looking forward to nothing more than sitting on the beach and reading gossip magazines, of playing with Javi in the sand, of sipping piña coladas with our friends.

Dan came on the phone and related today’s scene: “I snuck up behind him and just bear-hugged him, started yelling, ‘Dad, it’s me, Dan!’ He tried to unzip his jacket. He told me to let go, that he’d come back in. I was like, ‘Are you fucking kidding me?’ I don’t know how, but I just pulled him over and started yelling for the police, who were on the ground. I just held him until they came up.” He was breathless, pumped.

“Are you all right?” I asked.

Me?” he said. “Are you kidding? I’m a fucking rock. I’m fine.”

***

By the time I got back to the pool, the little girl had moved all of her toys back up to her lounge chair, and Javi was paddling around with Kevin. Our friends were in the pool as well, along with Kevin’s mother. His father had come down from his room and was parked at the bar, smoking a cigarette. The bartender, as usual, was nowhere to be found.

“Hello?” Kevin’s father yelled. “Anybody? Should I just get behind there and make myself a drink?”

Eventually a young man sidled in behind the bar and nodded.

“Cuba libre,” Kevin’s father said.

It started to rain. I sat beside him at the bar and ordered a scotch on the rocks.

***

The mother of a close friend of mine had been diagnosed the previous week with Parkinson’s disease, and another friend’s father had recently entered hospice with a terminal case of colon cancer. These were terrible illnesses, the parent wasting away, not wanting to go. Despite the emotional toll this must take, it seemed to me an uncomplicated kind of mourning—two people wrested away by a body’s breakdown. People offered public condolences, posted on Facebook. I had told next to no one about what was happening to my family, what had been slowly and painfully happening for months and months, during which I had been desperate to fix things. I brought my son to see my father at every opportunity, called my father’s psychologists and psychiatrists with worried anecdotes, confronted my mother about her needy behavior, scanned lengthy articles on the Internet, planned elaborate family trips we all knew would never happen. If my father had been diagnosed with a physical illness, even a terminal one, I could have accepted it, been open with people about it.

Instead, I took his recovery onto myself, feeling acutely and privately responsible. If only I did this, if only I did that. Was he in a slightly better mood today? Could I somehow get my infant son to lift his spirits? It was a never-ending dance, an impossible choreography, and he wasn’t even looking. Month after month, my father had wanted to die, had been obsessed with it, but he was still here—wasn’t he? “You kids kept him alive,” my mother had said. “You’re the reason he couldn’t bring himself to do it.” But was this a blessing or a curse? Had we been his saviors, or had we been some kind of tragic impediment, willing him to remain alive in endless, guilty misery?

My father had been the oldest of five, but only three were left. One of my uncles had been schizophrenic and off his medication, and had asphyxiated himself with a plastic bag in his early twenties. Terrible as this was, there was a medical explanation, a diagnosed illness with a name and an appropriate course of action that had not, tragically, been followed. Another uncle, Danny, had fallen prey to a more complicated depressive illness. Afterward, they’d found lists—pages and pages long—of everything he’d felt he needed to accomplish in a given day. Clearly, there was a deep obsessive streak, perhaps OCD, like my father suffered from. Danny had apparently paced back and forth on a bridge in San Francisco for hours before throwing himself off, landing on a red playground slide below.

In both cases my grandfather had visited his sons several days before their deaths, assuring everyone when he left that they were fine. How is this lack of awareness possible? Had my grandfather done all he could? Had he unknowingly pressured his sons into feigning health? There is something mystical about the force of positive thinking, that dull beacon of hope that gets people through difficult times. On the flip side is the blade, the willful ignorance that keeps someone from seeing the terrible reality in front of them.

***

After his second suicide attempt, my father was diagnosed with a severe form of agitated depression that had been worsened by the high dosage of Prozac he was taking. He’d padlocked his computer in an attempt to keep the CIA away from his investment information, and he was convinced that the American Medical Association was on the brink of revoking his medical license because he’d written himself a prescription, left unfilled, for tranquilizers. My mother caught him looking at website articles with names like “How many Tylenol does it take to kill yourself?” and “How to commit suicide but make it look like an accident,” which prompted one of many phone calls to his doctors. My parents had been having serious relationship issues after my mother’s own semi-breakdown seven months earlier. On Father’s Day, two weeks before Kevin, Javi, and I were supposed to move in with them (and as we searched for more permanent lodging), she’d sent a rambling, incoherent email to us, her children, explaining that her marriage was a sham and that she had taken enough pills to kill herself. When I couldn’t reach her, I called 911; the police found her hiding in my father’s room. My father was on vacation in Turkey with my brother, and when I Skyped with them to tell them that Mom had been taken to the ER, they appeared onscreen in a cave à la Osama bin Laden hideout. Stalactites dripped in the dim background of the screen, and my father’s bearded face hovered in the abyss.

“Jesus, where are you?” I asked.

“In a cave hotel in Cappadocia—asleep,” he said.

“Did you get my email?” I said quickly. “Mom’s on her way to the ER.”

There was a pause. “What do you want me to do about it?” he said flatly. “You know she’s always creating drama.”

I was stunned. What did I want him to do about it? I guessed I wanted him to come home immediately, as I was living halfway across the country with a six-month-old, a job, a house to sell, and a move to prepare for. They did come home, of course, and indeed it all turned out to be a hysterical, desperate plea for attention on my mother’s part. The damage had been done, though—my father slipped into a deep depression as he sifted through the wreckage of his perennially unhealthy marriage, the loss of his brothers, his dwindling place at work, his lack of future prospects.

***

What was going through my father’s head in the months of deep depression and despair before his suicide attempts? What had led him to leave the hospital the first time, assuring everyone he was fine, all the while planning a second attempt? He had emailed my mother, the first time, a one-liner that said, simply, “Look in the bag behind the computer.” There my mother found a brief suicide note that my father later admitted to having put there months before. How had he gone about his days, seeing patients, getting dinner with us, playing hollowly with my son, all the while desperately hatching these plans? I can’t know what my father was feeling, but it must have been comprised of blinding terror, guilt, self-hatred and wells of despair I can’t begin to fathom. Whatever it was had taken him not only from us, his family, but also from himself.

***

My father has never been one to discuss more than pleasantries and mundane daily details, even with his children. He will chide me for not maintaining adequate records for tax write-offs or ask what my son has done that day. If you try to ask him a question—about work, about how he’s feeling—the answer is always “fine.” Once, though, a few years ago, he was driving me back to the airport at the end of a visit so I could fly back to graduate school. The air had been mostly dead, the car silent for much of the drive, neither of us offering much, as was our way.

Suddenly he said, “You know, I’ve carried a lot of guilt since my brothers’ deaths.”

We were two minutes from the airport, and in the shock of the moment, all I could do was offer a generic remark.

“Even though it’s not your fault, it must be really hard to live with that.”

We pulled up to the terminal, and I got out of the car. I was shocked by my father’s sudden admission, so unlike him. He’d recently started therapy, so I guessed that this must have been one of the first things they’d talked about. But as I sat at the gate, rethinking everything I could have said, I became irritated. Why had he chosen that moment to delve into such deep psychological terrain when I’d been visiting for two weeks? In retrospect, could I have done something then to steer him on a different path? Maybe this had been his way of beginning to crack through his wall of pleasantries, the artificial bubble that seemed to envelop him wherever he went: I’m fine, that almost religious family refrain.

***

I spent Christmas afternoon getting drunk on the beach in the rain as my husband and our friends gingerly followed suit. My mother-in-law had taken our son in for his nap, and Kevin’s father had gone to his room. After my fifth scotch, things didn’t seem less dreary or strange, but I was laughing a little wildly now.

“Hey guys, look at that couple—they must be on their honeymoon—how cliché!” I said loudly, pointing to a guy and girl in their twenties who had buried each other in the sand. “There goes the comemierda!” I said, as the family with the little girl packed up their things, looking at us strangely.

“Shhh,” Kevin said. “Hey, maybe you should slow down a little?”

“Why? It’s fucking Christmas. We’re on a tropical island. Didn’t we come here to have fun? What’s wrong with you guys?” I said. “Another round?” Our friends were smiling a bit nervously, clearly caught in something they hadn’t bargained for.

“I might just have a water,” Becca said. “Can I get you one, Lauren?”

“Oh God,” I said. It was all hilarious—Christmas, my family, the tropical paradise, the rain, everyone tiptoeing around me like I was an invalid. “Seriously, guys? Fine, I’ll stop. There’s no service anyway.”

The bartender had indeed disappeared again, and as time passed, my dark humor blanched into a feeling of incredible nothingness. Not numbness, just nothing, anywhere, for miles around. My phone lay silent as well.

Any holiday in Puerto Rico is a good occasion for fireworks, apparently. That night at the Rincón Beach Resort, the sky came alive with them, like small explosions of mercy. Because we were on the sparsely inhabited west coast, absent were the familiar honking and screaming we would have heard in my mother-in-law’s condo just outside of San Juan. We were secluded, incubated in an alternate tropical world that sent out streaking flames of celebration everywhere I turned. He’s alive! He’s alive! He’s alive!they seemed to say, over and over, so that the phrase eventually lost all its meaning and became just a wave among the others, lapping up to the deserted beach.

* * * * *

Lauren Shapiro is the author of one of the essays in the book Writing Away the Stigma.

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