Catholicism, Attachment theory, and the Mental Health of our Students Catholic Association of Religious and Family Life Educators Ontario Dr. Phil Carney May 12, 2011 psychbus@cogeco.ca CARFLEO! “How does our Catholic faith tradition inform our understanding of and approach to the mental health issues of youth?” Email from Bronek Korczynski, January 20, 2011 Dear Ruben: allexperts.com/q/Catholics-955/2009/3/Mental-Illness-Deliverance.htm I am sorry to hear about your and your son's affliction. We will pray for your and your son. You can know that God accepts your offering of your suffering and that suffering is redemptive because God and the Church teaches that.... While it is technically possible that a person can be afflicted with a demon that causes some symptoms of mental illness, there will be more than that usually to indicate a demonic involvement. Mental illness is usually caused by brain chemistry issues. Also, mental illness tends to run in families. Beautiful document Could quote from every paragraph APOSTOLIC LETTER SALVIFICI DOLORIS JOHN PAUL II ON THE CHRISTIAN MEANING OF HUMAN SUFFERING Story of Job – problem of evil Christ’s sufferings – redemptive, and we are not defeated Good Samaritan Beautiful document Could quote from every paragraph The parable of the Good Samaritan belongs to the Gospel of suffering. For it indicates what the relationship of each of us must be towards our suffering neighbour. We are not allowed to "pass by on the other side" indifferently; we must "stop" beside him. Everyone who stops beside the suffering of another person, whatever form it may take, is a Good Samaritan. This stopping does not mean curiosity but availability. It is like the opening of a certain interior disposition of the heart, which also has an emotional expression of its own. A template, perhaps? Catholic Psychotherapy Association “As a long time therapist with a re-awakening of my faith, I was keenly aware of how (important ) Christ’s love is to the healing of the human heart. I felt incredibly alone with my desire to put this into the therapy I was doing, especially working within a Catholic Church.” Sandra McKay, President Reported in Denver Catholic Register, April, 2009 Let’s get our bearings...... ROLE OF CATHOLIC EDUCATION “In our own time, we hear a great deal about work being done in Ontario’s schools to create ‘schools of character.’ Society can only benefit from such efforts. At the same time, however, Catholic schools must continue to be schools of transformation, transforming not only students but society as a whole, into the image of Christ.” Catholic District school Board of Eastern Ontario “If you have a strong commitment to Catholic education........” Let’s get our bearings...... THE CHALLENGE FOR CATHOLIC SCHOOLS Dennis Murphy The challenge is to announce anew and in contemporary fashion the Christian and Catholic answer to the perennial search for our souls .... (Note: ie, there are others out there doing the searching. We better have answers! We have better answers!) The goal here this evening - The Catholic ‘brand’ and the brand loyalty challenge - Locate mental health issues as developmental issues, which are in turn Attachment issues - Show how you can intervene most effectively on mental health issues through your Attachment relationships with your kids - To show how our Catholic faith tradition brings Attachment theory to life in a way the clinical world cannot Here’s the challenge. Catholics in every profession live in culture of THE AGE OF ENTITLEMENT See in parish context. Selective self-exemption from .... -Catholic Mission Statements (hospitals, school boards, etc) -Church teachings -Practice of the faith -Specific needs of the kids (ie, passing by on the other side’) Not alone with the temptation Shoeless Joe Jackson President of Ford Motors ”SAY IT AIN’T SO, JOE!!” White Sox lost the 1919 World Series to the Cincinnati Reds How long was that Lexus in the parking spot of the President of Ford Canada? What if a Catholic teacher worked with kids in an environment committed to “..transforming ... students... In the image of Christ” but Quietly was loyal to a different team – or no team Chose not to display the brand Teaching in a Catholic school does not make you a Catholic teacher. - Just saying. National Institute of Mental Health (U.S.) Research shows that half of all lifetime cases of mental illness begin by age 14.1 Scientists are discovering that changes in the body leading to mental illness may start much earlier, before any symptoms appear. http://www.nimh.nih.gov/ Mental heath issues - data Centre for Addiction and Mental Health 2006 About 1 in 5 children and adolescents in the US, symptoms mental health disorder, in given year, and about 5 in 100, serious emotional disturbance with functional impairment. Canadian children and adolescents: prevalence of a mental health problem ranges from 18 to 22 per cent, and is about 25% among young adults. Suicide, third leading cause of death, Canadian/ US adolescents (after mva and other accident deaths). Prevalence of mental health problems among young people may be increasing (Adlaf et al., 2002). The Mental Health Foundation: mentally healthy individual is one who can: -Develop emotionally, creatively, intellectually and spiritually; -Initiate, develop and sustain mutually satisfying personal relationships; -Face problems, resolve them and learn from them; -Be confident and assertive; -Be aware of others and empathise with them; -Use and enjoy solitude; -Play and have fun; -Laugh, both at themselves and at the world. MHS Evidence Jan 2011 Quick tour through some of the diagnoses you will deal with, and that compromise child development Depression Persistent sad mood; Loss of interest or pleasure; Restlessness, irritability, or excessive crying; Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism; Sleeping too much or too little; Appetite change; Decreased energy; Thoughts of death or suicide, or suicide attempts; Difficulty concentrating; Persistent physical symptoms that do not respond to treatment. While adults may experience depressed mood, children and adolescents may display more irritable than depressed mood. An adult who is depressed may experience weight loss. Children, however, may not gain the expected amount of weight for their age. All About Depression.com May 2002 Quick tour..... Childhood Anxiety Disorders -Anxiety disorders: most common form of psychopathology in children with an overall prevalence rate of 8–10% . -Generalized anxiety disorder, separation anxiety disorder, and simple phobia are among the most frequently diagnosed (3,24). -Childhood anxiety disorders are often associated with other childhood anxiety disorders and with depression. It is extremely important ... to be aware of these. Susan Jo Perlmutter, M.D. 2000 Quick tour..... Childhood Anxiety Disorders Susan Jo Perlmutter, M.D. 2000 BEHAVIORAL INHIBITION -tendency to withdraw when exposed to unfamiliar situations ; SEPARATION ANXIETY DISORDER -become extremely distressed when separated from a parent; PANIC DISORDER -recurrent and unexpected panic attacks - discrete period of intense fear or discomfort SELECTIVE MUTISM -manifestation of a shy and inhibited temperament and may be a variant of social phobia. OBSESSIVE-COMPULSIVE DISORDER -recurrent obsessions or compulsions that are time consuming or cause marked distress or impairment. Quick tour..... Not a diagnosis, but a condition you will see a lot of: ANXIOUSNESS The child or youth is unsure of him/ herself, Is defensive, won’t admit to things, Everything is a justice issue, Takes things personally, Reluctant to try new or hard stuff, Makes fun of other people, Reluctant to join in File under: Attachment issues Quick tour..... Bipolar Disorder What Distinguishes Bipolar Disorder from A.D.H.D. and O.D.D.? Research has shown that approximately 7% of children attended by physicians at psychiatric facilities can be categorized as bipolar. According to the American Academy of Child and Adolescent Psychiatry, up to 30% of the 3.4 million children and adolescents with depression in the United States may actually be experiencing early onset of Bipolar Mania. HelpYourChildWithAnger.com 2008 Quick tour..... Bipolar Disorder What Distinguishes Bipolar Disorder from A.D.H.D. and O.D.D.? While hyperactivity may exist in all three conditions, intense mood swings are more indicative of manic-depressive syndromes. Bipolar children seem to be in a chronic state of alternation between abnormal behavior and normalcy. This kind of mood and behavior changes is not present in other behavioral issues. Another difference is a decreased need for sleep in bipolar children.They are usually insomniacs requiring fewer than 5 hours of sleep. They also do not seem to suffer from consequences of sleep deprivation. When manic, their energy level seems unquenchable. A third difference is the presence of manic elation which often takes the form of uncontrollable and hysterical laughter for no apparent reason. Episodes of elation can also appear as unusually risky behavior undertaken because of a grandiose concept of an invincible self. A fourth presiding symptom is rapid and incessant talking without listening to what others have to say. Quick tour..... Personality disorders Personality traits are enduring patterns of perceiving, relating to, and thinking about the environment and oneself. When significantly maladaptive and causing serious functional impairment or subjective distress, they constitute a personality disorder. Personality disorders are not formally diagnosed in patients younger than 18 years because of the ongoing developmental changes. Medscape Updated April 8, 2011 Quick tour ..... Conduct Disorder has been associated with: Child abuse, Family conflicts, Genetic defects Parental drug addiction or alcoholism, Poverty More common among boys. Prevalence? Qualities necessary to make the diagnosis (such as "defiance" and "rule breaking") can be hard to define. Behavior must be far more extreme than simple adolescent rebellion or boyish exuberance. Often associated with attention-deficit disorder. Both carry major risk for alcohol and/or other drug dependence. Can be an early sign of depression or bipolar disorder Children with conduct disorder tend to be impulsive, difficult to control, and unconcerned about the feelings of others. Medline Plus January 2009 Quick tour ... Oppositional Defiant Disorder (ODD) All children are oppositional from time to time. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out. Oppositional Defiant Disorder (ODD), ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngster’s day to day functioning. American Academy Child and Adolescent Psychiatry June 2009 Quick tour .... Oppositional Defiant Disorder (ODD) Symptoms of ODD may include: Frequent temper tantrums Excessive arguing with adults Often questioning rules Active defiance, refusal to comply with adult requests and rules Deliberate attempts to annoy or upset people Blaming others for his or her mistakes or misbehavior Often being touchy or easily annoyed by others Frequent anger and resentment Mean and hateful talking when upset Spiteful attitude and revenge seeking American Academy Child and Adolescent Psychiatry June 2009 Quick tour .... Aftermath So what is it we are supposed to do then? Be therapists? Love them to death? Cut them a lot of slack? Read up on all the disorders – or at least the most frequent ones? Pray for them? Use our relationship with them? Tremendous Resource #1 Dr. Gordon Neufeld Dr. Gabor Mate Tremendous Resource #2 Dr. Gordon Neufeld Attachment therapy Gordon Neufeld - Introduction Names and descriptions of syndromes of behaviour and learning problems have multiplied (eg, ODD, CD, bipolar, ADHD). They present a problem in that they tend to describe, not explain. They do not help us make sense of the child from the inside out. Consequently we are left to deal with what we see. Attachment therapy Gordon Neufeld - Introduction “Are there really all kinds of separate learning and behaviour problems or is there an underlying cause or common denominator? I am increasingly convinced that underlying (it all) is a singular condition. Like the immune system dysfunction that underlies a myriad of medical symptoms, syndromes, and sicknesses, there is also a psychological condition that underlies a diverse array of learning and behaviour problems. …… Attachment therapy Gordon Neufeld - Introduction “ ………In a nutshell, the problem is one of developmental arrest or psychological immaturity, what I shall refer to more simply as stuckness.” All kids qualify for ADHD, bipolar, ODD, CD. These patterns initially have to do with their immaturity. When the kids do not grow out of their developmental deficits, then they are at risk. Attachment therapy Gordon Neufeld - Introduction “Not everyone who gets older grows up….. Those kids who are stuck are also prone to an assortment of problems and disorders which in turn distract us from the root problem. Attachment therapy Gordon Neufeld - Introduction If there is a common denominator, then there is a singular approach. And that is to understand and work with the relationship context Attachment is the default approach for developmental immaturities. Most handicaps can be at least mitigated by an attachment approach. In all species, the more significant the handicap, the more attachment is implicated in the answer. No meds or pills will help a kid grow up. Rather meds help kids avoid blowing apart their primary attachment. Concise History Attachment Theory Journal of Consulting and Clinical Psychology 1996 London family psychiatrist John Bowlby: attachment behavioral system having primary and immediate responsibility for regulating infant safety and survival .... This system is ..... equal in import to systems guiding feeding and reproduction and as leading the infant to (a) continually monitor the accessibility of one or a few protective, older "attachment figures" (usually but not necessarily biological relatives) and to (b) flee to these individuals as a haven of safety in times of alarm. Allan Schore: Attachment in context of brain development The baby’s brain growth literally requires brain-brain interaction which occurs in the context of a positive affective relationship between mother and infant (Trevarthen) The child is using the output of his mother’s right cortex as a template for the hard wiring of circuits in his own right cortex that will come to mediate his expanding cognitiveaffective capacities The right hemisphere is dominant in human infants, and indeed for the first three years of life ATTACHMENT Attachment empowers by facilitating dependence Attachment and vulnerability go hand in hand. A child cannot attach without becoming capable of being hurt and wounded – especially by experiences of separation. Allan Schore: Attachment in context of brain development The loss of the ability to regulate the intensity of feelings is the most far-reaching effect of early trauma and neglect (van der Kolk) The infant’s transactions with an emotionally misattuned and unresponsive caregiver are stored in the infant’s developing corticolimbic circuitries as imagistic, visceral, and nonverbal procedural memories. They act as severely dysfunctional templates for how the word works. Attachment therapy Gordon Neufeld - Introduction The human brain is pre-programmed for: Becoming viable as a separate being (Emergent process); Becoming resilient and resourceful (Adaptive process); Becoming capable of civilized and considerate relating (Integrative process) No child is born with these characteristics: they need to be developed. Attachment therapy Gordon Neufeld - Introduction Goal of the Emergent process is viability as a separate entity. Sense of self is here! – be full of own ideas, initiative, interests, etc. Able to take responsibility, evaluate own efforts The essence of Adaptibility is the registration of futility., The secret in the maze is NOT in knowing the way through, but in recognizing blind alleys – something coming to an end before a new pathway opens up. Attachment therapy Gordon Neufeld – Introduction Everyone is born with potential to become civilized, cooperative, patient, fair, balanced, etc No-one is born with these attributes, but are rather uncivilized, inconsiderate, impulsive, unstable, lacking selfcontrol, etc etc We cannot command the attributes into existence, nor can they be assumed at will. They develop in the attachment context. Remember? Want to notice the connection between development and mental health. A mentally healthy individual is one who can: -Develop emotionally, creatively, intellectually and spiritually; -Initiate, develop and sustain mutually satisfying personal relationships; -Face problems, resolve them and learn from them; -Be confident and assertive; -Be aware of others and empathise with them; -Use and enjoy solitude; -Play and have fun; -Laugh, both at themselves and at the world. MHS Evidence Jan 2011 Emergent process The non-emergent have a tough time with ownership! Have not achieved a sense of self that can monitor, and take responsibility. Adaptive process The non-adaptive have a tough time with frustration! Do not get to ‘futility’ and ability to move on to new direction. Integrative process The non-integrative have a tough time seeing other points of view! EMERGENT, ADAPTIVE, INTEGRATIVE EMERGENT, ADAPTIVE, INTEGRATIVE EMERGENT, ADAPTIVE, INTEGRATIVE Working with Stuck Kids Three-pronged approach for creating a context of attachment: Collect the kids; Protect the relationship; Create a village of attachment. Engage the attachment instinct (their dependence on you) by COLLECTING the child: 1. Get in the child’s face or space) in a friendly way, collecting the eyes, smiles and nods (the ‘greeting ritual’); 2. Provide a ‘touch of proximity’ for the child to hold on to (in the palm for infant, warm, soothing tone); 3. Invite the child to depend upon you, NOT pushing them away. (Independence emerges from dependence); 4. Act as the child’s compass point (act as their guide, point things out, help orient them. We all have instinct to stay close to our guide). Working with Stuck Kids Three-pronged approach for creating a context of attachment: Collect the kids; Protect the relationship; Create a village of attachment. When you Engage the attachment instinct by COLLECTING You let them know the relationship with you is a safe place You let them know everything about them matters to you You calm their anxiousness (root, many mental health issues) You are able to focus on relationship-friendly consequences, not punishments You create a trusting environment in which they follow you and become teachable You facilitate Emergence, Adaptability, Integration Canadian Mental Health Assoc Mental Health and High School Curriculum Guide Goals are to help teachers and staff to: -Promote students’ awareness of mental health issues and reduce the stigma associated with mental illness; -Provide a safe and supportive environment in which all students can maximize their learning; -Remain accessible and responsive to students’ needs; -Help students develop their abilities to cope with challenges and stress; -Identify those students in particular need of assistance or support. NOT COLLECTING NOT COLLECTING NOT COLLECTING COLLECTING NOT COLLECTING COLLECTING COLLECTING COLLECTING (Eyes, touch of proximity) -What can our Catholic faith contribute to this understanding of preventing and treating mental health issues? -Wouldn’t you know, our God got to collecting long before we thought of it ............ Teachers, People Of God This is the model for our collecting There are no bad days for our God who collects us. God is there today, God will be there tomorrow. We do not have to wonder whether we will be heard, whether we will be loved, whether we will be held. We just will be. Burdens become lighter even as we approach, since we are so confident this is true. This love is about our growth, our healing, on this life. It is a taste of what we have to look forward to in the next. When you Collect your kids, you not only prevent and heal mental health issues, You bring your children God. They will know that one day, and remember it was you who did that for them. Teachers’ Context: People Of God Challenges!! Teachers before you have passed the Catholic flame to you. But conditions are not the same. Kids are not going home to prayer, Sunday Mass, or even just plain being held. Still yours is the Catholic educational heritage. In this and any other heritage, the first thing kids see is you. Pretending is not possible Because the kids see right through you. They need to hear you tell of this heritage of faith, see you show this heritage, experience you living it.