mental-health

The Transition to Motherhood: Pregnancy

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Part 5 in a series

In her book, Matresence, Lucy Jones says that pregnancy is a metamorphosis. Like a caterpillar that becomes a butterfly, the woman’s previous identity must melt away in order for her new identity and concept of self to emerge.

And during her own first pregnancy, Jones found this process very disturbing. She says, unlike other stages of life for which there are parties and ceremonies to mark the transition of one stage of life to another, during pregnancy, for which there are no ceremonies in our culture which celebrate the mother, the woman can feel profoundly awkward and alone.

Jones talks about how, during adolescence, she felt similarly awkward. She felt like she didn’t know what was going to happen next or how to be; she felt unsettled by the changes in her body.

But, she says, she had friends going through the same thing and films and articles and music which addressed the strangeness and alienation of adolescence, so she didn’t feel completely alone.

But as she went through her pregnancy, she did not feel accompanied. Part of this may have been because she, herself, did not understand what was happening to her mind, her body, or her self — and therefore she could not really talk about it with others.

She says that missing from pregnancy books or health apps was information about how pregnancy affects a woman’s mind – and her actual brain. She quotes Rosemary Balsam from the Western New England Psychoanalytic Society as calling this the “vanished pregnant body.”

She suggests that the very idea of the pregnant woman, of being two people in one, may make other people uncomfortable.

For example, there’s the the story of the runner, Allyson Felix. Felix was an Olympic medalist and many time US National Champion when she became pregnant. One of her sponsors, Nike, cut her pay by 70% and refused to offer her reasonable pay protection during her postpartum period. Felix reports being told “runners should just run” – in other words, women runners should not be pregnant.

Clearly having a premier spokesperson be pregnant was uncomfortable for Nike. And Jones talks about how it was uncomfortable for her – as it is for so many women — and not just because of the bodily changes, but also because of the emotional disequilibrium she felt and because of the changes in the way she perceived others as seeing her.

Experiencing this was hard for Jones because she felt external pressure to “pretend that pregnancy was a less dramatic and drastic event” than what she felt it to be.

And it is a dramatic and drastic event. For all women.

Thank goodness for Lucy Jones for saying so and letting us all heave a sigh of relief. We didn’t have to say it. But she did.

Toward the end of her pregnancy, Jones describes bowing out of work and not feeling guilty. She realized this was not typical of her — but she felt that she wanted to be at home and she didn’t mind being alone. She says that she felt “calm and placid, pleasantly vague, like nothing could touch me”.

Later she found out that this is normal — that there are physiological changes that accompany each of the many stages of pregnancy and that at the end of pregnancy, the reactivity to stress hormones is dampened. No wonder she didn’t feel the normal pressure to work and perform and please her boss. And luckily for her, she had the ability to step away.

The biology and neurobiological literature supports Jones. When she reports that she felt that her brain was changing during her pregnancies, she was right. In one study by Niu et all (2024), ten pregnant women were followed over the course of their pregnancies. Changes in brain structure were charted. Reductions in gray matter volume were found over the course of pregnancy. In other words — the pregnant woman’s brain actually shrinks! Their conclusion? There are profound neurobiological changes during pregnancy.

Moreover, in a review of the literature, Esel (2010) found evidence that the brains of pregnant women and women with children are very different from the brains of women who have not had children who are within the same age range. Moreover, Esel found ample evidence of neurobiological and hormonal influences on women and their feelings and behavior. She says that maternal behavior develops over the course of a woman’s life, including during pregnancy. This happens through the development of special neural networks, which are cooperatively developed by genetic, environmental, and hormonal factors.

In fact, the biology is fascinating. Esel points out the importance of hormonal influences in preparing women for motherhood. She says that estrogen, prolactin, and oxytocin stimulate maternal behavior after birth — and that the stimulation of the vagina during birth initiates the release of oxytocin, so important for the initiation of maternal behavior as well as milk production. She also discusses the finding that women are prepared to become mothers from their own birth. She says that early exposure to estrogen during the perinatal period in their own early lives may be responsible for women’s greater interest in and facility with social relationships over that of men. She suggests that this capacity primes women to be interested in and to relate to their infants once they become mothers. Then, during pregnancy the capacity for relating to their own infants is further primed by the high levels of progesterone and estrogen which are secreted. Furthermore, she says that the hormonal exposure of the brain during pregnancy plays an important role in the development of maternal neural networks and systems.

In the same vein Esel says that in humans, the ability to establish social relationships is inversely related to levels of fetal testosterone both in females and males — so in other words, men, from birth, are less primed to establish social relationships.

No wonder women feel different when they are pregnant — and no wonder they feel a shift in both body and identity. The hormonal influences on their brains, their bodies, their feelings and their behavior are powerful.

I look forward to reading the rest of Jones’s book to find out more about the research on the physiological and psychological changes that come about during pregnancy. I know too little about this.

In fact, most of us know too little about this.

Scientists are looking at aspects of the woman’s experience during pregnancy in a way that they might not have considered doing years ago, even though we have needed this information for a long time. But perhaps, as Jones suggests, science waited until there were enough women in the field to make this a priority.

References

Esel, Ertugrul (2010). Neurobiology of Motherhood. Turkish Journal of Psychiatry. https://www.turkpsikiyatri.com/Data/UnpublishedArticles/3uydyp.pdf

Jones, Lucy. Matrescence.

Yanbin Niu, Benjamin N. Conrad, M. Catalina Camacho, Sanjana Ravi, Hannah A. Piersiak, Lauren G. Bailes, Whitney Barnett, Mary Kate Manhard, David A. Cole, Ellen Wright Clayton, Sarah S. Osmundson, Seth A. Smith, Autumn Kujawa, Kathryn L. Humphreys (2024). Neurobiological Changes Across Pregnancy: A Longitudinal Investigation, bioRxiv, The Preprint Server for Biology doi: https://doi.org/10.1101/2024.03.08.584178

A Deeper Dive into the Transition to Motherhood

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More on matrescence – part 4 in a series

Posted July 20, 2024

Let’s take a deeper dive into the transition to motherhood in this, the fourth post in a series on this subject.

In the Introduction to her beautiful book, Matrescence, Lucy Jones says, “Pregnancy, then birth, and then – big time – early motherhood, simply did not match up with the cultural, social, and philosophical narratives I had grown up with…I started to realize that that my mind had been colonized by inadequate ideas about womanhood, about motherhood, about value, even love… A sense that I had been fundamentally misinformed about the female body and maternal experience set in fast” (p. 9, 10).

She describes how, during her pregnancy she noticed changes in herself which she had no language to describe – but she noticed that her “consciousness felt different: restructured or rewired” (p. 10).

She says, “I thought the baby would grow inside my body, …that I would still be the same person. But that didn’t seem to be the case” (p. 10).

I think that many if not most women feel all of these things. But do they have the language to speak about them? Or do they feel permitted to speak about them?

I suspect not.

Jones talks about how ill prepared she was for motherhood – how she had never changed a diaper and knew nothing about what it took to raise and take care of another human.

And I think many women feel this way – especially with their first babies.

Jones speaks about her guilt if she tried to do anything just for herself during those first months of motherhood.

She also writes about the idea that women are supposed to have a built in maternal instinct and how this works against the acknowledgement that motherhood absolutely requires the acquisition of knowledge and skills about babies, children and mothering.

And in saying this, I think Jones puts her finger squarely on the shame and embarrassment many mothers feel when they don’t know what the right thing is to do for their baby – whether it is something as simple as whether to put them down for a nap or something as complex and important as when to call the pediatrician.

As she says, “this is a set up in which mothers (are) destined to fail” (p. 11).

She says, “I thought early motherhood would be gentle, beatific, pacific, tranquil, bathed in a soft light. But actually it was hard core, edgy, gnarly” (p. 14).

Finally, we have someone who tells the truth about motherhood.

We have needed a Lucy Jones for a long time.

Women feel that they are not allowed to talk about the utter fatigue, boredom, tedium, panic and downright hardship of childcare. Yes, the difficulty of juggling work and child care is talked about. And the under valuation of parenting work is mentioned now and then. But as a society? We do not have much of a discussion around many of these issues – and we certainly have not made changing any of them a priority – in our own minds, with our partners and friends, or at the ballot box.

There is still pressure to put on a good face as a mother, to treat the work we do as joyous and to present that point of view to anyone other than our closest and most trusted friends and fellow parents.

Jones calls this “cultural apathy”. And she says that many women feel that they themselves are to blame for the extent of their troubles as new mothers. However, the fact is that a majority of women feel anxious after having a baby, at least 45% report feeling low, and at least 35% describe themselves as depressed. One in five mothers do not tell anyone about their feelings and over half report not feeling supported by their families. Almost half say they feel like they have to handle everything alone.

But there is hope. Jones writes about a burgeoning field of neurobiology that is looking at the changes in the brains of pregnant women and those who care for young infants. And she quotes Alexandra Sacks, a psychiatrist interested in this subject, as saying that simply by talking about the difficulties inherent in transitioning to motherhood, many women will feel relief.

And this is why, Jones says, she wrote her book: as an invitation to start talking about the process of becoming and being a mother.

And this is why I am writing this series.

Stay tuned for more.

References

Jones, Lucy. Matrescence

Matresence: The Transition to Motherhood – Isolation and Identity Shift

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A while back I wrote a post on matrescense, or the transition to motherhood, which seems to have struck a chord. This post is the second in a series on this subject.

To give some background, matrescence is a terms that was coined in the 1970’s by medical anthropologist, Dana Rafael, in her book, Being Female: Reproduction, Power and Change. More recently, the term was brought back to our attnetion by Aurelie Athan, a reproductive psychologist at Columbia University.

Athan notes that Rafael “pointed out that in many cultures, the birth of a new baby is announced by saying, “a woman has given birth.” Athan’s point is that the focus is on the mother and what she has done. And that emphasis is important. The mother is given credit for what she has accomplished. This is symbolic of the meaning the culture gives to the event and how it is handled. In cultures other than our own, mothers are often more supported after the birth of a baby, and more taken care of.

For example, in South Korea, it is common for mothers to go to a retreat for the first 21 days after they give birth. There, fresh meals are delivered three times a day, they can receive massages and facials and attend childcare classes, and there are nurses available to watch over the baby if the mother needs a rest.

There is a special soup to drink, traditional in South Korea during the postpartum period, lactation consultants and exercise routines to help with recovery, and body realignment to help new mothers get back in touch with their bodies.

In South Korea, eight out of ten mothers go to such a spa after giving birth.

This is the kind of thing that mothers in the United States can only dream about.

Here, mothers are often isolated in their own apartments or homes after their babies are born. During their leave from work, they often struggle with feelings of loneliness and anxiety. And this is especially true for first time moms who are not entirely sure what they are doing.

For example, a New York Times article profiled Alicia Robbins. When she had her first two children, she, like almost every woman who has birthed a child before her in this country, felt overwhelmed upon leaving the hospital. Never mind that she herself is an obstetrician and gynecologist. She said, having a child “was way harder than I expected. I kept wondering if it was OK that breastfeeding was so difficult or that I felt anxious. I kept asking myself, ‘Is this really my new normal?’”

Her mother came to help her, “but she kind of froze,” Dr. Robbins said. “I love her, God bless her, but we had fights over things like whether you need to sterilize the breast pump for three hours.”

In this country, as Aurelie Athan says, we talk about the baby, not the mother. We pay attention to the infant, give gifts to the infant, visit the infant….and we don’t talk so much about what the mother has accomplished and what we can do for her.

But the process of becoming a mother is something that we, in our culture, need to pay more attention to. As Daniel Stern said in his two books, The Motherhood Constellation and Becoming a Mother, giving birth to a new identity may be as hard, or even harder than the act of giving birth to the actual baby.

Becoming a mother changes who a woman feels herself to be. It expands her identity — but, as with many changes, this expansion can be fraught with uncertainty and anxiety. Who am I now? Do I know how to be a mother? Am I doing the right thing? What kind of mother do I want to be? Can I ever get back to doing the things I used to like to do? And if I do, will I be neglecting my baby? Can I still work? How much should I work? Can I still be good at my job?

The questions are endless.

Additionally, becoming a mother changes a woman’s identity as a partner. And this is not always easy. Sometimes a woman wonders if she still has room in her emotional repertoire for her partner. Sometimes the partner is jealous of the time a woman spends with her baby. Sometimes a woman feels she can only share her body with one person at a time and she feels resentful of other demands being made on her or torn about who that person should be — the baby or the partner? Often, a mother and her partner differ on how they each feel caring for the child should be handled. Conflicts come up over sleep training or how much of a schedule the baby really needs. And the energy for talking through these conflicts can be in short supply. Women often feel they carry more of the mental load for making doctor’s appointments, reading up on child development, and thinking about what the baby needs.

This identity shift is especially difficult, as a new mother needs her partner for support, and any resentment, difference of opinion, or outright conflict can get in the way of feeling supported.

The identity shift a woman faces after giving birth is hard. Like shedding a skin that no longer fits, the woman must say goodbye to aspects of herself and ways of being and doing that were part of her previous self, and she must grow into her new role as she works out what that will be.

Just knowing that all women experience this, that having a hard time with this shift is normal, and that it can be named and learned about — and even, in some cases, talked about with other mothers — can be helpful to new mothers.

I recommend that anyone suffering from this transition reach out — whether to friends, other new mothers, more experienced mothers, or even to a therapist who can discuss these issues openly.

After my last post, one such mother reached out to me and said that she felt less alone just knowing that what she was feeling was not unique to her.

****************************

For more good discussion of this subject, see the references section below and watch this blog for part 3 of this series.

To find a therapist, visit the Psychology Today Therapy Directory.

References

Jones, Lucy. Matresence

Rafael, Dana. Being Female: Reproduction, Power and Change

Stern, Daniel. Becoming a Mother

Stern, Daniel, The Motherhood Constellation

Today, As We Think About the Victims of the Massive Bombing Campaign in Ukraine, a Post on War and Children

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Because of the news of a massive bombing campaign including the bombing of a Ukrainian Hospital today, I would like to post on war on children.

This is an excerpt from my book, How Children Grieve: What Adults Miss and What They Can Do to Help:

One psychiatrist said of both the children and the adults in the Ukraine, “(They) aren’t just grieving a person; (they) are grieving (their) entire existence.”[i]

And, as the United Nation International Children’s Fund (UNICEF) says:

            “In war, children suffer the most”.

As I write, children are dying and losing loved ones every single day in multiple locations around the world, including Ukraine, Gaza, Israel, Russia, Sudan, Somalia, Libya, Myanmar, Yemen, Congo and numerous other countries. These children are suffering in ways that are quite simply horrific and completely incompatible with normal development.

In fact, globally, one in four children, or over 400 million children live in a country affected by armed conflict, terrorism, or disaster.[ii] And armed conflict can last throughout a child’s entire life, such as in Liberia where civil war caused widespread trauma from 1989 to 2004.[iii]

The effects of war are innumerable. They extend far beyond the trauma that is experienced by the loss of loved ones and the witnessing and being the victim of violence. In wartime, children, teens and adults may all experience a brutal shattering of parts of their inner worlds. Their minds may become black holes of horror and despair and their mental functioning can be intruded upon and assaulted by destructive forces. [iv]

Moreover, they experience all the secondary losses of war including the loss of home and community due to fighting and bombardment. They include all the losses embedded in the experiences of evacuation and immigration including the loss of contact with friends, and the division of families. They include all the difficulties associated with adapting to one or more new living arrangements. And they include the loss of food security, the loss of the provision of proper public health measures and the loss of general health care including mental health care.

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) estimated that approximately 20 million children and adolescents have been displaced from their country of origin as refugees in the year 2023.[v]

And we must remember that the numbers of children living through war and experiencing displacement are even larger than this because there are many kinds of war—including not only armed conflicts between nations – but also drug wars, gang wars, and more localized street fighting caused by conditions of poverty and social inequality – and these too cause people to suffer and to flee.

In the Ukraine alone, as of March 2022, half of all Ukrainian refugees were children.[vi] And this number does not even include all of the children who have been kidnapped and forced to adapt to life in Russia.  Again, this is a LOT of children who have lost their homes, friends, neighborhoods, schools and so much more.

The past two decades have marked increasing interest in the psychological impact of war on children. Many researchers have studied this subject, it is well documented that exposure to adverse childhood events (including violence and war trauma) leads to a higher-than-average incidence of acute stress disorder, posttraumatic stress disorder (PTSD) and physiological and mental illness).

The most important thing we know about the effect of war on children is that even above and beyond the exposure to risk and violence, the most traumatizing event for children is the threat of separation from one or both parents or actual separation from them. Given the intense attachment of children to their parents, this is the worst consequence of war for children and leads to the most suffering. [vii]

We also know that the most common mental health effects of exposure to war for children are elevated symptoms traumatic stress, depressive disorders, anxiety disorders and post-traumatic stress disorder (PTSD).

There is so much more to say about the effect of war on children. See this site for more in the coming weeks.

[i] Fleming, LaKeisha, How the War in the Ukraine is Affecting the Mental Health of Survivors.

https://www.verywellmind.com/ukrainian-mental-health-during-the-war-5225389

[ii] Gudrun Østby, Siri Aas Rustad, and Andreas Forø Tollefsen, “Children Affected by Armed Conflict, 1990–2019,” Conflict Trends 6.

[iii] Betancourt. T. S., et al., “The Intergenerational Impact of War on Mental Health and Psychosocial Wellbeing: Lessons from the Longitudinal Study of War-Affected Youth in Sierra Leone,” Conflict and Health 14, no. 62 (2020), https://doi.org/10.1186/s13031-020-00308-7.

[iv] Roth, Merav, Ten simple guidelines on initial therapeutic intervention with acute trauma following October 7, 2023. In Psychoanalysis in a Holy Land, Abramovitch, Cusin, Leo, Roth, Alaltiello and Volkan. Pgs. 135 – 162. Frenis Zero Press: Italy.

[v][v]

[vi] United Nations Children’s Fund (UNICEF). Two Million

Refugee Children Flee War in Ukraine in Search of Safety

Across Borders. UNICEF. Available from: https://www.unicef.

org/press‐releases/two‐million-refugee-children-flee‐war‐ukraine‐

search‐safety‐across‐borders.

[vii] Masten AS, Best KM, Garmezy N (1990). Resilience and development: Contributions from the study of children who overcome adversity. Dev Psychopathol 2: 425–444.

Can Children Grow From Loss?

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In our 4 part series on loss, I talked about the little losses of everyday life, how children understand death, how to introduce the topic of death to children and what a child may feel when they lose a loved one. But something I did not talk about is the fact that, as hard as losing a loved one is for a child, they can also grow as a result of the experience.

This may come as a surprise.

But many people, including children and teens, not only manage to survive difficult losses, but they also grow as the result of their experience with loss.

Scientists who study trauma and loss have found that there can be a variety of positive psychological changes for some people following challenging life experiences.

Lawrence Calhoun and Richard Tedeschi called this “posttraumatic growth.” They mentioned the following positive changes as being prominent for many people:

·    Greater appreciation of life

·    Greater appreciation and strengthening of close relationships

·    Increased compassion and altruism

·    The identification of new possibilities or a purpose in life

·    Greater awareness and utilization of personal strengths

·    Enhanced spiritual development

·    Creative growth

And, as it turns out, one crucial factor that allows people to turn a difficult event into one that promotes growth is the extent to which they explore their thoughts and feelings around that event.

Many people prefer “to look on the bright side” and to not focus on the difficult things that happen to them. In fact, one young woman who sees me in therapy told me that when she hurt herself as a child, her mother used to say, “pretend that didn’t happen”.

However, Calhoun and Tedeschi found that the ability to acknowledge that the event has happened and to think about and process the painful feelings associated with the event are what allow some people to grow from their difficult experiences.[i]

Two other researchers, Todd Kashdan and Jennifer Kane, also studied this subject. Using a group of college students, they looked at how much people tend to avoid difficult and painful thoughts and feelings versus how much they are willing to allow them. In their study, the most frequently reported traumas amongst their subjects included the sudden death of a loved one, motor vehicle accidents, witnessing violence in the home, and natural disasters.

Kashdan and Kane found that the greater the distress the person experienced, the greater the posttraumatic growth that resulted from it—but only in those people who did not avoid their feelings, or who did so infrequently.

 These findings support the benefits of encouraging children to experience and talk about their feelings following loss. It also supports the importance of having children and teens who are having difficulty experiencing or expressing their feelings get involved in some form of expressive psychotherapy, whether that be individual, group, or family therapy.

Another researcher, Jessica Koblenz specifically studied children who had lost a parent to find out what helps and what hinders them in their grief process. And she also found that there is growth from loss. One child in her study said they had a heightened sense of life and didn’t want to waste time or have regrets. Another said he had become more independent. Some mentioned that they learned to seek help from those who were able to provide it. Some found that exercise was a good method for coping with painful feelings, and others found humor helpful.

Teigan, a young woman I met through Winston’s Wish, told me that what happened to her after she lost her mother shaped what she wanted to do with her life. She described how one of her teachers at school called her every week after her mother died and provided her with much needed attention, support, and guidance. This teacher was an inspiration for Teigan, and she decided to become a grief counselor for children and teens so that she could help other students, just as her teacher had helped her. In the meantime, she was training to lead grief groups just like the one she had participated in herself.

For years, Calhoun and Tedeschi, studied the positive effects of trauma—including loss. They also found that some individuals who had suffered significant trauma experienced positive changes. These changes include improved relationships, new possibilities for life, a greater appreciation for life, a greater sense of personal strength, and increased spiritual development.

They also found some interesting contradictions. People they interviewed said things like “I am more vulnerable, yet stronger.” Individuals who experienced traumatic events tended to talk about their increased sense of vulnerability; however, these same people also reported an increased sense of their own capacities to survive and prevail.

Another experience often reported by trauma survivors was a need to talk with other people about the traumatic events, which tended to deepen some of their personal relationships. Some also found themselves becoming more comfortable with intimacy and having a greater sense of compassion for others who experienced life difficulties.[i]

In my clinical practice, a teenager whose father had died at the beginning of Covid said to me, “My dad’s death gave me a different perspective. I used to think that if a friendship ended or someone died, all the time you put into that relationship was wasted. Now I think that it was valuable. I would rather have had my dad for the time I had him rather than some other dad who was around longer.”

This young woman gained a new perspective and came to a new appreciation of the relationships in her life. She came to understand the importance of the person that her father was despite her lifelong frustration with having had an older dad. And she also recognized that relationships are important in their own right, even if they end prematurely.

Calhoun and Tedeschi also found that some people who faced trauma were more likely to become engaged with fundamental existential questions about death and the purpose of life. A commonly reported change was for the individual to value the smaller things in life more and to also consider the religious, spiritual, and existential components of life. A common theme for many people in this study was that after a traumatic event, philosophies of life can became more fully developed, satisfying, and meaningful.[ii]

Researchers such as Calhoun and Tedeschi have found that growth can occur not despite adversity but because of it.

It is true that they looked predominantly at adults, but interestingly, very similar findings have been found in research on bereaved children.

In a study of what helps and hinders children and adolescents who lose a parent, Jessica Koblenz found multiple areas of growth in many of the children she interviewed.[iii]

Seventy-three percent of the participants in her study felt that navigating and understanding death at an early age made them grow up faster.

And it is interesting to think about whether “growing up faster” is a form of growth or a toll that is paid by children who have experienced early loss. I suspect that some children might consider it a form or growth, some might feel it was a toll they paid, and some might feel that it is both. 

Some children in Koblenz’s study said they responded to loss by embracing life. One said, “I have a heightened sense of life, not wasting time, and not having regrets.” According to some grief theorists, this renewed sense of life is an adaptive form of meaning-making following loss.[iv]

Many of the children Koblenz interviewed said that support helped them to get through their loss. This finding is important because traditional psychological and psychiatric views of bereavement have minimized the role of relationships and support from others in coping with loss. However, more recently, evidence has shown that relational support plays a crucial role in a child’s ability to cope after a loss and may actually improve and intensify some existing relationships.

Interestingly, participants in Koblenz’s study stated that their most helpful source of support were other mourning children who could relate with their exact position.

Koblenz also found that becoming self-reliant was a coping strategy that some of the participants in her study utilized. In her study, kids said that they began to rely more on themselves once they decided that they could no longer depend on others. For some, it was easier to express they “were strong” and “could handle it alone” than to acknowledge their loneliness.[v]

Koblenz says that the sentiment of “needing to be strong” was expressed by many participants and reflected their inability to convey vulnerability. As one participant said of her childhood loss, “Everyone always said, ‘You’re so strong.’ No one ever said, ‘It’s okay if you’re not.’” From this Koblenz concluded that applauding children’s ability to handle their grief alone may make it difficult for them to feel they can be completely open and show their vulnerable selves. But some participants were able to find a balance of healthy independence while still reaching out to others in times when they needed help.[vi]

[i] Lawrence G. Calhoun and Richard G. Tedeschi, “The Foundations of Posttraumatic Growth: An Expanded Framework,” in Handbook of Posttraumatic Growth: Research and Practice, ed. Calhoun and Tedeschi (New Jersey: Lawrence Erlbaum, 2006), 3–23.

[ii] Richard G. Tedeschi and Lawrence G. Calhoun, “Posttraumatic Growth: A New Perspective on Psychotraumatology,” Psychiatric Times 21, no. 4 (April 1, 2004).

[iii] Jessica Koblenz, “Growing from Grief: Qualitative Experiences of Parental Loss,” Omega 73, no. 3 (March 2015): 203–230.

Resilience

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George Bonanno, one of the leading researchers on resilience, defines resilience as the ability to maintain relatively stable and healthy levels of psychological and physical functioning in the face of adversity. He says that resilient individuals may still be upset and disturbed by a loss or a very difficult event but that their upset is short lived and that after a few days or weeks they are able to go back to functioning in their usual way.

And he states that this is not as rare as we once thought.

He says, “many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. 

Unfortunately, because much of psychology’s knowledge about how people cope with loss or trauma has come from people who sought treatment, theorists have often viewed resilience as either rare or pathological.

Bonanno says that among adults, only 10 – 15% of bereaved individuals experience chronic distress or prolonged grief after a loss. This is a much lower number than we might expect!

He talks about some people as “hardy”, that is, they are able to withstand difficult events and move on. 

While he has mainly studied adults, perhaps we can also think about this in terms of teens and children. 

Bonanno says that people who seem to be hardy are usually committed to finding meaningful purpose in life, they possess the belief that one can influence one’s surroundings and the outcome of events and also the belief that one can learn and grow from both positive and negative events in life. He also says that people who are hardy are likely to be more confident and able to use active coping strategies as well as social support from the people around them.

Another attribute which has been found amongst people who prove to be resilient is the trait of self enhancement. Interestingly, people who think well of themselves, and perhaps even exaggerate their positive attributes, often do better under difficult circumstances. This  has been found to be particularly true following severe loss.

Research has been done on people who were near the World Trade Center on 9/11 in New York City as well as on Bosnian civilians who lived in Sarajevo after the Balkan civil war. In both cases, people who were high on the self enhancement scale were rated by mental health professionals as being better adjusted than those who were not as likely to engage in self enhancement. 

People who are full of themselves, people who are what some of us might consider over confident may sometimes be annoying to be around – but it turns out that this trait can have benefits when it comes to weathering adversity!

 Other researchers have found that certain pre-existing characteristics help people to weather adversity. For example, one study done during the pandemic found that people who have a sense of being able to affect others and their environment (called self-efficacy) are more likely to return to normal functioning after a significant loss. The team summarized the findings of their study saying that a high degree of self-efficacy served as a protective factor against depression and grief among the bereaved individuals who lost their loved ones due to Covid.[i]

In his review of the professional literature on this subject, another researcher found that individuals who were characterized as having what is called openness, who have a tendency to accept new experiences, who feel less nervous through disappointments, and who believe in themselves, also fare far better following loss. 

Similarly, individuals who are agreeable, those with conscientiousness traits, those who exercise their abilities and recognize their limitations, and those who set realistic goals all tend to have increased ability to persevere and persist in challenging situations.

In an interesting study on children and teens, it was found that those who have a tendency to ruminate and reflect on their experiences are both negatively and positively affected by this tendency when they are faced with an adverse event. As it turns out, while rumination on negative events can lead to depression, it can also facilitate processing, integration and making meaning out of the negative things that happen to us.

 And one last way that people who seem to be resilient are observed to cope with adversity is through the use of positive emotion and laughter. Often the use of positive emotions after loss and other difficult experiences has been seen as a sign of an unhealthy level of denial. However, in recent years, research has shown that positive emotions can reduce levels of distress following difficult events and it is thought that their use need not necessarily be seen as unhealthy. 

It seems that those cultures which have a tradition of telling jokes and funny stories about the deceased at a wake or funeral were on to something important years before the social scientists!

So loss and exposure to difficult events may be very painful, they may be difficult and recovery may be lengthy – but there ARE ways to cope, and many, in fact most people are resilient in the face of loss and adverse events.

References:

Bonanno, George.  Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? The American Psychologist, Jan. 2004. P. 20.

Bonanno, George. The Other Side of Sadness.

Lawrence G. Calhoun and Richard G. Tedeschi, Handbook of Posttraumatic Growth: Research and Practice (London: Routledge, 2014).

Todd B. Kashdan and Jennifer Q. Kane, “Post-Traumatic Distress and the Presence of Post-Traumatic Growth and Meaning in Life: Experiential Avoidance as a Moderator,” Personality and Individual Differences 50, no. 1 (January 2011): 84–89, https://doi.org/10.1016/j.paid.2010.08.028.

Jessica Koblenz, “Growing from Grief: Qualitative Experiences of Parental Loss,” Omega 73, no. 3 (2016): 203–230.

On July 3rd, my new book called How Children Grieve will come out – and in honor of the occasion, I am starting a 4 part series on loss.

~ corinnemasur2331 ~ Leave a comment

https://www.penguinrandomhouse.com/books/738355/how-children-grieve-by-corinne-masur

Part 1

The Losses of Everyday Life

Everywhere you look, someone is either writing or podcasting about how you should be raising your children. You should be more gentle; you should be less gentle. Your children need to develop an understanding of feelings; your children are overprotected and unprepared. Whether you are reading Sarah Ockwell-Smith or Johthan Haidt, you will find that you are doing it all wrong.

What’s a parent to do?

Well, if you ask me, it’s not one or the other. Sometimes children need limits and sometimes they need help understanding their own feelings and the feelings of others.

We don’t want to over protect our children so they are unprepared for what life is really like nor do we want to overexpose them to disappointment and difficulty.

So, again, what’s a parent to do?

Well, I would like to start with just one subject. And that is the subject of loss. 

Children – all children – experience losses and disappointments in their lives and we do not need to protect them from these or from the feelings that result from these. 

But we do need to prepare them and to help them when these losses happen.

We need to prepare them for both the little losses and the big losses so that as they mature, they will be able to handle what comes their way.

We don’t like to think about it, but children suffer losses all the time. And they need to be able to manage when these losses occur.

A friend doesn’t show up at school because she’s sick. Another friend moves away over the summer. A beloved stuffed animal is left behind on a trip. A promised adventure to the amusement park is cancelled due to rain.

These are small losses, but losses all the same.

So, do we go out and buy a new stuffed animal right away? Do we call the teacher and tell her how sad our child is that her friend is out sick? Do we try to introduce our sad child to other kids as soon as we find out her friend is moving? Do we substitute a trip to an indoor trampoline park instead of the amusement park?

You might be tempted to do one of these things.

But how about holding off?

Our job, as parents, is not to protect our children from experiencing loss, nor from the feelings accompanying loss.

What we need to do is to help our children with their losses, whether big or small, and we need to start early.

We need to convey that yes, it is sad to lose a stuffed animal or to miss a friend or to lose a much hoped for day at the amusement park – but we also need to convey that these losses can be survived.

Little losses are the best place to begin – because they lay the groundwork for dealing with bigger losses which will certainly come along at some point.

We should try to avoid giving our children the impression that life is always good.

Because it isn’t.

And we want our children to be able to feel what they feel when life isn’t good, and to be able to talk about it (if they want), and eventually to be able to move on.

The problem is that often these small losses are not spoken about. 

For the obvious ones like the loss of the stuffed animal, parents are often tempted to make the sadness go away by replacing the lost toy.

But why not let your child feel sad for a while?

Part of the problem with this is that for parents, it can be hard to tolerate a child’s sad feelings. It is painful for us.

But try to take a moment.  This is our job – we just have to try to allow the sadness and to show that WE can survive it ourselves. 

If we can tolerate our child’s sadness, this will help them to tolerate their own sadness.

And a missed friend or a missed day of fun?

Let’s also let them be sad.  Let’s try not to “make it all better”. Let’s talk about how sad and hard these things are. Let’s share times when we suffered in the same way. And let’s tolerate our children’s sadness and disappointment – and let them know that these things will happen from time to time in their lives.

And what about less obvious losses? The ones that we might not notice but which children are suffering with? 

They are what Pauline Boss calls “ambiguous losses” and I will talk about these in Part 2 of this series.

SCREEN TIME – AGAIN!!!

~ corinnemasur2331 ~ Leave a comment

Dr. Corinne Masur (Be sure to leave a comment below if you have something to say about screen time!)

In our parenting group on Friday one mother said, “at our house it’s always a battle about electronics”.

I think she speaks for 98% of all parents in the US. 

Once kids get on Youtube or once they are playing a game, they don’t want to stop. And in fact, it’s really hard to stop. 

So there’s either a battle – or there are frustrated parents shying away from a battle.

Parents are genuinely afraid to say no. Parents want to avoid a meltdown.

And this is doubly true in public. In our group, parents admitted to being afraid that if they say no when they are outside of the house, there will be a scene, a tantrum, yelling and screaming – and everyone will see it.

And then they will feel ashamed. 

The parents talked all about this. They admitted that sometimes they don’t set limits because they are afraid the ensuing battle will take away everyone else’s good time.

What if they are at a restaurant? Out with friends? Or on a trip with other families?

No one wants to be the parent who caused the meltdown that makes everyone else uncomfortable.

One mom said “I don’t think it’s healthy but that’s the way it is”.

Another parent said, “but if you let things go, it’s hard to make a change.”

This IS hard. 

If you don’t set limits early and often, kids are used to getting 10 more minutes…or an extra half hour. They persist at asking for more because they know sometimes they get it.

Parents are confused about what to do. Set a limit? Don’t set a limit? Give in to your child’s desire to stay on screen and give yourself another half an hour to look at your own phone? Or do the laundry? 

This is a conflict. Parents want and need more time for themselves. At the same time they want their kids to listen when they say, “It’s time to get off your screen”. 

Is it better to make a few rules? Ones that are just for your family – which don’t have to be like anyone else’s rules?

Or is it better to keep the peace?

Giving in sometimes and having established rules are not necessarily compatible. As we all learned in Intro to Psychology, the most reinforcing thing in the world is intermittent reinforcement. It’s better than all positive reinforcement and it’s better than all negative reinforcement – that is, if you want that behavior to persist, whatever that behavior is, rewarding it SOME of the time is the thing that will make it persist. In other words, if you give in sometimes, your child is even more likely to ask for more time on screen than if you say yes every time. Hard to believe – but true.

So what is a parent to do? You have a rule: 2 hours of screen time on Saturdays. But this particular Saturday you are sick and need a nap or you’ve been busy and you need time to catch up on work.  

It’s easier to give some extra screen time than to insist that your child find other things to do; it’s easier to give some extra screen time than to set up a playdate; it’s easier to give extra screen time than doing almost anything else!

We discussed all this in the group and in the end, the consensus seemed to be that it was important – to these particular parents – to figure out what worked for each of their own families. And then to try to be consistent. Some of them wanted to have no screens at meals at all. One mother wanted her kids to have no phones at all until age 13. But she was willing to let her 9 year old have an iwatch that couldn’t make calls. Two parents said phones at meals were OK as long as the kids ate their food before looking at the phone.

They all said they struggle with these questions – but they all also want more of a feeling of control in their homes.

Of course, you can’t entirely control your children. They are going to do some things and spend their time in some ways that aren’t your preference. But for their sake, and for your own, do you want to decide whether you WANT phones at meals or how many hours a day YOU want your children on devices?

You might find it worthwhile.

And you might want to stick by what you decide.

It’s hard to set limits, it’s hard to make rules and stick to them, it’s hard to say no and suffer the resulting melt downs – especially in public. But it is also important to think about whether it’s worth it. For you. And especially, in the long term, for your children.

All children have meltdowns sometimes. If you can tolerate your child’s meltdowns, and if you can allow them to happen because you’ve said no – you might actually find out that there will be fewer of them – and your child might – just might – get off her screen when it’s time. It’s not a guarantee. But there’s a chance.

Teens and Social Media – AGAIN!

~ corinnemasur2331 ~ Leave a comment

This post is by Ana Hagstrand

Ana is a psychologist in private practice in Philadelphia. She is the mother of three children and she enjoys outdoor adventures.

At what age should we let kids use social media?

As a clinical psychologist and mother of three, I’ve been grappling with this question. My oldest child is 13 and he claims that everyone has Snapchat except him. 

Looking at the scientific research, the wider mental health trends, and what I know about adolescent development, I’ve decided he will have to wait until he’s at least 15.

Here’s why: 

First, there are concerning trends in adolescent mental health. The rates of teen anxiety, depression, and suicide have risen significantly over the last decade. Numerous studies show that teens report persistent feelings of sadness and hopelessness at significantly higher rates and that mental health professionals are diagnosing higher rates of depression. Most alarming is that the suicide rate for 10-14 year olds increased 139% for girls and 70% for boys over the last decade. And what does this have to do with social media?

Adolescent mental health started to decline sharply in 2012, which is the year that we started using the word “selfie” and the year that Facebook acquired Instagram. 

Is there evidence that social media has played a role in these worrisome mental health trends?

Yes. 

You may recall that Facebook was initially only for college students and was rolled out at different colleges at different times over the course of two years before opening up to the general public. One study found that the rates of anxiety increased by 20% and the rates of depression increased by 7% at each college in the year following the introduction of FB. 

Several recent studies actually demonstrate causation, not just correlation between social media use and decreased mental health, and the apparent pathway is social comparison. In other words, use of social media causes people to engage in more social comparisons and fear of missing out (FOMO) and this in turn increases depressive symptoms and decreases self-esteem, body image, and self-perceived social acceptance. 

And it has been found that the harmful effects of social media are stronger (worse) for girls.

Some of the studies I just referenced were done on young adults, and it’s important to consider that there are several reasons why social media may affect adolescents even more than it affects adults. During adolescence, the brain regions associated with attention, feedback, and reinforcement from peers become more sensitive as teens navigate identity formation, acceptance, and social status. This is a normal part of adolescent development, but with so many peer interactions occurring online for all to see and possibly even enshrined forever on people’s social media feeds, the stakes seem higher than they were pre-social media. If adults feel pressure to curate a certain image on social media, of course it’s even more fraught for teens.

Teens have always had a tendency to think they have an audience that notices their every blemish, and we used to try to quell their anxieties by telling them that no one is paying nearly as much attention to them as they think. Now that argument doesn’t work. 

Social media, which started out as a vehicle for social connection seems to have turned into a way of quantifying social status.

So why do I recommend waiting until age 15? 

One large study in the U.K. found developmental windows of increased sensitivity to the harmful impact of social media. Apparently, the onset of puberty and the onset of adulthood are especially vulnerable times: age 11-13 for girls, age 14-15 for boys, and age 19 for all genders.

I’m under no illusion that we can control our children’s online activity at age 19, but let’s try and hold out until at least age 15. When many teens in a community are on social media, it impacts everyone negatively, even those who don’t use it, so I think it’s worth thinking through this together as a community of parents. Most of us have felt the dopamine-fueled pull of social media on our adult brains, and I doubt we will regret holding out a little longer before unleashing it onto our kids. 

Adolescence, with all its developmental tasks and hormones is certainly hard enough.

References:

https://www.nature.com/articles/s41467-022-29296-3(Developmental windows)

https://pubmed.ncbi.nlm.nih.gov/27940701

(national trends depression)

https://www.cdc.gov/childrensmentalhealth/data.html

(national trends anxiety)

https://stacks.cdc.gov/view/cdc/101761

(national trends suicide)

Makarin, Alexey. American Economic Review, Volume 112, No. 11, 2022

(Facebook rollout study)

Kleemans, Daalmans, Carbaat, & Anschütz (2018). Picture Perfect: The Direct Effect of Manipulated Instagram Photos on Body Image in Adolescent Girls. Media Psychology. 

(manipulated photos on IG lead to worse body image in girls)

González-Nuevo, C., Cuesta, M., Postigo, Á., Menéndez-Aller, Á., & Muñiz, J. (2021). Problematic Social Network Use: Structure and Assessment. International journal of mental health and addiction.

(social comparisons on SM and depression)

Samra, A., Warburton, W. A., & Collins, A. M. (2022). Social comparisons: A potential mechanism linking problematic social media use with depression. Journal of Behavioral Addictions.

(social comparisons on SM and self-esteem)

Lee (2022). The effects of social comparison orientation on psychological well-being in social networking sites: Serial mediation of perceived social support and self-esteem. Current Psychology. 

(social comparisons on SM and mental health)

Burnell, George, Vollet, Ehrenreich, & Underwood (2019). Passive social networking site use and well-being: The mediating roles of social comparison and the fear of missing out. Cyberpsychology: Journal of Psychosocial Research on Cyberspace.

(causal pathway: passively using SM🡪social comparisons and FOMO🡺worse mental health)

https://www.nature.com/articles/d41586-020-00296-x

(social media in a community hurts everyone)

https://docs.google.com/document/d/1w-HOfseF2wF9YIpXwUUtP65-olnkPyWcgF5BiAtBEy0/edit

(causation, girls)