Henry David Abraham, M.D.

By Henry David Abraham, M.D. The story goes that coffee was discovered when a shepherd noticed his sheep dancing after they ate beans growing on a hillside. Humans have been using that bean ever since for alertness, inspiration, and energy. Caffeine is the world’s most popular drug. The US is the world’s greatest importer of coffee- nine pounds a year for each one of us. At birth caffeine is present in 75% of infants, and thanks to sodas and cocoa, in preschoolers, too. So when caffeinated “energy” drinks appeared in gas stations and supermarkets, consumers yawned, until now. Today brands like Monster Energy and Red Bull are household names and a $20 billion a year business. One third to one half of teens and young adults will try them. As the use of these drug vehicles has increased, so have reports of problems. Most people are familiar with the common problems of caffeine- jitters, insomnia, and anxiety. Energy drinks kick that list up a notch, to include seizures, strokes, and at least 13 possible deaths. There are now 20,000 emergency department visits a year related to energy drinks. Kids with preexisting medical conditions, especially those of the heart or brain, are particularly vulnerable. Recently, the makers of Monster Energy moved to sidestep the FDA requirement that they report any problems with their products by calling them “beverages.” This moves Monster to a different aisle in the supermarket and lets them sweep bad news under the rug. “But wait a minute, Dr. Abraham. Aren’t you just being a caffeine cop? How much caffeine is in an energy drink in the first place?” Answer: about one to three cups of coffee. How bad can that be? This year 18 experts on child nutrition said how bad in a letter to the FDA. They pointed out that a caffeine drink is different from a cup of tea or coffee in a number of important ways. Caffeine in coffee or tea is in a natural, botanical form, while the caffeine in energy drinks is added by the manufacturer. Another difference is that chemically concocted caffeine drinks contain a wild mix of Frankenchemicals: compounds not often mentioned in polite company that have little or no connection to normal human nutrition. Occasionally these chemicals do things to you. Guarana, one energy additive, for example, has one of the highest concentrations of caffeine in any plant, triple the caffeine in coffee. A third important difference is a matter of the use of energy drinks by children. There is no minimum legal age to buy them. If a child consumes a drug at a dose intended for an adult, this is an invitation to an overdose. The smaller the child, the greater the trouble. This among other thoughts led a committee of the American Academy of Pediatrics to say, “…caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents.” That brings me to the cultural differences between coffee, tea and energy drinks. Hot tea or coffee is sipped slowly. People meet for coffee. They serve coffee and tea at the book club. They drink tea together at the Chinese restaurant. The makers of energy drinks live on another planet. An ad for Monster Energy on Amazon says it all. The 16 oz. can of Monster “packs a vicious punch but has a smooth flavor you can really pound down.” Not exactly “meeting a friend for coffee.” This Brave New World of “beverages” may explain a recent study where Australian teens suffered cardiac and neurological toxicity after drinking three to eight bottles of energy drinks at a clip. From a public health point of view, the greatest harm from an energy drink is when it is mixed with alcohol. Being drunk is bad enough, but being wide-awake drunk is stepping on the accelerator with your eyes closed. Under no circumstance should an energy drink be thought of as a cure for alcohol intoxication. It’s not. Now before the proprietors of Starbucks and Peet’s take out a contract on me, let the record show that I am not a caffeine cop. Coffee is my favorite drug- er, drink. Of all the drugs I worry about, coffee is not even a warning blip on my radar. Its benefits vastly outweigh the risks. Its psychological and health effects are varied and proven. It reduces the risks of Alzheimer’s disease, certain cancers, heart disease, and type II diabetes. Should teens drink coffee? It depends. As kids enter the teen years their clocks for sleeping and waking, like daylight savings time, spring ahead an hour or two. That means when adults are getting sleepy, kids are getting ready to rock. That also means that the next morning, as the world awakens, teenagers are zombies. This also means for many teens early morning classes are cruel but usual punishment. Short of starting the school day later, a cup of tea or coffee may work wonders for the early morning zombie. It does for many of us. But it’s not for everyone. Steven Spielberg never drank a cup of coffee in his life. Voltaire drank 30 cups a day. They both turned out all right.

Dr. Henry David Abraham is a psychiatrist in Lexington, MA. He is a co-founder of the International Physicians for the Prevention of Nuclear War which was awa rded the Nobel Peace Prize in 1985. Material for this article was adapted from his most recent book, The No Nonsense Guide to Drugs and Alcohol, an e-book for teens and young adults. It is now available online at Amazon.com and BN.com.

Parenting Matters is a collaboration between the Lexington Human Services Department and The Colonial Times Magazine.

Kevin M. Kozin, MTS, LICSW

By Kevin M. Kozin, MTS, LICSW

When experiencing a loss, it can seem that everyone has some sage (and often misguided) advice they are ready to give you. For example, you may hear remarkably unhelpful things like: Get over it, Move on already, Time heals all wounds. While possibly well intentioned, these words imply that a loss is something that a person “gets over.” For many losses, we do not “get over” the loss. Instead, we need to find a way adapt to the loss. We cannot “get over” things like the loss of a child or a partner, but we can find new ways of relating to that experience and adapting to the new situation.

Speaking about a loss can be difficult. Sometimes, “I’m sorry for your loss” is the best statement you can provide. When you are asked difficult questions about a serious loss, it’s OK to say, “I don’t know.” You may be joining with them in the “not knowing” of what is going on for them, and it can help to feel connected. It is often more helpful to use words like “died” or “death” instead of “passed on.” Especially with younger people, it helps them to understand what really happened.

Dr. J. William Worden describes four “Tasks of Mourning” that one must go through to facilitate a healthy adaptation, and Elisabeth Kübler-Ross describes the “Five Stages of Grief” which help to conceptualize some of the key emotions that people experience.

Dr. Worden is clear that these are active tasks, not things that happen to us, but things that we must do, to facilitate a healthy adaptation to loss. I’ve adapted Dr. Worden’s tasks to include all losses, by using “lost attachment.”

1. To accept the reality of the loss

2. To process the pain of grief

3. To adjust to a world without the lost attachment

4. To find an enduring connection with the lost attachment while embarking on a new life.

These tasks look nice and tidy with a simple four point plan of action. However, they can be remarkably difficult. Dr. Kübler-Ross describes the “Five Stages of Grief” as:

• Denial

• Anger

• Bargaining

• Depression

• Acceptance

In grieving, it is useful to experience all of these stages of grief as we process a loss. Unlike Dr. Worden’s tasks, you may notice that these aren’t numbered, but in bullet points. Worden’s tasks are more linear. You accomplish one task and then move on to the next. Dr. Kübler-Ross’s stages of grief are more fluid emotional states, and we may experience any one of them, and then move to a different stage at any time. There isn’t any one stage that is most useful or even necessary. A useful guiding principle is that in moving through the stages, the main concern is getting “stuck” anywhere but acceptance (that’s the eventual goal). So, one can experience denial, then depression, then acceptance, and move back to denial. It’s useful to notice when we are in these stages, but not to judge ourselves for being in any one of them.

There isn’t a timeframe for when things should change or healing should occur. In fact, some people never work thorough their losses. That’s why it is important to address the tasks in a deliberate and meaningful way. Healing isn’t about the amount of time that it has been since the loss.

Various age groups tend to process grief and loss differently. Infants and toddlers may sense a change in routine and caregivers, and can experience separation anxiety and regression. Having consistent caregivers is very useful at this age. Children of three to six years often struggle with the concept of the body not-functioning and finality of a death or loss. They can be prone to magical thinking and also regression. Consistent limit setting, patience, and simple (concrete) explanations are most effective. For example, a burial can be frightening if not better understood, since they may not understand the finality of death and become concerned that their loved one can’t breathe underground.

Between ages six to nine years, they begin to understand finality of death and may want details as to how someone died. They often have difficulty concentrating and worry about themselves and others, such as a caregiver or parent dying. It would be helpful to provide a space for talking about how the death/loss affects them personally. For ages ten to thirteen years, they may be able to understand that death is inevitable and happens to everyone. At this age, they may identify more with adults of their own gender and experience an array of feelings. They are often thinking about how death/loss affects relationships. For this age, it is helpful to encourage expression of feelings and foster open communication about death/loss.

Teens will often have the ability to confront and prepare for an impending loss. For teens and adults, they may not just be grieving for a current loss, but what might have been. They will often desire time with their peers. Some concerns is that the teen will be “parentified” and attempt to take on the role of the parent a parent during a major loss. Another possibility is that they may turn to risky behaviors. During this time, it is important to have open communication with the teen about their experience and to allow them the space to process their feelings, while offering support for when they are ready.

For all ages, be on the lookout for complicated bereavement, such as a grief response that is extended, amplified, delayed, distorted, absent, conflicted, chronic, or unresolved. This is when the grief response is interfering with psychological functioning, which can co-occur with adjustment disorders, depression, anxiety, substance abuse, PTSD, and suicidality. Some common indicators are sudden loss, conflicted relationships, pre-existing mental health issues, limited successful coping skills, financial or employment distress, or multiple stressors.

Never Worry Alone. In grief, one should not be alone in the process. Connectivity is a healing and protective factor. If you have concerns for another person, family, or yourself, you may benefit from working with a grief counselor. Below is a list of resources that may be useful in getting help or learning more about grief and loss. The way through grief and loss is together, not alone.

RESOURCES

The Children’s Room in Arlington – www.childrensroom.org

Offering a full array of bereavement services for families who have experienced early loss. Their website is full of helpful bereavement information.

Compassionate Friends – www.compassionatefriends.org

A national organization that helps families who experience the death of a child.

NASW Social Work Therapy Referral Service

www.therapymatcher.org or (800) 242-9794.

This is a free and confidential service from the National Association of Social Workers that connects people to psychotherapists on a range of issues – not just grief and loss.

Kevin M. Kozin, MTS, LICSW is a local psychotherapist and grief counselor in Lexington, MA and works with adolescents, adult, families, and couples. Mr. Kozin is highly active in the community in his work on the Board and Executive Committee of the National Association of Social Workers, Massachusetts (NASW-MA) and serving as the Co-Chair the Mental Health and Substance Abuse Committee of NASW-MA. He holds master’s degrees in Social Work and Theology from Boston University and completed post-graduate training at the Massachusetts Institute for Psychoanalysis. Information on Mr. Kozin’s practice can be found at www.kozincounseling.com or by contacting him at (781) 325-1858.

 

Lisa Foo, PhD

By Lisa Foo, Ph.D

The top of many Mother’s Day wish lists is a good night’s sleep for the whole family. What a challenge with our many responsibilities, endless things to think about, and being kept up by other family members!

The average daily sleep requirement is about 14.5 hours for infants, 13 for toddlers, 12 for preschoolers, 10.5 for school-aged children, 9 for adolescents, and 8 for adults. Many of us need higher amounts to compensate for accumulated “debt.” Research has linked insufficient sleep with not only fatigue, but also weight gain, heart disease, and diabetes. Decreased sleep can cause emotional and behavioral problems, including (ironically) child hyperactivity. Driving while drowsy is a major cause of car accidents and related injuries. Sleep serves an important role in learning, so late night cramming can interfere with remembering the information that was studied.

So what causes difficulties with falling asleep, waking during the night, or getting up too early in the morning? Everyone wakes briefly throughout the night when transitioning between deeper and lighter sleep, but most of us return to sleep easily and don’t even recall having been awake. Sometimes, however, our brains “click on” too much or have a hard time “clicking off” as we process stressful thoughts, making it hard to fall asleep or return to sleep.

Many sleep difficulties improve through developing healthy sleep habits. Staying up late and sleeping in on weekends can cause chronic jet lag in which our bodies can’t tell when to feel sleepy. Maintaining a fairly consistent sleep schedule throughout the week can fix that. Relaxing evening activities and predictable bedtime routines signal the body that it is time to sleep. It’s helpful to turn off electronic screens (TV, computers, cell phones, etc.) 30 to 60 minutes before bedtime, as they may keep our minds active and the lights that they emit signal the brain that it’s still daylight and time to be awake.

Regular exercise (not too close to bedtime) can improve sleep, as well as overall physical and emotional health. Utilizing deep breathing, muscle relaxation, and visual imagery can make it easier to fall asleep at bedtime and return to sleep after waking during the night. Noise, brightness, and temperature levels of the bedroom, as well as the comfort level of the bed and bedding, should be conducive to sleep. It’s helpful to avoid the bedroom during the day so that when you get into bed at night your mind associates that space with sleep and becomes drowsy, just as we often become hungry when entering a kitchen. When having prolonged awakenings during the night, try getting out of bed, going to another room with the lights dimmed, and doing something relaxing until you feel sleepy enough to return to bed.

Caffeine stays in the body for hours before being fully eliminated, so caffeinated coffee, tea, soda, and energy drinks can be eliminated or reduced and consumed only in the morning. “Decaf” coffees usually still contain some caffeine, and if taken in large quantities or throughout the day, can still interfere with sleep. While alcohol can cause sleepiness, it can also disrupt nighttime sleep. Abusing other chemical substances can also cause sleep problems. Regular use of over-the-counter sleep aids is not recommended without consulting with a medical provider, as long term use can cause grogginess or memory problems, and they may also become less effective over time. Sleep medications should NOT be mixed with alcohol, as the result can be fatal.

It sometimes can be tricky to use these recommendations with a child who doesn’t see the importance of sleep. Children may also need parents to ease bedtime fears or set limits regarding bedtime or middle-of-the-night behavior. It may also be necessary to address any larger anxiety or behavior problems. If your teenager is not getting enough rest, you might choose to have electronic devices turned into you before bedtime so as to reduce the temptation to talk or text during the night. Infant and toddler sleep is especially challenging due to the complexities of naps, nighttime nutritional needs, and little ones’ limited comprehension abilities.

Difficulties sleeping or chronic daytime sleepiness can be symptoms of underlying medical conditions. Individuals with sleep apnea have difficulty breathing while sleeping, and so without even knowing it experience frequent brief awakenings to breathe. Being overweight increases the risk of apnea, though individuals at a healthy weight can also have this condition. Discomfort, pain, or heartburn can cause sleep difficulties and may be assisted by strategies such as relaxation, not eating or drinking close to bedtime, avoiding trigger foods, or receiving appropriate medication.

If you or a loved one experiences sleep difficulties that are interfering with emotional or physical functioning, please consider seeking help from a mental health or medical provider. We can help create a plan to make it easier to fall and stay asleep, and also screen for and treat underlying disorders. For example, psychotherapy might be useful to address depression or anxiety, or behavioral therapy could help train a young child to follow bedtime limits. Individuals with sleep apnea can often be helped by a device that helps them breath better at night, or with assistance losing excess weight that is contributing to the problem. Sometimes prescription medications for other conditions can interfere with sleep and so can be switched, reduced, or eliminated in consultation with your provider. If a member of your family experiences other problematic sleep-related behaviors (screaming or walking while still sleeping, bedwetting or frequent urges to toilet during the night, attacks of excessive sleepiness during the day, etc.), please make sure to have them professionally evaluated.

I’ll end with a confession – I have children, and some of this article was written in the late evenings after they went to bed. And my infant sometimes woke me up a few hours later. Life happens. However, instead of just telling myself “I’ll sleep after I finish everything on my list,” I try to prioritize tasks so that I finish the most important ones before stopping for bedtime. Our children follow the examples that we set. Parenting takes a lot of energy and patience, both of which are easier to provide when we are well rested. I wish us all the best on our quest for households full of sweet dreams.

Lisa Foo, PhD, is a psychologist in private practice in Lexington. Dr. Foo is a Harvard graduate and Fulbright scholar who specializes in assisting individuals and families affected by health-related concerns. She previously worked as a senior psychologist and supervisor at a Level 1 trauma center. 33 Bedford Street, Suite 11; 612-237-8471; drlisafoo@gmail.com; www.drlisafoo.com .

Robyn Vogel, MA, LMHC

Do you wish you could tell your partner what you are feeling more easily? Are you looking for a way to have a productive conversation without playing the blame and shame game? Do your “discussions” sometimes last into the wee hours of the night leaving you exhausted the next day?

When you have something important to share with your sweetie, you will need these 4 simple steps:

1. Choose the right time for ‘you’ to have the conversation (consider your time & your energy level)

2. Ask your partner if s/he is willing to talk at that time

3. Be willing to hear ‘no’ and ask for a better time

4. Schedule the conversation and agree to an ending time

Getting your partner to listen when s/he is not truly available can feel very frustrating — which only adds to an already charged situation.

If your experience is anything like mine used to be, your life is busy and it’s hard to fit time in for anything extra! It’s “easier” to avoid difficult conversations than approach them. You are frustrated because you often have to sift your way through the fog of blame and shame to get to clarity. You don’t feel deeply heard.

Several years ago, I learned there was a different way. Thank goodness! And I teach it to all of my clients!

You and your partner are going to love how easy this is for you both.

PRACTICE TIP: Sit together facing each other. Close your eyes and take some deep breaths together. Synchronize your breath for a few minutes (feel silly? keep going…trust the process, it works!) When you feel connected via your breath, open your eyes and look deeply at each other.

Make an agreement: one person will share at a time and the listener will reflect back what s/he heard…bit by bi

Slowly….switching speakers as needed. Use “I” statements. If you find yourself saying “YOU”, take a breath and start over! A do-over is a powerful tool to use! I recommend you limit your conversation to 1 hour max.

Now, what if you have something important to share with your partner, but feel like all you want to do is blame him (or her)? Here is exactly what you need to move forward and avoid a screaming match.

Take 5-10 minutes to journal what you are upset about (don’t skip this very important step!)

Re-read what you wrote and highlight every “you” or “s/he” and change them to “I” (this is called “the turn-a-round” according to Byron Katie’s The Work)

Look over the “I” statements and find nuggets of truth (leave the rest)

Now choose the right time for ‘you’ to have a conversation. Ask your partner if s/he is willing to talk at that time. Be willing to hear ‘no’ and ask for a better time. Schedule the conversation and agree to an ending time no more than 1 hour later.

You’ll want to take the steps above to heart and please share them with your partner. The idea here is that you don’t blame or shame your partner and s/he doesn’t do that to you!

It feels terrible to be on the receiving end of someone else’s blaming! “Well everything’s ruined and I’m upset because of YOU!” “I’m disappointed because you did this and you did that…and you made me feel this way or that way…and on and on and on.” We’ve all heard those words before. Sadly. And have those conversations been productive? Are they loving?

There’s more but I don’t want to give you too much at once. So begin with the invitation above (the steps) – and practice as often as you can.

You and your partner are on your way to deeper love already! Congratulations!