Heal Your Daughter (eBook)

Introduction

Most of us who have a daughter have a daughter we want to heal. This book attempts to assist with that desire. It is intended to address your teenage daughter’s mental health needs, whether your daughter is thirteen or nineteen years old, or even older. I hope that the information, exercises, and inspiration provided will empower you to help not only her, but also yourself.

This is not an academic book. This brief book is intended to be a ten-thousand-foot overview of the new field of Lifestyle Psychiatry, as well as a guide to navigating it. It is offered in order to fill an insatiable need that I see in many of the parents of my primarily female patients: “I want to help her, but I don’t know how.”

Even if you are an academic or professional, what you probably need is not a treatise on the benefits of the Whole Food Plant Based diet, or whatever other lifestyle intervention might be under consideration, but instead a practical, compelling, and comprehensive guide to healing your daughter who – given that you picked up this book – is likely struggling with depression. It is intended to provide a map, a skillset, and a toolkit for you and her together to terraform her psychological landscape into one in which she can grow and flourish.

Importantly, these ideas and information are invitational only. There will be no attempt here to convince nor to persuade either you or your daughter. I will just provide the facts as my training and experience have led me to see them.

An essential fact that needs to be acknowledged here is that, no matter what you do, nor how diligently you do it, nor how cleverly you do it, you actually cannot heal your daughter. She must heal herself if she is to heal at all. But what you can do is to provide a setting, a milieu, an ambiance, in which her self-healing might become easier, and then offer her a companion in the doing. You can help her to heal herself.

The good news is that healing, even from the worst disasters of childhood and early adolescence, is possible. The early traumas that life inflicts need not be “managed” with ever-escalating doses of psychiatric medications; I believe that they actually can be healed – completely or almost completely healed. There is every reason for hope.

In this chapter, I will describe the problems addressed in this book – depression, cutting, and suicidal thoughts; introduce and describe the new fields of Lifestyle Medicine and Lifestyle Psychiatry; and suggest how the latter can help with the former.

Depression and the Scope of the Problem

The Diagnostic and Statistical Manual of Mental Disorders (DSM),i which is a publication of the American Psychiatric Association, is the book that determines what mental disorders a mental health professional can diagnose, as well as the criteria for those disorders. In DSM, depression is defined as two or more weeks of either sad feelings or the inability to experience pleasure, in conjunction with five or more problematic changes in the following areas: sleep, interest and motivation, guilt, energy, concentration, appetite, the rate of mental or physical activity, and/or suicidal thoughts. For her to meet the criteria for depression, her difficulties in functioning have to impact two or more domains, such as her family relationships, her academic performance, her friendships, and/or her extracurricular activities. Severe depression is defined as this, in combination with either self-harm, such as cutting, or suicidal thoughts.

The DSM offers descriptions of mental states. The descriptions don’t say anything about the etiology – the root causes – of those mental states. For depression, there may be different root causes. For example, depression could be situational, having to do with stress or trauma. Or it could be based in genetics, biology, nutritional deficiencies, psychological factors, or other factors.

Whatever the reason or reasons behind it, depression is very common. I want to start with the scope of the problem, not to depress either of you further, but to make you realize that your daughter is not alone in her depression, in her desire to self-injure, nor in her suicidal thoughts. Depression and suicide attempts, let alone suicidal thoughts, are at an all-time high in the United States and around the world.

The Center for Disease Control and Prevention (CDC) reports that depression and suicidal thoughts are indeed an important concern. CDC cites dataii on adolescents aged 12-17 years of age from the year 2017-2018, indicating that during that time period:

15.1% had a major depressive episodeiii

36.7% had persistent feelings of sadness or hopelessnessiv

18.8% seriously considered attempting suicidev

15.7% made a suicide planvi

8.9% attempted suicidevii

2.5% made a suicide attempt requiring medical treatmentviii

CDC also cites National Syndromic Surveillance Program dataix from the period January 2019 through May 2021, indicating that – based on data from 71% of U.S. Emergency Departments (EDs) in 49 states and the District of Columbia – ED visits for suspected suicide attempts among adolescents aged 12-17 increased dramatically during the recent pandemic. ED visits for suspected suicide attempts were:

22.3% higher during the summer of 2020 than during summer of 2019x

39.1% higher during the winter of 2021 than during winter of 2019xi

The increase was even more pronounced in teen girls. The rate of teen girls visiting an ED for a suspected suicide attempt was:

26.2% higher during the summer of 2020 than during summer of 2019xii

50.6% higher during the winter of 2021 than during winter of 2019xiii

In contrast, the number of ED visits for suspected suicide attempts remained stable among same-age adolescent boys.

These data show that an alarming percent of teens today are struggling with depression and suicidal thoughts, and that rates increased dramatically – at least for teen girls – during the recent pandemic. When society itself is experiencing a tidal wave of socioeconomic problems – disease, isolation, ideological confusion, poverty, crime, or whatever other stressor you can name – most of that society’s members will eventually become engulfed in that wave, one way or another. And this is the situation our daughters face.

Cutting and the Scope of the Problem

Non-suicidal self-injury (NSSI), usually in the form of cutting, is widespread among adolescents, with lifetime prevalence rates between 17 and 60% in recent studies.xiv There are relatively few studies regarding effective psychotherapeutic treatments for NSSI in adolescence. However, cutting is widely regarded as a coping mechanism for depression, anxiety, stress, poor self-esteem, and other emotions. Cutting is especially common among teens who have experienced trauma, particularly sexual trauma. The cutting itself is usually superficial and does not in itself lead to death. However, it has been found that those who do die by suicide are about ten times more likely to have been cutters than those equally depressed who were not cutters. Thus, cutting is thought to be a rehearsal, a training of the brain to self-injure when under duress. This can be quite a dangerous program to have running in your daughter’s brain. It is a dangerous habit to have acquired, particularly when stress becomes extreme, as it tends to do.

Suicidal Thoughts and the Scope of the Problem

The shocking thing is how common suicidal thoughts are in high-school-aged youth today. Even before the pandemic, over half of high school teens reported that they had experienced suicidal thoughts within the previous year. And as we just saw, rates of actual suicide attempts dramatically increased during the recent pandemic.

Of note, though, relatively few girl teens who attempt suicide succeed. Only a small proportion, less than one percent, actually die after such attempts. What this means is that – with the right treatments – most teen girls with suicidal thoughts can be helped. Evidence-based strategies include preventing and mitigating adverse childhood experiences (for example, abuse), strengthening economic supports for families, limiting access to lethal means (for example, safe storage of medications and weapons), improving access to evidence-based care, improving girls’ social connectedness, improving their coping skills, and so on.xv

Defining Lifestyle Medicine

There exists a new field of medicine called Lifestyle Medicine. Founded in 2017 as a board-certified field of medicine, Lifestyle Medicine consists of a set of guidelines for how your daughter can live so that she can enjoy optimal physical and mental health.

Two alternative definitions of this field have been proposed and accepted by the American Academy of Lifestyle Medicine.

The first definition focuses on the creation of vibrant health. Lifestyle Medicine is: “The evidence-based practice of helping individuals and families to adopt and sustain healthy behaviors that affect health and quality of life . . .”xvi

The second definition focuses on the reversal of disease:...