Talking about “late in life” fathers on Public Radio

This week I was a guest on Larry Mantle’s “AirTalk” show on the NPR local affiliate KPCC.  The conversation was about men who become fathers later in life and the emotional effects of becoming a dad past 40.  Larry did a terrific job fielding the callers and we had a lot of positive strength based comments from the fathers that called in from the greater Los Angeles area.  I think it is a interesting subject that doesn’t get enough attention, so I am grateful for Larry deciding to set aside a half hour on his show to explore it in greater detail.

Audio portion from “AirTalk” interview

Working with Couples Facing Fertility Challenges

I was asked recently by the Southern California Counseling Center to speak to therapists about working with couples and individuals experiencing difficulty with creating children.  The audience was very active and we discussed a whole host of issues.  Everyone has their own experience as they work through this process, but common themes are feelings of shame and blame, an emotional roller coaster of hope and despair, loss and mourning, sexual disfunction, decreased ability to empathize with partner as process drags on, communication problems in relationship (avoidance of difficult subjects), secrecy of process and isolation from friends and family, donor/surrogacy options and concerns about “stranger dna”.   Although my presentation was just over two hours, we only started to scrape the surface of this complex issue and how it effects sense of self and sense of couples.   I hope that my training was beneficial in opening up ways for other clinicians to consider the depth of possible stressors and gave them positive ways to interact with their clients as they guide them through this often traumatic time.

What about Dad? Fathers and Parenting

It is safe to say that although I have been neglecting my blog, I have been busy in the world presenting at various organizations. Recently I presented with Dr. Chen Oren at the Motherhood Consortium about the role of fathers in parenting. Dr. Oren is a friend and colleague of mine who co-authored and co-edited “Counseling with Fathers”.
The presentation focused on several areas: the effect of shift of gender roles on fathers, rules of masculinity and how that relates to relationships with partner and children, how having children changes the male brain and also findings from Dr. Oren’s recent study of fathers and how they view their own strengths and challenges. The audience actively participated in the conversation and it yielded a lot of good focus and exploration of the complexities of being a father. Dr. Oren and I may be speaking again very soon and are currently working on co-authoring an article.

Postpartum Depression Strikes Fathers, Too

The pregnancy was easy, the delivery a breeze. This was the couple’s first baby, and they were thrilled. But within two months, the bliss of new parenthood was shattered by postpartum depression. A sad, familiar story. But this one had a twist: The patient who came to me for treatment was not the mother but her husband.A few weeks after the baby arrived, he had become uncharacteristically anxious, sad and withdrawn. He had trouble sleeping, even though his wife was the one up at night breast-feeding their new son. What scared her enough to bring him to my office was that he had become suicidal.

Up to 80 percent of women experience minor sadness — the so-called baby blues — after giving birth, and about 10 percent plummet into severe postpartum depression. But it turns out that men can also have postpartum depression, and its effects can be every bit as disruptive — not just on the father but on mother and child.

We don’t know the exact prevalence of male postpartum depression; studies have used different methods and diagnostic criteria. Dr. Paul G. Ramchandani, a psychiatrist at the University of Oxford in England who dida study based on 26,000 parents, reported in The Lancet in 2005 that 4 percent of fathers had clinically significant depressive symptoms within eight weeks of the birth of their children. But one thing is clear: It isn’t something most people, including physicians, have ever heard of.

At first, my patient insisted that everything was just fine. He and his wife had been trying to conceive for more than a year. He was ecstatic at the prospect of fatherhood, and he did not acknowledge feeling depressed or suicidal.

Suspicious of his rosy appraisal, I pushed a little.

It turned out that he had just taken a new high-pressure job in finance six months before the birth of his son. Though he was reluctant to admit it, he clearly had more than a little concern about his family’s financial future.

And he was anxious about his marriage and his new life. “We go out a lot with friends to dinner and theater,” he said wistfully, as I recall. “Now I guess that’s all going to end.”

He had spent the nine months of pregnancy in a state of excitement about being a father without really registering what a life-transforming event it was going to be.

Unlike women, men are not generally brought up to express their emotions or ask for help. This can be especially problematic for new fathers, since the prospect of parenthood carries all kinds of insecurities: What kind of father will I be? Can I support my family? Is this the end of my freedom?

And there is probably more to male postpartum depression than just social or psychological stress; like motherhood, fatherhood has its own biology, and it may actually change the brain.

A 2006 study on marmoset monkeys, published in the journal Nature Neuroscience, reported that new fathers experienced a rapid increase in receptors for the hormonevasopressin in the brain’s prefrontal cortex. Along with other hormones, vasopressin is involved in parental behavior in animals, and it is known that the same brain area in humans is activated when parents are shown pictures of their children.

Unlike women, men are not generally brought up to express their emotions or ask for help. This can be especially problematic for new fathers, since the prospect of parenthood carries all kinds of insecurities: What kind of father will I be? Can I support my family? Is this the end of my freedom?

And there is probably more to male postpartum depression than just social or psychological stress; like motherhood, fatherhood has its own biology, and it may actually change the brain.

A 2006 study on marmoset monkeys, published in the journal Nature Neuroscience, reported that new fathers experienced a rapid increase in receptors for the hormonevasopressin in the brain’s prefrontal cortex. Along with other hormones, vasopressin is involved in parental behavior in animals, and it is known that the same brain area in humans is activated when parents are shown pictures of their children.

There is also some evidence that testosterone levels tend to drop in men during their partner’s pregnancy, perhaps to make expectant fathers less aggressive and more likely to bond with their newborns. Given the known association between depression and low testosterone in middle-aged men, it is possible that this might also put some men at risk of postpartum depression.

By far the strongest predictor of paternal postpartum depression is having a depressed partner. In one study, fathers whose partners were also depressed were at nearly two and a half times the normal risk for depression. That was a critical finding, for clinicians tend to assume that men can easily step up to the plate and help fill in for a depressed mother. In fact, they too may be stressed and vulnerable to depression.

And there is the child to think about. Research has clearly shown that maternal postpartum depression can impair the emotional and cognitive development of infants. A father could well buffer the infant from some of the adverse effects of maternal depression — but that is a tall order if he too is depressed.

Dr. Ramchandani, who also followed children for three and a half years after birth, reported that they were affected differently depending on which parent was depressed. Maternal postpartum depression was associated with adverse emotional and behavioral effects in children regardless of sex; depression in fathers was linked only with behavioral problems in boys. (The study did not report on possible effects when both parents were depressed.)

As for my patient, he recovered within two months with the help of psychotherapy and an antidepressant. Afterward, he summed up the situation in just 10 words: “And I thought only women get this kind of thing.”

All too many doctors think so too.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical

New York Times 12/7/09

Why Exercise Makes You Less Anxious

Joubert/Photo Researchers, IncA neuron in the brain.

Researchers at Princeton University recently made a remarkable discovery about the brains of rats that exercise. Some of their neurons respond differently to stress than the neurons of slothful rats. Scientists have known for some time that exercise stimulates the creation of new brain cells (neurons) but not how, precisely, these neurons might be functionally different from other brain cells.

In the experiment, preliminary results of which were presented last month at the annual meeting of the Society for Neuroscience in Chicago, scientists allowed one group of rats to run. Another set of rodents was not allowed to exercise. Then all of the rats swam in cold water, which they don’t like to do. Afterward, the scientists examined the animals’ brains. They found that the stress of the swimming activated neurons in all of the ’ brains. (The researchers could tell which neurons were activated because the cells expressed specific genes in response to the stress.) But the youngest brain cells in the running rats, the cells that the scientists assumed were created by running, were less likely to express the genes. They generally remained quiet. The “cells born from running,” the researchers concluded, appeared to have been “specifically buffered from exposure to a stressful experience.” The rats had created, through running, a brain that seemed biochemically, molecularly, calm.

For years, both in popular imagination and in scientific circles, it has been a given that exercise enhances mood. But how exercise, a physiological activity, might directly affect mood and anxiety — psychological states — was unclear. Now, thanks in no small part to improved research techniques and a growing understanding of the biochemistry and the genetics of thought itself, scientists are beginning to tease out how exercise remodels the brain, making it more resistant to stress. In work undertaken at the University of Colorado, Boulder, for instance, scientists have examined the role of serotonin, a neurotransmitter often considered to be the “happy” brain chemical. That simplistic view of serotonin has been undermined by other researchers, and the University of Colorado work further dilutes the idea. In those experiments, rats taught to feel helpless and anxious, by being exposed to a laboratory stressor, showed increased serotonin activity in their brains. But rats that had run for several weeks before being stressed showed less serotonin activity and were less anxious and helpless despite the stress.

Other researchers have looked at how exercise alters the activity of dopamine, another neurotransmitter in the brain, while still others have concentrated on the antioxidant powers of moderate exercise. Anxiety in rodents and people has been linked with excessive oxidative stress, which can lead to cell death, including in the brain. Moderate exercise, though, appears to dampen the effects of oxidative stress. In an experiment reported at the Society for Neuroscience meeting, rats whose oxidative-stress levels had been artificially increased with injections of certain chemicals were extremely anxious when faced with unfamiliar terrain during laboratory testing. But rats that had exercised, even if they had received the oxidizing chemical, were relatively nonchalant under stress. When placed in the unfamiliar space, they didn’t run for dark corners and hide, like the unexercised rats. They insouciantly explored.

“It looks more and more like the positive stress of exercise prepares cells and structures and pathways within the brain so that they’re more equipped to handle stress in other forms,” says Michael Hopkins, a graduate student affiliated with the Neurobiology of Learning and Memory Laboratory at Dartmouth, who has been studying how exercise differently affects thinking and emotion. “It’s pretty amazing, really, that you can get this translation from the realm of purely physical stresses to the realm of psychological stressors.”

The stress-reducing changes wrought by exercise on the brain don’t happen overnight, however, as virtually every researcher agrees. In the University of Colorado experiments, for instance, rats that ran for only three weeks did not show much reduction in stress-induced anxiety, but those that ran for at least six weeks did. “Something happened between three and six weeks,” says Benjamin Greenwood, a research associate in the Department of Integrative Physiology at the University of Colorado, who helped conduct the experiments. Dr. Greenwood added that it was “not clear how that translates” into an exercise prescription for humans. We may require more weeks of working out, or maybe less. And no one has yet studied how intense the exercise needs to be. But the lesson, Dr. Greenwood says, is “don’t quit.” Keep running or cycling or swimming. (Animal experiments have focused exclusively on aerobic, endurance-type activities.) You may not feel a magical reduction of stress after your first jog, if you haven’t been exercising. But the molecular biochemical changes will begin, Dr. Greenwood says. And eventually, he says, they become “profound.”

–Gretchen Reynolds  NYTimes 11/18/09

Reducing Stress With Relaxation Breathing

In a busy, chaotic world, everyone wants to reduce stress, but that can require a number of time-consuming adjustments such as improving self care and diet, exercising more, balancing work and family activities, and addressing interpersonal conflicts. However, there is one magic bullet, an exercise that is guaranteed to instantly reduce your stress and make you more relaxed in moments: Breathing 4-6-8. Breathing 4-6-8 involves inhaling through the nose for four seconds, holding your breath for six seconds, exhaling through your mouth for eight seconds, and repeating that process two more times without a pause.

Step 1: It is important for this exercise that you utilize your diaphram when breathing.  To do this, as you breathe, make sure that your stomach is expanding, not just your chest.   Practice this twice.

Step 2:  Always breathe in through your nose and exhale through your mouth.  To enhance relaxation, lightly press your tongue against the roof of your mouth or against your upper front teeth.

Step 3: Let’s begin. Get into a relaxed position, touch your tongue to your upper front teeth or the roof of your mouth, and INHALE through your nose for 1, 2, 3, 4, and HOLD 2, 3, 4, 5, 6 and EXHALE, 2, 3, 4, 5, 6, 7, 8 and INHALE 2, 3, 4 and HOLD 2, 3, 4, 5, 6 and EXHALE, 2, 3, 4, 5, 6, 7, 8 and INHALE 2, 3, 4 and HOLD 2, 3, 4, 5, 6 and EXHALE, 2, 3, 4, 5, 6, 7, 8.

Step 4: You are done—breathe normally. Compare your stress/ relaxation level to how you felt one minute ago.

Childhood Eating Disorders:Identifying and Responding

Are you worried that your child may have an eating disorder? How would you know if they did? What can you do to help? Everyday millions of children are under enormous pressure to look a certain way. According to the National Eating Disorder Association, over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting and taking laxatives (Neumark-Staainzer, 2005). 42% of 1^st-3^rd grade girls want to be thinner (Collins, 1991) and 40% of 8 to 13 year olds have reported that they have actively tried to lose weight (Rolland et al., 1997). What does this all mean? By middle school, body dissatisfaction and dieting behaviors are considered the norm. This is not surprising given the fact that it is estimated that children are bombarded with over 40,000 television ads a year telling them they must lose weight, shape up, eat this, not that and above all that they must change from what they are if they are to be “happy” and successful.

We are a culture based in ideas of self-improvement (learn more, work harder, make more money etc.).  Eating disorders fit nicely into the self-improvement metaphor. Losing weight or controlling one’s weight often leads to feelings of being “in control”, strength, accomplishment, productivity, power, being admired, driven, exceptional and accepted. We can therefore see why eating disorders catch so many individuals and why the diet industry is so successful. Dieting and the control over body size initially generate feelings of self-confidence and positive feedback from others. Of course, eating disorders end up taking away all the things they promise and instead often lead to a loss of close relationships, low self esteem, low self worth, depression, anxiety, and a host of serious health issues.

How can you identify someone in your family that might have an eating disorder?

The following list is not meant to be inclusive, however these may be signs that further conversations might need to occur.

• Has your child eliminated certain foods from their usual meal plan?
• Does your child talk about needing to be on a diet?
• Has your child suddenly become vegetarian?
• Is your child making excuses around meal times?
• Has your child become more isolated, less willing to attend family functions or visit with friends?
• Does your child make excessive comments about his/her body, such as, “I’m fat, I hate my legs, stomach, arms” “I need to lose weight.” “ I would have more friends if I lost weight.” “I can’t go out because I’m too fat.”
• Has your child changed how they dress, like suddenly wearing baggy clothes?
• Is your child exercising more than usual?
• Has your child become very “black and white” in their thinking?
• Is he or she uncomfortable with rest or relaxation, feeling he/she must be “productive” at all times?
• Is he or she easily angered or more anxious than usual?
• Have you discovered large quantities of food disappearing overnight?
• Does your child put enormous pressure on him or herself to be the best in all areas of her/his life (sports, academics, performing arts, relationships etc.)?

As a parent what can you do?

If your child is showing signs of an eating disorder:

• Try to avoid unnecessary power struggles around food. This often leads to feelings of inadequacy, which will lead right back using food to feel better.

• Try to remember that there is a reason your child is responding to their internal feelings with food or control of their body.

• Try not to blame, shame or place guilt on your child regarding her/his behaviors.

• Ask questions that open up space for your child to tell you how they are feeling. For example, if you see them struggling with food you might ask: “Is there anything I can do to help?” “What’s going on?” Instead of just focusing on the food.

• Help your child to identify values and qualities that matter to them outside of appearance, body or weight. Such as, being a good friend, good listener, caring, loving, adventurous, helpful, insightful, balanced etc. Find out what they care about. What are their purposes, hopes, and dreams?

• Avoid giving simple solutions. For example, “Just eat it”.

To help your child stand up to unattainable cultural standards of body and beauty:

• Avoid making food or thinness a moral issue, even for yourself. Avoid statements like “I was bad today because I ate a cookie.” “ I’m lazy because I didn’t exercise today.” “ I was so good today because I only ate healthy foods.” Remember: Food does not have a moral value.

• Help your child become a critical viewer of media. Explore with curiosity the messages that you are both exposed to and how they make you feel. For example, after your child just watched “Top Model” on TV, you might ask, “Do you find you are comparing yourself to those girls on TV? What does that feel like? “

• Dispel the myth that a certain body/weight or look will automatically lead to happiness or fulfillment.

• Remember that children have big ears. Choose to talk about your own appearance and your body in ways that are respectful. Avoid comments like “I can’t wear that with my thighs”

• Let your child see you choose to value yourself based upon your values, qualities and character, not your appearance.

• Don’t make comments about other people’s bodies, good or bad

Remember, although your child has to contend with a whole dieting culture, you can help your child value themselves for more than just their body. She /he sees what you do and what you find important at home everyday. But you are also subjected to the unattainable standards of our culture and if you understandably have trouble valuing yourself for more than your body or appearance, talk to a professional about it. In turn, as you change your attitude toward yourself, that will be a gift for your child.

Eating Disorders are complex problems that occur on a continuum, from obsessive dieting to severe restriction of food and feelings, binging, purging and over exercising. If you believe your child is headed toward dangerous territory, we encourage you to seek consultation from a trained eating disorder mental health professional.

Beverly Teller LMFT (818) 754-8252

Michelle Berg, LMFT (310) 433-0493

Talking With Your Teen

Don’t wait until your teen approaches you. Many teens won’t. Go to them and tell them you would like to talk.

Set a time to talk. Approaching them to talk might put them on the defensive and they may feel cornered. Tell your teen you would like to talk and discuss a time the works for both of you.

Eliminate distractions from the conversation.  If you are meeting in the house, shut off the T.V. or radio. Meet in a room that won’t have traffic coming through it. Give your child good eye contact and let them know that you are focused on the conversation because it is important to you. 

 

Don’t give ultimatums. Discuss your concerns and possible consequences to behaviors. Try to come to an agreement on what is appropriate. Once you lay down the ultimatum the conversation is over.

Share your feelings regarding the topic of the conversation. It is okay to disagree with your teen and let them know your feelings. However, be sure to listen to their disagreements. It is okay to be firm on your values and your hopes for your child, yet, make it clear that you don’t stop loving them because they disagree.

Admit it when you are wrong. Say you are sorry if during the conversation you realize you were wrong. Your teen will respect you more and most likely listen to you more in the future.

Don’t interrupt your teen when they are speaking. It is disrespectful. Talk to them the way you want to be spoken to. Listening to your teen without interrupting shows them that you care about what they are saying.

Avoid overreacting. Try to listen to your teens side of the story and explanations thoroughly. Don’t be accusatory or jump to conclusions. You might just find that, if you hear your teen out, it wasn’t as bad as you thought.

Respect their privacy. While a parent might want their teen to disclose everything about their lives, most teens want their privacy. Cherish whatever they tell you and respect that some things are just for them. If your teen feels that you truly respect their privacy they are more likely to disclose more. However, keep in mind, if you feel your teen is not safe, then prying might be warranted.

Don’t use absolutes when arguing. Try to avoid saying words like “always,” “never,” “all the time,” when talking about negative behavior. Those words are most likely inaccurate and they only make a teen feel like you only see the bad.

Use “I” statements to discuss your feelings instead of “you” statements. For example, state “I feel worried when I am not sure where you are at night.” instead of “You are never home on time and you worry me.” It sounds less accusatory when you use “I” statements and it will help keep your teen in the conversation instead of on the defense.

Take a break. Sometimes the conversation does not go the way you or your teen had planned. If you begin to argue or feel that you are getting to angry, take a break. Let your teen know that you want to continue having this discussion, that you love them, and set a time to start up again.

 

Dr. Eliezer Jones, phd