Feb 09

Smartphones and your love life

SmartphonesLoveLifeWexlerby Dr. Micaela Wexler

Do smartphones hurt relationships?
It turns out that smartphones and electronic gadgets can hurt our interpersonal interactions. What is worse, a recent study shows that intimate interactions are affected more than casual interactions.

A study published in the Journal of Social and Personal Relationships July 19, 2012 shows that the mere presence of a smart phone can interfere with conversations between two people.

Two experiments were done to measure quality of relationship and feelings of empathy. In the first experiment strangers were put in pairs, and sat in a room that contained only a table two chairs and a book on the table and another object. For half the pairs, the other object was a smartphone and for the other half, the object was a pocket notebook the same size as the smartphone.

In this experiment, the pairs of strangers were asked to discuss an interesting event that occurred in the past month. Following the 10 minute discussion, the participants filled out questionnaires that measure relationship quality over time. This questionnaire included questions such as, “It is likely that my partner and I could become friends over time.”

The group with the smartphone present reported lower relationship quality and less closeness. Few of them believed they could ever become friends with their partner, for example. The results showed a lower level of connection between the partners when a smartphone was present.

The second experiment measured the effect of smartphone presence on intimate conversations and casual conversations. The set up was the same, but the pairs of strangers were given different tasks. One half of those pairs in each group were given the task of discussing their feelings about plastic trees for 10 minutes. The other half in each group were given the task of discussing the most meaningful event that had occurred in the past year.

The results of this experiment spell trouble for couples.

Partner empathy and partner trust were the items most adversely affected by the presence of a smartphone. The groups discussing the plastic tree showed a small difference from each other; however the groups discussing a meaningful events showed a dramatic difference.

The smartphone groups scored lower on the question “I felt I could really trust my partner,” and “I felt my partner could understand my feelings.” That is not good for intimate, romantic relationships.

So, why is this? How can the mere presence of a smartphone lead to such dramatic differences?

First, anything that provides a source of instant gratification will stimulate the reward centers of our brains. Studies show that just thinking about a morning cup of coffee causes endorphins to rise.
ChildPsychiatrySnow9

When alcoholics just look at a drink or drive by a liquor store, the reward center in the brain fires up. It isn’t much of a stretch to realize a smartphone could have the same effect.

Smart phones are full of apps that provide instant gratification. Think of all the games you play you just can’t put down. That type of brain stimulation is addictive. We are all naturally driven to engage in those types of activities; we enjoy the endorphin rush these thrills give us. We can reliably feel good after playing one of these games, so we begin to depend on them.

When facing a stressful event, we crave that endorphin rush even more. For example, we crave our morning cup of coffee more on work days than weekends. So it is very likely that the mere presence of a smartphone is causing the reward center to fire away.

Except for that beginning stage, when everything is new and exciting, relationships do not provide a reliable endorphin rush. People with their complexities and needs are not very predictable: sometimes they thrill, sometimes they don’t. Our partner does not just offer fun and games. More often than not partners approach each other with topics that are stressful: bills, children, work conflicts, emotional needs and jealousies. Our brains respond to this, the parts of our brains dealing with danger are activated in the mere presence of anything that has been a source of stress. If there is a smartphone nearby, our partners lose out, because the reward center will always win.

So, what do we do? Smartphones are an ever present part of our lives.

I will confess, I am one of those people addicted to my smartphone. It is a significant part of my work as a rural psychiatrist. I get calls and text messages from all over the hospital and clinic all day long as well as several nights a week. Given the stressful nature of my job, I also began to rely on the endorphin rush provided by my games.

Dr. Wexler Smartphones

I have started to experiment with designated “no smartphone zones.” As a family psychiatrist, I advice families to keep gadgets away from the dinner table. For people who depend on their phone for work, as I do, I suggest the smartphone be placed away from the table. I have started forwarding my calls to a landline during dinner time with my partner or family. When a landline is not available, I have a special ring tone for the hospital. All other sounds are ignored. I will be the first to admit that implementing this plan is not easy.

For couples, I recommend no cell phones in the bedroom. I know how difficult this is to follow because I have yet to do it myself. But, given the results of these studies, I am sure I will reap the benefits when I finally banish the smartphone from the bedroom.

Another strategy that has worked for me came about by accident. I have an older version of the iPhone and I inadvertently updated the operating software. All my games stopped working! I was able to easily update my medical apps, but I couldn’t find newer FREE versions of my favorite games. Rather than buying new games, instead I went into my kindle and found free games through Amazon Prime. Now, whenever I need that endorphin rush I grab the kindle. Over time, my smartphone has become less associated with fun, so I’m probably not getting that endorphin rush. So, that might be a solution for you: take the games out of the smartphone and use a different device.

Smartphones can be used to enhance our relationships!

There are several apps specifically designed for couples.

SmartphonesLoveLife1

Couple is a free app available for both iPhone and android. It is similar to the Facebook app, except you each have just one friend. You can poke each other, share pictures, videos, texts and voice clips. It even has a feature called “thumb kiss” letting you touch thumbs in real time to get a “love vibration.”

Between is a similar app available for iPhone and android devices, but with the addition of a datebook and note sharing. The datebook is especially helpful for couples with busy lives because you can keep each other informed of your activities.

Icebreak for Couples is an app that couples can use to learn more about each other. It comes with activities they can share based on the answers to these questions.

Right now, my partner and I are using Between. We are loving it! The first thing we see when we open the app is our two pictures and the number of days we have known each other. For us, the calendar is crucial because we both have busy, fluctuating schedules in the medical field. I have the push notifications on, so I get alerts whenever she enters anything. We chat with each other using the app. We can send each other voice memos as well as texts.

If you find that you just can’t put your smartphone down, and are not able to adopt any of these strategies, then you need to examine the root cause of this behavior. You may need to see a therapist or psychiatrist to determine if you have an addiction, or if you have depression or anxiety that your are self medicating with your smartphone apps. You might need to take a good look at your relationship and your life. Behavior that is out of control should never be ignored, especially because help is available.

Dr. Micaela Wexler also blogs on child psychiatry topics at kidpsychdoc.com.

Jan 05

When you lose a parent to suicide

PeaceWinter2By Dr. Micaela Wexler
The loss of a parent is devastating for any adult. As a psychiatrist, it is one of the most painful transitions I encounter. Your status in the world is dramatically changed. Immediately upon the death of your parent, you are plunged into a sea of nostalgia, and it is easy to feel unmoored. You are no longer being tugged by the larger vessel that guided you your entire life. Now YOU are that vessel that will have to take the lead. It is a transition that we all anticipate but for which we can never truly be prepared.

When the death is due to suicide, it is not a transition; it is a calamity. While an accidental death brings shock and denial, death from suicide generates horror, anger, guilt, confusion and shame. Add to this the fact that there is still a great deal of stigma about suicide, which can become a significant obstacle to getting help. This is most likely why people who have lost a parent to suicide are at increased risk for committing suicide themselves: the feelings are overwhelming and it is difficult to know where to turn.

It is natural to turn to family members for help. They are the ones who knew your parent best, they have been part of your entire life, and there is no need to overcome the stigma of suicide with them. However, they are not the best choice in the immediate aftermath for the simple reason too have suffered a tragedy and are devastated, and therefore unable to offer much support.
This is a time when psychiatric or mental health care is absolutely essential.

Psychiatrists and other mental health professionals are well aware of the magnitude of this event, and will treat it with the urgency it requires. Besides needing someone with whom to talk, chances are that the suicide has caused enough of a physiological shock that you also need at least a short course of pharmacological assistance until you start your recovery. A psychiatrist or therapist can assist you in this manner safely. (A therapist will refer you to a physician if you need medication.)

It’s difficult to think while in such a state of shock, so I have provided the following advice and information.

First, call your primary care physician and ask for a referral.

If that doesn’t work, call your local emergency room. They will give you the number to local resources.

If you feel utterly incapable of doing either of the two previous items, then you need emergency care. Call 911.

If you have a family member who has become non-functional due to a family member’s suicide, do not put yourself in the position of being their main support. This is risky for both of you, especially if you were also affected by the suicide.

Helping someone else before you have coped with your own feelings is simply a bad idea. You are very likely to bury your own feelings while giving someone inadequate care.

If you and your loved one were both hit by a car while crossing the street, no one would expect you to become the primary care provider. With a family suicide, you are even more incapacitated than you would be if you were hit by a car.

So, in the aftermath of a family suicide, get a psychiatrist or therapist to help you and your family.

For more information, please visit my post on losing a loved one to suicide.

Oct 05

College students and mental health

By Dr. Micaela Wexler
As a family psychiatrist, I have noticed this is the time of the semester when college students first face mental health challenges. These can include issues like homesickness, anxiety about exams, alcohol abuse, difficulty with focus and concentration, romantic break ups, roommate conflicts, insomnia and time management challenges. Though these are common, and not considered serious, they can interfere with a student’s progress. These issues are easily treated, and should be addressed by students and the people in charge of supporting them.

The mental stress that is part of the college experience can trigger episodes of serious mental disorders. It is at this time of the semester, when first exam grades have been posted and class withdrawal deadlines are approaching that students with issues like bipolar mood disorder, eating disorders, severe OCD, or more rarely, psychoses or delusional disorders are especially overwhelmed. A significant number of people with these disorders are not diagnosed until early adulthood, so if they are in college when the first episode occurs, they usually find themselves alone, without psychiatric care.

It has become routine on college campus for a review of mental health services to be part of new student orientation. Many colleges offer a number of free counseling sessions to every student. However, when students are faced with an actual mental health crises, their thinking process tends to be derailed and they don’t always know what do to. The most frustrating aspect of mental health care is that oftentimes, even people with severe mental illness may fail to recognize they are at risk and need help.

College students can play an important role when it comes to mental health by being attentive to their peers. Students should trust their instincts and take action when they sense a fellow student is under mental duress.

All students should know the warning signs for suicide. An easy mnemonic has been developed by the American Association of Suicidology: IS PATH WARM (Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood Swings). Students should know where to turn for immediate help if they suspect a fellow student is suicidal.

Students do not need to sense a problem is as serious as suicide to take action. If a fellow student seems down, or has stopped eating, is losing or gaining weight rapidly, or getting intoxicated frequently, that person may need help. Help can take many forms. A student could ask a peer directly, “are you ok?” If that feels awkward, a student could bring up the topic in a general way, ie, by talking about something they heard in class, or on the news, ie, “I heard that severe stress in college can trigger (an eating disorder, a drinking problem, severe OCD, hearing voices). What do you think?”

Or, a student could say to a peer, “you have seemed really worried lately. Would you like to talk about it?”

A student should not take it upon themselves to be the sole source of support for a student in need. Before approaching the student in need, a college student should speak to a professor, resident assistant, a mental health provider, just in case the situation is more serious. This can easily be done in a way that protects the other student’s privacy and dignity.

On the other hand, talking with other students about the student having problems without ever offering support to the person who is depressed or behaving erratically is not only unkind, but potentially dangerous. There is still a great deal of stigma regarding mental health issues, and contributing to this should NOT be part of the college experience. Nowadays there are effective treatments for even the most serious of mental health challenges. Taking positive action in the face of mental duress can be rewarding for college students. Preventing mental health tragedies is something which will enhance the college experience for everyone involved.

Jul 12

Lost a family member to suicide? There is help.

By Dr. Micaela Wexler
If you have lost a family member to suicide, you should know that you and your surviving family members are at an increased risk for suicide. All family members should know the warning signs for suicide. An easy mnemonic has been developed by the American Association of Suicidology: IS PATH WARM (Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood Swings).

If you are wishing you were dead yourself, or feel you have these signs, you must get help immediately. Call 911 if you don’t know what to do. Or, call one of the following numbers:
1-800-SUICIDE
1-800-273-TALK

If you just need someone to talk to, you should also call those numbers. They can point you to resources in your area.

Websites where you can go for help:

www.suicidology.org – American Association of Suicidology – has a section for survivors

allianceofhope.org - provides an online support group. They have different forums for the different types of survivors, ie parents, children, co-workers.

www.suicide.org – a list of resources for those at risk as well as resources for those who have lost a loved one to suicide.

www.suicide.com – created by a suicide attempt survivor to help people who are suicidal

attemptsurvivors.com – a good blog to help understand the WHY behind suicide, blog posts written by people who have survived a suicide attempt

No Time To Say Good-bye, surviving the suicide of a loved one, by Carla Fine – carlafine.com – the best book on this subject which I have read

It is normal to feel intense emotions: guilt, fear, anger, hopelessness. A death from suicide is different from any other death because it is a violent choice. Many family members find it difficult to get through each day after a loved one commits suicide.

Regardless of how you feel, suicide is NOT done to punish those left behind. A person commits suicide due to unbearable emotional pain.

While it is true that there are known warning signs for suicide, some people may give no warning at all: they may seem peaceful or happy before committing suicide. This is common for people who have decided and planned out their suicide, because they feel they have finally discovered a way out of their pain. These suicides are the most shocking and devastating for families.

Other people who commit suicide do give signs that families don’t notice until it is too late. The following are some of these signs:
- a preoccupation with death or the afterlife
- sadness, hopelessness, loss of interest in life or those around them
- giving away belongings
- sudden change from severe sadness to seeming to be at peace
- sudden interest in “clearing the air” about past conflicts, events
- hints about suicide
- reckless behavior
- self injurious behavior
- previous suicide attempts
- loss of appetite, weight, energy, decrease in activities
- constant negative comments about themselves

If you realize your loved one was showing these signs, you should not blame yourself. These signs are subtle, easy to miss. Suicide is difficult for most people to talk about or confront. And, many people who are not suicidal also show these signs.

Every member of the family will react to the suicide in a different way. There is no correct way to respond.

If the loved one was a teenager or child, the younger siblings will need extra care and attention.

In the immediate aftermath of a suicide, other family members, especially the PARENTS, will not be good sources of support.

Do not suffer alone. Go to the resources I’ve listed. Or contact me. I am not able to provide care through my web site, but I might be able to point you to someone who can.

And, a reminder: if you need IMMEDIATE help, call 911.

Jun 29

Surviving teenage suicide

By Dr. Micaela Wexler
Teenage suicide is the most frightening event I have faced as a psychiatrist. It causes more pain and destruction than any other cause of death. The life cut short is often one full of promise and hope. In the aftermath of a teenage suicide, survivors are confused, consumed with guilt, overwhelmed with their feelings of anger, loss, betrayal, and fear. They really are not in the best position to ask for help.
The problem I have encountered as a psychiatrist is that survivors tend to be ignored, mostly because people do not know what to do. Or, they are scared of interfering. Or, they don’t realize just how fragile and in need of help survivors are.
So, how do we support these survivors? In this post I will share tips I have learned from my own experience as a psychiatrist, and at the end, I will give links to some helpful resources specifically for suicide survivors.
Parents, it is normal to feel tremendous guilt. It is very likely that you will become incapacitated by your grief. However, you are not at fault. Teenage suicide is a societal problem. If it was possible for a PARENT to prevent the suicide of their son or daughter, we wouldn’t HAVE a teenage suicide problem. When the funeral is over and all your child’s friends have disappeared, your feelings will worsen. Be careful who you reach out to. Reach out to someone with experience dealing with suicide: a professional, a medical doctor, clergy. Do not reach out to anyone who makes you feel at fault, and this includes family, friends, even your spouse. Ideally, you should reach out to other parents who have survived a similar loss, but that may be difficult to do in the immediate aftermath. Call 1-800-SUICIDE if you don’t know what else to do. Leave a post on this web site. Do not isolate yourself.
If you know a parent whose child has recently committed suicide, reach out to that parent ONLY if you can do it in a supportive manner. If you’re thinking to yourself: she shouldn’t have gone back to work, he shouldn’t have filed for divorce, they shouldn’t have pushed him so hard, etc, then DO NOT reach out yourself. Find someone else to offer that parent support. Only reach out if you are convinced you will be positive and supportive.
If you have a brother or sister who has recently committed suicide, your parents will not be there for you in the immediate aftermath. You will have to reach out to someone else: grandparents, relatives, your friends’ parents. If you have other brothers and sisters, reach out to them and be there for them. Your world has just been destroyed, and you may wonder what you did to contribute to your brother or sister’s actions. Most likely, you did nothing. Suicide has many causes; brothers and sisters are powerless to prevent such a monumental problem. Until you process your grief, the best thing you can do is talk about your brother or sister’s life. Do not hide your brother or sister’s cause of death. Ask your parents to send you to see a therapist, especially if you feel suicidal yourself. Call 1-800-SUICIDE.
Friends of the teenager need to reach out to each other. If you were a close friend, reach out to other close friends. Do not suffer alone. Go to the memorial services and the funeral. Make a Facebook page celebrating your friend’s life. You will blame yourself, this is normal, but do not hurt yourself. Call 1-800-SUICIDE if you are having a hard time coping with this. Give yourself a break: see if you can lighten school and work activities in the early days. Go see a therapist. And, remember that your other friends are entitled to their feelings, also. Some of them might be angry and blame the suicide victim, some may blame other people. This is all normal. What is not normal is to hurt yourself.
If your teenage child has lost a friend to suicide, your child needs you. Friends of a teenage suicide victim are at an increased suicide risk. Expect your child to be moody, angry, emotional, irresponsible, lazy, or completely in denial. Some teenagers are completely unable to confront a loss of this magnitude, and may behave as if nothing happened. That doesn’t mean they are not affected. A teenager who has recently lost a friend to suicide should not be left completely alone. Take all suicidal threats seriously. Watch your child for behavior out of the ordinary. Make sure your child has the support he or she needs.

Suicide is growing at an alarming rate, and affects everyone in our society. Caring for the survivors of suicide is an important job that requires everybody’s help. The obvious survivors of the teenage suicide include parents siblings, relatives, friends, acquaintances, teachers, coaches, clergy. But if we stop to think about it, we are ALL survivors because we are all negatively affected by teenage suicide. We are all forever deprived of the promise of that young person’s life.

The American Association of Suicidology has an excellent page with resources for survivors.

Alliance of Hope offers an online support group.

The following is an excellent book about surviving suicide:

No Time To Say Good-bye – Surviving the suicide of a loved one, by Carla Fine