TIME mental health

A Different Ending to My ‘Adam Lanza’ Story

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Long wrote the op-ed "I am Adam Lanza’s mother" two days after the massacre at Sandy Hook Elementary School, to allow herself to get help for her son. Now that Peter Lanza, the father of the shooter, has spoken out, she says she's so glad she did

In November 2012, I happened to hear author Andrew Solomon on NPR, talking about Far from the Tree, his book on children who are different from their parents in profound and life-changing ways. “Must get this book now!” I texted to my fiancé, who sent me a nearly identical message.

We were both thinking about my son, whom I call Michael. In the later months of 2012, Michael’s behavior was increasingly erratic and violent. Because he was so disruptive, he was asked to leave a prestigious math and science academy and was transferred to a restrictive program for students with behavior problems. One morning, a simple request that he return overdue library books quickly escalated into my son making death threats against me. In December 2012, when Adam Lanza killed his mother, my then 13-year-old son was in an acute care psychiatric hospital. I was physically bruised from restraining him as he tried to run into traffic and emotionally exhausted as I realized I had few options to help my son. After more than eight years of searching for answers, we still didn’t know what was wrong with Michael.

As I read Peter Lanza’s honest and heartbreaking assessment of his lost son Adam, I was again struck by the similarities between the Lanzas’ painful story and my own. In the immediate aftermath of the Sandy Hook shooting, when I wrote the blog post that was republished as “I Am Adam Lanza’s Mother,” most of us knew very little about Adam or Nancy. But I knew, because in many respects, I was living a parallel life.

I wrote the words, “I am Adam Lanza’s mother,” not to the world, but to myself. Before I could get help for my son, I had to admit how desperately I needed it. That first step—acknowledging to myself the gravity of my family’s situation, our tenuous and faltering grip on the external trappings of normalcy that I so desperately craved—is what ultimately allowed my son to get the help he needs.

More than a year later, Michael finally has a diagnosis, bipolar disorder, and he is finally on a medication that works. In the eight months since that diagnosis, Michael has not threatened himself or others; he will return to a mainstream school next fall. I wish that Adam Lanza could have followed my son’s path. The child Peter Lanza loved was bright, funny, a “normal weird kid.” What happened? Not even Peter Lanza knows.

Philosopher Claire Creffield, in analyzing the luck factor that separates an Adam Lanza from a similarly challenged child who does not commit mass murder, notes that “a host of chance events come together to make one imperfectly-parented child a killer and another imperfectly-parented child a well-adjusted adult.” Peter Lanza has come to the same conclusion: He told Andrew Solomon, “I want people to be afraid of the fact that this could happen to them.”

I want the same thing. While none of us are perfect parents, I personally do not blame either Peter or Nancy Lanza for what happened to their son. Both parents loved Adam. Neither parent imagined or wanted their child’s horrific end.

This is why what Peter Lanza did by sharing his story with Andrew Solomon is so important. Lanza’s story fills important gaps in our understanding of how a beloved child became a killer—and reminds us as a society that we have an obligation to help families and children before they find themselves on irreversible paths of violence. People have blamed Peter for being a distant father. I received the same type of criticism because I have raised my son for the past several years as a single mother. Yet I do not blame Michael’s father for his illness any more than I blame Peter Lanza for his son. Compassion, not judgment, is what we deserve.

In Lanza’s description of his son’s journey into isolation, I see too many similarities, not only to my own experiences, but to the experiences of millions of children and families. I am a mother, not a medical professional, and yet as I scroll down a list of symptoms that mirror my son’s, I can’t help but wonder why Adam Lanza was never diagnosed with a serious mental illness like schizophrenia or bipolar disorder. Still, I view my son’s very real mental illness as an explanation, but never as an excuse.

As we look at the changes we need to make in our mental healthcare delivery system, our goal should not be reactive—to prevent another Sandy Hook or Tucson or Aurora. Instead, our goal should be proactive—to provide early interventions, appropriate diagnoses, and medical treatment to children and families well before a crisis like Sandy Hook occurs. I am grateful to Peter Lanza for adding his important voice to the chorus of parents who are seeking solutions and change. Peter Lanza’s story is also a tragedy, a little boy lost, a society that turned away, at terrible cost.

Liza Long is a writer, educator, and mother of four children, one of whom has mental illness.

TIME health

Happy Daylight Saving: 6 Proven Steps To The Best Night’s Sleep You’ll Ever Have

woman sleeping
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Your Worst Enemy Is Probably You

Stop cheating yourself. You can’t cut corners on sleep and not have it affect you:

…by the end of two weeks, the six-hour sleepers were as impaired as those who, in another Dinges study, had been sleep-deprived for 24 hours straight — the cognitive equivalent of being legally drunk.

Being tired actually makes it harder to be happy. “Sleeping on it” does improve decision making and can help you follow through on your goals.

Lack of sleep makes you more likely to get sick and more likely to behave unethically. There is such a thing as beauty sleep:

Our findings show that sleep deprived people appear less healthy, less attractive, and more tired compared with when they are well rested.

“Take an A student used to scoring in the top 10 percent of virtually anything she does. One study showed that if she gets just under seven hours of sleep on weekdays, and about 40 minutes more on weekends, she will begin to score in the bottom 9 percent of non-sleep-deprived individuals.”

Yes, some people don’t need much sleep but they’re exceedingly rare.

Out of 100 people who think they can go without much sleep, only five really can.

Know Thyself: Night Owls And Morning Larks

Morning types are more concrete, logical, introverted and self-controlled. Evening types are more creative, risk-taking, independent and impulsive.

Night owls are smarter. And male night owls do better with the ladies.

But morning people are more proactive and happier — and you mood in the morning affects your entire day.

Working outside your preferred time frame can reduce performance but night owls might be able to teach themselves to be early birds by creating rituals that make them excited to get out of bed.

What Makes For A Great Night’s Sleep?

Via Dreamland: Adventures in the Strange Science of Sleep.

1) Exercise during the day promotes good sleep at night:

…those who exercised reported a better quality of sleep than those who remained sedentary.

2) Keep it cold:

One study by researchers in Lille, a city in northeastern France, found that subjects fell asleep faster and had a better overall quality of sleep following behaviors that cooled the body, such as taking a cold shower right before bed. The best predictor of quality sleep was maintaining a room temperature in a narrow band between 60 and 66 degrees Fahrenheit (or 16 to 19 degrees Celsius).

3) Avoid light before bed, and that includes TV’s and computers:

…bright lights— including the blue-and-white light that comes from a computer monitor or a television screen— can deceive the brain, which registers it as daylight. Lying in bed watching a movie on an iPad may be relaxing, but the constant bright light from the screen can make it more difficult for some people to fall asleep afterward.

4) Avoid coffee or alcohol at night:

It is obviously not a good idea to drink coffee in the evening if it keeps you up at night. Nor is drinking alcohol before bedtime a smart move. Alcohol may help speed the onset of sleep, but it begins to take its toll during the second half of the night. As the body breaks down the liquid, the alcohol in the bloodstream often leads to an increase in the number of times a person briefly wakes up.

Also:

5) Mattress quality doesn’t matter. The only factor that was relevant with regard to beds was when traveling, people sleep best on a mattress similar to the one they have at home.

6) Keeping a consistent sleep and wake schedule is more important than you think. Shifting Daylight Savings Time around lowers SAT scores. Jet lag can be devastating to performing at your best.

Trouble Sleeping?

A very common yet overlooked cause of insomnia is putting too much effort into trying to get to sleep.

And Ambien and other drugs are overrated for helping you get to sleep.

Do more aerobic exercise during the day instead. You don’t actually have to work out really hard, you just have to think you did.

Upside to insomnia? You’re more creative when you’re exhausted.

On the other hand, trying to stay awake? Coffee’s always good but don’t forget about gum.

Nightmares? Try video games. And if you see something scary, like a horror movie, discuss it afterwards. This can reduce the chance of nightmares.

Waking up in the middle of the night actually might not be such a bad thing — humans may naturally sleep in two phases.

Use Sleep to Improve Learning and Thinking

Sleep is vital for improving skills. Want to increase your learning ability? After you review something, take a nap.

By the same token, missing an hour of sleep can take points off your IQ.

Promise yourself a reward when you wake up and you might even be able to increase learning as you sleep.

By the same token, lack of sleep makes us more likely to waste time on the internet.

You may want to spend less time analyzing complex problems and just sleep on it.

If you can’t sleep, trust your gut when making decisions while exhausted.

Naps Are Like Having Super Powers

Use naps to increase alertness and performance on the job, enhance learning ability and purge negative emotions while enhancing positive ones.

Some research says the best naps are 10 minutes long.

How can you make your naps better?

  1. If you’re a morning person, the best time to nap is around 1 or 1:30PM. If you’re a night owl, nap later, around 2:30 or 3PM.
  2. The best naps are under 45 mins or 90-120 mins. Anything in between is likely to give you that groggy feeling.
  3. Naps don’t mean you’re lazy: A NASA study showed that in-flight naps improved subsequent performance by 34% and overall alertness by 54%.
  4. To make sure you’re productive after your nap drink a cup of coffee right before laying down. Caffeine takes about 20-30 minutes to kick in.
  5. No nap is too short: A 2008 study showed that even a nap of a few minutes provided benefits. Just anticipating a nap lowers blood pressure.

To learn the secrets of how astronauts sleep, go here.

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Related posts:

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4 Things Astronauts Can Teach You About A Good Night’s Sleep

This piece originally appeared on Barking Up the Wrong Tree.

TIME mental health

LSD Therapy Lowers Anxiety, Study Finds

People facing imminent death could benefit from the hallucinogenic

Scientists in Switzerland are testing the anxiety-lowering effects of LSD on people near death, and are reporting promising results.

A new study published in The Journal of Nervous and Mental Disease finds that people who are facing imminent death from cancer can experience positive changes in their anxiety levels from talking to a therapist while under the influence. LSD research has been banned in the U.S. since 1966.

The 12 participants–the majority of whom had terminal cancer–met with lead study author Dr. Peter Gasser for weekly therapy sessions for two months. Eight of the patients received full doses of LSD during their sessions, while the other four received a lesser dose. During their “trips,” which could last up to 10 hours, patients talked about their fears of dying and experienced distressing emotions.

A year after their sessions, researchers found that anxiety levels had improved by 20% on standard measures those for those who got a full dose, and that this lower anxiety level appeared to remain even after therapy. For the participants who took a lower dose of LSD, their anxiety worsened.

With only 12 people, the study is too small to make any significant conclusions. However, it’s part of a bigger movement among psychiatrists to use hallucinogens in therapy for disorders like PTSD and severe anxiety, The New York Times reports. Other researchers are also currently testing the effects of similar drugs on patients’ anxieties.

[The New York Times]

TIME mental health

More Bad News for Older Dads: Higher Risk of Kids With Mental Illness

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The effect of paternal age on autism, schizophrenia, and ADHD may be greater than previously thought

For so long, mothers – particularly older moms — bore the brunt of responsibility for genetic disorders in their children. And for good reason. Eggs are stockpiled from birth, not made anew with each monthly reproductive cycle, so eggs stored for decades until childbearing can develop genetic mutations. The older the mother, the greater the chance of abnormalities that can contribute to conditions such as Down syndrome, especially after age 35. Fathers, on the other hand, constantly make sperm, so their reproductive contribution was supposed to be fresher and free of accumulated DNA damage.

That may not actually be the case, however, according to the latest study in JAMA Psychiatry investigating how advanced paternal age can affect rates of mental illness and school performance in children. After a groundbreaking genetic analysis in 2012 highlighted the surprising number of spontaneous mutations that can occur in the sperm of older men, scientists have been delving into the relationship to better quantify and describe the risk. While some studies confirmed the connection, others failed to find a link.

MORE: Older Fathers Linked to Kids’ Autism and Schizophrenia Risk

In the latest research, Brian D’Onofrio, associate professor of psychological and brain sciences at Indiana University, and his colleagues attempted to address one of the biggest problems with studying the trend. Most of the previous investigations compared younger fathers and their children to different older fathers and their offspring. “That’s comparing apples and oranges,” says D’Onofrio. “We know young fathers and old fathers vary on many things.”

So his team turned to birth registry data from Sweden and compared children born to the same fathers, evaluating the siblings on various mental health and academic measures. The study included 2.6 million children born to 1.4 million fathers.

What they found surprised them – so much so that they spent about two months re-evaluating the data to make sure their numbers were correct. While the previous genetic study found that an older father’s DNA may account for about 15% of autism cases, D’Onofrio’s group found that the increased risk for children of fathers older than 45 years soared to 3.5 times compared to that of younger fathers. Children of older fathers also showed a 13 fold higher risk of developing attention deficit-hyperactivity disorder (ADHD), a 25 times greater chance of getting bipolar disorder, and twice the risk of developing a psychosis. These kids also had doubled risk of having a substance abuse problem and a 60% higher likelihood of getting failing grades in school compared with those with younger fathers.

MORE: Too Old to Be a Dad?

“What this study suggests is that the specific effect of older paternal age may actually be worse than we originally thought,” says D’Onofrio.

The scientists controlled for some of the well-known factors that can account for poor grades and psychoses and mental illnesses, such as the child’s birth order, the mother’s age, the mother’s and father’s education level, their history of psychiatric problems, and their history of criminality. Even after adjusting for these possible effects, they still found a strong correlation between higher rates of mental illness among younger siblings compared with their older ones.

The 2012 genetic study pointed to a possible reason for the higher rates of mental illnesses – because genetic mutations tend to accumulate each time a cell divides, older men may build up more spontaneous, or de novo, changes each time the sperm’s DNA is copied. While a 25-year-old father may pass on an average of 25 mutations to his child, a 40-year-old dad may bequeath each offspring as many as 65; the researchers calculated that the de novo mutation rate doubled with every 16.5 years of the father’s age. In contrast, regardless of her age, a mother tends to pass on about 15 mutations via her eggs.

The findings still need to be repeated by other groups, but the large sample size and the careful way that the researchers designed the study – to analyze the same fathers over time – suggest that the association is significant and worth considering for those who put off having a family. “This study suggests that paternal age does need to be considered as one of many risk factors associated with children’s mental health,” says D’Onofrio.

MORE: Fewer Drugs Being Prescribed to Treat Mental Illness Among Kids

Whether it gains the same amount of weight that maternal age does in family planning decisions isn’t clear yet, but even if it is confirmed, he notes that the correlation doesn’t predict that every child born to an older father will develop a mental illness. Older parents also have protective factors against these disorders, including more maturity and financial and social stability, that can offset some of the effect.

TIME Pain

10 Things Your Commute Does to Your Body

Commuting can have serious health effects
Commuting can have serious health effects chinaface—Getty Images

Your daily back-and-forth to work can have a serious impact on your overall wellness. Here's what you need to know—and how to make the most of it

The average American’s commute to work is 25.5 minutes each way, according to a report in USA Today. That’s about 51 minutes a day getting to and from work, or about 204 hours a year spent commuting. You know that commuting can be a huge pain in the ass—but what does all that back and forth actually do to your body, besides put you in a crap mood when you get stuck in traffic for what feels like the nine-thousandth night in a row? Read on to see how commuting impacts your mental and physical health—and what you can do to offset the damage.

Your Blood Sugar Rises

Driving more than 10 miles each way, to and from work, is associated with higher blood sugar, according to a report written by researchers from the University School of Medicine in Saint Louis and the Cooper Institute in Dallas and published in The American Journal of Preventive Medicine. High blood glucose levels can lead to pre-diabetes and diabetes.

Your Cholesterol is Higher

The same report in The American Journal of Preventive Medicine found that the 10-mile one-way drives were also associated with higher cholesterol levels among commuters. Scary stuff since cholesterol is a warning sign for heart disease.

Your Depression Risk Rises

The researchers from the University School of Medicine in Saint Louis and the Cooper Institute in Dallas also noted in their report that people with commutes of at least 10 miles each way have a higher tendency toward depression, anxiety, and social isolation. Sometimes it can be hard to determine if your down-in-the-dumps mood is a real problem or something that’ll pass. Check here to determine if you’re depressed or just feeling blah.

Your Anxiety Increases

A new report from the U.K.’s Office of National Statistics finds that people who commute more than half an hour to work each way report higher levels of stress and anxiety than people with shorter commutes or no commutes at all. While there’s not much you can do to shorten or eliminate your commute, you can make the most of it by doing something like listening to an interesting audio book. Check out these other ways to take advantage of the time you spend in transit.

Your Happiness and Life Satisfaction Decline

The same report from the U.K. found that people with commutes of any length experience lower life satisfaction and happiness than people with no commutes at all. Riding a bus for 30 minutes or longer was associated with the lowest levels of life satisfaction and happiness, but even if you’re lucky enough to bike to work and enjoy the beautiful outdoors, your satisfaction takes a nosedive commensurate to how long you spend doing it. Womp womp.

Your Blood Pressure Temporarily Spikes

Commuting during rush hour—especially when you’re concerned that you may be late to work or to an important meeting—can result in temporary spikes in stress levels that jack up your blood pressure, even if it’s normally stable. In fact, a researcher from the University of Utah set up an experiment where participants were placed in simulated driving scenarios: They were told they were late to a meeting and had a financial incentive to get to their destination quickly. Half the group was put in high-density traffic; the other half “drove” in a less congested environment. The people who drove in more intense traffic had much higher reports of stress, as well as higher blood pressure. If you feel like you’re always in a rush, it might be worth leaving well before rush hour—even if you arrive at work at the same time as you normally would, you’ll definitely feel less anxious on the drive over. Plus, you may also want to employ these tips on how to use yoga to de-stress during the drive.

Your Blood Pressure Rises Over Time, As Well

A study of 4,297 Texans found that the farther the participants lived from where they worked—the longer their commutes—the higher their blood pressure was. High blood pressure over time is a major risk factor for heart disease and stroke.

Your Cardiovascular Fitness Drops

The same study out of Texas found that people with longer commutes also had lower levels of cardiovascular fitness and physical activity. Cardiovascular fitness is critical for heart health and maintaining a healthy weight.

Your Sleep Suffers

The Regus Work-Life Balance Index for 2012 found that people who commute for longer than 45 minutes each way reported lower sleep quality and more exhaustion than people with shorter commutes. To get better a better night’s sleep and feel more rested, regardless of your commuter status, check out our story, “Why Are Modern Women So Exhausted?”

Your Back Aches

Spending hours a week slouched over in a car seat (either as a driver or a passenger) has negative consequences on your posture and your back; commuters are more likely to report pains and aches in their backs and necks. To counteract these ill effects, be sure to check out six ways to straighten up your posture.

This article was written by Carolyn Kylstra and originally appeared on WomensHealth.com.

TIME Military

Pentagon’s Efforts to Curb Mental-Health Woes Apparently Falling Short

Outside report says there is little evidence to show they make much difference

The Pentagon didn’t actually win the wars in Afghanistan and Iraq. Now a prestigious federal panel has concluded it’s also not winning its decade-long battle to shield troops’ brains and minds from mental-health woes stemming from those conflicts.

There is little evidence that the military’s so-called “resilience, prevention, and reintegration” programs, designed to beef up soldiers’ defenses against the mind-ravages of war, have had any beneficial effect, concluded the 291-page report released Thursday by an Institute of Medicine panel. Its members, a variety of mental-health experts with diverse backgrounds, said:

…A majority of Department of Defense resilience, prevention, and reintegration programs are not consistently based on evidence and that programs are evaluated infrequently or inadequately. For example, on the basis of internal research data that show only very small effect sizes, Department of Defense concluded that Comprehensive Soldier Fitness, a broadly implemented program intended to foster resilience, is effective—despite external evaluations that dispute that conclusion. Among the small number of Department of Defense -sponsored reintegration programs that exist, none appears to be based on scientific evidence. The committee was unable to identify any Department of Defense evidence-based programs addressing the prevention of domestic abuse. More recently, the services have implemented a number of prevention interventions to address military sexual assault, yet a Department of Defense review found that critical evaluation components needed to measure their effectiveness are missing.

The meager results don’t come as a shock to Elspeth Ritchie, who retired as a colonel from the Army in 2010 after serving as the service’s top psychiatrist. “The military took the approach of `let’s throw everything at it and let’s see what works,’” she says, recalling the thinking of some of her Army colleagues: “You put enough steel on target, the target is going to go down.”

The report singled out the Army’s Comprehensive Soldier and Family Fitness program, a $125 million effort created in 2008 to fortify soldiers’ mental health. While the Army concluded it was working in 2012, Thursday’s report said its evidence was based on a too-small sample to reach such a conclusion. The panel said the Army efforts did little to reduce the chances of a soldier suffering from post-traumatic stress disorder or depression. It added that the current one-size-fits-all strategy for addressing mental-health issues may not work best and “can lead to the inefficient use or waste of scarce resources that could otherwise be used to address the enormous task of preventing psychological health problems.”

The Army has said that these programs are not aimed at curbing depression or PRTD, but are focused on giving troops the tools they need to maintain a healthy mental outlook, which could reduce various mental-health ailments. The cost of such programs more than doubled between 2007 to 2012, to nearly $1 billion annually.

Mental-health problems skyrocketed in the U.S. military following troops’ repeated deployments to Afghanistan and Iraq. With a force too small to wage both conflicts, soldiers and Marines had to deploy repeatedly to the front lines. “As would be expected, there is a dose-dependent relationship between levels of combat experiences and well-being indices,” the Army’s recently-released ninth Mental Health Advisory Team report says. “This relationship is clearly demonstrated for the percentage of Soldiers meeting screening criteria for any psychological problem.”

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Army

The IOM report notes that mental illnesses among troops jumped by 62% between 2000 and 2011, with the suicide rate nearly doubling between 2005 and 2010. “In 2011 there was a total of 963,283 service members and former service members who had been diagnosed with at least 1 psychological disorder during their period of service,” the study found. “Nearly 49 percent of these service members had been diagnosed with multiple psychological disorders.” In recent years, mental-health diagnoses have eclipsed pregnancies as the source of most military hospitalizations.

Ritchie says the absence of proof that such programs aren’t working doesn’t mean they’re not; civilian efforts to achieve the same goals have similar “fuzzy” outcomes. “You try to add an hour or two of resilience training in basic training, but you really don’t know what [improvement] is related to that,” she says. “I remain skeptical, but at the same time I am sympathetic to the desire to do everything you can for the troops, even if the science isn’t there yet.”

TIME mental health

Is Too Much Tanning a Mental Illness?

People with obsessive-compulsive disorder and body dysmorphic disorder are more likely to be dependent on tanning
John Lamb—Getty Images

People with obsessive-compulsive disorder and body dysmorphic disorder are more likely to be dependent on tanning

You know the type. They have dark brown skin in the middle of February and take constant trips to the tanning salon. It’s the tanning addict.

We may joke about Snooki’s bad habits, but new research published in the Journal of the American Academy of Dermatology suggests that people who tan excessively also experience some mental health symptoms that should be taken seriously, like obsessive-compulsive disorder (OCD) and body dysmorphic disorders (BDD).

The researchers surveyed 533 tanning students at Bowling Green State University in Ohio and determined which ones exhibited behaviors dependent on tanning. Participants who responded “yes” to a minimum of three out of eight criteria points in the Tanning-DSM–a modified guide from the substance abuse criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders–were classified as tanning dependent. Participants who answered yes to two out of four questions on a tanning version of a CAGE alcohol screener–which tests for alcoholism–were classified as exhibiting problematic tanning.

Researchers discovered that women who screened positive for BDD and OCD were at a greater risk for being tanning dependent. The participants who reported tanning at a minimum of nine times in the last 30 days were at the greatest risk of being dependent on it.

But calling a behavior “addicting” is serious business, and psychiatry is not quick to do so. “We have tanning addiction in the title, but we don’t jump to the conclusion automatically that tanning is and can be an addiction,” writes study author Lisham Ashrafioun. “We’re saying that we shouldn’t necessarily rule this out especially if people are tanning excessively, even if they aren’t experiencing any OCD or body dysmorphic disorder.”

TIME mental health

Study: Switching Schools May Give Your Kids Psychotic Symptoms

Chronic marginalization and chronic exclusion could cause hallucinations and delusions

Changing schools can be a wrenching social and emotional experience for students, say researchers from Warwick Medical School in the U.K. And the legacy of that struggle may be psychosis-like symptoms of hallucinations and delusions.

Dr. Swaran Singh, a psychiatrist and head of the mental health division at Warwick, became curious about the connection between school moves and mental health issues after a study from Denmark found that children moving from rural to urban settings showed increased signs of psychoses. The authors also noted that the students had to deal with not just a change in their home environment, but in their social network of friends at school as well.

Singh was intrigued by whether school changes, and the social isolation that comes with it, might be an independent factor in contributing to the psychosis-like symptoms.

MORE: Homeland and Bipolar Disorder: How TV Characters Are Changing the Way We View Mental Illness

Working with a database of nearly 14,000 children born between 1991 and 1992 and followed until they were 13 years old, Singh and his colleagues investigated which factors seemed to have the strongest effect on mental health. The children’s mothers answered questions about how many times the students had moved schools by age nine, and the children responded to queries about their experiences either bullying others or being victims of bullying. The survey even included a look at the children’s in utero environments, and their circumstances from birth to age 2, by asking the mothers about where they lived (in urban or village areas, for example), and about financial difficulties or other family social issues.

Based on their analysis, says Singh, switching schools three or more times in early childhood seemed to be linked to an up to two-fold greater risk of developing psychosis-like symptoms such as hallucinations and interrupting thoughts. “Even when we controlled for all things that school moves lead to, there was something left behind that that was independently affecting children’s mental health,” he says.

MORE: Do Psychotic Delusions Have Meaning?

Factors such as a difficult home environment – whether caused by financial or social tension, or both – living in an urban environment, and bullying contributed to the mental health issues, but switching schools contributed independently to the psychosis-like symptoms.

Singh suspects that repeatedly being an outsider by having to re-integrate into new schools may lead to feelings of exclusion and low self-esteem. That may change a developing child’s sense of self and prime him to always feel like an outlier and never an integrated part of a social network; such repeated experiences of exclusion are known to contribute to paranoia and psychotic symptoms.

Bullying created a secondary way in which repeated school moves could lead to mental health issues — bullying is known to be associated with psychotic symptoms, and mobile students are more vulnerable to bullying,

The negative emotional experiences students go through in trying to adjust to new schools can have physiological consequences as well. “Repeated experiences of being defeated in social situations leads to changes in the brain and in the dopaminergic system,” says Singh. That makes the brain more sensitive to stress, and stress, with its surges of cortisol, can lead to unhealthy neural responses that can contribute to mental health problems. “Something about chronic marginalization, and chronic exclusion, is neurophysiologically damaging,” he says.

MORE: Lasting Legacy of Childhood Bullying: Psychiatric Problems In Adulthood

Singh and his team plan to continue to follow the students for several more years, to determine how frequently the psychosis-like symptoms manifest into true psychotic disorders like schizophrenia. So far, the findings don’t suggest that kids who move schools three or more times are priming themselves for future mental health problems – what the data suggest instead is that children who are more mobile early in development may need more attention and help to settle into their new environments and make strong social connections. “If we start thinking of mobile students as a potentially vulnerable group, then we can shift how we view school moves,” he says. Psychiatrists and psychologists, for example, often ask young children about their family and friends, but rarely inquire about how often they have moved schools. In his continuing investigation, Singh also hopes to dissect the reasons why students moved, to see if that can be another factor explaining the intriguing connection – if children move frequently because they are bullying others or being bullied, for example, that may suggest that the association to psychosis-like symptoms may have more to do with the students’ pre-existing behavioral state than the experience of uprooting themselves so frequently.

TIME psychology

Facebook’s Gender Labeling Revolution

William Andrew—Getty Images

The pressure to choose a public identity can be harmful for people who haven’t decided on a private one, but at the very least seeing that long list can make you feel less isolated

At age 8, Eli Erlick wanted to be treated as a girl. But teachers denied the child’s request to join the girls’ gymnastic team or play on the girl’s side in the “Battle of the Sexes” academic competition. “That’s impossible, Eli,” they said. “You’re a boy.” Still, Eli persisted in wearing lip gloss and skirts, and spent the rest of elementary school eating lunch alone to escape the daily harassment of classmates.

By 13, Eli’s parents allowed their child to begin the transition from male to female, which meant adopting a feminine appearance, changing school records, and starting hormone treatment a few years later. That’s also when she learned about the concept of transgender, an umbrella term used to describe people whose gender identity differs from the sex they were assigned at birth. “It was such a relief. I found a word to finally describe who I was,” says Erlick, 18, a freshman at Pitzer College in Claremont, California, who founded the national advocacy organization Trans Student Equality Resources.

She also found joy in Facebook’s announcement last week that the social media giant has added 58 new options to the binary “male” and “female” choices in the user profile gender question. They include everything from androgynous to gender questioning to pangender. Erlick checked three boxes she felt represented her: Trans Woman, Trans Person, and Trans Feminine (because that’s how she presents herself to the world). “Being able to identify as a trans woman is so powerful,” she said. “I want to be among people like me.”

Mental health professionals who serve the transgender community overwhelmingly praise the decision for giving a voice to the more than 700,000 transgender people living in the U.S. who have long felt invisible. In 2012, the term “gender identity disorder” was stricken from the The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2012, though gender dysphoria is recognized and describes those who experience emotional distress over “a marked incongruence between one’s experienced/expressed gender and assigned gender,” which can lead to depression, post-traumatic stress, suicide, and other mental health disorders.

But “for people who are clear about who they are and want to be visible and have people mirror their identity back to them, this is a tremendous movement forward,” says Diane Ehrensaft, PhD, a clinical psychologist and director of the Mental Health Child and Adolescent Gender Center in Oakland, California.

But what if you’re 15 and not sure who you are? The sheer number of choices can be overwhelming, cautions Ehrensaft. The pressure to choose a public identity can actually be harmful for people who haven’t yet decided on a private one.

Many transgender people like Erlick knew who they were from a young age, but others need years – even decades – before they’re ready to check a box (or several). While the “coming out” experience is widely varied, there is a common sequence. “There’s a coming to consciousness that there’s something going on inside me that doesn’t match how the world sees me. One child told me ‘I shouldn’t have a penis. I’m a girl,’” says Ehrensaft. Then there’s a period of exploration. “You try a lot of things on for size. The expansive Facebook categories give you lots of choices. You’re swimming around in them. You might just grab a pole. You can always change it,” she says. (The last two stages involve disclosing your identity and then resolving to live in your gender.)

But jumping around from “gender nonconforming” to “gender fluid” to “transsexual” may be harder in a forum like Facebook after making a public statement, especially to an audience of family and friends who don’t understand their nuances, she says. (Parents of some of Ehrensaft’s clients learned about their children’s gender identity this way.) Also, even though the act of declaring who you are to the Internet can feel liberating, it’s also anxiety-producing. “Every time they make themselves public, they open themselves up for possible pushback from hostile people,” she says.

Yet there is an upside to so many choices. For those people who are wrestling with their identity, the existence of something other than the generic “transgender” is educational, adds Ruben Hopwood, PhD, trans health program coordinator at Fenway Health in Boston. “I see people who tell me ‘I don’t like my gender.’ Now this will push them to think more thoroughly about what they’re feeling,” he says.

Even if you refuse to check any gender box (just like you don’t have to advertise your relationship status or political views), seeing that long list can make you feel less isolated. “People going through this often think they’re the only ones like this in the world,” Hopwood says. “This is a message that you’re not alone.”

A previous version of this story stated that Eli learned about the concept of transgender at age 16. It has been corrected.

Sarah Elizabeth Richards is the author of Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It.

TIME mental health

How To Avoid Cabin Fever During This Endless Winter

Alison Mueller skies to work through several inches of snow along Woodward Avenue as the area deals with record breaking freezing weather January 6, 2014 in Detroit, Michigan
Alison Mueller skies to work through several inches of snow along Woodward Avenue as the area deals with record breaking freezing weather January 6, 2014 in Detroit, Michigan Joshua Lott—Getty Images

Get moving and seek out sunlight... but avoid bingeing on junk food and Netflix

It’s President’s Day, and thanks to the polar vortex you’ve probably been cooped up inside your house for days or maybe even a full week as the snow continues to fall. And the weather is taking a toll. Many are complaining of cabin fever or worse — snow rage.

Cabin fever isn’t a psychiatric diagnosis, but it does exist, says Josh Klapow, a clinical psychologist with a PhD at the school of public health at the University of Alabama at Birmingham. “Basically, it’s your mind’s way of telling you that the environment you are in is less than optimal for normal functioning,” he says. “It’s when you’re in a space of restricted freedom for a period of time that you can no longer tolerate.”

Before you get full on “snow rage” — a term the media has coined for the extreme angst people are feeling about the weather — and pull a shotgun on a snow plow driver, here’s how you can recognize when you’re getting too stir crazy and how you can cope.

You probably are getting cabin fever if any of the following are true:

  1. You’re feeling cooped up
  2. You’re having difficulty concentrating on what’s in front of you
  3. You feel lethargic, or simply feel unmotivated to do anything
  4. You are feeling irritated and on edge for no apparent reason

The best way to get yourself out of your slump and in a happier mood is to get moving, find natural sunlight, and do anything that can engage your cognitive activity. The more ambitious snowed-in people can go for a run around the bloc, start a home improvement project or read a book by window. Those feeling a little less motivated can at least make a snow angel for 10 minutes, sketch out projects they will take on once it’s sunny again, or at least pull up the blinds and play a brain-teasing app like QuizUp. Anything but watching marathons of TV on the couch. Sorry, House of Cards fans, but unless your body and brain are active you are likely to become listless and depressed.

Also, avoid foods that will only make you feel more sluggish or more irritated. “We have a tendency, particularly in this country, of shoving ourselves full of high-carb and high-fat foods when we have nothing else to do. That’s not good because they create lethargy,” says Klapow. “The other thing we do is sit around and drink coffee, which is also bad because that feeds agitation.”

For some, it’s not just a matter of motivating themselves to cheer up but also motivating kids who have been stuck inside during a series of snow days. “I can say as someone whose kids have been home for the last four days, you get to a point where you’re turning around and being like, ‘Are you still here?'” jokes Klapow.

Though having children home for days at a time during the school week can be tough, solving their cabin fever is even easier than solving yours. “Kids are going display their cabin fever in a more obvious sort of way. They’re going to pick on each other or they’re going to jump up and down,” says Klapow. “But we can tell them to go bundle up and run around outside for 15 minutes, whereas its harder to motivate ourselves to do the same as adults. You can control what they’re eating, even though its harder for us to regulate our own food intake. But helping your kids get energized with games and the right eating habits can help you alleviate your cabin fever too.”

It’s important, he says, to find ways to up our mood before we reach our tipping point. “Snow rage is not a clinical diagnosis,” Klapow says. “But you can think of it as the point where individuals have lost their ability to control their emotions, and the results are actions that are harmful to others — like yelling at a spouse or hitting your neighbor with a snow shovel.”

Let’s hope the snow ends soon so it doesn’t come to that.

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