I was really excited to be invited as a guest on Michael Max’s wonderful Qiological podcast. We had a really wide ranging and interesting discussion on all things adolescent – from the Chinese Medicine view of puberty, to the challenges of being a teen and to working with teenagers in the treatment room. We also focussed on possible reasons for the increase in mental/emotional health problems in teens today. Please do have a listen and share with anybody else who might be interested.
Rebecca Avern talking about teenagers on the Qiological podcast
I hear the same story time and time again in my paediatric clinic. The basic theme is – one moment a parent felt connected to their child, needed and loved. Suddenly, they feel as if their child hates them, doesn’t want to be around them and that they have lost their connection with them. When listening to heartbroken and concerned parents, I have found it usually helps if I explain, from a Chinese medicine perspective, the underlying process that is causing the change in their child.
Adolescence is an in between phase, when the young person is no longer a child but not yet an adult. It marks a transition between one stage of life and the next. A caterpillar does not become a butterfly with the click of a finger. They build a chrysalis around themselves, retreat inside it, dissolve their previous form and, sooner or later, emerge as a butterfly. There are many similarities between this process and the human one. Young people in the height of the adolescent change are akin to the chrysalis stage. They often build a protective shell around them and retreat from loved ones, before emerging as a beautiful butterfly and spreading their wings!
One of the ways in which this analogy stops being helpful, however, is that in humans the change from child to adult tends to be a much less smooth and linear process. Most young people go back and forth a few times – one minute retreating into a childlike state, the next leaping forwards to ‘test out’ being an adult. Parents can become easily bewildered by a child who one minute is screaming at them to get off their back and the next is not wanting to go to sleep without them at night. It is reassuring and useful to be able to remind parents that this is absolutely normal and, in itself, does not indicate any kind of pathology.
So, how on earth do we explain what underpins this massive process of transformation? I have found the Chinese medical perspective is a really helpful way to understand it, even for those without any prior knowledge.
In order for young people at this age to grow and develop as fast as they do , to start breaking free from their parents and become more independent, there is an enormous surge of yang in the body. Yang is powerful, transformative, hot and volatile qi. It is resonant with the energy of the Spring – when all of a sudden plants and trees begin to shoot up, blossom and sprout green leaves. It is yang which initiates and drives the internal processes of a young person so that they gradually leave behind childhood and head towards being an adult.
Imagine what it must feel like to suddenly have this surge of yang within you. It is as if a small flame has fuel poured on it and suddenly flares up into a roaring fire. It is the feeling you would get if you were put behind the wheel of a powerful sports car when you had been used to driving an old banger. It feels powerful, at times frightening, at times out of control and at times hugely exciting. It can feel to the young person like surfing a big wave.
Moreover, if you have constraints put on you when this powerful yang is roaring inside, you will feel them incredibly strongly. This is why young teenagers often act as if they have just been put in prison when you ask them to be home for supper! Yang also surges up towards the Heart (which, in Chinese medicine, is the seat of emotions). This is why teenagers feel things so strongly. It intensifies and brings to the surface feelings that were previously lurking around in the background.
In order to counterbalance this surge of yang, there is also a strengthening and consolidation of yin that goes on at the same time. Yin encourages retreat, sleep and calm. It explains why teenagers need so much sleep, and why they have a tendency to want to spend so much time in their bedrooms and are often less willing to interact with the family. This is the equivalent of the chrysalis stage for the caterpillar. In order for any change to take place, there has to be a period of retreat. Explaining this to the parent of a teenager who may be feeling hurt by their child’s disinclination to engage, can help them to understand it’s an important part of the process and not a personal rejection.
There are numerous books and articles for parents offering advice about how to manage living with teenagers. I am not going to add more advice, too much of which can estrange a parent from their instinctual, natural parenting instincts. But I urge parents to just bear in mind this explanation of what is going on, in order to better understand their child. There are three key points to remember:
- Your teenager has not suddenly stopped loving you
- They are fulfilling their job description if they are beginning to separate from you
- This time will pass and, if you let them spread their wings, they will fly back to you as a loving adult when they are through the transition!
 Adolescents grow faster than at any other time of life, with the exception of the first year.
Net of Knowledge have put together a fantastic resource for practitioners during lockdown. They have organised a free webinar a day throughout April. I am delighted to be giving one of them on Wednesday 15th April, entitled Supporting Teenagers During An Extraordinary Time. Please click on the link to register:
Are your teens now at home for the foreseeable future? What will be important to them and how can you support them?
Yesterday I watched the excitement and elation of five pre-teens and young teens as they heard the news that school was going to be out for the next few weeks at least. One of the first things they did was to download apps to make sure they could easily communicate as a group if they were not able to see each other. They then began writing their ‘No school bucket lists’, and top of all of them was the resolution to ‘make sure not to become distant from my friends’.
Even in extraordinary times, teenagers are still teenagers. And there is nothing more important to most teens than their friendships. Whilst as parents, we may look forward to being able to spend more time with our teenage children and to deepen our connection with them, no doubt their main concern will be how they are going to cope with being stuck at home with their parents. It is natural for a teenager to increasingly separate from their parents, to go out and find their own tribe. It’s a time when they need to explore their identity, and to find out who they are outside of their family. So, any enforced isolation is likely to jar with their deep drive and instinct to go outwards into the world.
|In Chinese medicine, adolescence is resonant with the Fire Element. The Fire Element governs how we manage our relationships with other people and ourselves. The qi of the Fire Element intensifies during adolescence, which is why children of this age tend to feel things very passionately! This intensity also drives teens to fulfil their developmental role of this time – ie. to make strong connections with others outside the family.|
Whilst those of you who regularly read my blog will know that I have written a lot about the potential negatives of screen time and social media, this is one time when the benefits of it will come into their own. If technology allows our teens to keep those connections with their new-found tribes, it will make this time of uncertainty and disruption a lot easier for them than it otherwise would have been.
At the same time, although teenagers would rather do just about anything than admit to needing their parents, they really do still need us! They are in a state of huge internal flux. Put that together with the enormous external changes they are currently experiencing, and it makes for a potentially anxious time. The more as parents we can work on managing our own anxieties and fears (which may be great at the moment), the more our teens will benefit. What they need from us at the moment, more than ever, is to feel that we are solid and stable. That is not to say we need to pretend that ‘everything is ok’ when it is patently not, but that we need to let them know that, despite all the difficulties, we as a family will come through it.
So, as well as recognising that over the next few weeks or months, our teens will have a strong need to connect with their peers, it might also be beneficial to ringfence some time each day to put away screens and to connect as a family.
Here are some other potential benefits for teens of an enforced, prolonged period out of school:
- Time to catch up on some sleep: teens are growing and changing so fast and good sleep is crucial for this process.
- Time to slow down and lean in to a more yin lifestyle: most teens have crazily chaotic lives with little downtime. Learning how to be still and have downtime at this age will serve them well for the rest of their lives. Have a look at this blog post – ‘How does a child get real downtime in the 21st century’ – for more thoughts on what actually constitutes ‘downtime’.
- Time to reframe what is important: there is a lot of talk about rising anxiety levels at the moment. But I believe, if dealt with appropriately, this time of crisis could actually help teens to reduce their level of anxiety. Through conversation, we can help them to see that a lot of things they may worry about, are actually of very little consequence. One teen, who is prone to huge amounts of anxiety, and who has just found out she won’t be able to take her A levels said to me ‘I was gutted at first but now I’m OK. It’s made me realise there are more important things in the world. We will get through this and I trust that my life will work out – maybe just differently to how I expected’.
William Arthur Ward wrote ‘The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.’ I wish you and your teens, and indeed all your loved ones, all good wishes in adjusting your sails over the coming weeks.
This week (March 2-8th) is eating disorders awareness week. It is both sad and shocking that eating disorders amongst young people in the western world seem to be on the rise. Whilst many in the developing world are starving, more and more children and teens in the developed world are starving themselves. If they are not starving themselves, many have come to have a disturbed relationship with food and eating. This may cause a daily misery.
The causes of eating disorders are many and varied. They are also relatively poorly understood. Studies point towards a combination of genetic predisposition, psychological and sociological factors. Trauma and difficult family relationships are known to also play a part. But in my experience of working with young people, the seeds of an eating disorder lie in emotional dysfunction. The emotional dysfunction is the root; the disordered eating is the manifestation. An eating disorder is an expression of internal unhappiness. It is a misguided, and sometimes dangerous, way of expressing emotions that, for a variety of reasons, are not able to be either managed or expressed verbally. The young person may not even be conscious of them.
One particular case illustrates this point. I treated a 13-year-old girl who had orthorexia (an obsession with eating only extreme ‘health’ foods) and who had rapidly lost an alarming amount of weight. She was under the care of CAMHS who had put her on a strict weight gain programme. Whilst this was necessary in order to preserve her physical health, it did not address any underlying, dysfunctional emotional patterns. What struck me about the girl when she spoke was the mismatch between her words and her demeanour. She was pathologically polite and did not admit to having any angry feelings at all (even towards her father, who had recently left the family, not responded to her attempts at communication and not acknowledged her thirteenth birthday). Yet her eyes were hard, her voice clipped and I saw flashes of anger across her face.  Through dialogue and acupuncture treatment to bring balance to the Wood Element (which, in Chinese medicine, is associated with emotions in the anger family), the girl began to recognise that she did in fact feel angry and then to be able to express these feelings. The more she expressed the feelings, the less she controlled her eating.
Somewhere along the line, this girl had completely disconnected from her feelings because they felt overwhelming, too painful to sit with or because she had imbibed a value that feeling angry is in some way not ‘good’ or ‘acceptable’. In her case, the predominant emotion was anger. But it could be sadness, fear or a feeling of unlovability, and is very often a mix of many different feelings. When a child disconnects from or ‘packs away’ an emotion over an extended period of time, she will no longer have much consciousness of it being there at all. At this point, the spirit of the young person becomes compromised and a pathological behaviour often arises. This may be disordered eating, self-harm, addiction or OCD, for example.
There are always multiple risk factors for the development of mental illness, as well as multiple protective factors. As parents, we can influence some of these factors but not others. For example, we cannot stop our children’s exposure to images of ‘perfect’ bodies on social media and in the press. But one area where we can have a positive influence is to support our children in becoming comfortable with and adept at verbalising and expressing a wide range of emotions. Some possible ways of doing this are:
- With young children, giving them a word for a feeling we think they may be experiencing. For example, ‘I wonder if you feel jealous that Tommy got that scooter you had been wanting for his birthday’.
- To avoid ever saying to our children ‘don’t be sad’ or ‘you don’t need to feel angry’. This conveys the message that the child is somehow wrong to have this feeling. Sometimes we shut down these emotions in our children because we, the parent, can’t bear the thought that our child is unhappy or because we feel hurt or angry when the emotion is directed at us.
- To model to our children that we, the parent, experience a wide range of emotions and are OK nevertheless. For example, to say that we have had a bad day at work and are feeling frustrated as a result of it, rather than saying ‘I’m fine’ when we are patently not. We can show them that, despite the frustration, we are fundamentally ‘OK’. Our frustrated feelings haven’t prevented us from coping, and they will pass.
Food and eating are so often intertwined with emotion, and eating disorders are especially so. Even though serious eating disorders are mental health conditions, the seeds of them usually lie in emotional dysfunction. Helping our children to express a wide range of emotions, and supporting them to become more emotionally intelligent, will lessen the chances of them expressing their unhappiness through disordered eating.
Cicero wrote that ‘diseases of the soul are more dangerous and more numerous than those of the body’. Eating disorders may mean our children’s bodies are poorly nourished but in order to prevent or heal these common and distressing conditions, we need to nurture our children’s souls.
 In Chinese medicine, we use subtle signs such as the tone of voice, the subtle hues in the complexion and incongruent expression of emotion to diagnose imbalances in a person’s qi.
It's less than two weeks to go now before the start of my online course, TCM and the teenage years. In this four part webinar, I will discuss the many ways in which teenagers benefit from acupuncture, and how to go about treating them.
For many reasons, being an adolescent in the early 21st century is not easy, and our teenagers are manifesting huge levels of stress. The number of young people who come to the Panda Clinic with anxiety, depression and related conditions is worryingly high.
The good news is, however, that the results when treating teenagers who are struggling physically, emotionally or psychologically can be nothing short of miraculous. Adolescence is a time of flux and this means we can harness the potential that this flux provides us with to iron out pre-existing imbalances and ensure that new ones do not develop.
There are only a handful of places remaining on the course. If you are interested, to sign up please go to: https://www.treatingchildren.com/store/xpD696cV.
As always, the long summer holidays seemed to disappear in a flash and before we know it the kids are heading back to school for another year. My eldest daughter started secondary school this morning. Here she is cycling off for her first day with her friends, looking so grown up and independent!
It’s easy to forget, that underneath this new found independence, tweenagers are in the midst of a years-long process, throughout which they will transition from being a child to an adult. There are several physiological changes that occur during this time, an awareness of which can help both the parents to support their child in navigating this process more smoothly. I will describe them from a Chinese medicine perspective.
The first is that there is an enormous surge of yang in the body. This is the energy which helps fuel the enormous physical and psychological growth that takes places in the lead up to and during adolescence. It’s necessary and important however, at times, it can cause problems. It’s as if the child has been used to driving a clapped-out old banger, and suddenly gets put behind the wheels of a powerful sports car. It may take some time to be able to handle this new power and, in the meantime, there may be a few crashes along the way. These could manifest in a child as moodiness, tantrums and sometimes even physical recklessness.
Secondly, the qi of a tweenager is more ‘open’, as always happens when a person is in transition from one stage to the next. This means that, although the child may act as if they know everything, you (the parent) are the biggest embarrassment in the world and know absolutely nothing, actually they are especially vulnerable to anything that is going on in their external environment. So as parents, while we may need to play more of a hands-off role, making sure that the home is stable and as devoid as possible of extreme emotions, and that we are available when the car crashes do happen, is vitally important.
Lastly, as a result of the rapid growth and development taking place, tweenagers and young teenagers are prone to developing deficiency of various Organs and substances (to use Chinese medicine speak). So trying to ensure that they eat properly, get a reasonable amount of sleep and some downtime will make a big difference. As any parent of a child this age will know, this is not always easy. But it’s important to keep trying, while at the same time remembering the importance of maintaining rapport with your child.
So, with these points in mind, here's hoping for a happy start to the new school year for everyone!