Sunday, August 16, 2015

Teenage psychology and life outcomes from teens to twenties

http://well.blogs.nytimes.com/2014/06/23/cool-at-13-adrift-at-23/

MIND

Cool at 13, Adrift at 23

Photo
Credit
Gianluca Fabrizio/Getty ImagesAt 13, they were viewed by classmates with envy, admiration and not a little awe. The girls wore makeup, had boyfriends and went to parties held by older students. The boys boasted about sneaking beers on a Saturday night and swiping condoms from the local convenience store.
They were cool. They were good-looking. They were so not you.
Whatever happened to them?
“The fast-track kids didn’t turn out O.K.,” said Joseph P. Allen, a psychology professor at the University of Virginia. He is the lead author of a new study, published this month in the journal Child Development, that followed these risk-taking, socially precocious cool kids for a decade. In high school, their social status often plummeted, the study showed, and they began struggling in many ways.
It was their early rush into what Dr. Allen calls pseudomature behavior that set them up for trouble. Now in their early 20s, many of them have had difficulties with intimate relationships, alcohol and marijuana, and even criminal activity. “They are doing more extreme things to try to act cool, bragging about drinking three six-packs on a Saturday night, and their peers are thinking, ‘These kids are not socially competent,’ ” Dr. Allen said. “They’re still living in their middle-school world.”
As fast-moving middle-schoolers, they were driven by a heightened longing to impress friends. Indeed their brazen behavior did earn them a blaze of popularity. But by high school, their peers had begun to mature, readying themselves to experiment with romance and even mild delinquency. The cool kids’ popularity faded.
B. Bradford Brown, a professor of educational psychology at the University of Wisconsin-Madison who writes about adolescent peer relationships and was not involved in the study, said it offered a trove of data. The finding that most surprised him, he said, was that “pseudomature” behavior was an even stronger predictor of problems with alcohol and drugs than levels of drug use in early adolescence. Research on teenagers usually tracks them only through adolescence, Dr. Brown added. But this study, following a diverse group of 184 subjects in Charlottesville, Va., starting at age 13, continued into adulthood at 23.
Researchers took pains to document the rise and fall in social status, periodically interviewing the subjects as well as those who they felt knew them best, usually close friends. About 20 percent of the group fell into the “cool kid” category at the study’s outset.
A constellation of three popularity-seeking behaviors characterized pseudomaturity, Dr. Allen and his colleagues found. These young teenagers sought out friends who were physically attractive; their romances were more numerous, emotionally intense and sexually exploring than those of their peers; and they dabbled in minor delinquency — skipping school, sneaking into movies, vandalism.
As they turned 23, the study found that when compared to their socially slower-moving middle-school peers, they had a 45 percent greater rate of problems resulting from alcohol and marijuana use and a 40 percent higher level of actual use of those substances. They also had a 22 percent greater rate of adult criminal behavior, from theft to assaults.
Many attributed failed adult romantic relationships to social status: they believed that their lack of cachet was the reason their partners had broken up with them. Those early attempts to act older than they were seemed to have left them socially stunted. When their peers were asked how well these young adults got along with others, the former cool kids’ ratings were 24 percent lower than the average young adult.
The researchers grappled with why this cluster of behaviors set young teenagers on a downward spiral. Dr. Allen suggested that while they were chasing popularity, they were missing a critical developmental period. At the same time, other young teenagers were learning about soldering same-gender friendships while engaged in drama-free activities like watching a movie at home together on a Friday night, eating ice cream. Parents should support that behavior and not fret that their young teenagers aren’t “popular,” he said.
“To be truly mature as an early adolescent means you’re able to be a good, loyal friend, supportive, hardworking and responsible,” Dr. Allen said. “But that doesn’t get a lot of airplay on Monday morning in a ninth-grade homeroom.”
Dr. Brown offered another perspective about why the cool kids lost their way. The teenagers who lead the social parade in middle school — determining everyone else’s choices in clothes, social media and even notebook colors — have a heavy burden for which they are not emotionally equipped. “So they gravitate towards older kids,” he said. And those older teenagers, themselves possibly former cool kids, were dubious role models, he said: “In adolescence, who is open to hanging out with someone three or four years younger? The more deviant kids.”
Dr. Allen offered one typical biography from the study. At 14, the boy was popular. He had numerous relationships, kissed more than six girls, flung himself into minor forms of trouble, and surrounded himself with good-looking friends.
By 22, he was a high-school dropout, had many problems associated with drinking, including work absenteeism and arrests for drunken driving. He is unemployed and still prone to minor thefts and vandalism.
But as Dr. Allen emphasized, pseudomaturity suggests a predilection; it is not a firm predictor. A teenage girl from the study initially had a similar profile, with many boyfriends at an early age, attractive friends and a fondness for shoplifting.
Yet by 23, Dr. Allen wrote in an email, “she’d earned her bachelor’s degree, had not had any more trouble with criminal behavior, used alcohol only in responsible ways and was in a good job.”
Dr. Mitchell J. Prinstein, a professor of psychology at the University of North Carolina at Chapel Hill who studies adolescent social development, said that while teenagers all long to be accepted by their peers studies suggest that parents can reinforce qualities that will help them withstand the pressure to be too cool, too fast.
“Adolescents also appreciate individuality and confidence,” he said. “Adolescents who can stick to their own values can still be considered cool, even without doing what the others are doing.”

From the New York Times blogs - on life after cancer

http://well.blogs.nytimes.com/2015/03/16/lost-in-transition-after-cancer/

Lost in Transition After Cancer

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Suleika Jaouad, who was 22 when she learned she had leukemia, has been told she is in remission, but said she felt far from healthy at age 26.Credit
 Ashley Woo

“You are being deported,” a surgeon announced to me last fall. That’s a scary thing for a child of two immigrants to hear. But he was referring to the removal of my port, a medical device implanted just beneath my right collarbone — a gateway for the dozens of rounds of chemotherapy, antibiotics and blood transfusions that have entered my body since I received a leukemia diagnosis at age 22.
I love a good pun, but I wasn’t in the mood for laughter or lightness that day. After three and a half years of cancer treatment, I no longer needed the port. My doctors had finally pronounced me in remission. I had thought I’d want to celebrate or dance a jig in my hospital gown or throw a rager when I got there. But it didn’t feel anything like the endgame I had imagined.
It took me a long time to be able to say I was a cancer patient. Then, for a long time, I was only that: A cancer patient. Now that I’m done with my treatment, I’m struggling to figure out who I am. On paper, I am better: I no longer have cancer, and with every passing day I’m getting stronger. The constant flood of doctor’s appointments, blood tests and phone calls from concerned family and friends have trickled to a slow drip. But off paper, I feel far from being a healthy 26-year-old woman.
My disease has left countless invisible imprints in its wake: infertility, premature menopause, a thyroid condition, chronic fatigue and a weakened immune system that sends me to the emergency room on a regular basis. And that’s just the short list. Then there are the demons of depression and the fears of relapse that sneak into my head just when I think I’ve gotten a grip. The rattle of a cough in my chest. A strange bruise on the back of my leg. A missed call from my oncologist. Each of these triggers rips me out of my fragile, new reality leaving me to wonder: What happens if the cancer comes back? Will I ever feel normal again? And most daunting of all, how do I move forward with my life?
Writing about all of this has not come easily to me. It is hard not to speak in clichés about cancer. It can be even harder not to feel as if I have to live up to those clichés. I sometimes feel a deep sense of guilt for not doing a better job of making lemonade out of metaphorical lemons. I know that I am one of the lucky ones, and I am deeply thankful to be alive. In writing about the problems I am facing now, I worry about sounding ungrateful — or worse yet, insensitive to my friends in the cancer community who may never go into remission. These fears color the unexpected challenges that emerge during life after cancer, and can overwhelm the need to talk about them. After all, I’m supposed to be better. So why don’t I feel better?
When I finished my last cycle of chemotherapy, in April 2014, friends and family congratulated me on being “done.” What they couldn’t know was that in some ways the hardest part of my cancer experience began once the cancer was gone.
The first few weeks after I finished treatment unfolded like a circus of horrors. I was hospitalized four times for Clostridium difficile, or C. diff, a life-threatening intestinal infection I caught because of my weakened immune system. My relationship with my boyfriend of three and a half years came to an end. And Melissa Carroll, one of my best friends, whom I had met through the blogosphere, died of cancer at age 32.
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While still in treatment two years ago, Ms. Jaouad showed her dog to children in her New York neighborhood.CreditAshley Woo
While in treatment, I had been surrounded by the world’s best army: my supportive family and friends and a brilliant medical team who had worked tirelessly to keep me alive. The goal had been to cure the cancer. Now that I had survived the “cut, poison, burn” of the disease, I no longer had the cavalry running after me. Suddenly, I found myself standing dazed and alone in the rubble, wondering what had happened and where everyone had gone.
I fell apart the way the author John Green says you fall in love: “slowly, and then all at once.” I was discharged from the hospital on May 16, 2014, which coincidentally was the day my ex-boyfriend was scheduled to move out of the apartment we shared in Manhattan. “You should cry,” I kept telling myself after he left. But I couldn’t. I wandered around the apartment, calmly inspecting the empty closets and dresser drawers left behind. In one of the drawers I found a dusty, old pack of cigarettes. I knew better, but I lit one up anyway. I smoked it slowly, sitting cross-legged on the kitchen floor, my hospital bracelet still wrapped around my wrist. The inner scaffolding that had kept me strong and brave during my treatment had crumbled. I no longer wanted to be anyone’s inspiration.
I’ve spent the last year of my life searching for Suleika B.C. (before cancer). I’ve looked for her all over New York City — the old bars she used to frequent, the coffee shop where she had her first date with the ex-boyfriend, the apartment above the Pearl Paint sign on Canal Street that she shared with 10 roommates her first summer out of college — but the more I look, the more I’m beginning to realize she no longer exists. There is no going back to my old life. The problem is I don’t know how to move forward either.
I’m not alone in feeling this way. A growing body of evidence suggests that cancer survivors continue to struggle with medical, financial, professional and psychosocial issues long after the end of their cancer treatment. For many, the experience provides a renewed sense of life and purpose, but the task of rebuilding your life after something as devastating as cancer can also be a deeply disorienting and destabilizing one.
A report last year by the American Cancer Society, in collaboration with the National Cancer Institute, estimates there are almost 14.5 million cancer survivors alive in the United States today, and that number will grow to almost 19 million by 2024. Although more and more Americans are surviving cancer thanks to early detection programs, new treatment regimens and awareness campaigns, much remains to be learned about the short- and long-term issues faced by survivors. With long-term survival comes a new challenge: how to keep cancer survivors healthy and emotionally stable after treatment ends.
“We like to think of the end of cancer treatment as the closing of a chapter, but what most people don’t realize is that the emotional struggle continues long after,” Dr. Kevin C. Oeffinger, a primary care physician and director of Memorial Sloan Kettering Cancer Center’s adult long-term follow-up program, told me recently over the phone. “Feelings of post-treatment depression and anxiety are amazingly normal. I would go so far as to say that if you don’t have them it’s a surprise.”
I spoke with Xeni Jardin, a journalist who writes frequently of her experiences with breast cancer, about what life after treatment has looked like for her. I have been following her on Twitter ever since my diagnosis, and her brutally honest, humorous and often heart-wrenching writing has long been an inspiration to me.
“I have learned since the day of my diagnosis that cancer affects all of who we are,” Ms. Jardin told me. “There was no aspect of my life that wasn’t torn apart as my body was literally torn apart. In my case, after my treatment ended, I experienced mental health issues that were more intense and more debilitating than I’d ever experienced before in my life.
“This thing that we experience that is casually referred to as post-treatment depression is much more than just that. It has many facets: spiritual, psychological, social, medical and financial, among many other things.”
Ms. Jardin went on to describe the increasingly frequent panic attacks she began experiencing while driving on a Los Angeles freeway and bouts of depression that prevented her from leaving her bed or her house for days at a time. “Somebody encouraged me, in a way I was ready to hear, to get professional help,” she said. “And so I called my hospital, and I said: ‘Hey, I want to kill myself. I keep finding myself in these cycles of panic where I want to die, and I’m not sure why I bothered with treatment. I need help.’ ”
Ms. Jardin spoke with a social worker in the oncology division who reassured her that someone would get back to her soon, but no one from the hospital ever did.
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Ms. Jaouad with her dog, Oscar, in 2013.Credit Ashley Woo
She followed up with the hospital a few weeks later and scheduled an appointment. “I spoke with the same social worker, who got very quiet when she realized that neither she nor anyone else had called me back.” Ms. Jardin was able to get an appointment the next day with a psychiatrist who diagnosed her with chronic low-grade depression and anxiety caused in part by Tamoxifen, a medication that is intended to reduce the risk of developing breast cancer again and that she will be taking for several years. But there was one catch: The psychiatrist couldn’t treat her. Because of hospital policies and budget cuts, he was allowed to provide psychiatric care only for patients in active cancer treatment. Ms. Jardin would have to seek treatment somewhere else.
“The medical system that saved my life wasn’t able to help me not want to take my life,” she told me. “I have developed a deep love and reverence for the oncologists and nurses, and I believe that these people really do understand that, in some ways, it never ends for us. But I also believe that collectively the system of care failed to prepare me for the mental health crisis that I would experience. There’s no excuse for that.”
While an increasing number of cancer treatment centers have begun offering post-treatment care plans and support groups to help patients navigate these challenges, many patients continue to fall through the cracks. “Sometimes we do a good job of preparing people for this, but often we don’t,” Dr. Oeffinger said. “We need to do a better job.”
“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick,” Susan Sontag famously wrote in “Illness as Metaphor.” But she doesn’t talk about this no man’s land that exists between the two kingdoms, inhabited by people like me who are neither sick nor well. It is a different kind of deportation than the one the surgeon was referring to: It’s a journey into the wilderness of survivorship. This time I’m finding that there are no protocols or discharge instructions, no roadmaps or 12-step plans to guide me back to the kingdom of the well. The road back is going to be my own.

View the “Life, Interrupted” video series and read previous “Life, Interrupted” columns, to learn more about Ms. Jaouad’s journey with cancer.
Suleika Jaouad writes about the challenges faced by young adults, health and her experiences with cancer. Connect with her on Twitter or Facebook.

'The Japanese women who married the enemy'

http://www.bbc.co.uk/news/magazine-33857059

'The Japanese women who married the enemy

  • 16 August 2015
Seventy years ago many Japanese people in occupied Tokyo after World War Two saw US troops as the enemy. But tens of thousands of young Japanese women married GIs nonetheless - and then faced a big struggle to find their place in the US.
For 21-year-old Hiroko Tolbert, meeting her husband's parents for the first time after she had travelled to America in 1951 was a chance to make a good impression.
She picked her favourite kimono for the train journey to upstate New York, where she had heard everyone had beautiful clothes and beautiful homes.
But rather than being impressed, the family was horrified.
"My in-laws wanted me to change. They wanted me in Western clothes. So did my husband. So I went upstairs and put on something else, and the kimono was put away for many years," she says.


Hiroko Furukawa dancing in Japanese attire
Hiroko enjoyed wearing traditional Japanese clothes

It was the first of many lessons that American life was not what she had imagined it to be.
"I realised I was going to live on a chicken farm, with chicken coops and manure everywhere. Nobody removed their shoes in the house. In Japanese homes we didn't wear shoes, everything was very clean - I was devastated to live in these conditions," she says.
"They also gave me a new name - Susie."
Like many Japanese war brides, Hiroko had come from a fairly wealthy family, but could not see a future in a flattened Tokyo.
"Everything was crumbled as a result of the US bombing. You couldn't find streets, or stores, it was a nightmare. We were struggling for food and lodging.
"I didn't know very much about Bill, his background or family, but I took a chance when he asked me to marry him. I couldn't live there, I had to get out to survive," she says.
Hiroko's decision to marry American GI Samuel "Bill" Tolbert didn't go down well with her relatives.


Media captionImages of the devastation in Tokyo after they were bombed by the US in World War Two.
"My mother and brother were devastated I was marrying an American. My mother was the only one that came to see me when I left. I thought, 'That's it, I'm not going to see Japan again,'" she says.
Her husband's family also warned her that people would treat her differently in the US because Japan was the former enemy.
More than 110,000 Japanese-Americans on the US West Coast had been put into internment camps in the wake of the Pearl Harbor attacks in 1941 - when more than 2,400 Americans were killed in one day.
It was the largest official forced relocation in US history, prompted by the fear that members of the community might act as spies or collaborators and help the Japanese launch further attacks.


US soldier posting a Civilian Exclusion Order for Japanese-Americans. Photo courtesy of the Museum of History and Industry
US soldier posts a Civilian Exclusion Order for Japanese-Americans

The camps were closed in 1945, but emotions still ran high in the decade that followed.
"The war had been a war without mercy, with incredible hatred and fear on both sides. The discourse was also heavily racialised - and America was a pretty racist place at that time, with a lot of prejudice against inter-race relationships," says Prof Paul Spickard, an expert in history and Asian-American studies at the University of California.
Luckily, Hiroko found the community around her new family's rural farm in the Elmira area of New York welcoming.


Media captionSome Japanese wives attended bride schools to learn the American way of life and customs.
"One of my husband's aunts told me I would find it difficult to get anyone to deliver my baby, but she was wrong. The doctor told me he was honoured to take care of me. His wife and I became good friends - she took me over to their house to see my first Christmas tree," she says.
But other Japanese war brides found it harder to fit in to segregated America.
"I remember getting on a bus in Louisiana that was divided into two sections - black and white," recalls Atsuko Craft, who moved to the US at the age of 22 in 1952.
"I didn't know where to sit, so I sat in the middle."
Like Hiroko, Atsuko had been well-educated, but thought marrying an American would provide a better life than staying in devastated post-war Tokyo.
She says her "generous" husband - whom she met through a language exchange programme - agreed to pay for further education in the US.


Atsuko and her husband Arnold
Atsuko (second left) married Arnold (second right) and moved to the US in 1952

But despite graduating in microbiology and getting a good job at a hospital, she says she still faced discrimination.
"I'd go to look at a home or apartment, and when they saw me, they'd say it was already taken. They thought I would lower the real estate value. It was like blockbusting to make sure blacks wouldn't move into a neighbourhood, and it was hurtful," she says.
The Japanese wives also often faced rejection from the existing Japanese-American community, according to Prof Spickard.
"They thought they were loose women, which seems not to have been the case - most of the women [in Toyko] were running cash registers, stocking shelves, or working in jobs related to the US occupation," he says.
About 30,000 to 35,000 Japanese women migrated to the US during the 1950s, according to Spickard.
At first, the US military had ordered soldiers not to fraternise with local women and blocked requests to marry.


Hiroko Tolbert an her former husband Samuel Tolbert
Hiroko married American GI Samuel 'Bill' Tolbert in Japan, and moved to the US in 1951

The War Brides Act of 1945 allowed American servicemen who married abroad to bring their wives home, but it took the Immigration Act of 1952 to enable Asians to come to America in large numbers.
When the women did move to the US, some attended Japanese bride schools at military bases to learn how to do things like bake cakes the American way, or walk in heels rather than the flat shoes to which they were accustomed.
But many were totally unprepared.
Generally speaking, the Japanese women that married black Americans settled more easily, Spickard says.


Japanese woman learning how to bake a cake
Some Japanese wives went to bride schools to learn how to live the American way

"Black families knew what it was like to be on the losing side. They were welcomed by the sisterhood of black women. But in small white communities in places like Ohio and Florida, their isolation was often extreme."
Atsuko, now 85, says she noticed a big difference between life in Louisiana and Maryland, near Washington DC, where she raised her two children and still lives with her husband.
And she says times have changed, and she does not experience any prejudice now.
"America is more worldly and sophisticated. I feel like a Japanese American, and I'm happy with that," she says.


Media captionTwo Japanese war brides, who married US serviceman after the end of World War Two, recall the struggle to find their place in the US.
Hiroko agrees that things are different. But the 84-year-old, who divorced Samuel in 1989 and has since remarried, thinks she has changed as much as America.
"I learned to be less strict with my four children - the Japanese are disciplined and schooling is very important, it was always study, study, study. I saved money and became a successful store owner. I finally have a nice life, a beautiful home.
"I have chosen the right direction for my life - I am very much an American," she says.
But there is no Susie any more. Only Hiroko.'
The full documentary Fall Seven Times, Get Up Eight will air on BBC World News this weekend. Click to see the schedule.

Tuesday, August 11, 2015

'Frances Kelsey, Doctor Who Saved The U.S. From Thalidomide, Dies At 101'

Frances Kelsey, Doctor Who Saved The U.S. From Thalidomide, Dies At 101


August 10, 2015 | by Aamna Mohdin

Photo credit: Frances Kelsey. The U.S. Food and Drug Administration via Wikimedia Commons
Frances Oldham Kelsey has been described as a hero, and for good reason. The Canadian-born doctor saved the U.S. from thalidomide – the dangerous drug that caused thousands of babies to be born with malformed limbs and countless more miscarriages.
Thalidomide was being used during the 1950s in Europe to treat insomnia and morning sickness in pregnant women. But when the drug reached the Food and Drug Administration in September 1960, Frances Kelsey – the new medical officer – was skeptical about its safety. Kelsey requested further information from the manufacturer and, despite significant pressure and complaints, persevered with her enquiry.
Her persistence paid off as evidence against thalidomide began pouring in. Thousands of babies whose mothers took the drug were born with flipper-like arms and legs, missing limbs and organs and other birth defects. Kelsey's refusal to approve thalidomide saved countless children from being born with birth defects associated with the drug. A number of lawsuits have been filed against thalidomide worldwide, which include recent bids from victims for compensation from manufacturers.
Kelsey, who died on Friday at the age of 101, helped improve the regulatory procedure for approving pharmaceutical drugs. CBC Canada reports that while thousands were affected in Europe, only 17 children were born with thalidomide-related defects in the U.S.
New legislation following the thalidomide disaster tightened regulations and gave more power to the FDA over drug testing. As the The Washington Post explains, the new regulations forced pharmaceutical companies to conduct phased clinical trials, to be honest about adverse effects and make sure participants give informed consent during drug testing. The law is still in force today.
Kelsey was awarded the Distinguished Federal Civilian Service by President John F. Kennedy. During the White House ceremony, Kennedy, according to The New York Times, said: “Her exceptional judgment in evaluating a new drug for safety for human use has prevented a major tragedy of birth deformities in the United States.”
Just 24 hours before her death, Kelsey was presented with the Order of Canada in a private ceremony. "We knew that death was imminent, and I sat beside her bed, held her hand, told her why I was there and why it was so important that we have the opportunity to recognize her, and took the medal and had an opportunity to put it in her hands," Elizabeth Dowdeswell, lieutenant governor of Ontario, told CBC Canada.

http://www.iflscience.com/health-and-medicine/frances-kelsey-who-saved-us-thalidomide-dies-101