Youth Work Book Review: The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science

Throughout my career as a youth worker and particularly over the past few years of educating youth workers I have been asked thousands of times what books I recommend youth workers should read. One of the top books I always recommend is The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Norman Doidge, MD. It has almost nothing to do with contemporary youth work, however I think that it paints an amazing picture of the plasticity of the brain. This is key to why I recommend it as adolescence is a time where the brain is undergoing an amazing transformation.

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You have to get this book.

Norman Doidge, a Psychiatrist, psychoanalyst  and researcher  delivers a very important and informative book that should be read by all. Dr. Doidge takes us by the hand and carefully explains that the brain can and does change throughout life. Contrary to the previous belief that after childhood the brain begins a long process of decline, Doidge shows us that our brains have the remarkable power to grow, change, overcome disabilities, learn, recover, and alter the very culture that has the potential to deeply affect human nature.

The long-held theory that brain functions were localized and specialised (like a machine) has now evolved to embrace the recognition that the brain is plastic and can actually change itself with exercise and understanding. This is a massive change in our limited understanding of the equipment that helped mankind land on the moon, create cities and solve the worlds diseases… our own brain!

In chapter 1, we meet Cheryl, a woman who has completely lost her sense of balance. She must hold on to the wall to walk, but even that does not steady her. And when she does fall, there is no relief for she still feels like she is falling perpetually into an abyss. This excruciating disorder due to total loss of vestibular apparatus makes her life a living hell. Such people are called “wobblers” because that is what they do. They behave and look like they are walking a tight rope. It is not surprising that many “wobblers” have committed suicide. Enter Paul Bach-y-Rita and his team who have invented a hat. This hat/helmet, with its tongue display and electrodes, acts as a sensor of movement in two planes thus giving Cheryl the ability to orient herself in space, thereby losing the terrible vertigo that led to wobbling. Cheryl and those like her who wear this seemingly magical hat can experience through the tongue connecting to the brain what is needed to maintain balance by finding new pathways in the brain that process balance. The broader implications of this discovery are mind-boggling.

Another hero in the plasticity movement is Michael Merzenich, one of the world’s leading researchers on the subject. Based on his belief in practicing a new skill under the right conditions, he claims that brain exercises can compete with drugs to treat schizophrenia and that cognitive function can improve radically in the elderly. Learning itself increases the capacity to learn by changing the structure of the brain which he likens to a living creature with an appetite needing nourishment and exercise. Working with a monkey he showed how brain maps are dynamic and work by the ‘use it or lose it’ principle. Two phrases associated with Merzenich are ‘use it or lose it’ (as with any muscle) and “neurons that fire together wire together” meaning that throwing a ball, for instance, many times in the same way creates a brain map where the thumb map is next to the index finger map, and then the middle finger. So, brain maps work by spatially grouping together events that happen together. Multi-tasking or divided attention does not lead to lasting change in brain maps.

The story of Mr. L in Chapter 9 illustrates exactly how psychoanalysis changed his character defenses by helping him access his deepest feelings about loss. Mr. L learned that it was safe to give up the denial that protected him for over 40 years from the pain of early loss. He exposed the memories and emotional pain that he had hidden, permitting psychological reorganization. Mr. L changed from an isolated, depressed man unable to commit to anyone, to a man able to experience profound love, marry, and have children.

In chapter 11, “More Than the Sum of Her Parts,” we meet Michelle, born with half a brain. The fact that her right hemisphere took over from her left hemisphere the functions of speech and language, while performing its own functions speaks clearly for neuroplasticity. Michelle leads a comfortable, though somewhat impaired life, enjoys movies, a job, and her family. The story of how one half of her brain took on functions of the missing half is an adventure.

My personal favourite Chapter, Seven, “Pain – The Dark side of Plasticity” introduces us to the neurologist V.S. Ramachandran, described as the Sherlock Holmes of modern neurology. Learning about this man is a fascinating experience in itself. He is heroic in his simplicity and curiosity. “Your own body is a phantom, one that your brain has constructed purely for convenience” says Ramachandran – and this statement has influenced so much of my thinking. His interest became phantom pain – pain that amputees feel after amputation and he discovered that rewired brain maps were the cause. The brain’s plasticity enables rewiring of missing neurons. These discoveries also explain a positive outcome of certain brain remapping and this is in the sexual realm. Phantom orgasm and phantom erection can be experienced in the feet of men with amputated legs and feet leading Ramachandran to wonder about foot fetishes in a neurological way. I will not even try to explain how the mirror box Ramachandran devised to help his patient Philip cope with excruciating pain from an elbow that was amputated works. But, successful amputation of this phantom limb through using the mirror box led others to use it – and there’s more! Ramachandran says that the distorted body images of anorexics and some who go for plastic surgery are caused by the brain and then projected onto the body. So, could one conclude that if one gets the message that he/she is ugly or fat, whether consciously or unconsciously, through loved ones or culture, the brain distorts the perception of the body? Anorectic people actually believe that they are always too fat – defying the reality of scales. It is no coincidence that Ramachandran is from India where his culture was open to what we would call mystical thinking. Psychotic people actually hear voices and hallucinate. Can the theory of brain plasticity be used to explain and even cure such cases. Read this chapter and decide for yourself. The idea that illusion and imagination can conquer chronic pain by restructuring brain maps plastically, without medication, needles, or electricity must be really bad news for the pharmaceutical industry.

The Brain That Changes Itself is one of those books that makes us imagine how much our brains may actually be able to do. Our young people in a state of brain growth have amazing opportunities for their brains to stretch and be pliable. As youth workers this critical time offers us an amazing time to speak into the lives of our young people.

You have to get this book!

Youth work career development: Qualifications, depth and breadth

One of the most often cited reasons for staff turnover in the youth sector is the lack of promotion opportunities. Whether it is leading teams or projects many youth workers want to move up the ladder. However we also have a relatively low entry point to becoming a youth worker with over 50% of the Australian youth sector having a Certificate IV or less. This lack of career progression options has been an issue within the sector for many years with the Australian Youth Affairs Coalition recently bringing it t the forefront again. It also forms the basis for one of the most frequently asked questions I get from students at university and TAFE… how do we get a decent job in the youth sector?

youth-work-degree

So with limited opportunities and a limited pool of highly qualified youth workers, what is a youth worker to do??? Plan their career!

Whether you are just starting your career or you are years into it, it is important to realise that no one other than you is looking out for your career progression. Most youth work organisations do not do succession planning or if they do it is mainly focussed on the top job. So if you thought that your manager was getting you ready for or had a focus on developing you for your next role, the chances are you are wrong. There are a few managers and organisations who take very seriously the idea of staff development and succession planning. However for the most part you are on your own.

[Tweet “Whether you are just starting your career or you are years into it, you need to think about career progression.”]

If there are limited opportunities for you to progress upwards in your organisation (usually because you are in a small or medium sized organisation) then you may need to think laterally. What other organisations do work you want to be involved in? What requirements do they have for staff? What qualifications do they want you to have? Is there specific knowledge or experience you need for the roles? In our experience you will need depth of knowledge about young people and a breadth of experience if you are to stand out for the roles you want.

If you imagine a Certificate IV as the minimum standard and a PhD as the maximum depth that your qualifications can have, look at the depth of your qualifications. More depth provides you more opportunity to get promoted. The other axis to look into is breadth. If all you have focused on is youth work you may have great depth (which is fantastic for an academic) but you will have no breadth. Now if you choose to gain some qualifications in the peripheries then you begin to gain some breadth. Drug and Alcohol, Mental Health, Management, Business, Family Therapy, Education; all of these periphery qualifications and more can give you more options for your career.

Depth and breadth of your qualifications are only one part of your career development plan. It gives you options. To begin the process though you have to have an area in mind that you want to end up in. At the beginning of my career I knew that I wanted to be the best at working with young people who were at the crisis end of the spectrum. That meant I had to Gain qualifications in these areas. I gained qualifications in Youth Work, AOD and Dual Diagnosis. Qualifications gave me some options. If you don’t have much depth or breadth November is always a great time to check out some options for building your qualifications.

Knowing mental health: Eating disorders

The final week of our mental health month brings us to eating disorders. As youth workers we have seen a marked increase in eating disorders over the past ten years with body image being consistently rated by young people in their top few issues. Approximately 15% of Australian women experience an eating disorder during their lifetime however it is not just an issue for females either. Many young males also deal daily with eating disorders. The mortality rate for people with eating disorders is the highest of all psychiatric illnesses, and over twelve times higher than that for people without eating disorders. Approximately one in twenty Australians has an eating disorder with the rate increasing in the Australian population.

There is a high level of co-morbidity of mental illnesses with eating disorders. Eating disorders are most commonly accompanied by depression and anxiety disorders; however, substance abuse and personality disorders are also highly prevalent in people with eating disorders. In fact, research suggests that approximately 60% of people with an eating disorder will also meet diagnosis for one of these other psychological disorders (Beyondblue, 2014).

Knowing mental health

Knowing eating disorders

According to the Diagnostic and statistical manual of mental disorders (fifth edition), “eating disorders are characterised by a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning“. The following diagnoses come under feeding and eating disorders:

  • Pica
  • Rumination disorder
  • Avoidant/restrictive food intake disorder
  • Anorexia nervosa
  • Bulimia nervosa; and
  • Binge eating

Each of these diagnoses, save for Pica, can only be assigned individually to a person in a single clinical episode. Meaning you cannot have a diagnosis of Anorexia nervosa and Bulimia nervosa in the same presentation. This is due to their substantially different clinical course, outcome options, and treatment needs. The diagnostic criteria for these disorders is relatively straight forward however the disorders themselves are quite misunderstood. As youth workers we must have a solid understanding of these disorders so we can break the stigma and provide the most appropriate treatment options and support to our clients.

Knowing mental health: Depressive disorders

Depressive Disorders

While each one of us from time to time all feel sad, moody or low, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood, it is a disorder which has an impact on both physical and mental health. Adolescence is a critical time for mental health and it is estimated that 75 per cent of adult mental health conditions emerge before a person reaches the age of twenty-five. Around 550,000 young people in Australia aged between sixteen and twenty-five years live with depression or anxiety.

Ultimate Mental Health

Depression, it can be beaten.

According to the DSM5 the following diagnoses come under depressive disorders:

  • Disruptive mood dysregulation disorder
  • Major depressive disorder
  • Persistent depressive disorder (dysthymia)
  • Premenstral dysphoric disorder
  • Substance/medication induced depressive disorder
  • Depressive disorder due to another medical condition
  • Unspecified depressive disorder

[Tweet “#UltimateMentalHealth In adolescents #depression is often observable as irritable mood over sad or low mood.”]

Of the above disorders the most common one for youth workers to encounter in their young people is the diagnosis of ‘major depressive disorder‘. It is characterised by discrete episodes of at least two weeks duration (although most episodes last considerably longer) involving clear cut changes in affectcognition, and neurovegetative functions and inter-episode remissions. While these brain disorders can be diagnosed as one off episodes they are more often recurrent in a majority of cases. In adolescents depression is often observable as irritable mood over sad or low mood.

Major depressive disorder often finds itself in comorbid unity with anxiety in many of our young people. It is important for youth workers to have a good understanding of the diagnosis of depression as the consequence of leaving this disorder without treatment cans be fatal. The severity of the disorder and the persistence of psychotic features and remission status make up the criteria for diagnosis. If the disorder is severe it can lead to suicidality and in turn death.

Knowing mental health: Depression

Knowing mental health: Depression

Depression can be kicked

Depression

We continue mental health month at Ultimate youth Worker with the most spoken about of brain disorders, Depression. Depression goes by many different names and it stalks people with the skill of a bloodhound. It chases you down in everyday situations and squashes your ability to reach your goals. The most disturbing quality of all is it slowly stops them of life. When we speak of depression as a disorder of the brain we are speaking of the everyday crippling sense that the world is going to squash us that some of us feel that stop us from living our life to the full.

The common feature of all depressive disorders is the presence of sad, empty, or irritable mood, accompanied by somatic (physical) and cognitive (mental) changes that significantly affect the individuals capacity to function. The black dog and its friends spend most of their time making our mood low which in turn makes us physically and mentally feel like we are walking in mud. Our ability to deal with the day to day stresses of life, work productively and fruitfully, and make a contribution to our community becomes limited and if it persists can become a chronic condition.

[Tweet “#UltimateMentalHealth Do you understand depressive disorders in young people? #youthwork”]

The major differences among the depressive disorders are issues of duration (how long the symptoms last for), timing (whats happening for you at the time), or presumed aetiology (the causes, or manner of causation of a condition). Symptoms of depressive disorders can last from two weeks to a number of years. The onset of the symptoms can be a certain time of the month through to a significant bereavement and anything in between.

Major Depressive Disorder

…represents the classic condition known to most of us in this group of disorders. It is characterised by discrete episodes of at least two weeks duration (although most episodes last considerably longer) involving clear cut changes in affect, cognition, and neurovegetative functions and inter-episode remissions. While these brain disorders can be diagnosed as one off episodes they are more often recurrent in a majority of cases.

As youth workers we will work with many young people with depressive disorders. We must have a strong understanding of the diagnostic criteria, treatment options and recovery planning for young people living with depression. We can then support them to make informed decisions about the treatment planning and recovery orientation. We owe it to them to be well informed.

Knowing mental health: Anxiety disorders

Anxiety is a problem faced by around one in ten young Australians aged 18-25.

For young people aged 13-17, the figure is approximately one in twenty-five. Anxiety is a normal emotion experienced by everyone at some stage. It is an emotional anticipation of future threats. It is often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviours. Anxiety disorders differ from developmentally normative fear or anxiety by being excessive or persisting. However, Anxiety disorders come when a persons level of anxiety is heightened over an extended period of time beyond developmentally appropriate periods. Anxiety disorders differ from one another in the types of objects or situations that induce fear, anxiety, or avoidance behaviour, and the associated cognitive ideation (American Psychiatric Association, 2013).

Knowing mental health: Anxiety

What do you know about anxiety?

When our young people gain a diagnosis and tell us that they have anxiety it could be one of a number of disorders which come under this umbrella. According to the DSM5 the following diagnoses come under anxiety disorders:

    • Separation anxiety disorder
    • Selective mutism
    • Specific phobia
    • Social anxiety disorder
    • Panic disorder
    • Agoraphobia
    • Generalised anxiety disorder
    • Substance/medication induced anxiety disorder
    • Anxiety disorder due to another medical condition
    • Other specified anxiety disorder
    • Unspecified anxiety disorder

[Tweet “14% of females and 8% of males have experienced an anxiety disorder in the last twelve months”]

We aren’t going to go into detail about all of these here (Phew). What we want to give you is an overview. In time we will go into some detail on these disorders.

Approximately twice as many young women are diagnosed with anxiety disorders as males. 14% of females and 8% of males have experienced an anxiety disorder in the last twelve months this is equivalent to around 435,000 young people in Australia every year.  This mean we are extremely likely to have clients with an anxiety disorder during our career. Anxiety is the number one mental health issue we will find ourselves working with.

Anxiety disorders often have comorbid disorders alongside them so it is important for us to understand the extent of the issues surrounding an anxiety diagnosis. Get to know the diagnostic criteria for these disorders. Know as much as you can about them. Your young people will thank you for it.

Anxiety

Knowing mental health: Anxiety

Anxiety

Don’t empty today of its strength

We kick off mental health week with the most prevalent of disorders, Anxiety. Anxiety robs people of their ability to cope with the turmoil of everyday situations. It robs them of the ability to reach their potential. Most of all it robs them of life. When we speak of anxiety as a brain disorder we are not speaking of the everyday anxieties we feel when we have to do something like driving in heavy traffic or speaking in front of a group. We are speaking of the crippling anxieties that some of us feel that stop us from living life to the full.

When our thinking becomes so disordered by anxiety we cannot do even the most basic tasks. We cannot get out of bed, leave the house or even hold a conversation. Our ability to think clearly and rationally is basically gone. Your limbic system takes control and your primal fight or flight instincts kick in. your frontal lobe, the part of the brain that orders rational thought, has been overridden. All the fears and failures you can imagine are now in control of your thought and actions. You are now in a state of complete primal anxiety.

Add to all of this the fact that adolescence is already a time of storm and stress and we have a setting that is ready to ignite.  Our young people are already experiencing changes in their brains which they are struggling to deal with and on top of that anxiety is nipping at their heals. Any strength that they had to face the daily challenges of being an adolescent is torn away to deal with their anxieties. Grades, relationships, groups, fears, all of these and more conspire against our young people. They set them up for worry and dread.

As youth workers we often provide a first point of contact for young people to address their anxieties. By developing a trusting relationship where young people can confide in us their fears we can support them to begin a journey of recovery. Understanding the triggers, diagnosis and treatment options available to our young people assists us to guide them through the maze of service provision to find the right support options for them. It gives them back the strength they need to beat their anxiety.

youth workers need to stop mental health stigma

In my class on mental health I often ask if we are beating back the stigma of mental illness. Students often say no… but after some thought and discussion they often change their mind. “We are beating back the stigma of anxiety, depression and body image” they would say. It is then that I ask them, “What would you do if you were running a youth program and one of the participants had a psychotic break?” Most of the students with fear in their eyes speak about keeping all the other participants safe while seeking help for the one having the break. This leads me to ask what they would do if one of their young people was depressed. No fear here, they would just get alongside the young person. Stigma is still very much at the forefront of challenges for mental health.

I agree with my students, we have made leaps forward. But, we still have a long way to go. While we have made great steps forward in areas such as anxiety and depression; eating disorders, schizophrenia and personality disorders to name a few are still very stigmatised. Much of the stigma still comes from fear. We fear that which we don’t know. When was the last time you saw a schizophrenic portrayed as “normal” in the media. they are always touted as weird, scary or worse. What about people with personality disorders how are they portrayed on film?

As youth workers we believe that young people have enough issues without having to add stigma to the list. However we as much as any member of the general public stigmatise mental illness. We don’t mean to do it, but in our fear we allow our prejudices to come to the fore. Fear comes from our lack of knowledge. As the general public knows very little about mental health so it is with youth workers. Even though our clientele are likely to have mental health issues we do not really study it and unless we spend significant personal resources we will have minimal understanding of brain disorders at best.

Mental health is important

We must have an understanding of brain disorders

To stop the stigma of mental illness we must have a solid understanding of the causes, diagnostic criteria, treatment options and recovery options. We need to be better than we are right now. Unfortunately this means going against the grain. I was speaking to an educator recently who believed that because youth workers don’t diagnose we don’t need to know how a diagnosis is formed. It is this antiquated idea of youth work and how we support young people that causes stigma. The same educator could not see why we need to have more than mental health first aid as it is psychologists who will do the work. I mentioned that it was youth workers who often hold the cases and that most psychologists will only give a dozen sessions.

We need to have a better understanding of mental health. It stops the stigma!

Mental health

Mental health… Do you understand?

Mental health
Mental health is…

Mental health is the leading health issue of our time!

It is the leading cause of preventable deaths in the western world. One in four of our young people will have a diagnosed mental health issue by the age of 25. Many of the leading mental health diagnoses are most prevalent in adolescence. Most of all mental health is an issue of which youth workers must have a rock solid understanding. Unfortunately, most youth work education gives a youth worker a passing knowledge at best… and this is dangerous.

[Tweet “At Ultimate Youth Worker we believe that all youth workers should have a first responder understanding of mental health.”] At Ultimate Youth Worker we believe that all youth workers should have a first responder understanding of mental health. In the same way that paramedics have enough understanding of medicine to save your life and get you to hospital, we believe youth workers should have enough understanding about mental health to assess, triage and refer to mental health clinicians. We need more training. We need more education. We need more understanding.

Most young people are thankful for our empathy and care… but know how limited our knowledge of their issues are. Over the month of October we will be devoting time to help you understand more about mental health. October is mental health month and as a treat each week we will focus on one mental health issue and give you more depth than any course you have ever attended. We want you to be the best you could possibly be, and to do that we want you to have the best resources possible.

Organisations such as BeyondBlue and Headspace have fantastic resources aimed at young people and their families. They give a cursory understanding of the issues and provide a comforting nudge in the direction of support. As a tool for youth worker knowledge however they are limited. As youth workers we are often in a position to first identify mental health issues in young people and as such we need to have a better grasp of the issues. We must gain more than a mental health first aid certificate if we are to truly support our young people to recover their mental health.

Knowledge is power. It is also responsibility.

Life is what happens to you while your busy making other plans.

Plans are important

I was talking with a student of mine today about the need for youth workers to have plans. Career plans. Professional development plans. Self-care plans. Plans for working with clients. Plans for networking. Plans, plans, plans. It dawned on me as I said this that most youth workers I know don’t really do this. We sit around and lament that nothing is happening or we spend our time up to our neck in crisis.

Prior Preparation Prevents Piss Poor Performance

plans are important
Planning meeting in progress

Making plans

If we are to excel as youth workers, to truly become “Ultimate” we must plan our work and work our plan. If we do not plan we are at the mercy of whatever storm comes our way. When we don’t have plans we are saying blatantly that we do not care what happens in the future.

We need to become proficient at forward planning. It doesn’t mean we have to have it all worked out… But we have to start somewhere.

Here are a few places for us to begin our plans.

Career development: Begin by getting a handle on the type of youth work career you want. Then work out where you are starting from. Think about the depth and breadth of your qualifications, the experience you have and your values. Then plan for your future. Listen to this podcast to help you out with this task.

Self Care Plan: There are really only a few things our team harp on about and at the top of the list is self care. Youth workers really struggle with this concept so its a good place to begin a plan. Try this one.

Networking: A youth worker is only as good as the network they keep. Ultimate Youth Workers know that they need a solid network. It helps us to provide the most exceptional service to our young people. Plan who you need on your network and use a tool like LinkedIn to manage it.

With these quick plans in hand you will be better than 90% of your colleagues who fail to plan even a little. But don’t rest on your laurels. Get out a piece of paper and start planning today.