心理健康、亲子沟通--专家回复13 Reasons Why and How


李春燕    05/07     6614    
3.5/2 

美剧13 Reasons Why引出大量讨论 (http://lichunyan.weidb.com/p80075&g=1682&tag=175),我们建了“亲子共同成长--Beyond 13RW”微信群,整理出下列问题,得到华人医生的回复。欢迎转发并收集家长反馈。您从专家回答中学到了什么?会如何增进亲子沟通?

Question to Dr. Steven Sust
Emergency Psychiatrist--Santa Clara Valley Medical Center; Clinical Instructor--Stanford U School of Medicine; Child and Adolescent Psychiatrist--San Mateo County Behavioral Health and Recovery Services. 

5/7 update on Mental Illness 

There's a lot of stigma around mental illness but my hope is that we can talk about environmental stress and its effects on our external behavior plus internal thoughts/feelings. The hope is that if talking openly and catching things early might decrease chances of a crisis then that would be better. What we do know is that early preventative interventions work much better and opening the discussion about problems, stress, and sharing with trusted people for support is an important topic that might prevent the social isolation that comes when overly distressed and no one you feel comfortable talking to. 

Mental illnesses do not just show up one day all of the sudden and it's important that parents and students be aware of early signs and feel comfortable enough to talk to that person and offer to help before it potentially gets worse. 

1. Is the Guidance Counselor realistically portrayed? (may overlap some questions below)

Well I'm trained as a medical doctor and do not work directly inside of schools like the show's school counselor. However it would be hard to believe that any school staff nowadays would react in such a way to any child hinting at any kind of rape or sexual assault. School staff must comply with USA federal law and report any reasonable suspicion of child abuse. Admittedly, a child might be too intimidated to reach out for help from adults so I think it is worthwhile for each school's parents to have low threshold for speaking to school counselor when there are any early concerns. 


2. Is Mr. Porter not comfortable talking about the subject or not patient enough?

I think he is both because it's always very heartbreaking to hear about anyone talking about their traumatic experience. I think the ringing phone is very stressful too but he can place it on "silent mode", right? 


3. Being a male psychiatrist, have you encountered situations that made you feel uncomfortable? Will a female counselor be any different in Hannah's case? (Note: This question may sound strange from your professional perspective) 

I'm fairly comfortable with almost any topic as long as people are willing to explain things to me. However patients are (understandably) initially uncomfortable talking about themselves but I like to think that gets better as they get to know me better. There are some patients who have had negative experiences with the opposite gender so they might prefer to work with someone who is the same gender, but each case is different.


4. What could have Mr. Porter done differently?

The counselor should have put phone on silent mode. I would also not focus as much on speculation/prediction of future legal outcomes because I am not a lawyer. I am worried about safety and every patient of mine knows this. 

When someone comes to us with a situation like Hannah's then we want them to know how concerned we are and how we can be helpful. I'd encourage them to tell me what they can because Hannah wanting to make sure someone gets punished implies that Hannah experienced wrongdoing and that should absolutely be explored. 

At some point I would also ask if the person wanted to talk to a rape/trauma specialist who could better answer Hannah's legal question. This single school counselor unfortunately did not have a colleague who could discuss with him. I'd like to think that if he could've talked about it more, the counselor would have realized the severity of the situation and done everything in his power to connect Hannah to the rape/trauma services, notified parents, and filed a child protective service report about this physical/sexual abuse
.

5. Would Hannah have been better off going to the police or other therapist? Note that her family is not so resourceful, especially given the financial stress and her own mistake handling the deposits.

I believe Hannah's case would've been different if she had been connected to more appropriate resources for her situation as I alluded to in question4. It is true that Hannah's resources are limited but there has to be some kind of counseling available somewhere. 

People often overlook resources such as local schools that train mental health providers, and some religious institutions have staff who provide counseling as well  so it's worth investigating at local religious institutions. 

One thing that Stanford trying to work to bring to USA is something called headspace which allows for any child or young adult to walk in and talk to counselor regardless of the person's ability to pay. Can read more here: 

Headspace is a work in progress. If you'd like to hear more about it then email the people on the page with questions and/or kind words of encouragement(加油!). Could always use more voices of support for headspace because we'd all ideally like for all of our kids to have easy access to help.

6. Watching the exchange between Hannah and the counselor made me cry. I think it is the most powerful and thought provoking scene. But I found it difficult to blame the counselor. What is a typical day of a school counselor? Are they limited in what they can or cannot say? Do they just go by some talking points? 


This scene is hard to watch and is yet another tragically missed opportunity in the show for someone to meaningfully intervene in Hannah's life. I think my answer to question5 covers most of the topics. I'm not sure what level of comfort a school counselor has around some of Hannah's situation, but I'm pretty sure that school counselors can recognize when a child needs more help (if someone were to notify the school counselor).

7. After watching all 13 reasons, I am not very convinced why Hannah decided to kill herself.  Yes, she was raped, but Jessica did not kill herself.  There is something more to Hannah that it did not explore.  I think it's the mental illness issue.  Are you convinced that there is enough for her to take her own life?  Like Skye said, everyone is going thru the same thing, you don't just kill yourself.  There is mental issue for people who kill themselves.  Thoughts?

Suicide is a deeply debated issue in many fields including psychiatry, psychology, and philosophy. I think that each person is unique and handles different amounts of stress differently. The sometimes extreme amount of stress we experience can distort our  perspective and maybe even make it seem like there's no options other than suicide. 

Unfortunately, society sometimes neglects to ask about the happiness and wellbeing of our students which is reflected in actors defensively saying that everyone is experiencing stress but not killing themselves. Hannah was obviously troubled by the multiple stressors she experienced and the multiple missed opportunities when she reached out for help. 

I'm sad about any suicide but I'm also saddened that a community could fail so badly at helping this poor girl who was looking for just one person to show that they truly cared about her wellbeing when she needed it. I know that the world has more good people out there and it's instances like this when I hope good people will be more active in catching these kids early before they fall. 

Obviously if you are distressed then you should talk to a counselor, but for those who wanted to read an introductory book about topic of suicide then you can read: 

[Stress related]
Okay someone asked how parents can help students deal with stress. Well I guess that depends on the child. Stress can be both good and bad. Too much stress can be overwhelming and too little stress means there's no challenge in life. As parents, I'd recommend trying to understand what each child's personal values are. Trying to establish a balance between things a child values and the other everyday responsibilities is a difficult skill to learn on their own and requires practice with parents early on. 

Once parent and child have determined mutually satisfactory balance then will be in a much better situation to identify when things aren't going so well. If you notice your child is stressed then it's worth talking with child gently about it and trying to get them to explain the problem, and if the child wants then can collaboratively brainstorm with child to help solve the problem. 

Can watch chipao videos for some examples 

8. Another concern I have is about Bryce.  He seems very indifferent of his behavior, even rape.  Yet, he is the typical Jock and a "popular kids" in school.  He is the very dangerous kind, but it seems the society takes him as is, which is really a social problem.  I guess the best defense for girls is to stay away from him.

There's no question attached to this but I'll say that Bryce's character is not developed enough for me to understand why he behaves without remorse/regard for the people he hurts or threatens. 


Q: some are just evil? 
A: Well... there are people who are evil. However I believe most people are born to behave both good+bad, but the environment they grow up in shifts their behavior pattern. Also, children's brains don't reach final maturity until somewhere between 25-30 years old so it's hard to say whether it's easy to label someone as evil at such a young age. Might be more charitable to characterize Bryce as "misguided".

9. My main concern is if I were one of the kids' parent,  what can I do to help? 

Parents can help by calmly showing concern and talking honestly and gently with your child about what you've noticed in changes in child's appearance or behavior. Actually, you should talk/check with them even when not as concerned too. If you can get them to explain the problem then you can also talk together about best way to collaborate on solution. If that fails then would ask if parent could discuss with school counselor and see if this is something that might benefit from referral to a therapist/counselor for a more detailed assessment+recommendations.


10. I just finished watching the whole series. There shouldn't be a season 2! Question: should there be a season 2? 

Sorry but there will likely be a season2. Companies want to earn profit so that Netflix share price can go up. This show is super super popular and I think Netflix wants more popularity. Like the old saying: "nothing personal... it's just business." In capitalist economy, companies decide what to do versus not to do because customers spend more or less on them. 

Thus knowing that season 2 is coming, I would suggest parents get into the habit of talking with their teens about these topics and again understand why their children value some things or people versus other values that might be different. This show presents that opportunity for parent and child to have these discussions and will provide practice for season 2 which might involve school students and guns based off of what's been revealed in season 1 so far(?).


11. Will those intense sex scenes actually teach kids how to do that kind of thing? As parents how do we discuss this with kids so they will not follow suit or do we need to disuss this part with kids?


Unfortunately kids who have access to the Internet or any part of the outside world could potentially have access to or seen something similar to the show's sex scenes already. I do think it's very very important for parents to talk with their children about healthy relationships and what are most important values in a romantic relationship. I'd particularly stress the importance of trust + personal safety in any relationship and watching out for one another when there's any suspicion of violence. Otherwise you would make it an ongoing topic of discussion. Please watch chipao video called "Unsuitable Boy" for an example of that discussion.

12. 6th or 7th graders are watching, while knowing it is inappropriate, is it due to peer pressure? 

Children of all ages are curious and it's very much a family decision on whether or not to watch the show. If you decide to let your children watch then I would recommend watching together as a family so that you can talk about each episode and have open supervised discussion about thoughts/feelings that come up while watching. If your child is too uncomfortable with the show's content then they can walk away if they'd like. Admittedly, it's a very very difficult family decision on whether to watch the 2 rape scenes and the final suicide because they are very very graphic so parents be warned.


13. We see Clay as a typical middle-class rule-abiding good kid, resembling Chinese American boys to some extent with regard to dating. What advice to you have for parents of Chinese American boys, as someone who grew up here? 

Advice to parents regarding dating for the ABC(American born Chinese) children... I don't really have much to add beyond what I mentioned in question11. Personal values are important to be aware of and having secure enough relationship with parents to openly discuss would be nice, but generally it might be difficult for parents to accomplish.


14. As new immigrants, or families in general, how do we counter the social influence on kids? Many parents feel powerless.

The difference in the rate of acculturation to USA between parents and children can be very different and cause a lot of stress in parent-child relationships. Unfortunately there's little control that parents have over the child's decision on what they like about different aspects of American culture. However, that (1) does not prevent you from asking why the child finds that part of American culture so valuable, and (2) does not prevent you from having discussion about how parent values might differ and how to figure out some compromise on how the family can co-exist with the difference. 

Please note that American teens are trying to find their identity during adolescence so there will be multiple opportunities for parents to practice the above conversation, and there's a good chance that children will change which aspects of American culture are adapted into their persona. 



转发。5/7/2017 上午8点50分KQED的California report报道Stanford 心理学教授Rona Hu 在了解到前二年Palo Alto五个自杀的孩子四个都来自东亚家庭背景后从去年开始用戏剧型式帮助亚裔家长改进与孩子的沟通。 If you haven’t had a chance to see Rona Hu’s vignettes before, I recommend watching her videos at https://www.youtube.com/watch?v=eNHmRCRf1lQ&list=PLM_IsuL-RJXIqLVlilDOheSFqrLE0UHcA&index=1 我刚刚看完了所有的video,这几个斯坦福的教授和学生,用表演的形式把我们亚裔家长在家和孩子沟通说话的方式表现了出来,真的挺形象,在他们的表演里,能看到自己的影子!他们用两种表演方式表现出来,一种是我们本能方式,一种是改进版的方式,效果真的不一样。希望大家有时间都看一看,一定会有益处! 


Dr. Sust 就在这些视频里,下面是其中之一 “What's Wrong with You?" https://youtu.be/3FFMhUEzB9A 转:“It's the best parent-child relationship "show" I have ever seen so far. Absolutely recommend for every parents: show not lecture”

这些skits引发我们群友大量反馈。 转其中一位“受益匪浅。感触最深的:1. timing of the criticism 2. Express how you feel as a parent rather than directly accuse the child. 3. Communication is the key! For example, what is wrong is quite different from what is wrong with you?”



备注:刚Google了一些Dr. Su参与的其他活动 http://med.stanford.edu/phs/events/2016-spectrum-symposium-presenters.html http://www.montereyherald.com/article/NF/20160410/NEWS/160419986

下图是13RW剧中Mr. Porter, the school guidance counselor.

下文:谁是罪魁?

http://screenertv.com/television/13-reasons-why-mr-porter-courtney-real-villains/