Nancy Rappaport's Blog

I am a child psychiatrist who spends a lot of time talking with teenagers, but I am remarkably clueless when it comes to understanding how they may spend six hours a day glued to the computer screen. I may be able to ask questions casually ("Do you like girls, boys, or both?") and feel relatively hip, but when it comes to exploring their interest in video and computer games I become remarkably self-conscious about my ignorance (and, more honestly, my lack of interest).

This changed for me after attending a workshop with social worker Mike Langlois (gamertherapist.com), who has made it his mission to help rehabilitate those of us who may mask our anxiety by thing we have moral superiority over those who waste time on video games and who don't appreciate how to assess when computer gaming is a problem.

He provided a primer on basic terms in video games, explaining demographics, trends of gamers, and suggesting how to assess gaming use, abuse, or addiction. I left this workshop feeling less intimidated; now I am ready when a parent tells me his teenager is addicted to computer games, and I am ready to ask more questions when a teenager brightens when sharing his latest strategic maneuver in World of Warcraft.

The video game that I am most familiar with is Pac Man; I love the colorful icon as it races around gobbling up dots. Thirty years ago I made my way through Mexico, the summer after I graduated from college, playing Pac Man while sipping Corona beer. It is probably my coolest outdated pathetic video game moment. So learning the lingo or basic vocabulary (in this case, that of the popular game World of Warcraft) is useful as a window into the world that many of my patients and my own children find fascinating.

I learned that you can customize your character, and this can help to identify you with your character. Often, the character you choose can reflect your personality; your "avatar" is the physical representation of the character. Nonplayer characters (or NPC) are not operated by other players but by the computer. For those readers who are familiar with Pac Man, these are the ghosts in Pac Man. Boss is the big bad character you fight to get to the next level. Sometimes the whole point of the game is to "down the boss" so you will get rewards. (For more terms, see the list below.)

This new vocabulary shows me that I have overlooked a powerful way teenagers make meaning of some of their need to defend, gain power, or negotiate. It has also given me the opportunity to explore (if they play World of Warcraft) and ask how they feel about the boss or what spells they may need, which shows me what they are motivated to learn on their own.

It isn't surprising that 97 percent of teenagers between 12 to 17 play computer, web, portable or console games. Or that 99 percent of boys and 94 percent of girls play video games. But over 50 percent of white, black and Hispanic (English speaking) adults play video games and over half of these playing adults graduated some college and make more than $75,000 per year. So games, I discovered, are played by many.

So maybe players are motivated for achievement, status, or the challenge of the game. Or they may enjoy the social teamwork, the group achievement, or making friends. Or they may be gratified by the escape, the story line, or discovering hidden treasures.

Just knowing the different positive aspects of gaming softens my approach. Now how do I better assess when gaming is too much? I used to ask teenagers, and their parents, how much time they spent playing games and stopped there. Although there is no current diagnostic criteria for Internet or gaming addiction, two researchers (Kim and Haridakis) identified three dimensions of Internet addiction: escaping reality, intrusion in function, and impacting relationships. This is more helpful to assess then simply how much time someone is spending playing video games.

If a teenager is captivated by World of Warcraft and researches how to strategically help his guild and is able to maintain his grades and get to school, we may want to understand what the game means to him but not feel it necessary to curtail his involvement because he is addicted. But if he is escaping reality and his responsibilities, this may be cause for concern.

I confess I am not a convert, I have not signed up for World Warcraft nor paid its monthly fee. Although my instructor sees the opportunity to gain confidence by playing video games, I still have a certain aversion. But I know the next time one of my kids starts to talk about a video game or a patient talks about his virtual character, I am going to remain more curious and try to appreciate the knowledge and skill that he may be gaining while also paying attention to when his gaming may be overboard.

Gaming vocabulary:

DPS: Damage per second; this is when you might recoil, concerned that videos are encouraging aggression.

Aggro: Aggression from the boss.

Healer: In World of Warcraft the most important character is the healer, the one who heals.

Buffs: Certain spells that can buff you up. The higher the level you go, the more privileges you get.

Loot: What you get when the boss is eliminated. The loot can be gear that your character puts on for battle, or it may be gold.

Guilds: Initiated by real people and come from the term of a group of artisans, but the guilds set about to participate in World of Warcraft.

Epic win: When a player has done the most incredible job.

Epic fail: When a player loses in a most colossal way.

Two weeks ago, I took a trip to Katmai National Park, a remote part of Alaska. The bush pilot dropped my husband, a guide, and me off and as he hopped on to his float plane said, "If I don't hear from you in ten days, I'll come looking for you." We were dropped off to kayak and camp in the location with the highest concentration of Grizzly Bears in the world (2000 in the last census). Risk taking comes in all forms: surfing, parachuting, cliff jumping, running a yellow light, venturing out of our comfort zone.

I knew I was taking on certain risks with this adventure and I came to appreciate my guide's keen wilderness risk management. Whereas the public's idea of those of us venturing into the wilderness may be to perceive it as reckless, dangerous and a disregard for safety, my guide emphasized risk management. This approach is a systematic approach to minimize exposure to risk that works to identify, analyze, evaluate, address and monitor risk.

What are the optimal precautions to take in bear country? One person out of 16,000 commits murder but only one grizzly bear out of 500,000 ever kills someone and only one black bear out of one million does. We had a guide who was trained to use a gun. We walked together on the "bear highways" which they made in the thick woods when foraging for food. We stored our food in tight containers. We called loudly so as not to surprise a bear. And we prayed that we would never come between a mother bear and her cub because we were told she could become aggressive. As we were right on the coast when we camped, the waves created white noise so you could be surprised by a chance encounter. The rustle of the tent could put me on high alert. Our guide reassured us that more people are killed by moose in Alaska than grizzly bears; grizzly bear assaults just bring more attention.

How do we think about risk and safety after the tragedy of the recent Grizzly assault on a group of teens in Alaska? Any parent who has a child on an expedition must be filled with apprehension. Yet the statistical probability of this most recent attack was as close to zero as you could get - in fact, there's never been a bear attack on a group of seven or more people - until now. Thanks to the risk management practices of their group, none of the boys were killed.

I am called to explore the wilderness because of the reinvigorating majesty of nature and solitude and the test of my strength. Each time we hear of a tragedy, we are reminded of the risks that are inherent in what we decide to do (driving to work, being in love, venturing into bear country). We need to stay aware of the challenges we may confront, be they inclement weather, aggressive animals, or drunk drivers, and recognize the hazards of our risk while managing our safety as best we can. David Ropeik, instructor at Harvard University and author of How Risky Is it, Really? says that the way we perceive and respond to risk is a mix of facts and feelings, reason and gut reaction, cognition and intuition. We all want to keep ourselves alive and constantly manage risk and do our best to keep ourselves safe. Camping with roaming grizzlies wasn't completely logical, and assessing the risk wrong could be fatal, but the reality is we make risk choices all the time. The glimpses I had from the safe distance of my kayak of grizzlies lumbering on the coastline and the heavy fur blowing in the wind reminded me that they demand respect and caution.

This post originally appeared on Psychology Today on 7/26/11.

Nancy was interviewed in an article in today's Boston Globe!

She has also recently:
-been featured in the Harvard Gazette

-been interviewed by Deborah Harper for the PsychJourneys blog

-scheduled more events in Massachusetts, Maryland, and Minnesota - click "Events" to see the schedule


If you enjoyed the book, please become a fan on Facebook!

Happy September!

You can listen to the Diane Rehm Show segment here. Enjoy!

Nancy will be a guest on the Diane Rehm Show this Thursday, 9/3. She will be discussing her book "In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide" during the second hour of the show.

Please tune in on your local NPR station!

Please note a schedule change: now on Tuesday 9/1!

Some questions and answers from Nancy Rappaport about her book, In Her Wake A Child Psychiatrist Explores the Mystery of Her Mother's Suicide.

In Her Wake, the story of your mother’s suicide, is a deeply personal one. What motivated you to share it with people outside of your immediate family?

I started to write In Her Wake in the middle of the night after I became a mother to my first daughter, Lila. When you have your own children, the shadow of your relationship with your own parents is evoked. With the loss of my mother when I was four years old, I thought I had a unique vantage point as a daughter, mother, wife and child psychiatrist, to ask tough questions and be a tour guide in the darkness. At times I was afraid to find out the answers to the questions that came up as I tried to understand who my mother was, particularly to the most haunting question I had: “Why did my mother kill herself?” I wanted my reader to care about my mother and come to appreciate my enduring love, and my evolving understanding of my mother and father. I wrote to come to some resolution and acceptance. All of us have things that happen in our life that we may choose to examine closely as a way of illuminating who we want to become, and I hope this is a balance of unrelenting curiosity, sadness and ultimately hope.

You and your mother share the same name and were both writers. What else do you share when it comes to your mother?

My mother and I have a striking physical resemblance: high cheekbones, a piercing gaze, a broad smile. In fact, sometimes people mistakenly think that the photograph on the front of the book is me on the set of a play staged in the 1950s but it is my mother in a newspaper shot. When I’ve spoken with people who knew my mother they’ve told me that she took enormous pride in being a parent, and described her as a highly energetic woman who was bright, and was compelled to make a difference in her life. I like to think that I share these traits.

How has writing In Her Wake changed how you think about your mother?

I grew up thinking my mother had abandoned her six children, that she left my father to run off with another man. I thought she killed herself when she could not regain custody of her children. I had only a few memories of my mother and no photographs of her when I was growing up. My only vivid memory is standing on an airplane step holding her hand in the hot sun. Writing In Her Wake I have come to appreciate as a mother and as a child psychiatrist that there are many nonverbal impressions that may not be in conscious recall that occur in early ages that can shape our connection to our parents. After reading my mother’s diaries and her novel, and interviewing people who knew her, I have a much more intimate sense of who she was and a newfound confidence that she loved her children.

How did you approach your mother’s story as both a daughter and as a psychiatrist?

As a daughter, I wanted to understand how she could be a good mother (if she was) and still choose to kill herself. I wanted to know what she felt about taking care of her children, how she felt about my father not only during the divorce but during the ten years she was married to him—and what her relationship was like with her own mother. As a parent, I also wanted to find a way to explain in a developmentally appropriate way to my own children the longing, loss and love I felt for my own mother.

As a child psychiatrist I wanted to explore what may have happened to my mother as she was growing up that could have made her vulnerable to depression. I wanted to see if there were any clues about how my mother came to see suicide as the only viable option, and how she came to believe that she was expendable. I also became increasingly curious about what the experience was like for my father and for my five older brothers and sisters. I wanted to know more about how they made sense of my mother’s life and death.

How should a reader experiencing symptoms of depression or other types of mental illness approach your book?

When people are depressed they can often feel frozen in time. They may find it difficult to remember a time when they felt positive about life. They can feel worthless and humiliated that they are not functioning at their best. My deep conviction is that all of us are loved by somebody and ultimately I want to help a suicidal patient see that suicide is not a viable option. I hope a reader who is depressed or has bipolar disorder or has suffered a loss can be patient and recognize that the process of healing takes time. If someone who is suicidal is not getting professional help, I hope that my book will make it easier to ask for help and demystify the process of therapy and taking medication. This is not a “ How to” manual but it invites the reader to be courageous on their own journey of asking tough questions. I also hope to encourage readers to allow others to help them so they can find the necessary strength to find their way.

Has the process of writing In Her Wake changed your approach to counseling?

We all have stories in our family that may be so powerful that there are tacit rules of silence. I am more curious now about valuing how different family members see the same incident, whether it is a divorce, death, an affair or any number of other common family heartaches. I have come to appreciate the toxic combination of hopelessness, depression and impulsivity that lead to suicide and how urgent it is to intervene. I feel more confident now that confronting our darkest moments of loss and confusion can shift our understanding of life. One of the greatest comforts I provide to my patients is to let them know that they are not alone.

To schedule an interview with Nancy Rappaport, contact Angela Hayes, Goldberg McDuffie Communications, 212-446-5104, ahayes@goldbergmcduffie.com