Addressing mental health in the teen years
Forty-three year old Daniel sits down at his computer to compose a plausible lie to tell Lizzie. But first, he re-reads her email for what seems like the seventeenth time.
Hi Dan! Are you coming to the reunion? It would be great to see you again! Best, Lizzie. P.S. Do you even remember me?
Remember her? How could he forget the way that she beamed whenever they passed “accidentally” in the corridors of Lincoln High? Why didn’t he try talking to her?
Yet, she of all people contacted him about their 25-year class reunion. Could she be interested? And if they were to meet, would she look at him in the same way?
Not if she knew what was going on with his son. Let’s face it: he wasn’t exactly the perfect father, what with the overwork, the disorderly divorce, and the conflict that preceded it.
No, it’s too late for love. That part of his life is definitely over.
He reads her email one more time, hits “reply,” then hesitates again. Lack of practice in the prevaricating arts has rendered him hopelessly inept at hiding the truth. But there’s no way he will admit to Lizzie that the real reason he is skipping the reunion is that Josh cracked up.
When Josh began his junior year, Daniel was so proud of his son’s intellectual gifts! Soon, the two would start looking at colleges together. Daniel began to accumulate brochures, visit websites, and talk about how fun and rewarding his college experience had been. It never occurred to him that while he was so fixated on Josh’s future, his son was holing himself up in his room with the shades pulled, cutting classes, and saying some curious things that he attributed to Josh trying to yank his chain.
But then Josh began a nightly walkabout, wandering the streets for hours on end, returning after bedtime without a hat, his ears white with cold. When one bleak December night he didn’t return, Daniel circled the city, searching until he finally found him sitting at dawn on the icy railing of the Tributary Bridge, eyes fixed on the water, far, far below.
Although Dr. Marvel assures Daniel that Josh is stable and needs to — what was the word — “emancipate” in order to develop — how did she put it? — “an autonomous identity,” Daniel feels in his bones that giving Josh too much space is what caused his slide in the first place. After all, I’m the parent. Why didn’t I see this coming?
As he stares at the blank computer screen, trying to come up with something sensible to say to Lizzie, Daniel worries and wonders, filled with sadness, embarrassment, and confusion, regretting the wrong he has done and the right that he has not. He feels more alone than he ever has in his life.
Unwilling to lie yet unable to tell, he gives up, logs off, and heads to the fridge. Then he remembers that it’s Family Night at Dr. Marvel’s clinic. If he rouses Josh from his computer, they can still make the last half. But would it do any good or would it only make them both feel worse — especially if Josh’s mother is there with her new fellow?
Never having asked for help, he is not going to start now. Peeling the tape off of the cracker box with his right hand while holding his beer with his left, he eases himself onto his trusty old sofa and sinks into the merciful nepenthe of cop show-induced forgetfulness. He yearns to have Josh plop down next to him like he used to, but doesn’t want to ask for any more than he can give.
If Daniel had only given Family Night a try, he would have found himself in excellent company. With the demand for youth psychiatric services on the rise (Judith Warner, We’ve Got Issues: Children and Parents in the Age of Medication), more parents than ever are in Daniel’s position, desperate to help, reluctant to pry, yet sensing that their children, nearly grown though they may seem, need them now more than ever.
Their conundrum mirrors the struggles of their teens, longing to venture into the mysterious new worlds of learning, work, and love, while quietly aggrieved at leaving the nurturing shelter of their childhoods behind. A time of great beauty and of terrible loss, is it any wonder that adolescence is also a time when emotional vulnerabilities show in a form that professionals call mental illness?
While culturally created rites of passage have guided transitions into adulthood across time and space, the adolescent’s unspoken yearning for secure family connections during this perilous process is often overlooked. Programs for troubled adolescents are now beginning to address this need by including family members in the treatment process. Robert Whitaker, award-winning author of Anatomy of an Epidemic, describes studies across the globe showing that young people whose therapy occurs in the context of their families often recover with no further psychiatric episodes. Many go on to lead lives rich in meaning, compassion, and productivity.
The bind that many parents find themselves in is that they love their kids so deeply that it hurts. Although they want to do the right thing, at times they unknowingly withdraw — as Daniel does — and that is when their teens become most vulnerable.
What, then, are the worrisome signals? This depends on the form that the syndrome takes. In schizoaffective disorder, the illness with which Josh is eventually diagnosed, the “prodrome” — or early warning signs — often manifest during adolescence. Afflicted individuals may develop unusual thoughts or beliefs; hear imaginary sounds; or see vague illusions. This can be so frightening that they react in a way that intensifies their symptoms — such as by pulling away from their friends and family, experimenting with chemicals, isolating in their rooms, or becoming suicidal.
If you sense something is amiss with your teen, start by sharing your concerns directly with your child. Avoid emotional or value-laden words. Keep it simple. Then, make an appointment with your family physician. At this delicate juncture, it is critical your adolescent feel that he or she is leading the process.
You and your child, together, then, can describe the changes that you have noticed, each in your own way. Your physician will most likely refer you to a team of professionals specializing in various treatments for adolescents. Such programs often include educational components that teach young people skills to deal with the stresses of their lives and to monitor the flux of their symptoms. The goal is to intervene as early as possible to prevent the illness from turning pernicious, while protecting the person’s friendships, educational pursuits, and family connections.
On an optimistic note, the field of adolescent mental health is drawing many of the brightest and most caring clinicians of the day. Scientists working across the globe are collaborating to develop interventions that seek not merely to eradicate symptoms but to enhance the quality of life as well. Websites describing such state-of-the-art research include preventmentalillness.org; eppic.org.au; and orygen.org.au. You might also want to check out the website for the National Institute of Mental Health, nimh.nih.gov. Finally, the National Alliance on Mental Illness (nami.org) provides hands-on resources, including contact information for free 12-week courses for family and friends of people with mental illness.
what to do?
There are occasions — and these are the very hardest — when, for one reason or another, loved ones are not invited into the therapeutic process. If this is the case for you, please do not give up hope, take it personally, or devolve into anger. To paraphrase Blaise Pascal, the heart has reasons that reason knows nothing of. Your teenager may need to work through an issue before including you; or perhaps he or she is simply not ready.
In the meantime, you can still be a deeply important part of the process of recovery. You might want to begin by following the three steps described below. Although seemingly simple, these practices can be devilishly difficult to carry out, as they require tectonic shifts in the tenor and hue that our communications cast, especially when our emotional worlds are at stake.
Step One: Heal thyself. Remember this ditty: when we escape, they escalate. Adolescents crave positive attention. When they sense their parents pulling away by fleeing emotionally, as Daniel unconsciously does, they destabilize. We don’t need to be perfect. After all, mistakes, even really big ones, are a part of all relationships; but we do need to be present.
Step Two: Talk. Start by reminding yourself of the Hippocratic Oath: first do no harm. This means stopping negativity — all of it — the tone of your voice, your facial expressions, and the natural proclivity to focus on “problems.” Instead, find your “mind of love.” It sounds cornball, but it works. Resist the impulse to “resolve issues” or “discuss” heavy subjects. Instead, listen; validate; empathize; and support. Keep it light. Find something to agree with. Say, “I don’t blame you for feeling that way.” Praise effort, not outcome: “I am amazed at how well you handled that situation.”
Step Three: Envision a positive future. In opposition to the widespread belief that emotional struggles denote weakness, research and historical analyses indicate overwhelmingly that the obverse is closer to the truth: those who are beset with psychological instability tend to be uniquely sensitive, gifted, or otherwise original. In The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom, Jonathan Haidt suggests that we can only reach our full potential by suffering, and then finding deeper meaning in our traumatic experiences by talking them through with others.
There is cause, in other words, for hope. Even amidst the anguish of bearing witness to your child’s struggles, seek opportunities to celebrate. Emotions are contagious. So, go ahead and show your joy. Don’t be afraid to encourage your child’s dreams.
the bad … and the good
One morning while reading the morning paper, a thunderous pounding at the front entry startles Daniel so severely that he rips the sports page in two. Bam-Bam-Bam!!! Bam-Bam-Bam!!! As he ponders the merits and demerits of calling 911, an ear-splitting CRACK rivets his attention to the sudden appearance of a black boot emerging through the middle of the door, now dangling limply on one hinge. In walk three bona fide cops, two federal agents and a man in a black hat.
While Daniel had been watching television all those months, Josh, becoming ever more delusional, had turned his intellectual gifts to ingeniously hacking into the email of the Oval Office in order to warn the President “of an imminent invasion by extraterrestrial endotoxins plotting to invade the micro-architecture of the executive cytoskeleton.” Oops.
Being Josh is a minor and definitely not well, the charges are commuted from espionage to legal insanity warranting extended commitment. This drives Daniel into therapy of his own, which he first hates — and then loves. He learns that no cop show comes close to the intensity of real life and the joy of parenting his son through good times and bad.
It is Family Night once again. Daniel and Josh are setting out their signature salami salad for the pre-meeting potluck. Guess who brought the deviled eggs? Ding! Lizzie.
In a moment of desolation morphing into a sort of “all-is-lost-so-who-cares” abandon, Daniel emailed Lizzie, pouring his heart out. She wrote back, then he wrote back, then she wrote back … and you can guess the rest.
Dr. Kara Witt is a psychologist in the Twin Cities.
Anatomy of an Epidemic by Robert Whitaker, New York: Crown Publishers, 2010
The Drunkards Walk; How Randomness Rules our Lives by Leonard Mlodinow, New York: Vintage/Random House, 2008–2009
The Happiness Hypothesis: Finding Modern Truth in Ancient Wisdom by Jonathan Haidt, New York: Basic Books, 2007
We’ve Got Issues: Children and Parents in the Age of Medication by Judith Warner, New York: Riverhead, 2010
Early Psychosis Prevention and Intervention Center
National Institute of Mental Health
National Alliance on Mental Illness
Orygen Youth Health
Prevent Mental Illness