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I Just Want You To Be Happy
Preventing and Tackling Teenage Depression
By Rowe Bennett Tonge
Allen & UnwinCopyright © 2009 David Bennett and Anne Bennett, Acacia Arch Pty Ltd and Bruce Tonge
All rights reserved.
What is normal teenage behaviour?
There are times when parenthood seems nothing but feeding the mouth that bites you.
— Peter De Vries, The Tunnel of Love
Living with an adolescent has been likened to riding an emotional roller-coaster. A seemingly happy and confident kid can suddenly lash out angrily, become painfully self-conscious or turn blackly pessimistic. Most parents understand that growing up can be difficult — they went through it themselves. What's important to know is where an ordinary down period ends and depression begins.
Even before the earliest signs of puberty appear, children experience emotional shifts as their internal chemistry starts to change. Without knowing quite how or why, they start to feel different, awkward, unsettled. As puberty progresses, they get moody and emotionally volatile. Hormones are often blamed. Rapidly rising levels of testosterone give boys a marked increase in sex drive, energy and a need to move. Surging oestrogen levels can make girls weepy, emotional — and almost desperate to communicate. For both sexes, the teenage years are a time of extreme sensitivity. Particularly in the early stages, anything — or nothing at all — can touch off a mood swing.
Bursts of euphoria are as common as episodes of gloom. A recently miserable teenager might start giggling at something that to an adult seems patently unfunny. Sudden exuberant shouts after hours of quiet absorption in a computer game, or endless yakking on the phone about a new love affair, are good signs: this is what normal adolescence looks and sounds like.
Adolescence is the time when we work out who we are, what we believe, what is our cultural and religious identity, what we are good or not so good at, and what interests us. During that long and often painful process, teenagers copy the clothing, attitudes and behaviour of people they like or admire. They define their own style through choices in music, sport or hobbies. This is also a time when teenagers develop and 'practise' their sexuality through fantasy, observation of others and tentative, then more passionate, relationships.
Time out to refurbish emotionally
During these years, kids need time to be alone. They need time out to ponder momentous questions like, 'Am I normal?' 'Who am I?' 'Who will I become?' 'What should I believe in?' They may retreat physically, to the bedroom or some other private place, or just become withdrawn and unwilling to talk. Silence provides a sort of psychological privacy. 'Absolutely nothing happened at school today' is a way of saying 'I want to keep my thoughts to myself.' Psychologists call this process 'introspective withdrawal' and consider it extremely important. One group of researchers used long-range beepers to track what teenagers were doing and how they were feeling at different points in the day. They found that young people are often melancholy when they're alone but that after a while their mood lightens, as if they've been emotionally refurbished by solitude.
But where do emotional ups and downs stop being normal? How can we tell when the way kids are acting is something to worry about?
Adolescent thinking and the brain
We now know a lot more about some aspects of adolescent behaviour thanks to recent studies that used magnetic resonance imaging (MRI) to take snapshots of children's brains at two-year intervals. Some areas of the human brain are mature by the end of childhood. These areas don't change any further. But the prefrontal cortex — responsible for controlling impulses and emotions and anticipating the likely consequences of one's actions — is not yet mature. This area continues to develop through the teenage years. The highest-level areas of the prefrontal cortex may not be completely mature until people hit their twenties.
Teenage brains, in other words, are not yet fully adult. They are changing in a way that makes their owners more open to new ideas and change but also more likely to experiment and take risks. An immature brain plus a flood of hormones, especially in the case of boys, where testosterone promotes thrill-seeking and limittesting, is a potentially dangerous mix.
The prefrontal cortex has been called the 'area of sober second thought' because when it is mature it helps us reason better, develop more self control and make better judgements. This is a helpful — and hopeful — point for parents who may be struggling with a teenager's erratic and otherwise infuriatingly normal behaviour.
Many parents and teachers recognise that intellectual and emotional development take time, but it's easy to lose patience when teenagers seem completely oblivious to us. As one teacher commented in a school report, 'Jack spends a lot of time contemplating matters other than those immediately to hand.' As one girl put it: 'Parents and teachers don't have a clue what goes on in our heads.' Fortunately, daydreaming too is part of normal development.
Adolescent daydreams are complex. They may be disjointed and vague, romantic or heroic, sinister or vicious. They are important to the dreamers, but rarely shared with adults. There are good reasons for this. Daydreaming lets adolescents try out different behaviours in their imaginations without having to face the hazards of the real world. This is especially true of erotic fantasies. It lets kids privately plan ahead and thus gain motivation and confidence. Daydreaming — as adults too know — also provides a temporary escape from the stresses of everyday life. Persistent vague and inattentive behaviour can, however, indicate a hearing or learning problem, especially in boys. It may also be a sign that a teenager is worried or stressed. Asking the teenager if anything is troubling them might help decide if things need to be taken further.
So what's a parent to do?
Giving in to frustration and tearing out your hair may be one way to go, but possibly not the most effective one. Seeking an instant explanation doesn't always work, either — you are liable to be told, 'Leave me alone, stop bugging me.'
Perhaps the best approach is to ask if there's a problem without expecting an answer right away, and be ready to engage when the teenager is ready to talk. Despite appearances to the contrary, adolescents are continually seeking their parents' love and approval. When they don't get it, they may behave as if they have given up and start needling and being annoying. Paradoxically, ignoring a parent can be one of the most effective ways of getting his or her attention!
That's the other important thing parents can do: pay attention. If we can stand by and listen without becoming uptight, over-anxious or overcontrolling, be sympathetic but calm, and go easy on the advice, the situation can remain manageable. The key is to convey that we endorse the child and have faith in him or her. We also need to bear in mind that relationships between parents and teenagers cannot always be sunny, no matter how much we might want them to be. Tempests and troubles are a normal part of healthy relationships. But paying attention helps us pick up the signs of a real problem.
The messages to remember
Adolescence is a time of rapid change and exuberance, but also of emotional upheaval, moodiness and erratic behaviour.
Highs and lows are part of life, and all teenagers must learn how to deal with them in order to become strong, mature adults.
The prefrontal cortex, aptly described as the 'area of sober second thought', matures late. This helps explain the impulsive, risky behaviour typical of adolescence.
Persistent sadness, grumpiness or irritability may signal depression and should be acted on.
The starting point for parents is listening. Their actions and comments should convey the idea: 'I believe in you. You are going to be OK.'CHAPTER 2
Is it sadness or depression?
Happiness comes of the capacity to feel deeply, to enjoy simply, to think freely ... and to be needed.
— Margaret Storm Jameson
During the ups and downs of adolescence, many parents will ask the question: 'Is this behaviour something to worry about?' Emotional lows are, as we've seen, quite normal, and even the everyday kind — when the cat dies or an exam is failed — call for sympathy. Parents are usually able to recognise reactions to specific stressful events, and few would underestimate the suffering involved. At such times, comfort and support are all that is needed.
But most parents are also aware that depression is common and know what damage it can do to lives and relationships. So what are the signs that a teenager has moved beyond being down in the dumps or sad to having depression? Not all teenagers react to depression in the same way, but these are some general indicators:
Depressed young people are persistently sad and downhearted. When a painful or stressful event is over, they don't bounce back. They want to pick themselves up but can't. If a teenager remains tearful, sullen and out of sorts for two weeks or more, it's a sign something is amiss. Depressed adolescents appear to lose interest in life and take little pleasure in activities they used to enjoy. They become apathetic and have trouble thinking and concentrating — deteriorating school work is a dead giveaway. They pull away from other people, including family and friends. They may spend a lot more time in their room or glued to the computer. They may medicate themselves with alcohol, cannabis or other drugs. When parents start to feel sad vibes coming through most of the time and think, 'I don't know you any more', there's likely to be more going on than an ordinary bout of the sads.
Depressed young people are often physically unwell. They may complain of frequent headaches, other aches and pains or the general 'blahs'. Excessive tiredness and lack of energy are also very common. They may spend half the night tossing and turning or lying awake, unable to get back to sleep. They may sleep during the day and stay up at night; this can be a way of isolating themselves. They may eat more — or stop eating — and either gain or lose a lot of weight. Arguments with parents over missed meals may make young people withdraw even more. Depression can also result from ill-health. Viral infections such as glandular fever can leave teenagers feeling fatigued for months and may trigger a persisting depression. Drinking alcohol and smoking cannabis can lead to depression, which in turn may lead to more drinking and drug abuse.
Depressed young people may behave in ways that are unusual for them. One of the clearest signs of teenage depression is persistent irritability — fierce and uncharacteristic. Everything seems to be too much trouble, 'everyone is stupid', and trivial things can trigger angry outbursts. The shouting and snapping and door-slamming may not look like depression, but the sadness will be evident if you look and listen carefully. Kids with a history of being somewhat hyperactive and naughty may become even more disruptive, impulsive, aggressive or frankly antisocial (for example, stealing). This may get them into trouble with the police. Instead of treatment for their depression, they receive punishment at the hands of the authorities (school, welfare agencies or the courts). It is unlikely to help and may make their depression worse.
In more severe forms of depression, teenagers have unrelentingly gloomy thoughts, feelings of anguish, loss and hopelessness, and a mounting sense of frustration or fear. Their very existence becomes painful, and the idea of escape through suicide becomes deeply appealing. They may think about death. They may contemplate suicide. Some feel life is empty and futile. As one girl said: 'When you're really depressed you think, "What is the point?" You live, accomplish nothing and then die.' Some decide they are so useless that they deserve to die. If they've clashed with a friend or parent, they may think that if they themselves were dead it would fix the problem. Or they may conceive of suicide as a way to get back at those who have hurt them. In these cases the young person may not fully understand that death is final. She may vaguely expect that somehow, magically, suicide will solve all problems and she will return to a better life.
Hopefully, before this advanced stage is reached, someone will have tuned into what is going on. Studies of teenage suicides show that in the month before their death, most mentioned their despair to someone — if not a parent, then a teacher, GP or friend. Paying attention, in such cases, can be a matter of life and death. If the alarm is sounded, professional help sought and the right support provided, teenage suicides can be prevented.
It is her fourth cold in three months. She is chronically tired and has stomach pains, which are preventing her from going to school. Lucy is a shy, sensitive fifteen-year-old. Her parents have taken her to naturopaths, chiropractors, then the family GP, who referred her to a psychologist. The consultation with the psychologist went like this: 'I sense that something else is wrong.' 'No.' 'Are you worried about anything?' 'No.' 'How is school?' 'Good.' 'Who do you hang around with at school?' 'Nobody.' Then, with tears welling in her eyes, Lucy said: 'My friends have dumped me. They swear at me. Older kids stole my bag. No one cares and everything is my fault. I'm bored and I've got nothing to do.'
Is Lucy being bullied or is she depressed, or both?
The kinds of questions to ask Lucy are: 'How long have you been feeling sad? When can you last remember feeling happy? How has your school work been going? What are your usual interests and have you been interested in them lately? How are your friendships? How is your appetite? Have you lost or gained weight recently? How are you sleeping? If the bullying stopped, would you feel completely better? Would that fix everything?'
If Lucy says she's felt sad or uninterested in her usual activities for over two weeks in a row, it is likely that she is depressed and requires treatment. On the other hand, if her problems resolve when her teachers intervene and stop the bullying, we would generally conclude that she is not depressed, just responding appropriately to a stressful situation. In this case, reassurance and validation may be all that she needs.
Fourteen-year-old Tim, the middle of three boys, was in Year 8 at high school. His father was an engineer and his mother a management consultant. Tim had always been a sociable, pleasant and happy kid with plenty of friends. Neither his parents nor his teachers were worried about him except that they felt he could do better academically. However, over recent months, they had noticed a change. He had become obnoxious, rude, argumentative, both at home and at school and, of course, his room was a mess. Although a good basketball player, he now wanted to drop out of the team and also give up his clarinet lessons.
What could be happening here? Is this behaviour part of normal adolescent rebellion or something to worry about? When this case is presented in forums, unfortunately some parents respond with negative comments such as:
This is normal fourteen-year old behaviour.
The other children in the family turned out fine, so it can't be the parents' fault.
It is his mother's fault because she's working.
His behaviour is completely inexplicable.
Any sudden change in behaviour is a cause for concern. There is always a reason — absent parents, permissive parenting, parental marital problems, bullying at school, early onset of mental illness. The first questions to ask in this case are: Does Tim think there is a problem? What does he think it is due to? Why? If the behaviour continues or deteriorates, Tim's parents can focus on creating a loving environment at home, looking at ways of overcoming family conflict, visiting the class teacher to discuss school performance, encouraging Tim to invite his friends home to gain an understanding of his relationships with them, and creating a safety net of family, friends, school and community.
Parents can try to focus on what they can do, rather than creating more problems by attempting to control what they cannot control. Young people respond well in the long term to consistency, quiet confidence and perseverance through difficult times.
Carlo is fourteen. He was taken to a psychiatrist by his mother at the suggestion of the school counsellor. Eighteen months before, Carlo's father had died suddenly at the age of 40 from a stroke. Carlo, his mother, and his younger brother and sister were all shocked and stricken with grief. But with lots of support from the wider family and community, they gradually recovered — all except Carlo. He became increasingly irritable, angry and uncooperative at home. He stopped playing football and hockey and shunned his friends. He stayed for hours at a time in his room, watching television, or wandered aimlessly in a park near the house. He was negative and pessimistic about himself and his future. In a school essay, he wrote that there was no point to life. This led the school counsellor to refer him for help.
When Carlo walked in, he was clearly resentful. He muttered crossly while his mother explained the background. He didn't seem to want to talk, but agreed to draw a picture of a bad dream. When he drew an angry monster, the psychiatrist asked him to draw what happened next. He drew a picture of himself being attacked by the monster, which he said 'wrecks my brain'. Asked how he felt about that, he said it made him very sad and drew tears on the pictured Carlo's face.
Excerpted from I Just Want You To Be Happy by Rowe Bennett Tonge. Copyright © 2009 David Bennett and Anne Bennett, Acacia Arch Pty Ltd and Bruce Tonge. Excerpted by permission of Allen & Unwin.
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