Beneath the Surface: A Teen's Guide to Reaching Out When You or Your Friend Is in Crisis

Beneath the Surface: A Teen's Guide to Reaching Out When You or Your Friend Is in Crisis


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Depression and mental illness don’t discriminate. Even in the most picture-perfect life, confusion and turmoil are often lurking beneath the surface. For a teenager in a world where anxiety, depression, and other mental illnesses are commonplace, life can sometimes feel impossible. Whether or not you or someone you love is suffering from any of these issues, it’s important to be able to recognize the warning signs of mental illness and know where to turn for help. This comprehensive guide provides the information, encouragement, and tactical guidance you need to help yourself or others experiencing:

• Depression • Academic or parental pressures • Eating disorders • Bullying • Self-harm • PTSD • Peer pressure • Anxiety • Substance abuse • Technology addiction • Suicidal thoughts or actions

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Product Details

ISBN-13: 9781608686353
Publisher: New World Library
Publication date: 09/10/2019
Pages: 184
Product dimensions: 5.40(w) x 8.40(h) x 0.50(d)
Age Range: 13 - 17 Years

About the Author

Kristi Hugstad is a certified grief recovery specialist, speaker, credentialed health educator, and grief and loss facilitator for recovering addicts. She frequently speaks at high schools and is the host of The Grief Girl podcast and talk radio show. She lives in Orange County, California.

Read an Excerpt



It's an age-old problem: Parents don't understand their teen, teens don't understand their parents, and both groups wonder why the other can't just see things their way. Sound familiar?

If you feel like your brain works differently than your parents', teachers', or any other adult's, there's a good reason — it does! The teen brain isn't just an adult brain with less experience. It's a brain that functions differently than an adult brain.

The first thing you should know is that a teenager's brain hasn't finished developing yet. In fact, it won't be considered "mature" until sometime between age twenty-five and thirty. Think about that; teens make some of life's most important decisions — like where to go to college, what career to pursue, perhaps even who to marry — before their brain is fully developed. So while adults might dismiss "irrational" teen choices and behavior by blaming it on raging hormones or peer pressure, teens are simply reacting and responding based on their brain's current functionality (not to say teens aren't affected by hormones!).

As the brain develops, it does so from the back forward. The reptilian portion, or the back of the brain, is the first to mature. This is the area of the brain responsible for the most basic human instincts. In a nutshell, it's what keeps you (and the human species) alive. This is where fight-or-flight instincts arise as well as the innate urge to reproduce. This area isn't logical or emotional; it's all about self-preservation.

The middle of the brain, also called the limbic or second brain, develops next. This area is responsible for memory, emotion, pleasure, connection, love, and trust. The second brain determines your mood and helps you balance your self-interest with your concern for others. Think about it like this: A toddler might hit a friend to get a toy back, but as we grow, we begin to notice the needs of others and will at times (though certainly not always!) sacrifice some of our innate self-interest on their behalf.

The front region of the brain, called the cortical brain, matures last. This is the area responsible for logic, reasoning, rational thinking, organization, and decision-making. The cortical brain is divided into lobes with various functions and responsibilities. This section is the "newest" portion of the brain, evolutionarily speaking. Basically, the reptilian and limbic brains are structurally very similar to those of the first humans. But the cortical brain is different. It enables higher thinking. The only catch is that it takes a few decades to mature.

That brings us to where you are right now. Teens have a fully functioning reptilian brain, and the limbic brain matures rapidly around puberty, when it experiences a lot of change. I don't have to tell you that; after all, you're alive and you're feeling all the feels. What's different about the teen brain is that the front part is still in a state of plasticity — meaning it's changing all the time. This can be a huge advantage in some ways. The brain's plasticity allows teens to change and adapt based on circumstances. This state is perfect for absorbing information; that's why children and adolescents learn languages and music more easily than adults.

Of course, there's a catch. Basically, the different areas of the brain mature at different rates. The connections between your frontal cortex, where rational thinking and decision-making occur, and your limbic system, where emotions arise, strengthen through age and experience. But during the teen years, those areas don't communicate optimally, and consequently, teens might make decisions or behave in ways that their parents or other adults simply don't understand. Scientists believe this is why teens are so much more prone to risk-taking and recklessness than mature adults. Additionally, teens feel mature, grown-up feelings in one part of the brain that another part of the brain cannot yet fully process. That puts teens in a tough, and often confusing, state of mind (literally).

So when teens multitask to get everything done — do chores, ask parents to sign forms, be at practice on Saturday morning, write an essay Thursday night, study for a Friday quiz, clean their room — well ... it can be completely daunting. Really, it's no wonder if you forget about a quiz and your bedroom floor is covered in clothing. The life of a teen is overwhelming no matter how good their organizational skills and how developed their brain!

However, in addition to understanding the teen brain, it's also important to understand the parental brain. All brains are hardwired for survival — to doing whatever is necessary to keep ourselves alive. But a parent's brain is also wired to keep their child (you!), alive. Scientific research shows that both men and women experience changes in their brain and endocrine systems (where hormones are created) after having a child — whether biologically or through adoption. The instincts formed through these changes provide parents with one major goal: to do whatever is necessary to protect their child. Moms and dads — and really all loving adult caretakers — are wired to do what's best for their children, though it may seem they are only trying to make decisions for you or to nag and control you. Whether or not they actually know and do what's best, protecting their children is usually their motivation.

Your teen years really are a time of discovery. You're learning and growing and discovering who you are. That's because your brain is doing the same thing. Your brain is still developing, and its three parts are still figuring out how to work together in a balanced, effective way — so that no part has too much or too little power. However, it hasn't figured this out yet, which is why outside stressors and behaviors can alter that balance and cause problems. For example, everyone desires reward and seeks pleasure, emotions that live in the limbic brain. But the brain's reward center is kind of on overdrive during the teen years. This area is driven by dopamine, a chemical that makes us feel good. This feeling is important to everyone, but it's vital to teens. That's why impulsivity and giving in to peer pressure are so common for teens. The desire for pleasure and approval often surpasses other instincts and abilities, including the fear response in the reptilian brain that's wired to protect you and keep you alive. When this happens too often, reward-driven behavior can become addictive, even when you know what you're doing is dangerous and harmful, such as taking drugs. This is why addiction often starts in the teen years. When left unchecked, the limbic brain can eventually take over, overshadowing even someone's survival instincts, rational thinking, and decision- making abilities, which is why addicts behave in such reckless, life- threatening ways.

Of course, as an adult with a fully developed brain, you will eventually have a better perspective as well as better decision-making ability — but that doesn't make the here and now much easier, does it? If you struggle making decisions, or always seem to make the wrong ones, know that's part of the process. And don't underestimate your parents and other caring adults in your life. They've been where you are, and they remember it all too well. No matter how it may seem, they want to protect you and help you be as happy and healthy as possible.

And that's exactly what I hope this book does — helps you be as happy and healthy as you can be.



Most children grow up thinking their home, family, and upbringing are "normal," even when they're not. Children and teens living in a home where one or both parents are depressed often don't realize this isn't the norm — though this situation is more common than you may think.

In fact, fifteen million kids in the United States have parents with depression.

As a result, these fifteen million kids are at greater risk of developing depression themselves. But depression can happen to anyone. It can occur after a trauma or during a stressful situation, or it can develop due to someone's particular brain chemistry. Why someone develops depression is important, particularly if it's due to situational or lifestyle factors, which can be changed. But more important than the why is the how. As in, how do you deal with depression? That is the real focus of this book because depression can put someone at risk for any number of issues, including suicide. The faster you recognize the symptoms of depression, the faster you can get treatment and reduce the risk of other, even more serious issues. Additionally, the more you know, the better you can help others.

Are you at risk for depression? Consider the following questions, all of which may indicate that someone is already depressed or at risk for developing depression. If you find yourself answering affirmatively even to several questions, it doesn't necessarily mean you're depressed, but you may have an increased risk of becoming so. Later we'll talk about what you can do if you or someone you love is suffering from depression.


Do you currently live with a family member who suffers from depression?

Studies have shown that living with a mother or father who has depression, whether the cause is environmental or genetic, increases your own risk of developing the condition. You may not know if a parent suffers from depression; if you feel safe asking, do so. If not, consider whether they exhibit the signs described in this book. Further, you don't have to live with a depressed family member to be at risk.

Does life feel pointless?

Everyone may occasionally feel hopeless as they navigate through school, work, and life. But if a hopeless feeling persists day after day and affects your daily behavior, it could be a sign of depression.

Do you find it impossible to concentrate?

Depression can make it hard to concentrate even when you're reading or watching something you love.

Have you withdrawn from your friends and family?

It's important to do your own thing and be independent, but this should be balanced with a healthy amount of socializing and bonding with friends and family. Depression sufferers often turn down opportunities to be with others simply to be alone.

Have you noticed a sudden change in your weight?

Extreme weight loss or gain can be a symptom of depression. If you've lost your appetite or find yourself seeking comfort in food, this may be because your brain chemistry is being affected by depression.

Do you have insomnia, or do you sleep too much?

Look, teenagers need their sleep and often don't get enough. But if you go through long periods of sleeplessness or of sleeping too much, depression may be the reason.

Do you have physical pain that won't go away?

Depression doesn't just cause emotional pain. Depression can cause chemical imbalances in your brain that make you perceive pain differently, and it could be the reason for a persistent physical pain that doctors can't find a reason for.

Have your grades dropped? Have you stopped participating in extracurriculars?

Depression has two best friends: apathy and lack of energy. These can combine to affect your performance in school and your extracurricular activities, and they can sap your passion for activities you once loved.

Have you ever thought of suicide?

If you answer yes, you're not alone, and suicidal thoughts can be caused by depression. However, if you're currently thinking about suicide, seek help and treatment. Tell someone. With counseling and, if necessary, proper medication, you will begin to feel better. When you're suffering from depression, the idea of feeling better might be difficult to imagine. This is the time to practice trust and courage. For immediate help, see the organizations listed in the resources section at the back of this book (page 145).



Depression refers to feelings of intense sadness that don't go away after a few hours or even a few days. It's not feeling sad when things go wrong, which is expected; it's feeling sad all the time, when everything is going right, too.

Depression affects a person's thoughts in such a way that they don't see when or how a problem can be overcome. It leads people to focus mostly on failures and disappointments and to emphasize only the negative side of their situation. Someone with severe depression is unable to see the possibility of a good outcome and may believe he or she will never be happy or that things will never be right for them again.

Looking on the "bright side" is often impossible for someone suffering from depression. Depression is like wearing sunglasses in an already dark room: It completely distorts your thinking. That's why depressed people often can't recognize that their perspective is limited or obscured and that emotional problems are temporary and changeable, so they turn to the permanent solution of suicide. Someone with depression may feel like there's no other way out, no other escape from emotional pain, and no other way to communicate desperate unhappiness. They lose hope that their mood will ever improve. They lose the ability, after feeling down for a long time, to step back and view their situation objectively.

Sometimes people who feel suicidal may not even realize they are depressed. When depression causes someone to see all situations in a negative way, suicidal thinking is a real concern.

It's important to remember that there isn't a standard form of depression. No two brains are exactly alike, and since depression is a disease of the brain, there will never be two identical cases. Additionally, the distinct details of someone's life and situation affect the ways in which the disease manifests itself, though the feelings of hopelessness are often similar. Here is Jackie's story, which is about when she was a teenager in Baton Rouge, Louisiana.


I always knew I was different than other girls. Not only was I taller and stronger, I also felt comfortable playing sports with boys, I refused to wear skirts or dresses, and I preferred to keep my hair short. In school during recess or other athletic events, I'd sometimes hang back, out of fear I'd be teased for "acting like a boy." That had happened to me before, and it was really hurtful.

My father is an alcoholic, and my mom is my best friend, but she's nothing like me — she used to be a dancer, and she's won beauty pageants. She loves to obsess over fad diets, exercise videos, and food portions. Whenever I didn't feel good about myself or my body, I was too ashamed to share my feelings with my mom because I thought she would judge me.

At the time, I was actually suffering from what I later learned is called gender confusion. This gave me anxiety, which then morphed into depression. Again, I didn't know there were names for the things I was feeling at the time; I just knew I felt really crappy, and I felt like something was wrong with me. I felt like my body and my gender didn't match. I couldn't deal with the stress, and I felt like my parents really cared about my appearance. So, in an effort to be the "perfect female," I vomited after I ate, alternating through unhealthy periods of bingeing followed by violent purging. This is called bulimia.

Well, bulimia didn't help my self-esteem. Every time I looked in the mirror, all I felt was guilty — guilty about who I am, what I was eating, how I looked, and how the rest of the world perceived me. I thought that if I told my parents how I really felt about myself and my body, they would be disappointed in me or even angry with me.

Instead of asking for help, I turned to food and substances as coping mechanisms. At times of extreme depression, I binged on foods I knew were off-limits: donuts, French fries, and milkshakes. Then, I'd vomit as much as I could and vow to start over again. To help curb my appetite, I began using a prescription stimulant that I was able to buy from kids at school.

Throughout high school, I continued to slip into a deep clinical depression. Every day, I felt like I would never live up to what everyone else expected of me and that I could never share my bad feelings because everything I felt was wrong.

When I graduated high school, I moved away from my hometown to attend college, and in the anonymity of my new surroundings, I finally felt I could become who I really am. I went to student health services, and they referred me to a psychologist, who diagnosed me with gender dysphoria, in addition to the bulimia I knew I had, which explained why I didn't feel like me — I felt more male than female. I then sought out support groups for gender dysphoria and eating disorders, where I met other students to whom I could relate. Slowly, I began the process of accepting myself for who I really am. I began eating healthier and better. Slowly, I was able to look in the mirror and accept my size and shape as mine.


Excerpted from "Beneath the Surface"
by .
Copyright © 2019 Kristi Hugstad.
Excerpted by permission of New World Library.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Introduction: Gavin’s Story

Personal story of Gavin’s severe depression, suicidal thoughts and eventual recovery.

Chapter 1: Listen Up

Acknowledgement of teen pressures and issues, that that it’s OK not to feel OK, and

assurance that there is help. Hugstad also discusses the fact that the teenage brain is not yet

fully developed, which may cause teens to engage in risky or impulsive behavior.

Chapter 2: You are not Alone / Take the Quiz

Ten questions for readers to answer about their own lives and behavior that may indicate

that they’re depressed and may need help.

Chapter 3: What is Depression? (Jackie’s Story)

Personal story of Jackie’s struggle with gender identity and subsequent depression and eating

disorder. Extensive discussion on depression as underlying cause for many destructive teen

behaviors, and the importance of getting help.

Chapter 4: Eating Disorders

Underlying issues that may lead to eating disorders, facts and statistics and how to get help.

Chapter 5: Bullying (Caitlin’s Story)

Personal story of Caitlin’s sister’s suicide resulting from bullying at school. Discussion of

bullying and cyberbullying, how to recognize symptoms and warning signs and how to help.

Chapter 6: Self-Harm (Kaley’s Story)

Personal story of Kaley’s sexual abuse and resulting PTSD and self harm. Discussion of risks,

signs and symptoms of self-harm.

Chapter 7: PTSD

Discussion of post traumatic stress disorder causes, symptoms and the importance of getting


Chapter 8: Pressures on Teens

Discussion of peer pressure, academic pressure and potential negative impact on teens’ selfesteem

and mental health. Hugstad provides coping strategies teens can implement themselves,

as well as suggesting professional help when appropriate.

Chapter 9: Anxiety (Asher’s Story)

Personal story of a dyslexic teen’s anxiety and depression and positive transformation after

therapy and medication. Discussion of anxiety symptoms and risk factors, panic attacks and

importance of treatment.

Chapter 10: Substance Abuse

Physical, social and behavioral warning signs of alcohol and drug use and potentially

devastating physical, emotional and social effects.

Chapter 11: Teen Suicide (Ethan’s Story)

Personal story of Ethan’s lonely childhood, video game addiction, depression and suicidal

thoughts and his ultimate recovery after his parents’ intervention. Further discussion of risk

factors and warning signs of suicide, and truth about “myths” surrounding suicide.

Chapter 12: My Story

Hugstad’s story of her husband Bill’s life as a teenager and young adult, his depression,

substance abuse and ultimate suicide.

Chapter 13: There is Hope

Strategies for overcoming obstacles, focusing on goals rather than obstacles and staying

motivated. Cultivating hope – and getting help from a support system and treatment team.

Chapter 14: How Can I Help a Friend?

An invitation to teens to support their peers in small, but meaningful ways, with suggestions

as to what to say and what not to say, and how to be a good listener.

RESOURCES: Where to Go for Help

A guide to the many hotlines and websites teens can contact to seek help for self-harm,

bullying, substance abuse, depression, suicide prevention and more.


Questions related to the content of each chapter designed to generate deeper conversation.

What People are Saying About This

From the Publisher

“An in-depth guide that can educate and empower teens in crisis. An important book that should be purchased for public and school library collections.”
School Library Journal

Beneath the Surface is a thoroughly ‘kid friendly’ and comprehensive guide that provides the information, encouragement, and tactical guidance you need to help yourself or others. . . . Exceptionally well written, organized and presented.”
Midwest Book Review

Beneath the Surface is critical to any parent, whether or not the parent realizes it. As a man who never took one psychology course, I appreciate that Kristi Hugstad wrote about a serious topic in a way that I could embrace and learn from. This book not only changed my life, it changed the life of my child.”
— Kevin Thaddeus Fisher-Paulson, columnist, San Francisco Chronicle

“Exploring everything from the addictive effects of excessive video gaming to the warning signs of alcohol and drug abuse, Kristi Hugstad leaves no stone unturned in her quest to raze the stigma of depression. She does so in a way that is effective, accessible, and highly informative. A must-read for anyone wanting permission to help themselves or a friend, this book reads as though it’s reaching out to grab you and hold you in your time of need.”
— Regina Louise, author of Somebody’s Someone

“Each year as a high school teacher, I see more and more students struggling with depression, anxiety, and overwhelming stress. Beneath the Surface is a powerful work that uncovers the growing epidemic of pressures facing adolescents today and offers the tools necessary to help students navigate these pressures directly. Kristi Hugstad’s writing eloquently and accessibly captures the depth of these issues through her own story as well as the stories of others. When you find yourself wondering what you can do, or you have a student who is struggling, here is a book that can help. It is a starting point for a conversation that just might save someone’s life.”
— William Meyer, author of Three Breaths and Begin

“In Beneath the Surface, Kristi Hugstad writes about how to recognize the warning signs of depression and suicide and shares valuable resources that we can all use to prevent suicide. As a college professor who interacts with young students on a daily basis, I experience how the epidemic of stress and poor mental health is affecting the personal and professional lives of my students. This is a must-read for high school and college students, parents, healthcare providers, and educators. Read this book — and apply it.”
— Mahtab Jafari, professor of pharmaceutical sciences, University of California, Irvine

Beneath the Surface is a well-written outreach mainly to adolescents, but frankly to anyone seeking to help a family member or friend suffering with depression and suicidal ideation. Kristi Hugstad struggles to come to grips with her own riveting experience of losing a husband who completed suicide despite her best efforts. Hugstad weaves together science, psychology, and social connections by relating the poignant stories of adolescents suffering from depression. The book describes groupings of common clinical manifestations of depression to provide a guidepost to assist teenagers and others who come into contact with adolescents with malignant suicidal ideation. She provides scientific knowledge and her own experience to promote awareness and offer tools for dealing with deep depression and high suicide risk. A great read that’s clinically relevant and helpful.”
— Nadine Levinson, DDS, clinical professor, psychiatry, University of California, Irvine, School of Medicine; training and supervising psychoanalyst, San Diego Psychoanalytic Center

“As I know from personal experience, the teenage years are often the most difficult and challenging in a human being’s life. This book offers invaluable insight and support that will help any troubled teen come through the turbulence of those years.”
— Steve Taylor, PhD, author of The Leap and The Calm Center

“My hope is that Kristi Hugstad’s book Beneath the Surface will give teens hope and insight into their emotional lives and help them emerge stronger, as well as wiser.”
— Maureen Healy, author of The Emotionally Healthy Child

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