A 14-year-old: “I’m confused, I can’t tell you what I’m going to do,” and “What’s happening in my teenage years?”
A 14-year-old told me that attachment was confusing. I start to cry and feel nothing, but then I think to myself, “You’re a teenager, teenagers are confused, and anyway, don’t get attached to anything, it’s all going to change.” But then I think of the changes coming and I feel exhausted before really knowing what I want.” She is so articulate about herself, more than I could have been at her age, or even twice her age. It’s hard to see the cause of her confusion, because of her capacity to take stock.
When B. spoke about her gender identity, something suicidal broke through. The pressures, contradictions and vulnerability of being a girl felt too much, and she would double over in my office saying she had her period, as if to demonstrate something unbearable about verging on womanhood. Identity seemed to name a point of the utmost pain and confusion. Identity politics — so fraught on both sides of America’s political divide — wasn’t the cause of B.’s pain. In fact, identity politics, too, is born from the suffering our adolescents pinpoint.
Freud felt that adolescence was the decisive time for separation, establishing the differences between generations, as each adolescent confronts the realities of adult life for the first time. The danger for this age group is getting swallowed up by their families or by the flimsiness of group psychology before they’ve established a “trial” identity. He wrote that it might be looked upon as an attempt at cure that ends often enough in a complete devastation. The other side of adolescence is when we seem to be in various forms of neurological and psychotic disorders. The most common psychotic breaks occur in the years following puberty.
A patient went to the ER for an episode of depersonalization after looking in a mirror and he couldn’t recognize himself. After this breakdown, there was something in her that gave rise to anxiety and panic attacks. I’ll call her by her first initial, too, A. After a couple of years of therapy, A. gained some ground articulating the desires that scared her and were causing diffusion.
On the other end of the spectrum, one can often find in the stories of adolescent, mostly white, male school shooters the same set of difficulties swimming around identity, a self that is falling apart, an internal attack that is cured through imagining an external one, and saddest of them all, cries for help before the act that remain unanswered: The 15-year-old who is accused of killing four students at his high school in Oxford, Mich., in 2021, wrote in his journal: “the first victim has to be a pretty girl with a future so she can suffer like me.”
I am trying to make teenagers feel less paranoid, give them room to worry and explore their complicated feelings without knowing what I’m talking about. But don’t we live in a country full of aggressive, blaming speech, a preference for quick solutions, and the reduction of real impasses to superficial actionable items, disavowing anxiety while sowing confusion?
Children with Suicidal Thoughts and Mental Health Matters: A Pediatric Campus for Mental and Behavioral Health Services in the U.S.
Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide and Crisis Lifeline, or visit the hotline’s website.
There has been a steady increase in the number of children who are seen in emergency rooms for suicidal thoughts, according to a new study – and the increase started even before the Covid-19 pandemic, which brought record high demand for psychological services for children.
Brewer thinks the true numbers are probably much higher than what the study found, because not all children who struggle with thoughts of suicide go to the emergency room.
To help more of these children, Holmes’ hospital system is working with county health and human services to help create a pediatric-focused mental and behavioral health campus. It will double the size of Rady’s inpatient behavioral health unit, in addition to beefing up services for children who need therapy but don’t need to be hospitalized.
“Over the last nine years, where we would see about anywhere from one to two patients a day that were having a behavioral health crisis, now we’re seeing 20-plus a day,” said Holmes, who was not involved in the new research.
Other places in the US aren’t so lucky. There is a national shortage of beds for children who need help with their mental health. A 2020 federal survey found that the number of residential treatment facilities for kids had fallen 30% from where it was in 2012.
Children also are responding to trauma in their lives and social influences on their health like poverty, historical trauma and marginalization, trouble at school, online bullying and the pressures brought by social media, in addition to a lack of access to counseling and therapy.
Brewer said adults can intervene when a child is thinking about suicide. She said that caregivers should be on the lookout for trouble at school or among friends, and should watch for a child who is showing signs of more anxiety or aggression than usual.
“They may act out or have problems sleeping. Irritability and being more withdrawn and isolating themselves are a lot of things that we oftentimes will think about,” Brewer said.
It is important that parents sit back and listen to their kids and talk to them. Really try to relate and understand what is going on with them and help promote positive relationships,” Brewer said.
Brewer said that there needs to be more of a strategy to help support all sorts in different ways and focus on the traumas and social influences of health. “We need to make sure more children will have safe places to grow and thrive.”
The survey showed that the mental health challenges were increasing among teens. More than 40% of high school students said that feelings of sadness or hopelessness prevented them from engaging in their regular activities for at least two weeks of the year.
Responses for the CDC’s bi-annual Youth Risk Behavior Survey were collected in the fall of 2021, offering the first look at trends since the start of the Covid-19 pandemic.
“Many measures were moving in the wrong direction before the pandemic. Kathleen Ethier, director of the CDC’s division of Adolescent and school health, said at the media briefing that the mental health crisis among young people continues. She noted that the findings are alarming.
Girls were worse than boys and there was distress among teens who identified as lesbian, gay, bisexual or questioning.
Few measures of adolescent health and well-being showed continued improvement, including declines in risky sexual behavior, substance use and bullying at school. But most other indicators “worsened significantly,” according to the CDC report.
How do we deal with mental health challenges? The message of the National Center for Mental Health (NICE) Conference on Mental Illness and Suffering
Among those tools are training for staff to recognize and manage mental health challenges, counseling and mentorship programs and others that encourage connection and intervention.
King called for action from Congress to address the youth mental health crisis and emphasized the importance of regular conversations about mental health.
Many of the challenges facing youth health and well-being are “preventable,” Houry said. I want to be filled with hope when I look at our children’s future.
The researchers also analyzed the data by race and ethnicity, finding that Black and Hispanic students were more likely to report skipping school because of concerns about violence. White students, however, were more likely to report experiencing sexual violence.
The increase in sadness and hopelessness was reported across all racial groups over the last decade. Black students were less likely to report the negative feelings compared to other groups, but they were more likely to report suicide attempts.
Data on risk factors for trans students is not known because the survey asked about students’ sexual orientation but not their gender identity.
The Rise of Social Media in Children’s Mental Health and Adolescent Psychiatry: A Case Study of the Suicidal Behavior of Teens
Dr. Victor Fornari, the vice chair of child and adolescent psychiatry for Northwell Health, New York’s largest health system, noted that the drop in teen well-being coincided with the rise of smartphones. Although the technology’s full impact on adolescents’ mental health is still unknown, he said, there is “no question” of an association between the use of social media and the dramatic increase in suicidal behavior and depressive mood.
He said kids are now vulnerable to cyberbullies and critical comments like “I hate you”. “It’s like harpoons to their heart every time.”