Teenage is the transition phase from being a child to an adult and it is said that many mental illnesses have their onset during this time. This year’s World Mental Health Day focuses on teenagers suffering from depression and anxiety. While parents and psychologists are trying to figure out how to help their children deal with the emotional disturbances of growing up, we try to understand what goes on behind the teenage tumult.
Do you remember watching the movie Titanic? Do you recall that moment when the legendary liner smashed into an iceberg in the middle of the ocean? Not much was made of it at the time. Sailors on board began playing a game of improvised football with the chunk of ice that was sliding around the deck. Below decks, however, beneath the passengers dancing away their concerns, the hull began rapidly filling up with water, and by the time help came, it was too little, too late. The concerns surrounding mental health are much like that iceberg. There is far more to the problem at hand than meets the eye.
Cries for help from teenagers who are just coming to grips with the weight of the expectations that they are expected to not just meet, but surpass, after they have just come out of their carefree childhood years are often unfortunately ignored by parents who might think they know better, coldly asking their children to get it over with and pay no attention to the troubles that constantly rumble within them, not knowing that ignoring them might only make things worse.
Psychotherapists in Oman, though, have a single word of advice to those who ignore their children...don’t.
Specialising in psychiatry for the last 15 years, with a specialisation in child and adolescent psychiatry, Dr Vijay Ram Naresh, who currently works as a psychiatrist at Aster Medical Centre, spoke to T weekly about why adolescents and young adults today are more prone to suffering from bouts of depression and anxiety.
“When you talk about depression and anxiety, these are two different disorders, but when you start looking from the perspective of teenagers, then the expectations from the self, from the family, and from the society mean that everyone is expected to be good in every department,” he said. “You want the same boy or girl to be good in sports, good in singing, good in studies, and good in everything. As a family, what we could not do for ourselves, we want our child to do all of that.”
The doctor also pointed out the physical manifestations of psychological concerns that parents needed to look out for in their children. The World Health Organisation has listed a number of symptoms to look out for when it comes to diagnosing depression, some of which include headaches, restlessness, body aches and increased blood pressure, all of which could have long-term repercussions on people’s mental and physical health.
“The child is struggling to cope with it, and one of the ways you do cope, is a child successfully being able to complete what is expected. If not, either the child will succumb or escape. When you succumb, you normally present certain signs and symptoms such as feeling unwell, feeling tired, losing interest in things around you, and this is more of a depressive kind of presentation, or you become restless, you are always on the edge, and this is a manifestation of anxiety,” added Naresh. “The third form is when you try to escape, then you start to develop a stance of ‘I don’t bother about anything my family says’ and then you become a rebel.”
While teenage depression might be hard to spot, when asked about this teenagers raises concerns that one must ponder over. Here are a few thoughts shared by adolescents and young adults on conditions of anonymity.
“Sometimes I feel like my parents are trying to live their lives through me,” said a young girl who wanted to follow her artistic dreams. “I, for example, want to grow up and become an artist, but my father wants me to be an engineer, because his definition of success is different from mine. If I am going to be doing a job, then I want it to give me satisfaction, not just to go into an office and do work for the sake of doing it.”
Another young teen added: “I really wish my parents could stop telling me what to do all the time. I understand that they are looking out for me and they have my best interests at heart, but sometimes I wish they would let me try to do things differently. If I fail, so what? At least I will learn things the hard way and then I can follow their example, but unless I try things out for myself, I will not learn.”
A young adult who is currently at university added, “My mother and father both used to go to work and I had to take care of my younger brother and myself when I was in school. I really wish I had someone to talk to, because I was just a teenager, and I had to go home, open the door, buy some food from the restaurant below and do everything by myself. It made me more independent, but I think it is really important for a child to have a parent at home.”
But psychiatric disorder is not always easy to identify. WHO stats revealed that globally, more than 300 million people of all ages suffer from depression, and has been identified as the leading cause of disability worldwide. Dr Naresh says that to differentiate between mind and body is like separating salt from water. “You don’t know whether or not the water is salty unless you actually taste it, and you cannot differentiate between the two. For any diagnosis, if my body is stressed, it will have some bearing on my mind, and if my mind is stressed, then it will take its toll on my body. Panic attacks and palpitations are some of the best examples of symptoms, so if you have these, you will ultimately end up with either a physician or a cardiologist,” added Naresh.
This social stigma that existed around psychiatry centred on the manner in which mental patients had been previously treated in society, where they were unfortunately forced into straitjackets and locked up in asylums, or sold to circus shows by families who did not know any better. Any affliction of the mind, after all, was previously termed as madness, and people unfortunately thought that mental patients were just that — mental. Families therefore choose to disguise mental illnesses as physical ailments, because those who sought out counselling to sift through their problems were considered to be stereotypically weak, especially in a society that praises physical prowess. People were therefore expected to put on a brave face and pay little attention to the workings of the mind.
“But things are changing, so in the future, things could be different from where they are now. People are not comfortable with being labelled as someone who has mental instead of physical weakness,” he added. “We have to communicate with children and we cannot replace our family time with physical gifts. That will not replace my time and my guidance and my life with them. Secondly, don’t shy away from seeking help. Notice any changes that are happening around you. If a boy who is silent has suddenly become outgoing, look for the change. Be attentive for any sudden changes,” said Dr Vijay.
When it comes to dealing with teenage mental health, most parents feel that the current lifestyles accelerate teenage depression. More and more schoolchildren are increasingly becoming latchkey kids, as they return home to empty houses with both parents away at work.
“We share many things, but we don’t share true feelings,” said a parent, who did not want to be named. “That has its own burden and has its own share in adding to the problem. If children have a problem, it is definitely accelerated due to the current scenario,” said a parent of a 16-year-old girl currently undergoing counselling sessions for anxiety. On setting limits for children, most parents feel that it’s important to draw a line. A child asking for an ice cream is not something to which we will ever say no but when the demands get bigger, that is when the impact begins to show. If you always give a child an ice cream when he/she asks for it, then he/she will expect you to say yes to whatever he/she asks.
“When you say no, children begin to believe they are being denied something and then this affects them negatively. So you must set limits at the start. “If my son wants a video game, he has to earn it. Otherwise, he will think he is entitled to everything without working,” said the father of a 12-year-old boy.
In addition, T weekly also reached out to Dr Gerald D’Costa, a psychologist at Badr Al Sama’a Polyclinic. He said that times were changing, and although change was slow, people were now more accepting of feelings that differed from the traditionally “manly” ones.
“The new generation of teenagers is more accepting to counselling. Since schools have counsellors, they tend to use their services more often. However, their first area of support is their friends and they usually try to solve all problems there. Social media and phones allow them to communicate with each other quickly and daily. They are more active on social media platforms and tend to seek advice from these platforms.”
But these platforms on their own were not the long-term solution to problems, which if left unchecked, could lead to far worse. Across the globe, more than 800,000 people die due to suicides every year, and WHO research shows that investment in mental health has a four-fold return. Dr D’Costa emphasised the need for parents to take an active interest in their young ones’ lives, even if what lay within was not the easiest of situations to deal with.
“The world is changing and we change along with it. Parents and teachers have to adapt to new platforms and if possible schools need to provide counselling services through telephone and social media platforms. Parents have to view the online life of teenagers as necessary in this modern world but will need to keep an eye on it. Peer pressure and teenagers’ trends to experiment and accept modern values as the right way of life have to be countered with better education and communication from parents and teachers.” –[email protected]
Case studies of teenage anxiety and depression
Case Study 1
I had a family of high performers with a father and grandfather both being high achievers. The elder brother was also very good in academics and was studying abroad. Then came a child who was not that sharp. When he grew up, he was not respected like his elder brother, he was always compared to his elder brother, his father always talked about what has been achieved and he was expected to achieve the same.
But the family doesn’t understand why he is able to perform. I as a professional understand that he is not capable, but the family does not. Not everyone can run 10 kilometres an hour. We all have our limitations. The boy may not have the same interests, he may be better elsewhere. Depression may not always be seen in the form of sitting alone or crying, it’s not that. It at times can be irritability. He presented irritability, anger outbursts, difficulty in interacting with his friends, difficulty in interacting with his brother, with whom he was compared regularly, so he is not able to cope with the stress that was presented on him, and he is behaving in a different way.
Their complaint was anger and irritability; he was picking fights with his brother. It was difficult to categorise it, but the family had some exposure to psychology so they were open minded to any treatment.
Case Study 2
There was a girl whose personality had taken a hit because she was not cared for and had a lack of confidence. In her teens, there was the urge to get the appreciation of those around her and she then opted for an arranged marriage and that also went bad. She didn’t want to do anything, she didn’t want to sleep, and she had crying episodes. Depending on the severity of symptoms, treatment was decided. With the boy, a change of environment helped, and with the girl, talking sessions of psychotherapy helped. If this does not help, though, then you go for medication. Therapy sessions are defined, but the last few sessions usually focus on preventing a relapse, or on stopping the re-emergence of symptoms, otherwise, follow-up sessions are needed.
Usually, what we see as a professional is that there needs to be a good amount of homework as well. It is not a medicine that you just pop into your mouth after which things are fine.
It is very easy to point a finger at someone else, but the expectation was that he was born in the family and he was expected to perform a certain way. I had to explain to the family that it’s okay to not perform like everyone else. In a class, not everyone can get 99% marks, after all. There will be some with 80% or 70% marks, but the problem is that everyone wants their child to get 90 per cent marks.