Here is an important article by a therapist about naming and navigating depression in the lives of teenagers.
Naming and Navigating Depression in the Lives of Teenagers
Photo by Nicole Mason
How do I know if he’s depressed or if this is just normal teenage behavior?
This mom could no longer tell the difference between teen angst and moodiness and something more serious. She brought her son to my counseling office and asked the question that echoes concerns I’ve heard from parents through the years, both as a therapist and a ministry leader.
Under this mom’s concern is the fear many parents have when it comes to the issue of depression and teenagers: Am I going to miss something crucial in their mental health which could lead to serious consequences?
This is a good instinct, because like many issues related to mental health, there are two really important factors that frequently obscure the true nature of what is going on: First, depression itself can be somewhat tricky to diagnose, not to mention deciding what type of depression is at hand. Second, there are cultural contexts in which talk of depression (like that of anxiety) brings about lots of shame and guilt, often driving those who suffer from it underground in order to avoid any stigma.
Most parents can paint a picture that describe their teenager’s behavior as (though not limited to) moping around the house, spending inordinate amounts of time alone in their room, seeming emotionally short-fused in verbal tone and responses, and generally refusing to engage in family activities. These are some of the things that often stand out when concerns begin to creep up about depression.
The problem, of course, is that most of us can recall times in our adolescent years when we mimicked similar behavior, and we may have not been depressed. I vividly remember a time when I was about 17 years old and my dad sat me down and told me that it felt like they were running a hotel and restaurant for me and that I showed little desire to engage with the rest of the family. Was I depressed? Possibly. But I was also 17 and in the midst of significant transitions in my life surrounding school, identity/relationship/faith formation, not to mention all the changes in brain development.[[For a helpful reference on teen brain development and its implications on everyday behavior, see Dan Siegel, Brainstorm: The Power and Purpose of the Teenage Brain (New York: Penguin, 2014).]]
So how do we understand depression at work in the lives of our teenagers?
The Anxiety and Depression Association of America write that:
“Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general. When these feelings last for a short period of time, it may be a case of ‘the blues.’
But when such feelings last for more than two weeks and when the feelings interfere with daily activities such as taking care of family spending time with friends, or going to work or school, it’s likely a major depressive episode.”[[Anxiety and Depression Association of America: http://www.adaa.org/understanding-anxiety/depression]]
The National Institute of Mental Health (NIMH) reports that “About 11 percent of adolescents have a depressive disorder by age 18″[[National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/depression/depression-in-children-and-adolescents.shtml]]and that in the past it was thought that young people actually couldn’t suffer from true clinical depression. But today we know so much more about depression. The NIMH reports, “We now know that youth who have depression may show signs that are slightly different from the typical adult symptoms of depression. Children who are depressed may complain of feeling sick, refuse to go to school, cling to a parent or caregiver, or worry excessively that a parent may die. Older children and teens may sulk, get into trouble at school, be negative or grouchy, or feel misunderstood.”[[National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/depression-in-children-and-adolescents/index.shtml]]
When you look at the research on depression and its symptoms, you will find a list that runs across organizations and resources like the NIMH, ADAA, and the DSM. Some of the symptoms of depression that you might notice in your teenager include:
- persistent feeling of being sad or anxious, or describing themselves as feeling “empty”.
- a loss of interest in activities that your teenager used to find pleasurable like a particular hobby, sport, or time with friends.
- change in eating habits (not eating/overeating) and sleeping habits (inability to sleep/sleeping a lot).
- describing themselves in ways that are shaming, as well as talking about feeling worthless and helpless.
- decreased level of energy and fatigue, and an inability to concentrate on tasks or make decisions.
- change in mood (irritability, irrationality, etc.)
- thoughts and talk of suicide.
- physical issues such as aches and pain, or digestive issues that don’t seem to go away.
If you are a parent or work with teenagers it can be difficult to determine the difference between “normal” teenage behavior and a teenager who is depressed. Back to my story above, when I was 17 and my dad confronted me about my behavior, was I depressed? I had always excused that phase as some type of adolescent angst, until I began to work more on my own family of origin issues (specifically the death of my mom when I was 11 due to breast cancer) as well as learning more about depression. I’m now convinced I actually was pretty depressed at that stage of my life, but the resources and tools were not available then to help those around me make discerning decisions about what I was going through.
So when you wonder about depression and teenagers, you may find it helpful to ask yourself a couple of questions:
- Do the behaviors I am witnessing deviate from the typical and “normal” behaviors of this teenager?
- Has there been some recent event that might be related to this change in behavior and mood in this teenager?
Once you can answer these questions, a few follow-ups help the process of discerning what to do next:
- Is this behavior some form of depression brought on by the onset of something such as the death of a loved one, a rejection by a close friend, or failing to get onto the team or into the school they had hoped for?
- Is this behavior a part of their personality?
- Have I always thought this was part of their personality, but could be a form of long-term depression? In my own teenage story, what was probably seen as some quiet and withdrawn personality trait or some form of teen angst was probably an ongoing struggle with depression that was being masked.
As a therapist these questions often help me formulate some type of possible diagnosis so that I may begin to know what steps to take next. But sometimes I have a hard time knowing what to do next. If you find yourself unsure of what the next steps are for you, this is when I would recommend that you seek out professional help.
What can we do to help?
Depression, like talk of suicide, is one of those mental health issues that many people find overwhelming. It’s easy to feel helpless. I believe we all can utilize a specific set of skills that can be helpful to those teenagers around us suffering from depression.
1. Do Not Judge
One of the worst things we can do to someone who is suffering with depression is to judge them. When someone is depressed they are already wrestling with feelings of worthlessness and shame, and further judgment only perpetuates this shame cycle and drives the person further into hiding. Often people look at those with depression and think, “If they just do this … or that,” but what we fail to realize is that depression can have a decimating effect on even basic actions like eating, sleeping, exercising, and prayer.
Instead, work towards approaching those with depression with empathy and compassion. Ask yourself the question, “What do I need to do to get in their shoes and see things from their perspective?” These forms of understanding defuse judgment and make it safe for the person with depression to come out of isolation and hopefully engage in a way that is life giving.
Unfortunately, one of the more unsafe places for teenagers to talk about their depression has been in the Christian community, which has historically been stuck in all kinds of unfortunate stigmas related to mental health. I have voiced my concerns before about the perception of depression in the Christian community[[See “Christian and Depressed,” Relevant Magazine, http://www.relevantmagazine.com/life/whole-life/christian%E2%80%94and-depressed.]], but we have a long way to go still.
2. Explore All Options
Depression is multi-faceted and needs a very robust approach. If you know a teenager struggling with depression, I recommend that you keep your options open and explore all kinds of possible treatment. Pastoral caregiving, professional counseling, and psychiatric medication could all be helpful at different times, as well as looking at various aspects of self-care and the young person’s physical, emotional, mental, and spiritual lives.
Begin by engaging that teenager in a non-judging way to best determine what they may need. In my experience, some teenagers navigate through depression in a healthy way because there is someone present in their life who cares about them. Sometimes a teenager may need the safe space of counseling for a few months to work through depression, and other times playing pick-up basketball with a friend may do the trick. The point is that not one size fits all, and it’s helpful to experiment with different approaches and see what works.
3. Be Present
One of the most powerful transforming agents in the life of someone who is struggling with depression is the healing presence of someone else. A presence that is non-judging, compassionate and empathetic, and willing to just be with the person suffering from depression. Too often we find ourselves wanting to try to do something to fix the person who is depressed, when one of the only things we can really offer is our ability to sit with them. I believe that one of the reasons people struggle to be with someone they know who suffers from depression is because it bumps up against their own feelings of inadequacy and inability to find a quick fix.
In his beautiful book Let Your Life Speak, [[Palmer, Parker. Let Your Life Speak: Listening for the Voice of Vocation. Jossey-Bass. 1999. Also see http://www.couragerenewal.org/parker/.]]educator Parker Palmer talks quite vulnerably about his own seasons of depression. He notes that one of the most helpful things he experienced was a friend who was willing just to be present. Palmer talks about how this friend asked permission to come by every day at four o’ clock in order to take off Palmer’s shoes and massage his feet. In an interview with On Being host Krista Tippett, Parker states:
What he mainly did for me, of course, was to be willing to be present to me in my suffering. He just hung in with me in this very quiet, very simple, very tactile way. And I’ve never really been able to find the words to fully express my gratitude for that, but I know it made a huge difference. And it became for me a metaphor of the kind of community we need to extend to people who are suffering in this way, which is a community that is neither invasive of the mystery nor evasive of the suffering but is willing to hold people in a space, a sacred space of relationship, where somehow this person who is on the dark side of the moon can get a little confidence that they can come around to the other side.[[http://www.elissaelliott.com/the-spiritual-dimension-of-depression/]]
An Opportunity for Growth
I know few teenagers who escape adolescence without some brush with depression. The teenage years are full of difficult transitions, broken relationships, peer pressure, struggles at home, school and work, which make that time of life a ripe environment for depression to take root.
Ultimately, I believe one of the best things we can offer a teenager who is struggling with depression, is the opportunity to help them see their pain and suffering as a catalyst for growth in their lives. But it is a journey they can’t enter into on their own, and you may be that trusted guide they are needing and wanting.
- Is there a teenager in your home or your ministry who is showing signs of depression? Check the list in the “Discerning depression” section above and think about whether those signs exist in ways that are becoming disruptive to everyday life.
- Think about ways to talk with your teenager in a non-judgmental and non-threatening posture about what is going on, and offer to help or to seek help. Try to identify someone they can go to who they already trust to talk with about this, if they don’t want to talk to you.
- As Rhett suggests, consider a cluster of support that addresses depression from multiple angles rather than assuming one counseling session or prescription will resolve the issue. Locate and talk with other parents whose children have suffered from depression, and other adults who face depression themselves. Ask them what helps, what doesn’t, and what resources in your community might be particularly useful.