All the Light They Cannot See

After the Rain
After the Rain

Summer endures. Yet Labor Day has passed and with it a sense that the transitory respite from school is over, or soon will be. For some young people, the transition back to a more structured and demanding schedule happens without so much as a blink of the eye. Others struggle with increasing demands on their time and talents.

And the fallout isn’t pretty.

In 2014, the American Psychological Association (APA) reported on its “Stress in America” survey, stating that young people are experiencing stress equal to, and in some cases exceeding, that of adults. One important trigger appears to be school.

APA states, “Teens report that their stress level during the school year far exceeds what they believe to be healthy (5.8 versus 3.9 on a 10-point scale) and tops adults’ average reported stress levels (5.8 for teens versus 5.1 for adults).” In addition, close to a third of teens (31 percent) reported feeling overwhelmed, with a similar number (30 percent) saying they were feeling sad or depressed.

One interesting manifestation of such stress is a report in The Onion of an increase of American fifth-graders taking a gap year to unwind prior to starting middle school. It’s satire, of course, but the fact that there is a parody reinforces the point.

Perhaps more disconcerting than the stress itself is that these young people seem to minimize its impact on their emotional and physical health.

With few teens stating that their stress levels are declining (16 percent) and significant numbers (31 percent) indicating that stress has increased and will continue do so in the future (34 percent), there is reason for alarm.

Indeed, an August 2015 article by Avital E. Falk, Ph.D., and John T. Walkup, M.D., stated, “Anxiety disorders constitute the most prevalent class of mental health problems in children and adolescents,” estimating rates of those suffering to be in the 15-20 percent range. These disorders include ones related to general anxiety, separation anxiety and social anxiety.

Falk and Walkup go on to characterize individuals with an anxiety disorder as “hypervigilant,” constantly on the lookout for potential tripwires and avoiding new experiences based upon fear.

Seventeen-year-old Amanda, a rising senior in the Northeast, told me in a recent email about her anxiety and depressive episodes. “I like a plan. I like knowing what's coming next. My brain is about seven steps ahead of the present, which can be debilitating. The constant need to be on top of the future became a life-changing issue towards the end of seventh grade. While my friends were all hanging out on Friday afternoons, I would normally decide not to go because of the ‘fear of the unknown.’ I mean, who would be there? Where were we going? Not surprisingly, I began losing friends, which made me feel socially isolated and alone. I recall a time I ate lunch in the bathroom because I didn’t know who would be at the lunch table for me to sit with.”

Such escalation is not uncommon.

Eighteen-year-old Andrew from the West Coast described to me his struggles with depression in high school, saying, “Having a good person to turn to when issues arise is necessary for sure. But far too often I felt like I was just moving from one bad experience to another.” There were days, he said, when even just getting out of bed was not a viable option.

A report generated by the Substance Abuse and Mental Health Services Administration (SAMHSA) this past July added an exclamation point to Amanda and Andrew’s plight: one in nine 12- to 17-year-olds experienced a major depressive episode (MDE) in the year prior to completing the survey.

SAMHSA defined an MDE, for the purposes of the survey, as “experiencing depressed mood or loss of interest or pleasure in usual activities for a period of 2 weeks or longer, as well having at least four other symptoms, such as problems with sleep, eating, energy, concentration, and self-worth.”

Sadly, the hops, skips and jumps between stress, anxiety, depression and suicide may be small.

Prior to the release of the SAMHSA data, the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention (CDC), revealed last April that the suicide rate in the United States “surged” to a near 30-year high. In total, more than 40,000 people committed suicide in 2014 as compared to about 30,000 in 1999.

Of particular alarm was the notation that suicides among girls ages 10-14 years old tripled during the same time period.

In his New York Times article “Why Do Girls Tend to Have More Anxiety Than Boys?” psychologist, physician and author Leonard Sax juxtaposes the “laid-back, underachieving boy” against the “hyperachieving, anxious girl.” In the first instance, Sax says, “My patient’s parents are concerned about their son. He’s not working hard at school and his grades are sliding. At 16, he spends most of his free time playing video games like Grand Theft Auto or Call of Duty, or surfing the Web for pictures of girls. He’s happy as a clam.”

Conversely, the parents of the girl, whom Sax describes as a straight-A student and athlete with a lot of friends, are proud of her … and apparently unaware that she is not sleeping well, is often short of breath and has taken to cutting herself with razor blades in areas her mom and dad cannot see.

While the changes inherent in puberty have historically boosted boys’ self-esteem and lowered that of girls, Sax sheds some new light on a stubborn trend. He says, “Another factor has to do with differences in how girls and boys use social media. A girl is much more likely than a boy to post a photo of herself wearing a swimsuit, while the boy is more likely to post a photo where the emphasis is on something he has done rather than on how he looks. If you don’t like Jake’s selfie showing off his big trophy, he may not care. But if you don’t like Sonya’s photo of herself wearing her bikini, she’s more likely to take it personally.”

He concludes that boys are less exposed to the “toxic” effects of social media than are girls because they are less invested in what other people think of their photos, they overestimate how interesting their lives are and they are more likely to spend their time on video games than on Instagram.

Social media and video games aside, the numbers are staggering. A guide to student mental health issued this month by the National Alliance on Mental Illness and The Jed Foundation noted that suicide is the second leading cause of death for those ages 15-25.

In addition, the CDC points to 2015 research conducted among students in grades 9-12, with questions asked about the previous 12 months before the survey.

· 17.7% of students seriously considered attempting suicide (23.4% of females and 12.2% of males)

· 14.6% of students made a plan about how they would attempt suicide (19.4% of females and 9.8% of males)

· 8.6% of students attempted suicide one or more times (11.6% of females and 5.5% of males)

· 2.8% of students made a suicide attempt that resulted in an injury, a poisoning, or an overdose that required treatment by a doctor or nurse (3.7% of females and 1.9% of males)

Perhaps not surprising, many mental health professionals point to a relative lack of life experience as a precursor to suicidal ideation, suicide attempts and actual suicides. What does this mean? That many young people experiencing significant distress for the first time may believe they will always feel that way and can no longer endure the pain they feel.

Nicholas Strouse, director of Westport Family Counseling in Connecticut, adds, “Depression is a chemical and psychological warfare for which human beings have no inherent defense. Irrational beliefs become a defining trait that convinces those suffering with depression that they are flawed, beyond repair, and worthless. The experience is pervasive, and ultimately this feels, subjectively, permanent. One’s life stage is definitely a factor in one's capacity to handle depression. Youth are more vulnerable, by nature. It is as young people mature that they acquire important life experience and gain both the self-awareness and interpersonal skills necessary to cope with life's challenges.”

All adults, be they parents, neighbors, teachers, coaches or pretty much anyone else, can redouble efforts to let all young people know that, despite how happy they may be, it is likely – even probable – that at some point (maybe sooner, maybe later) they will feel distraught, perhaps hopeless and bereft of remedy. We can let them know help is abundant (if at times hard to access) and that there does exist a light they momentarily, or situationally, do not see.

We can help them build resilience and a foundation of optimism for the future. In fact, when sorting through the rubble of data, one can find threads of hope.

For her part, Amanda discovered that hope through professional intervention. “I knew something had to change. I am lucky that my mom and I have a close relationship, so I was able to keep her in the loop. She decided to take me to a psychiatrist who she thought I could connect well with. After a few sessions with my new ‘savior,’ I began to see a glimpse of light at the end of the tunnel. He figured out why I get so anxious and why my anxiety leads to such a level of sadness. Once I started talking about how I was feeling and taking medications to assist in easing my anxiety, my world began to turn around. When the light shines through, you see the world around you in a brighter way.”

Andrew, who found relief in hobbies, offers, “I think a stronger emphasis has to be placed on reorienting typical teenage perspectives. Kids should be told that, mathematically, you have not lived some of your best experiences yet.”

Josh, 16 and a high school junior in New York, figured that out on his own when dealing with stressful peer relationships during the spring of ninth grade. He told me, “It sucked, but I tried to concentrate on my school work rather than the social stuff, which was probably good in the long run anyway. Even if I miss out on something, I’m like, ‘whatever, it’s only high school.’”

Other messages reflect strategies we can employ in coaching young people through crisis, including emphasizing that they can focus on what they can control; reflect on what they’ve learned; take decisive action; practice gratitude; look for new opportunities; evaluate their priorities; recognize their inner strength; take care of themselves; and remain psychologically flexible. Cognitive behavioral psychologists stress that very flexibility, encouraging young people to anticipate as many positive outcomes as negative ones.

In those is all the light they cannot see.

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