The screenager, depression and hope
by Richard Hogan
In my experience working with adolescents in my dual capacity as a schoolteacher and school counsellor I have found that adolescent depression is a complex and pressing mental health issue, which can prove to be very demanding and problematic for both client and practitioner. In this article I attempt to illustrate the complexities of adolescent depression while also offering an insight into some of the themes I have found important in my conversations with young adults. The modern child seems to lack many of the coping skills needed to manage and regulate their experiences. This lack of grit is becoming pathologised, almost like they are deficient somehow and need medication to right the balance. Research shows that the amount of children on heavy psychotropic medication has quadrupled in the last five years. This increase does not speak to an epidemic but rather a shift in how we view the issue and how we treat it. So it is more important than ever that we keep an open mind when working with adolescents who present with symptoms of depression.
The arrival of the screenager
Adolescent depression is on the increase. Research shows that about 20% of adolescents experience anxiety and depression during the course of any given year and may need the use of mental health services (Papantuono, et al., 2014). I find myself working more and more with adolescent depression. It seems to me like we are in the middle of an epidemic and I’m often puzzled because schools have never been more proactive with their policies on good mental health promotion. So I find myself asking: ‘What could be causing it and how, as therapists, can we begin to work with it effectively?’
Not since the 1960s has there been such a glaring gap between the world of the adolescent and the world of the parent. The teenager of the 60s dared do something that had not been done before – they spoke about their feelings and they commented on the nature of the world and the systems that they were living in. They critiqued hierarchies and organised themselves collectively against what they saw as tyrannies. This was a very different landscape from the teenage world of their parents. The times were, as Dylan prophetically told us, ‘a changin’. The teenager of the 60s was born around the end of the Second World War. The teenager of today was born around the arrival and rapid dissemination of digital technology or the ‘Tech War.’
In ‘Digital Immigrants, Digital Natives’, Marc Prensky (2001) employs an analogy of native speakers and immigrants to describe the generation gap separating adolescents (digital natives) from their parents and teachers (the digital immigrants). The digital natives that Prensky describes, are surrounded by digital media to such an extent that their very brain structures may be different from those of previous generations (Vanslyke, 2003: 1). The modern teenager is navigating a world where there is a monstrous aperture between them and their parents. The tectonic plates under which the world of the teenager stood have dramatically shifted. Proliferation of technology, exposure to the internet, elaborate use of social media and extensive reliance on various digital devices have all impacted on how they live their lives and what they do with the time that they have (Koay, 2015). For example, ‘digital natives’ are used to receiving information really fast. They like to parallel process and multitask. They prefer their graphics before their text rather than the opposite. They prefer random access (like hypertext). They prefer games to ‘serious’ work (Prensky, 2001). In contrast, those not born in the digital world, according to Prensky, find it hard to understand how a ‘digital native’ thinks. This new way of communicating that the digital age has brought with it, has interrupted communication patterns. Communication is now abbreviated, fast, instantaneous and functional. What I have often found when talking with parents about their child is that they cannot understand why their child refuses to engage with them at the dinner table. When I talk with the young adolescent about their parents’ concern, they generally delineate how their parents misinterpret their reticence as some sort of mental dysphoria: ‘I have nothing to tell them, nothing happened today in school, so what? Should I just make it up? Is that what they want?’ I have heard this sentiment many times in relation to dinnertime conversation or as one student called it ‘dinner time interrogation.’
I have observed over the years how adolescents even find watching a movie problematic, because it requires a certain level of concentration over a relatively long period of time; long that is to the modern adolescent. For example, ads on YouTube are five seconds in length – even this is seen as too long! Snapchat conversations are under five seconds in length and they disappear after being read. A tweet, traditionally, had to be less than 140 characters. Everything in the adolescent world is quick and multifaceted, so conversations over dinner can seem laborious and under-stimulating. Does that mean we give up trying to talk with them? Of course, not. But it is important to know that communication has changed. When I am talking with an adolescent about their low mood or suicidal ideation, this idea is certainly present in my questions. I explore communication patterns with their family and friends. I find doing, what I call a ‘friendogram’ very helpful; I do both genogram and friendogram. The friendogram is interesting because it is continually shifting and changing week-by-week whereas generally the genogram stays static.
Often what parents view as depression might in fact be an issue of friendship. Young adolescents and in particular young male adolescents find it difficult to voice a rupture in peer relations. Parents perceive that there is a change in their child but cannot understand what the cause of this change is. I had a conversation with a parent recently where she described her concerns about her son because his mood had dipped quiet dramatically in recent times. She described how he had changed, and spoke of the worry herself and her husband were experiencing. In the first few sessions with her son we talked about his mood and how it had changed. However, it wasn’t until I looked at his social network through the friendogram that the real issue emerged. In our drawing of the friendogram he became upset when we were looking at his network of friends. One friend in particular caused him great upset. He told me: ‘Take her off the list – she’s no friend of mine!’ When we explored this further he revealed that he had sent her a compromising picture of himself on Snapchat and she had ‘screenshot’ it and sent it to her friends; now he was the source of derision. This was causing him much distress. He couldn’t voice this to his parents because he was too embarrassed to tell them; he thought that they would be disappointed in him. Eventually he did talk to his parents about what was troubling him and the issue resolved itself. A friendogram can be a very useful tool to help elucidate what is going on in the young adolescent’s social life.
Life for the modern teenager is remarkably different these days than in any other time that has gone before. Couples are generally marrying later in life and for the most part are having children at a later stage, further increasing the age gap between parent and child. So, what does all this mean for how we, as therapists, conduct a session with a young adult that is exhibiting signs of depression? Up until the 1990s clinicians and researchers had assumed that children and adolescents did not experience depression (Rutter, 1986). However, recent studies show that adolescent depression has reached almost epidemic proportions in modern society. It is almost impossible to traverse the floor of any reputable bookshop without encountering a plethora of self-help books on depression. Pharmaceutical companies have developed a trillion dollar industry around pushing their products on a thriving market (Anderson, 2014). Ads on TV and radio outlining how depression is the West’s second biggest killer (Jones & Asen, 2000) are ubiquitous and tablets are designed not to make us well, but to in fact make us better! We have, it seems, fallen in love with depression.
I am very aware of this recent trend when talking with a young adult. Often the clients I see come with a self-diagnosis of depression. In this type of case, where there has been no clinical diagnosis of the disorder, I am slow to introduce the word ‘depression’ into the conversation. The family have often organised themselves around this label, so I attempt not to join them in this. When we consider Shakespeare’s Hamlet, an interesting concept appears. It wasn’t until the birth of psychoanalysis that he started to suffer from depression. So what had he until that point? Well, maybe it was depression, or melancholia? Or maybe the fact that his uncle murdered his father and was now sleeping with his mother was upsetting him. But we don’t have a pill for that! And it certainly wouldn’t fit neatly on our prescription bottles like Zoloft or Prozac. The social construction of depression is a very important consideration when working with adolescents. After all, the concepts now used to describe human experience were invented, not discovered (Bentall, 2009).
The following are some themes that I find particularly useful when conducting a conversation with a young adolescent who is presenting with an experience that we have come to call depression.
Where there is power, there is resistance
(Foucault, 1978: 221)
When working with adolescents, I find the joint themes of power and powerlessness two of the most recurring. Adolescents often feel incredibly powerless. The system of the parents, the school, society, peer groups and, in certain cases, the system of the state (e.g. social services) are all pressing down on them. This idea of ‘pressing down’ is an interesting one when working with adolescent depression. I often have externalising conversations around the idea of pressing down. Often the adjective changes dramatically. It can move so quickly from depression to a force pressing down. The force is described as power. So therefore, the power is making them powerless. Spending time on the appropriate adjective to describe their lived experience is very important in my work. Often the adjective changes over the course of the sessions. In Maps of Narrative Practice (2007), Michael White gives us a good case study that highlights this point. The young adult Liam describes his feelings of hopelessness. Through ‘re-authoring’ conversations, Liam comes to the conclusion that, ‘the depression he’d been struggling with for so long was ‘fake depression’.’ (White, 2017:74) White is quick to point out that he is not saying that, ‘he had been ‘faking it’ but rather, he had reached this understanding on the basis of a realisation that he wasn’t messed up’ (White, 2007: 74).
Adolescents who feel powerless – or without a voice – often present with depressive symptoms. I have often wondered do these symptoms position the family in a certain way that give a voice back to the young adult? The homeostasis is being perturbed therefore everybody in the family rallies around the ‘perturber’. That is a lot of power to give a young adult who perhaps has never felt powerful. Looking at it this way brings us into contact with Bateson’s desire to shift the traditional linear thinking, and the traditional perception of the individual mind, to a way of understanding the mind as part of a circuit (Bateson, 1971). This means that the concept of mind is considered within the context of all relevant completed circuits (Bateson, 1971: 244). It’s useful to think about what role the depression has in the family. Who is it serving? And to what end? Often as therapists we want to alleviate the symptoms but we get stuck because we meet resistance. We forget that sometimes what an adolescent presents with may seem like something they want to ‘get rid of’ through our adult lens, but through the eyes of an adolescent, the depression might serve a function; they may indeed need it to survive. Resistance is therefore necessary and understandable. It is shifting this perspective that can sometimes create a striking moment.
Conversations around the nature of power and powerlessness are very insightful and can help the young adult see that their situation isn’t without hope and that what they have been grappling with might not necessarily be depression. I had a student recently tell me, ‘My grandfather suffered from depression, so I got it from him.’ This reductionist way that families sometimes have of viewing a problem can help to concretise the issue. It is viewed as a genetic flaw passed down through the generations. This might be attractive for the parents too. It removes blame and parents certainly can feel blamed when a family therapist is talking to them about their child. The Milan group (the first group of psychotherapists to break away from psychoanalysis as an asymmetric process, to a more systems oriented process) saw that families came to therapy with a paradoxical request; families wanted the stability of an unchanged system, but also wanted the problem member of the family to be cured (Becvar & Becvar, 1996: 240). They also saw that it was not possible to change the pattern of behaviour and communication in one part of the system without affecting the family system as a whole (ibid). I find working with the family around the theme of power and powerlessness can yield significant change. It can help to move the family system from its entrenched thoughts about depression as being something that is ‘fixed’ and ‘incapable of moving’ or ‘within’, to something they all have power over. These conversations help to build hope at a systemic level.
‘I just don’t know who John is anymore?’
‘When will that lovely boy come back to us?’
‘He was such a great child, where has he gone?’
Adolescence can be a time of loss for both parent and child. I get asked those types of questions a lot by very anxious parents and the sadness in the room for the loss of their once beautiful garrulous child is tangible. Equally, when talking with adolescents about this theme they often feel the same way. They feel the loss that their parents feel but also their own guilt around that loss, and their own sense of loss around the hero figure that is no more. For the first nine or so years, a child generally looks up to their mother and father as an infallible colossus. In adolescence they rely more heavily on their peer group. If a parent has difficulty adapting to a changing family environment during a child’s adolescence, the adolescent may perceive less parental support or love and be more prone to developing depression or other mental health difficulties (Stice et al., 2004). Similarly, as an adolescent struggles to manage the emotional, physical and social changes that accompany the transition to adolescence they may experience depressive symptoms such as sullenness, irritability or diminished energy that frustrate or dishearten the parent and in turn, can negatively affect that parent’s mental health (Perloe et al., 2014: 614). Managing both the parent’s and the child’s expectations of each other is an important feature of working with adolescent depression. Parents often come to view adolescence as a ‘moving away’ from them but I like to reframe it and instead talk in terms of ‘being together differently’ or I describe it as a time of ‘discovery’ for the family. This kind of reframing conversation can help both parent and child to see their position differently. Parents can seem like they are resistant to change, and adolescence is such a time of change. However, in my experience, it’s not necessarily change that they are fearful of, but its what will be lost. So looking at the loss each member of the family system is experiencing can be a very helpful way to work with adolescent depression.
The wider world of the adolescent
Often adolescents find it easier to talk about music, lyrics or literature than the issues they are experiencing. Over the years I have had many conversations about people such as Kurt Cobain, Jim Morrison, John Lennon, Marilyn Manson, NWA, Sylvia Plath, Amy Winehouse, Alex Turner or whatever group or person is current at that particular moment. Its important to get a sense of the adolescent’s world. What are they feeding on? What messages are they interested in hearing? And whom are they receiving them from? And why? Conversations around music and literature have proven to be very fruitful to me in my work with adolescents. These often help to gauge the inner working of the adolescent’s mind, as they often reveal something that the more ‘conventional’ conversation might not. What I have also found is that the adolescent might be reticent or embarrassed to give words to a certain feeling or emotion, however a certain song or poem might say it for them, therefore allowing the conversation to take place in an indirect way.
To irreverence and beyond
When an adolescent comes into therapy, the power that the symptoms have in that family unit is very much in the room; the roles are clearly defined and the narratives about each member are dense and stifling. The family may want us to join them in their immediacy or urgency to ‘solve’ the issue. I had a conversation with a 14-year-old boy who was experiencing many difficulties at home. The most troubling behaviour for the parents was his recent barricading of himself into the toilet. His mother told me that he was spending hours barricaded in the toilet and it was affecting the entire family. It was obvious to me that this behaviour was causing much distress within the family unit and I wondered was this family distress further adding to the behaviour that had created it? When we first met he was reticent to mention this recent behaviour appearing embarrassed. Picking up on this embarrassment I said:
R: You know what? I haven’t barricaded in a long time. You get to a certain age and they frown upon everything. Can you show me how teenagers are barricading today? Has it changed since my day?
Without even thinking he jumped up, animated and energised by the task. He instructed me to move the chairs in front of the door.
C: We need to put a chair up against the handle, so the door won’t open.
We were busy for a few minutes moving the chairs around and creating our barricade. We then stood back from it and admired the magnificence and the beauty of the thing. And then I said:
R: One question?
R: Why the toilet?
To which, he burst into laughter.
R: I mean the bedroom, I get! But the toilet? It’s the last room I’d want to spend too much time in.
We both laughed at this idea.
The laughter had removed the power of the behaviour. His mother was waiting for me one morning as I came into work to report that there had been a cessation of barricading in the family home. Now, that’s not to say that he was miraculously cured – he still has other issues that are ongoing – but in that instance taking an irreverent approach to the issue bore fruit.
More than ever we are surrounded by a societal discourse that promotes a pharmacological approach to the issue. While research shows that this approach can indeed be efficacious in dealing with adolescent depression, this article attempted to show how important it is to begin a collaborative dialogue with a young adult who is experiencing a difficulty in their personal life. In my experience as a schoolteacher, lecturer and in recent years as a systemic school counsellor, I have observed how the medicalised approach can in some cases promote the early pathologising of a young adult and in fact can concretise the issues so much that they become a part of the young adult’s identity; an identity that they can spend the rest of their lives living with. It is here, I believe, that the therapist can play an important role in helping to keep hope alive.
Richard Hogan has been a schoolteacher and lecturer for over 15 years. He is the Head of 5th Year in the Institute of Education and clinical director of Therapy Institute. He writes a weekly column for The Irish Examiner where he explores his approaches to adolescent mental health. He is the author of the forthcoming book, Parenting the Screenager: A Practical Guide for Parents of the Modern Child.
Anderson, R. (2014). Pharmaceutical industry gets high on fat profits. Retrieved on 9 September 2019 from http://www.bbc.com/news/business-28212223.
Bateson, G. (1997). A systems approach. International Journal of Psychiatry, 9, 242-244.
Beavar, D.S., & Becvar, R.J. (1996). Family therapy: A systemic integration. (3rd ed.). Boston: Allyn and Bacon.
Bentall, R. (2009). Doctoring the Mind: Why psychiatric treatments fail. London: Penguin Books.
Foucault, M. (1978). The History of Sexuality. London: Penguin Books.
Jones, E., & Asen, E. (2000). Family, couple therapy and depression. London: Karnac
Koay, M. (2015, October). Working systemically with adolescents in schools. Paper presented at the SAC counselling symposium. Evidence informed practice – towards a better state of well-being. Retrieved on 9 September 2019 from https://www.michellekoay.com/ TalksPresentations.en.html
Glenn. (2009). Integrating family therapy in adolescent depression: An ethical stance. Journal for the Association for Family Therapy and Systemic Practice, Vol. II, 214 – 227
Papantuono, M., Portelli, C., and Gibson, P. (2014). Winning without fighting. A teacher’s handbook of effective solutions for social, emotional and behavioural difficulties in students. Malta: Malta University Publishing.
Perloe, A., Smythers-Esposito, C., Curby, W, T., & Renshaw D, K. (2014).
Concurrent trajectories of change in adolescent and maternal depressive symptoms in the TORDIA study. Retrieved on 9 September 2019 from https://pdfs.semantic scholar.org
Prensky, M. (2001). Digital natives, digital immigrants. In M. Prensky On The Horizon (pp. 1-6) MCB University press, 9(5).
Rutter, M. (1986). The developmental psychopathology of depression: Issues and perspectives. In M. Rutter, C.E. Izard, and P.B. Read (Eds.), Depression in young people: Developmental and clinical perspectives (pp. 3-30). New York: Guilford,
Stice, E, Regan, J., & Randall, P. (2004). Prospective relations between social support and depression: Different directions of effects for parent and peer support? Journal of Abnormal Psychology, 113(1), 155-159.
Vanslyke,T. (2003). Digital natives, digital immigrants. Some thoughts from the generation gap. Retrieved from https://depd.wisc.edu/html/TSarticles/Digital%20Natives.htm
White, M. (2007.) Maps of narrative process. New York: Norton.