In my work as a school psychotherapist, I have been alarmed by the increasing number of students coming to me because they are experiencing difficulties in their personal life.
Teenage depression seems to be reaching almost epidemic proportions. A UK study found that the number of adolescents prescribed anti-depressants rose from 6,000 in 1994 to 345,000 in 2003. This is a worrying statistic. But what has brought about this massive surge in the number of teenagers using strong psychotropic medication to ameliorate symptoms of depression and anxiety?
In this country, it is estimated that 450,000 people will suffer from depression at any one time.
Common symptoms of depression in childhood include low mood, loss of interest in once enjoyed activities, psychosomatic symptoms and in severe cases thoughts of suicide.
In my experience, teenagers often come to me with a self-diagnosis of depression. Or they will have ‘googled’ it and have all the facts about the disorder.
Recently, one student said to me ‘have you read that a scientist in England has identified the depression gene?’. When I said I hadn’t, he went on to explain in detail how the gene was ‘the chromosome 3p25-26’.
When I enquired what this new scientific find meant for him, he said, ‘well, I must have that so.’
What struck me about this conversation was how animated the student had become, which was unusual for him because he had come to me due to his low mood. As we explored this further, it seemed to me that the self-diagnosis of this ‘depression gene’ was something that helped his family understand him.
This gave him a real sense of identity and purpose within his family. He proudly explained that his grandfather had depression and everyone said they were alike and that his grandfather must have passed it on to him.
I often wonder, in some cases, does depression give a child a voice?
Life for the modern teenager is remarkably different than any other time that has gone before.
Couples are generally marrying later in life and for the most part are subsequently having children at a later stage, which further increases the age gap between parent and child.
Up until the 1990s clinicians and researchers had assumed that children and adolescents did not experience depression (Rutter, 1986).
However, it is almost impossible to traverse the floor of any reputable bookshop without encountering a plethora of self-help books on teenage depression. Pharmaceutical companies have developed a trillion dollar industry around pushing their products on a thriving market.
I often question, with all this publicity, are we making depression attractive for our children?
If they don’t have it, do they perceive themselves as ordinary?
While it is very commendable and courageous that celebrities speak about their own experience of living with depression, it can at times create a scenario almost akin to celebrity endorsement.
We need to manage our children’s understanding of a celebrity’s lived experience with depression.
I am very cognisant of this recent trend when talking with a young adult. Often the clients I see come with a self-diagnosis of depression.
And in this type of case, where there has been no clinical diagnosis, I am very 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. The social construction of depression is a very important consideration when working with adolescents.
After all, concepts now used to describe human experience were invented, not discovered.
“Where there is power, there is resistance” (Foucault, 1978)
The system of the parents, the school, society, peer group and in certain cases the system of the state (social services) can at times press down on a young adult.
This idea of ‘pressing down’ is an interesting one when working with adolescent depression.
What commences as being described as depression ends up being delineated as a force pressing down on them or making them powerless.
Spending time on the appropriate adjective to describe their lived experience is something I have found very important in my work. Often the adjective changes over the course of the sessions.
In my experience, adolescents who feel powerless or without a voice often present with depressed symptoms and I have often wondered do these symptoms position the family in a certain way that give a voice back to the young adult?
It is 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.
However, 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.
The prevalence of depression among teenagers is increasing. However, we must remain calm about it, and listen and avoid joining the hysteria.
Most children who come to me exhibiting symptoms of depression, for the most part, leave therapy after they feel like they have met someone who has truly heard them.
By Richard Hogan
