Seventeen-year-old Meghna had been dating Bhasker for eighteen months when he broke up with her -over the phone. The following Monday Meghna sat where she and Bhasker had eaten lunch together since last September. Her friends sat with her. “I say you’re better off without him”, Ameesha said. “Yeah,” agreed Kavya. “You guys fought all the time anyways”. “I hear Sachin and Prachi just broke up”, offer Julie with an excited smile. ” You’ve always has crush on him, haven’t you?”
Meghna didn’t answer. She lifted her tray and left her friends without a word. They don’t understand, she thought. They’ve all had a lot of boyfriends. But Bhasker was her first real boyfriend, and she had entertained fantasies about marrying him ever since they started dating. When they first started going out, Meghna had made up her mind to be everything Bhasker wanted. She’d lost a little weight and begun dressing with him in mind. She tried so hard to please him; If he showed slighted pleasure in something she did or said, she would work to do more of the same. When their relationship became more physically intimate, she determined to give Bhasker anything and everything; they began having sex after six months as friends.
When Bhasker broke up with her, Meghna couldn’t believe it. She cried and begged him to leave her. She told him she’d change; she’d do anything he wanted. But her refused. Her first reaction was anger. After all I’ve done to make him happy, and still wasn’t enough. She thought. Then her anger turned inwards. I did everything I know how to do, and still wasn’t enough. I must be totally worthless. I’ll never have a man love me. I don’t deserve to have a man love me.
Over the next few weeks, Meghna started spending more time in her room. She seldom went out with her friends, preferring instead to stay home, listen to music and stare at the bedroom walls. She found it difficult to eat, and after few weeks of having trouble getting to sleep, she began to sleep most of the day, both in class and at home. She began to miss college frequently, and her grades dropped drastically. When her parents confronted her about her conduct, she shrugged, “I don’t care” was her only response. ” I don’t understand,” her mother told the youth leader. “She seems like she’s totally different girl than she was”
Problem of Depression
Once thought to be a singularly adult problem, depression is a regular state of many teens – and young adults. While it is difficult to measure how many teens suffer depression, “the findings suggest that a substantial proportion of young people are suffering from strong feelings of unhappiness and despair”. One source state, “nearly 5 percent of all teens are identified as clinically depressed every year.”
It is a complex and dangerous condition that often seems to defy description and definition. This is partly because people use the term depression to refer to different things: a general sadness, “the blues,” humiliation from failure, or a period of stress and emotional volatility. Even mental health professionals have struggled for years to devise a clear definition.
Webster’s Tenth Collegiate Dictionary defines depression as “a state of feeling sad” but adds a second definition: “a psychoneurotic or psychotic disorder marked especially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and helplessness, and sometimes suicidal tendencies.”
Teenage depression is difficult to identify because its symptoms are different from the classical symptoms of adult depression.
Dr Ross Campbell writes: a teenager with mild depression acts and talks normally. There are no outward signs of depression. Mild teenage depression is manifested in fantasies, in daydreams, or in dreams during sleep. Mild depression is detectable only by somehow knowing the young person’s thought pattern and though content. Few professionals even can pick up depression in this state.
In moderate depression, also, the teenager acts and talks normally. However, in moderate depression, the content of the teenager’s speech is affected, dwelling primarily on depressing subjects such as death, morbid problems, and crises. Since many adults today seems to dwell on pessimistic trains of thoughts, the teenager’s depression may go unnoticed…..In the vast majority of cases, only in severe depression does the teenager actually appear depressed….There is an expectation to this, however. Teenager depression is difficult to identify because
teens are good at ‘masking’ it; that is, they can cover it by appearing OK even when they are absolutely miserable. This is often called smiling depression.
This is a front which teenagers employ unconsciously…. primarily when other people are around. When depressed teenagers are alone, they let down or relax the mask somewhat. This is helpful to parents. If we are able to see our teenagers at times when they believe no one is looking at them, we may be able to identify depression.
Adolescent depression can also be hard to recognize because it can be often mistaken for or accompanied by other things, such as premenstrual syndrome (PMS) in girls.
Causes of Depression
“Since teenagers are in transition between childhood and adulthood,” writes Dr. G. Keith Olson, “it is not surprising that…many adolescents’ depression relates to development struggles….Some depression in adolescent is quite normal, probably more normal during this developmental stage than any other (except perhaps old age).” Still, depression can be extremely complex, and the causes may be numerous and varied.
Collins writes, depression often has a physical basis. At the simplest level, we know that lack of sleep, insufficient exercise, the side effects of drugs, physical illnesses, or improper diet can all create depression. Thousands of women experience depression as part of a monthly premenstrual syndrome (PMS) and some are victimized by postpartum depression following childbirth. Other physical influences, like neurochemical malfunctioning brain rumors, or glandular disorders, are more complicated creators of depression.
There is evidence that depression runs in families and may have a genetic basis. This is difficult to demonstrate conclusively, research reports are sometimes contradictory. Other research has linked depression to brain chemistry that often can be altered by antidepressive drugs.
Tim LaHaye writes, some psychiatrists like Dr Ostow, considers ambivalence the most common precipitative cause of depression. He defines ambivalence as
the sense of being trapped, that is, being unable to remedy an intolerable situation.
Collins refers to this as “learned helplessness,” and says, “When we learn that are actions are futile no matter how hard we try, that there is nothing we can do to relieve suffering, reach a goal or bring change, then depression is a common response. It comes when we feel helpless and give up trying.”
Researchers Joan Robertson and Ronald Simons reported that, according to a study they conducted, “Perceived parental rejection was significantly associated with both depression and low self-esteem showing a strong relationship with depression.” Their findings agree with earlier studies (Brown and Harris, Brown et al) that found that
young people who experience or sense rejection from their parents are more likely to experience depression.
K Brent Morrow and Gwendolyn T Sorell are among those researchers who have traced a connection between depression and abuse – particularly physical and sexual abuse. They have concluded that
severity of abuse was the single most powerful predictor of self-esteem, depression and negative behavior in incest victim.
A young person’s mental habits and ways of thinking also can make him or her susceptible to depressive illness. Collins cites psychiatrist Aaron Beck who says that depressed people show negative thought patterns in three areas:
First, they view the world and life experience negatively. Life is seen as a succession of burdens, obstacles, and defeats in a world which is “going down the drain. Second, many depressed people have negative view of themselves. They feel deficient, inadequate, unworthy and incapable of performing adequately. This in turn can lead to self-blame and self-pity. Third, these people view the future in a negative way. Looking ahead they see continuing hardship, frustration and hopelessness.
Numerous researchers and authors cite stress as a pivotal factor in depression. Olson write:
When a person encounters stressful events in life that feel overpowering or threating, one possible reaction is depression.
Such events in the life of a teen may include “the rupture of an intense relationship with peer, family discord; parental separation, divorce, or death of a parent; unwanted pregnancy or abortion; and any event which lowers the teenager’s self-esteem such as expulsion from school, failure to make a team, academic failure or not being invited to a popular social event.”
A young person who has not learned or devised ways of effectively handling and expressing anger is more likely to struggle with depressive illness. Doctors Minirth and Meier write:
Over and over in the literature on the subject, depression is described as anger turned inward.
In vast majority of cases, anger is very apparent in the facial expressions, in the voice, and in the gestures of depressed individuals. They are often intensely angry, but they do not recognize their anger. A young person may be angry at a friend or loved one who has died, or at his or her own helplessness. If he or she has been taught (by his parents, teacher, religion etc.) that anger is always bad, the youth may repress anger rather than resolving it.
Collins writes, it is not difficult to understand why guilt can lead to depression. When a person feels that he or she has failed or has done something wrong, guilt arises and along with it comes self-condemnation, hopelessness and other symptoms of depression.
Guilt and depression so often occur together that it is difficult to determine which comes first.
Perhaps in most cases guilt comes before depression but at times depression will cause people to feel guilty (because they seem unable to “snap out” of the despair). In either case a vicious cycle is set in motion.
Effects of Depression
The effects of depression can read like a catalog of physical and psychological afflictions. Among the effects are physical and emotional effects, shortened attention span and / or daydreaming, masked reactions, withdrawal, suicidal behavior, and depressive tendencies in adulthood.
Minirth and Meier catalog some of the physical ramifications of depression: Clinical depression includes the physical symptoms…. These biochemical changes have various physical results: The body movements of the depressed individual usually decrease. Quality of his sleep is affected….Initially, rather that sleeping too little, he may sleep too much. His appetite is also often affected. He either eats too much or too little (usually too little). Thus, he may have either significant weight loss or weight gain. He may suffer from diarrhea, but more frequently from constipation. In women, the menstrual cycle may stop entirely for months, or it may be irregular. There is often a loss of sexual interest. The depressed individual may suffer from tension headaches or complain of tightness in his head. Along with slow body movements, he may have a stooped posture and seem to be in a stupor. He may have gastrointestinal disturbances. He may have a slow metabolic rate. He may suffer from a dry mouth. A rapid heartbeat and heart palpitations are fairly common. These physiological changes scare most individuals into hypochondriasis (an overconcern with physical illnesses).
While teens may not exhibit the classic signs of adult depressions, as mentioned above, they may evidence some emotional effects of depression, such as those described by Minirth and Meier: One major symptom of depression is sad affect (or moodiness). An individual suffering from depression has a sad facial expression, He looks depressed. he either cry often or feels like it. His eyes are cast down and sad. The corners of his mouth droop. His forehead is wrinkled. He looks tired, discouraged and dejected. His features are strained. As the depression progresses, he gradually loses interest in his personal appearances.
Shortened Attention Span/Daydreaming
Campbell suggests, in mild teenage depression, the first symptom generally seen is a shortening of attention span. …[The teen’s] mind drifts from what he wants to focus on, and he becomes increasingly distractable. He finds himself daydreaming more and more. This shortening of attention span usually becomes obvious when the teen attempts to do his homework. He finds it harder to keep his mind on it. And it seems that the harder he tries, the less he accomplishes. Of course, this leads to frustration, as the teenager then blames himself for being “stupid” or “dumb.”
Researchers Marion Ehrenberg, David Cox, and Ramond Koopman points out that adolescents do not typically express their depression directly but rather through the use of “mask,” or “depressive equivalents.” Collins lists the following “masked reactions”:
- aggressive actions and angry temper outbursts
- impulsive behavior including gambling, drinking, violence, destructiveness or impulsive sex
- accident proneness
- compulsive work
- sexual problems
Other masked reactions might include delinquency, school phobias, and poor grades.
Campbell writes: In this miserable state the teenager may withdraw from peers. And to make matter worse,
he doesn’t simply avoid his peers, but may disengage himself from them with such hostility, belligerence, and unpleasantness that he alienates them.
As a result, the teenager becomes very lonely. And since he has so thoroughly antagonized his good friends, he finds himself associating with rather unwholesome peers who use drugs and/or are frequently in trouble.
Many studies have linked adolescent depression to suicidal behavior (including Carlson and Cantwell; Crumley; Pfeffer, Zuckerman, Putchik, and Mizruchi; Simons and Murphy). Collins writes: Not all depressed people attempt suicide, but many do, often in a sincere attempt to kill themselves and escape from life. For others, suicide attempts are an unconscious cry for help, an opportunity for revenge, or a manipulative gesture designed to influence some person who is close emotionally. While some people carefully plan their self-destructive act, others drive recklessly, drink excessively, or find other ways to flirt with death.
Depressive Tendencies in Adulthood
One of the more long-term effects of teenage depression is the well-documented tendency of depressive adolescents to experience major depressive episodes in adulthood. Young people who do not successfully resolve their struggles with depression during their teen years are likely to face further battles with depression as adults.
Response to the Problem of Depression
“Most people don’t ‘snap out’ of depression,” Collins points out. “The road to recovery is long, difficult, and marked by mood fluctuations which come with special intensity when there are disappointment, failures or separations.” Still, a patient youth leader, teacher, or parent can help a young person through a depressive episode by employing a strategy such as the following:
“Fairly early in the treatment of adolescent depression,” writes Olson, “the [young person] needs to be able to ventilate or in some way release his or her feelings of anger, guilt and self-doubt. These repressed feelings will block all other efforts at movement out of depression until they are given up…. The counsellor’s task is to encourage such expression, accept it and work toward helping the [young person] channel this released energy into constructive directions.” This may be accomplished by:
- Prayer both in preparation to talk to the youth, and in guiding the young person (when he or she is ready) to talk honestly and fervently to God about his or her depression, and to seek His help in conquering it.
- Patient encouragement of the young person to talk (without cajoling).
- Interested questions (such as, “When do you feel most depressed?” “Do you spend a lot of time alone” and ” What do you usually do when you start feeling depressed?”)
- Frequent reassurances and words of comfort.
- Alertness for evidence of anger, hurt, poor self-esteem, etc.
A parent, youth leader, or teacher will want to empathize with the young person suffering from depression – to try to “walk” with him or her, as authors Don Baker and Emery Nester put it. However, in the case of a depressed person, a warning is also in order. Because of the counselee’s feeling of helplessness, he or she will probably place on unrealistic expectations to catalyze a magical cure…. The display of inadequacy, dependency and need are partially motivated by conscious or unconscious wishes for the counsellor to take care of them….The counselee [may feel] strong dependency on the counselor. The adult need to take special care, therefore, to empathize without letting an unhealthy dependence develop.
Olson writes, the presence of emotional support and reassurance from the counselor is vital when working with depressed adolescents. Complete acceptance of the [young man or woman] is one of the best ways to communicate support. The counsellor’s realistic optimism that there is “light at the end of the dark tunnel of depression” is often very encouraging to a counselee who feels absolutely hopeless. And when the depressed teenager shows some gains or makes some movement, compliments and statements of encouragement are in order.
David A. Seamands, in his book Healing Damaged Emotions, suggests several directions in which a concerned adult can point a depressed youth:
- Avoid being alone. Force yourself to be with people. This is one of the major areas where you have a definite choice in your depressions.
- Seek help from others. Tell someone how you’re feeling. Ask someone for help in combatting your mood. Seek out people and situations which generate joy.
- Sing. Use uplifting music to manipulate your moods.
- Rest confidently in the presence of God. For God’s presence is cause for hope and means of healing.
As with many other situations in which an adult wishes to influence a young person, it is crucial to enlist the youth’s determination and participation in his or her recovery, rather than simply advising to the youth. Don Baker and Emery Nester offer specific ways to enlist the young person’s cooperation.
Encourage the depressed [person] to be involved in sone new activity. Help him choose things he has always wanted to do but for which he has never had time….Aim for an activity that is available, geographically and financially. It best serves if it is time-consuming. It should be within the capabilities of the individual. Gardening, painting, photography, or an aerobic sport such as running, or swimming are often activities that fir above criteria.
If there is any possibility that the depressed young person represents a danger to himself or herself, take immediate steps to obtain intervention by a professional counselor. Be alert for indications such as:
- talk of suicide
- evidence of a “thought-out” plan of action for killing oneself
- feelings of hopelessness and / or meaninglessness
- indications of guilt and worthlessness
- recent environmental stresses (such as death in family, parental divorce etc.)
- an inability to cope with stress
- excessive concern about physical illness
- preoccupation with insomnia
- evidence of disorientation or defiance
- a tendency to be dependent and dissatisfied at the same time
- a sudden and unexplainable shift to a happy, cheerful mood (which often means that the decision to attempt suicide has been made)
- knowledge regarding the most effective methods of suicide
- history of prior suicide attempts (those who have tried before often repeat their attempt.)
Don’t hesitate to ask the young person directly if he or she has contemplated suicide and take the answer seriously.
Finally, referral to a psychiatrist or physician may be warranted in some cases (with parental permission).
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Bijo Joseph is the founder of Bijoyful Foundation, a faith-based NGO (reg. 357152/sec. 8 co.) that aims to deliver positive changes in the lives of young people troubled with adverse mental health, addiction or other life challenges through range of strength-based, recovery and livelihood programs and support offered by coaches, counsellors, social workers and volunteers. He has the youth leadership experience of 17 years and with educational foundation from TISS, Mumbai & IIM Calcutta.