The parents brought their teenager into the Emergency Department because she was acting bizarrely. The normally cheerful, outgoing girl was suddenly sullen, irritable, and lashed out at the slightest provocation. She also seemed paranoid, suspicious of everyone around. Usually ready to hug, she now acted afraid of any contact. During my physical exam her eyes darted back and forth, and she flinched when I reached out with my stethoscope.
The onset of mental illness can seem sudden. In medical school they called it “the psychotic break,” where previously well teens become paranoid or delusional, often when faced with new stress, like moving away to college. This break was thought to herald life-long illness like schizophrenia or bipolar disorder. However, it turns out that most teenage psychological troubles have a slower, more subtle beginning; and if treated early, can have a happier ending.
Seemingly dramatic changes in behavior are often preceded by symptoms that are missed or denied by teens or parents. These include weight loss and drop in appetite, plummeting grades, chronic abdominal pain or headaches, irritability and combativeness. These can easily be dismissed as normal teen “phases,” which they often are. Unless they’re not.
Other signs that your teen is coping badly are…having to cope. Profound stress can push your teen to depression or other maladjusted behaviors. Are parents divorcing or having other troubles, like infidelity? If you as a parent think you’re stressed by the situation, it’s as bad or worse for your kids. Love and security that they counted on their whole lives has now blown up. Many divorcees state that they wouldn’t have divorced if they’d known what it would do to their kids. Other profound stressors include moving; a parent’s job loss or other economic hardship; and death of a loved one, like a friend or close grandparent. If your kid’s facing these issues, be ready to get help.
The more distressing symptoms of mental illness, like our girl above, are clearer signs that it’s time to get help now. These include alcohol and drug use, sexualization or being sexually abused, eating disorders, or paranoia and hallucinations.
It’s no fun dealing with angry parents who make their teen’s mental illness a battleground. Often they bring their kids to the Emergency Department demanding that they be drug-tested, to “win” the fight over suspected abuse. In the most recent instance, after I told a mom that we could not legally force a drug test on a teen, she stormed out of the ER, yelling that it was her right to know. Fortunately, the teen stayed behind, and we had a good talk about her drug use, her depression, and how she could get help.
Having proof that your teen is using drugs won’t make him or her snap-to. Looking back, I could have handled the situation better by asking the mom, “how will a positive test help you and your child?” and explore the issue from there, rather than shut her down with the law. If the girl’s behavior already made mom worried that she’s abusing drugs or alcohol, that behavior is often evidence enough that she needs help, better than a drug test.
Like we discussed above, symptoms of depression or other mental illness can be subtle, or not-so-subtle- weight loss, plummeting grades, chronic headaches and abdominal pain, drug use and promiscuity. Now that you’re properly scared, where to get that help?
If you belong to a major denomination church, clergy and staff often have training and offer competent counseling. Your child’s doctor should have a list of mental health services, and some even do counseling and anti-depressant prescribing themselves. School counselors also should know their cohorts in the community. You’ll want a counselor that partners with a psychiatrist or other provider who prescribes. Anti-depressant or mood-stabilizing medication often helps get teens through a bad patch, and keep them steady as they learn new, healthier habits with thinking and interactions.
If you find yourself getting angry at your teen’s behavior, when they’re combative, sullen, or just plain lazy, take a step back. Maybe they’re not acting this way to piss you off, maybe they’re crying for help the only way they know. Laziness may just be laziness, or that inability to get off the couch could be depression. Don’t take it as a personal affront, take it as a call to action.