Notes for Adolescent Problems, Disturbances:
Mental Health Stress, and Coping

School of Family and Consumer Sciences 400.404/504    Instructor: D. Witt

Mental Health Disturbances

Depression
Depression is the most common psychological disturbance among teenagers.
Typically, depression is associated with feelings of sadness, meaninglessness, or emptiness
There are four sets of symptoms:

  1. emotional manifestations - dejection, decreased enjoyment of pleasurable activities, and low self-esteem.
  2. cognitive manifestations - pessimism and hopelessness
  3. motivational symptoms - apathy and boredom
  4. physical symptoms - loss of appetite, difficulties sleeping, loss of energy
Most of what passes for depression is often only depressed mood arising from a situational dilemma
  • more than 1/2 of all teens occasionally feel sad and hopeless
  • 1/3 often say they have nothing to look forward to
  • 1/4 have regularly depressive feelings
However Depressive Syndromes (a wider range of symptoms than just sadness) are serious.
  • about 5% have the symptoms of depressive syndrome
  • about 3% meet the diagnostic criteria for clinical depression, or depressive disorder.
Diagnostic Criteria for Mild Depressive Disorder:
  • depressed or irritable for most of the day, for more days than not, for at least a year
  • in addition, at least two of the following:
    • poor appetite or overeating
    • insomnia (can't sleep) or hypersomnia (oversleeping)
    • low energy or fatigue
    • low self-esteem
    • poor concentration or difficulty making decisions
    • feelings of hopelessness
  • symptoms cause clinically significant distress or impairment in social, school., or other important areas of functioning.
All three are more likely to occur as the teenager approaches and goes through puberty.
After puberty, the likelihood of depression decreases.

The gender difference here is that there is a higher prevalence among girls.Interestingly, depression often occurs concomitantly with the use of drugs.  Further depression and drug use are often linked to suicide attempts.

Suicide Among Adolescents
One of the main results of rampant depression among adolescents is suicide attempts.

  • 15% of American tenth graders attempted suicide in 1987. 
  • Nationally, about 500,000 teenagers attempt suicide every year - about 1 in 6 American teenagers.
  • Of these, 98% fail in the attempt.
  • 1 in 3 reports having contemplated suicide at some time.
  • Interestingly, the suicide rate is especially high among Native American and Alaskan Native adolescents.
Suicide is not usually a response to immediate stress, as is often reported.
Suicide attempts are the result of a relatively long standing and developing negative attitude.

Some Warning Signs:

  • direct suicide threats (i.e., "everyone would be better off if I were dead."
  • previous attempts - no matter how veiled or minor, 4 out of 5 teenagers who succeed in suicide have attempted before.
  • preoccupation with death in music, art, and personal writing
  • loss of a family member (death or divorce), ending a significant love relationship, even the loss of a beloved pet.
  • family disruptions, such as divorce, unemployment, serious illness, or relocation.
  • disturbances in sleeping and eating habits, and in personal hygiene
  • declining grades or lack of interest in school or hobbies that had been previously important
  • drastic changes in behavior patterns - a quiet person becoming talkative, a usually gregarious person becoming sullen and withdrawn
  • pervasive sense of gloom, helplessness, and hopelessness
  • withdrawal from family members and friends, coupled with feelings of alienation from significant others.
  • giving away prized possessions and otherwise getting their affairs in order
  • series of "accidents" or impulsive, risk-taking behaviors (taking dares)
  • drug/alcohol abuse
  • disregard for personal safety

All suicide threats are meaningful and should be taking seriously.  Even overhearing someone making such a threat should be reported to school officials or parents. With support from friends and family, and professional treatment, children who are suicidal can heal and return to a more healthy path of development. Again, suicide - depression - drug use/abuse are often part of the same, larger pathology.  Something's the matter - these behaviors are symptomatic of a perceived dilemma.

What to do when a teenager you know shows some of the warning signs?

  • Ask direct, straightforward questions in a calm manner (i.e., Are you thinking about hurting yourself?"
  • Assess the seriousness of the teen's intent by asking questions about feelings, important relationships, who else the person has talked with, the amount of thought given to the means to be employed.
  • Find out if a gun, pills, rope, or other means has been procured, or if a specific plan has been developed. If any of these are admitted, the situation is very serious. Stay with the person until more help can be obtained.
  • Listen and be supportive - but do not trivialize or give insincere assurance
  • Encourage the young person to get professional help and assist the person in doing so.
  • Maintain a close relationship after the crisis has passed.

Eating Disorders
For a variety of complex reasons, people tend to be very irrational about their body image. Eating Disorders can be a pathological response to negative body image. We tend to overeat because of a variety of stresses, then we crash diet, fail to lose weight, and have to deal with further negative self-image.

Sometimes our relationship with food surpasses this type of neurotic behavior, moving into one of the two main categories of Eating Disorder. It happens to girls much more often than to boys.

  • Anorexia Nervosa is characterized by a "relentless pursuit to be thin". A teenager with this problem is typically a perfectionist, good in academics, while simultaneously suffering from low self-esteem.
    She looks in the mirror and sees fat, regardless of how thin she really is. Ultimately she simply starves herself - sometimes resulting in damage to her body, and in a minority of cases resulting in death.
  • Bulimia is a different illness, although thinness is still the goal. This person will often eat normally, even binge eat at times, then attempt to purge herself by vomiting or other means (she will sometimes use laxatives).

Eating disorders are apparently easy to hide for years, often being discovered almost by accident. The "causes" of eating disorders can be seen by looking closely at the typical victims - young women. In our society, thinness is glorified in the fashion magazines, and other media. The idea is that thin is more attractive than even normal weight.  In study after study, women report being dissatisfied with their weight. Some women are capable of maintaining this dissatisfaction while weight as little as 70% of their ideal, optimal, healthiest body weight. Conversely, young men can be as much as 30% overweight and still report satisfaction with their weight.

This preoccupation with body image beyond healthiness, is yet another way the culture fosters unhealthy attitudes in the population. For more information on psychological disturbances in teenagers, try these links:

Drugs and Devianc

    Teenagers take drugs for different reasons and certainly take drugs for different reasons from their adult counterparts. For each reason there is a socially (morally) appropriate response we could make:


   
The root causes of maladaptive behaviors and patterns of thought often are associated with mediating factors:

There's a lot of money to be made in the sale of drugs to adolescents, and even more to be made in the individual arrest, incarceration, and treatment of teenagers for drug related crimes. Truthfully, while no responsible person wants teenagers to use drugs, the real solutions to drug problems in American society have more to do with adults and public policy than with teenagers themselves.

    Factors associated in research with low rates of Alcoholism (and drug use in general):
    1. a healthy economy
    2. plenty of future to go around
    3. "inoculation" (early exposure to alcohol in diluted forms) which demystifies alcohol
    4. effective models of sobriety and moderation
    5. zero tolerance for excessive use
The Functions of Deviance (including Drug Use):
Kai T. Erikson, Merton Social Structure & Anomie - the idea here is that society provides "ends" or goals that are widely shared, but doesn't provide equal "means" or avenues to the realization of goals. Thus someone who wants to be rich might steal instead of work hard. Read The Jungle by Upton Sinclair

Chicago School of Social Science's terms Anomie & Alienation, along with the work of I.I. Thomas, E. Durkheim are important in this discussion.  The idea being that through a series of evolutionary events, some people find themselves on the margins of social life. Where they once were happy as carpenters who were responsible for building the whole house, now they are nailers, who only nailing boards together at the "house factory". They suffer an extreme loss of identity, resulting in anomie (feelings of never being satisfied). In their search for satisfaction, they experiment with cults, or sex, or drugs. Read Rivethead by Ben Hamper.

Differential Association - Sutherland & Cressy - the idea here is that when born into an environment that is developmentally pathological, one associates with the wrong crowd, resulting in the transmission of deviant values and behaviors. Read Claude Brown's Manchild in the Promised Land.\

    Is the problem of drug & alcohol abuse a sociological or psychological problem?
    How much is psychological (individual malfunctions)
    How much is sociological (something about the structure of society that allows the problem).

    Primary & Secondary Deviance - the idea here is that almost everybody engages in primary deviance of some kind. This is usually trivial behavior that goes unnoticed until an official labeling event takes place. Here's a story, told by my teacher C. Eddie Palmer. It seems there once were two boys who plotted to steal bubblegum from a local candy store. The store owner saw one of the boys and called the police. When captured by the police, the boy who was identified kept his mouth shut and went to the reformatory, where he learned a whole bunch of criminal behaviors from the boys inside. All this time, the boy who escaped continued in school, as usual. After the reformatory, the boy with the record was labeled as a bad kid by the people in the neighborhood. Every time something turned up missing, he was blamed. "Oh, there goes the thief!" they would say. Finally, the bad kid gave up trying to behave and submitted to every criminal impulse he had.

    We can't always be sure that reasoning behind drug use is psychological and individual if there are societal underpinnings. One this is true, we can't solve social problems with psychological tactics. Prior to therapy we have to remove the outside causes.

Drug and Alcohol Abuse in America
    Drugs historically hit adolescents in the 1920's with easily available illegal rum and "bath tub" gin. As families moved to cities, parents relinquished control of young people to secondary agents of control (i.e., the truant officer, the police, the school, the factory).

    The first law enforcement agency assigned to removing illicit alcohol from society was Eliot Ness and the Treasury Department of the Federal Government, which turned into the Drug Enforcement Agency and the Bureau of Alcohol, Tobacco & Firearms after Prohibition was repealed. After the distribution of alcohol was legalized, the agencies needed a new criminal offense to go after, so they began concentrating on marijuana and narcotics. At the time there were very few criminals in the drug business. As the agencies grew, so did the drug problem.

    The idea here is that the policing of drug distribution might have less to do with law enforcement and the public welfare as it does with the encouragement of bureaucracy. Further, as we add to the numbers of social control agents, we are increasing the likelihood that they will find people to charge with crimes. What happens when we catch all the criminals - what'll happen to all those police officers? This won't happen because

    Drugs in today's youth market in order of their preference among high school students who use them.

    There are Gender Differences in the use of drugs.

    Males are using a wider variety of drugs with more frequency.
    Females are catching up to males in the areas of alcohol consumption and cigarette smoking.

    C. Risk Factors
    While the vast majority of adolescent drug users are not serious abusers, there are some who are at-risk of the development of serious habits:

    -psychological factors - individuals with certain personality characteristics - easily angered, highly impulsive, easily depressed, those who have achievement difficulties, and those who have been taught tolerant attitudes about deviance in general.

    -interpersonal factors - those with distant, hostile, or conflicted family relationships, those with parents who are permissive or are users themselves.

    -contextual - those living in a social context that makes drug use easier - ease of availability, lax community norms, inability of social control agents to enforce laws, mass media presentation of drug culture as glamorous.

    Similarly there are factors that Decrease the likelihood of substance abuse:

    • positive mental health
    • high self-esteem
    • absence of depressive symptoms
    • high academic achievement
    • close family relationships
    • involvement in religious activities - and so on.
    Both the protective and risk factors operate in society on individuals regardless of race or ethnicity. Obviously, there are social class factors that make risk greater.

    Functions of Drug Use

    To say that something is functional means that it serves some useful purpose or need - either to the individual or to society. In the case of drug use among adolescents, drug use as-a-problem provides jobs for police, lawyers and other legal types. It sells newspapers. It provides a rasion d'etre for therapists, counselors, and others in the helping professions.

    Drug use also serves a personal function. The drug subculture arises as a reaction to urban competitiveness and the omnipresence of urban-industrialism in the form of an escape from its rigors.

    Pretty simple, really. Kids take drugs so they won't have to compete. As members of a new subculture, they have their own norms and values (which is part of adolescence - to fool the adult crowd). They can belong to a group that values their presence. Further, the drug user can skirt competition by using denial, what Matza calls Techniques of Neutralization:

    • denial of responsibility
    • denial of injury (to self or others)
    • denial of victimization (it's not hurting anyone!)
Social Control
    A. Socialization is the first line of defense against deviance, of which drug abuse is a part.
    With adequate family life, a teenager can internalize the norms and values that lead to health and social conformity.

    B. Primary Group Controls - from family, friends, work groups - if the primary group is not in favor of the behavior in question, the individual will be more likely to change.

    C. Secondary Group Controls - through fines, bonuses, threat of imprisonment - if society implements a near zero-tolerance for the behavior, it will diminish.

    D. Control through Force, Coercion and Punishment - From a societal point of view, individuals can be made examples for others to see. An old sailor told me a story once that is relevant here. When he was in Navy recruit training in the early 1940s, he was asked to witness the punishment phase of a Courts Martial in which the offender was being "drummed" out of the Naval Service. Whatever his crime, his judges thought it was severe enough to warrant the following treatment:

    He was marched into the center of a large parade ground that was lined with sailors/witnesses. In the center of the field there were three men, an officer who would read his punishment, and two enlisted sailors who were to rip and tear all military insignia from the prisoner's clothing. All this time, there were drummers playing the same, slow cadence. After all the military markings were torn away from his clothing, the legs, sleeves, and front and back of his shirt were ripped open. Then they took away his shoes. He was ordered to turn around and march to the front gate of the Navy base. As he walked away, all the witnesses turned their backs to him. When he got to the gate, his escorts opened it and shoved him through it.

    This depiction of a Successful Degradation Ceremony illustrates the power of social control when applied ruthlessly and publicly. The point of it was not to make an impression on the prisoner, who was thought to be morally bankrupt. The point of the ceremony was to encourage good behavior from all who witnessed the event.

    For further reading see;

  • Risk Factors for Adolescent Depression
  • A Teenager's Greatest Worry
  • Teen Help: a national toll free hotline for teens
  • Adolescent depression and related problems
  • Manic depression and adolescence
  • Panic disorders and adolescents
  • Schizophrenia