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The Kids are
Hurting
Gripped by depression and
anxiety, adolescents are swamping psychiatric wards and
therapists' offices across the country. "If this were an
infectious disease, we would call this an epidemic."
from Andrew Julien of the
Courant, December 15, 2002
For more articles visit
www.bridges4kids.org.
Gripped by depression and anxiety, adolescents are swamping
psychiatric wards and therapists' offices across the country.
This stressed-out generation of American youth is caught in a
double-bind: intensifying pressure to meet an ever higher
standard of success, and waning support and comfort within
their families.
• • •
A paralyzing sense of emptiness would grab hold of Kimberly
the way an early winter's night creeps up and suddenly
swallows the day. She'd look at the other kids at high school
and marvel at how easy it all seemed to them - the right
friends, the right clothes, the right life.
In Rocky Hill, a sleepy suburb of capes, colonials and trim
lawns along the Connecticut River, life glides along in
predictable rhythms, and Kimberly desperately wanted to be
part of the flow.
But she wasn't. There was no good reason for Kimberly to feel
so alone, at least not to anyone looking in from the outside.
She was a pretty 16-year-old, with porcelain skin, wide eyes
and long black curls that tumbled down her back. She lived
with both of her parents on a quiet street in a pleasant
neighborhood. She was smart.
The harder she tried to fit in, though, the more she hated the
fact that she didn't seem to be able to find a place for
herself in the maelstrom of American suburban adolescence. One
day she showed up for school wearing regular jeans when all
the other girls were wearing flares, as if a memo had been
sent around to everyone but her.
"I wanted something to hope for," she said. "But I couldn't
find it."
Some kids who feel that way end up hating their school. Many
end up hating their parents. Others pierce their tongues, wear
dark clothes and play at hating everything. Teenagers have
always looked for ways to break away from the world they know
as they struggle for identity and independence.
But Kimberly sank deeper and deeper into a well of depression,
fighting to keep her growing sense of worthlessness at bay.
She felt hopeless and alone, certain that nobody could
understand what she was going through. When a good friend left
her out of a planned outing to the beach one summer day in
that catty way only teenage girls seem capable of, Kimberly
decided she'd had enough.
Home alone one afternoon, she slashed away at her wrists. With
blood from the wound slowly seeping into her bathrobe,
Kimberly headed up the stairs to find a stash of pills.
• • •
The kids are not all right.
Every day across America, kids like Kimberly are showing up
close to death in hospital emergency rooms or close to tears
in the offices of psychologists, psychiatrists and social
workers. They are the lost children of the 21st century,
debilitated by depression, overwhelmed by anxiety, desperate
to get back to the simple joys of childhood.
"If this were an infectious disease, we would call this an
epidemic," said Joseph Woolston, chief of child psychiatry at
Yale-New Haven Hospital.
Many of these children in crisis are poor and lack even the
basic necessities. But others - who seem to have everything a
child might want - suffer nonetheless from a new sort of
emptiness.
They've been called Generation Stress - the stressed-out
generation of American youth, obsessed with an almost
unattainable vision of perfection: the best school, the
hottest clothes, the coolest music, the nicest body, the
greatest friends.
A growing crowd of child psychiatrists, school psychologists
and educators across the nation fear that many children are
suffering from emotional and behavioral illnesses because of a
toxic combination: unrelenting pressure in their lives and
crumbling bonds in their families.
Over the past year, The Courant spent time with children and
parents behind the locked doors of an adolescent psychiatric
ward and in private therapy sessions. More than 100 children
and parents were interviewed, along with dozens of national
experts, as part of an in-depth inquiry into the problems
facing America's young people.
The devastating toll that abuse, poverty and violence take on
mental health cannot be overstated. But emotional illness in
children is no longer a problem that can be written off as yet
another ill of the underclass. It also touches children in
suburban towns, children who are comfortable.
The stress they deal with every day is powerful - and
everywhere. They are under pressure to live up to ever-higher
expectations of teachers and parents. They are bombarded by
images of perfection in ads, on television and in movies. They
are subjected to the increasingly harsh judgment of their
peers.
"Kids are under tremendous pressure to succeed," said
Elizabeth McCauley, who heads the department of child and
adolescent psychiatry at Children's Hospital in Seattle.
"They're just really focused on this list of accomplishments
in order to project a certain image."
At the same time, children often are forced to navigate this
new world without the support and stability that used to be a
given in many families. If the lives of American families of
an earlier generation once seemed boring and predictable,
today's families tend to live at a breakneck, often chaotic,
pace.
The demands of the modern workplace keep many parents at their
jobs into the night. Divorced dads and moms are not around.
Dinner often takes a back seat to games or practices. And at
times, parents are so stressed out and tired that they are
content to shuffle their children off to watch television or
play video games.
Without a safe harbor at home, children are more vulnerable to
myriad social and cultural pressures. It also is far easier
for a child to slip deeper into trouble when no one is paying
close attention.
Biology, too, plays a critical role - and many experts say it
would be a giant step backward to gloss over the immutable
power of genetics in determining who will fall victim to
mental illness, particularly serious emotional disturbances.
Still, as our world has changed dramatically - becoming
faster, more intense, more demanding of an accounting for each
fleeting moment - it is clear that something fundamental has
been lost. And our children are suffering as a result.
"Human beings are not wimps. We can deal with adversity. But
our research shows that our ability to deal with stuff is
limited - and everyone has a breaking point," said James
Garbarino, co-director of the Family Life Development Center
and a professor of human development at Cornell University.
Signs of trouble continue to crop up. Over the past two
decades, the number of young people in America who have taken
their own lives has increased threefold. Numerous studies
point to elevated rates of depression among teenagers.
One of the most extensive analyses of the issue, published in
the journal Pediatrics, found that nearly one in five children
suffers from some sort of emotional or behavioral illness,
nearly triple the level of 20 years ago.
A sweeping analysis of depression in children and adolescents
published in The Journal of the American Academy of Child and
Adolescent Psychiatry concluded that more children are
affected by the disease - and are showing more severe symptoms
earlier in their lives. A study in Washington state found that
more children are hospitalized for a psychiatric illness than
for any other single reason.
College counseling services find themselves overwhelmed by
wave after wave of students suffering from stress and anxiety.
At middle schools across the country, bullying is taking a
severe toll on the victims. The massacres at Columbine and
other schools have become tragic symbols of how twisted the
world of seemingly normal teenagers can be.
"We are beyond the tipping point," Woolston said.
• • •
Mallory DiStefano is upset today.
She's still fighting with her roommate. And, last night, those
other girls on the ward went on for hours talking about
cutting themselves. It's exactly what she doesn't want to
hear, and even telling her psychiatrist about it this morning
is making Mallory fidget and squirm.
Mallory knows all about trying to hurt yourself - she's been
cutting for more than a year now - and she was sent to this
hospital to get better, not to hear girls chatter on.
"I just feel all this anger. And depression. And anxiety,"
Mallory seethes. She wants to scream.
Robert Sahl is listening closely. He is sitting with the
16-year-old in a small, cluttered room in a locked psychiatric
ward at the Institute of Living in Hartford, one of New
England's most respected psychiatric hospitals. The shady
campus tucked behind red brick walls has the feel of a college
campus, a design that masks the pain and anguish of the people
inside.
Mallory is just one of more than 400 children who come through
the ward every year. The traffic is so brisk on Donnelly 2
North that as soon as one child is discharged, another is on
the way to take his or her place. When things get really bad,
suicidal teenagers and out-of-control children wait for days
in the emergency room at the children's hospital across the
street, like airplanes circling with no place to land.
Another teenager on the ward, a boy, sits straight and stiff,
his hands gripping his arms. He is staring at the carpet,
making no eye contact. He is clearly working hard to contain
his agitation. He looks as if there's a coil inside his chest
waiting to explode.
The boy tells Dr. Sahl he's so angry he can even imagine
killing people who make him feel bad, so Sahl asks him how he
would do that. If you could kill someone, the boy said, you'd
want to do it slowly. You'd want to use a knife.
Sahl hears stories like this all the time, from sons and
daughters who are so angry they cut themselves after fighting
with their parents, from teenagers with eating disorders who
have become so thin that the skin around their eyes is red and
raw, from kids who have given up on themselves.
"I think it's often difficult for even myself to understand
everything they're going through," said Sahl, assistant
medical director in the institute's child and adolescent
psychiatry division. "I can only imagine the amount of
distress the kids are feeling - and their families."
Still, it is hard at times to believe these children are so
troubled. The day room on Donnelly 2 North brims with the
breezy jangle of teenage banter - giggles and voices raised in
mock anger, boys posturing for girls, sounds that recall the
boisterous cacophony of a high school cafeteria. The click and
clack of a foosball game marks the passing hours with a steady
beat.
But the kids here are hurting, as they are at hospitals,
clinics, retreats, schools and homes across the United States.
The children have different names, they live in different
states, they come from broken homes and intact families.
Some of their stories make the headlines: An 11-year-old so
stressed-out over his performance on statewide mastery tests
that he suffered behavioral outbursts. A boy in Norwalk
allegedly killed by a friend during a re-enactment of a
violent video game. A troubled 16-year-old in East Hampton
dying of an overdose from the drug Ecstasy.
The picture that emerges is clear - a sweeping landscape of
pain.
"It was like you were grieving for somebody all the time,"
Kimberly said. "You try and go on with your daily life, but
it's hard. What I was feeling was just that pain - all the
time."
• • •
Far from Hartford, in the Great Basin desert of southern
Idaho, a group of parents is eagerly awaiting a reunion with
their children. The summer morning is still, save for an easy
breeze and the soaring arc of a kestrel out hunting for
breakfast, as moms and dads in polo shirts and tailored shorts
wind their way in a narrow line toward the campsite.
They have sent their children to Idaho, to the SUWS wilderness
therapy program, largely because the kids were out of control
- angry, violent, depressed, hooked on drugs or alcohol. For
the past several weeks, the parents have not been allowed to
see or speak to their children, and today they hope to get
back the children they used to know.
The parents move slowly down a narrow path through a flat
field of dirt and sagebrush, tentative after all these weeks.
The kids begin to move toward them, a uniform mass of beige
and gray, like two trains creeping toward each other on the
same track.
Suddenly, as if by signal, the two groups break into a run as
shouts of joy pierce the silence. The tears and hugs speak
volumes about how much has been lost by these families as they
have struggled with the turmoil of emotional and behavioral
illness.
"She's got her smile back," said Tracy Atwell, whose daughter
had run away from home. Atwell, of Ketchum, Idaho, hopes the
apparent changes will stick, aware that when a teenager gets
so wrapped up in anger, hatred or sadness, it is amazingly
difficult to find the way back to the simple pleasures of
being a child.
"They don't see the good in themselves anymore," she said.
One counselor at the camp summed it up in just a few words:
"Sometimes," he said, "I can't understand how teenagers lead
such painful lives."
Just a few miles away, Cliff Stockton guides a dusty SUV down
a lonely road toward a campsite where a group of new arrivals
has just finished a morning hike. It's a hard time for these
boys; some have been abruptly whisked away from their lives
and dropped in the desert, told little about why they are
here.
"I'm really homesick," a 15-year-old from Louisiana says,
looking as if he's about to cry. "It's not that I was on
drugs, I just wasn't appreciative of my parents."
Stockton, a therapist, believes in the value of the wilderness
in helping these children repair their lives. His reluctant
patients often have significant adjustment problems - teenage
angst taken to extreme and sometimes dangerous levels. They
come from many of the wealthier communities in the nation -
Marin County in northern California; the dot.com suburbs of
Seattle; Connecticut's Fairfield County.
Perhaps the most valuable lesson children learn out in the
desert, he said, the one that seems to escape them when they
are surrounded by comfort and privilege, is that success or
failure is about what they do, not what they own or who they
are. The Idaho desert is a scrubby place of dusty earth and
squat sagebrush, a long way from the shopping malls and the
parties, the drugs and the booze.
"It's not because you don't have the right clothes," Stockton
said. "Now it's just you."
One of the basic themes of the program is that if one member
of a family is sick, the entire family needs healing. Lisa
Mokrycki, who lives in Wethersfield, knows that well.
Mokrycki has two boys, 12 and 14, who both suffer acutely from
depression. Her life is a daily struggle as she navigates a
fractured mental health system, tussles with educators over
what her boys need and hopes the day will pass without a
crisis.
Some days are really good - a family outing with no
disruptions, when she is able to cherish the simple joy of
being a mom. And then there are the trying days, when she
tries to take a shower or do a load of laundry and hears
screaming, a sign that trouble might be on the horizon.
"There are some days you just wonder, am I going to be able to
do this? Are they going to grow up and be OK?" Mokrycki said.
"I just sometimes wonder what's going to happen. I don't know.
I can't tell you. There's always a glimmer of hope - and
sometimes you feel desperate."
In Greenwich, teenagers are so desperate to take a little edge
off the stress that they have formed a nap club, where some
two dozen students gather once a week after school to listen
to soothing music and grab a quick snooze.
"There's a lot of pressure put on teenagers in our society,"
said Kelly Hannigan, a senior who is the club's co-president.
• • •
It may seem obvious that in a culture where children are
driven to meet ever-increasing demands, are bombarded by
graphic sexual and violent images and have less security at
home, the sheer weight of those pressures will add up and
overwhelm some of them.
Yet many experts see the issue narrowly. In a society eager
for a simple bottom line, the problems faced by adolescents
are often blamed on a single culprit: divorce, working moms,
the Internet, sexually explicit rap lyrics, violent video
games.
Such simplistic answers also make financial sense. If a
problem is related to a crisis at home and isn't affecting a
child's schoolwork, local education officials can avoid having
to spend money on it. If the problem is solely biological, an
HMO can pay for Ritalin or Prozac and reduce the need for
costly therapy sessions.
At the same time, advocates for the mentally ill have grown so
weary of the stigma and shame that go along with mental
illness that they are often reluctant to discuss the social
roots of behavioral problems, preferring instead to focus on
brain chemistry.
Biology is, in fact, a key piece of the puzzle. Scientists
today better understand the powerful role of genetics in
determining who is vulnerable to mental illness, and the
prevalence of new medicines has made it possible for many to
lead normal lives by focusing on chemical imbalances in the
brain.
But a growing number of experts believe that it is also
critical to weigh the influence of a complex mix of forces -
bullying, family problems, the media and others - to gain a
complete understanding of why so many children are in pain.
Mental health is like a bridge above a ravine. Pile too much
weight on the bridge, and the supports will snap. To
understand why the bridge collapsed, you need a clear picture
of everything that piled up, not simply the final straw. You
also have to know if the bridge itself was strong, or weak;
whether it may have been vulnerable to collapse for any reason
particular to its nature.
"There's a lot more stress on kids - academically and socially
- and that stress is the fuel of emotional problems," said
Gary Isenberg, a West Hartford psychologist. "The stress level
has been increased in every sphere of a kid's life. It's the
sum total of that that I think is creating more breakdowns in
pathology for kids."
Jean Adnopoz, an associate professor in the Child Study Center
at Yale University School of Medicine, said children often do
not get the treatment they need because the people taking care
of them fail to see the entire picture.
"I think we're very good at creating serious mental health
problems in children," she said. "We're not so good at
preventing them."
• • •
Kimberly, who was not successful in her attempt to take her
life that day in Rocky Hill, no longer feels as desperate as
she did then.
But she still remembers vividly how hopeless and lonely she
felt. Like many teenagers, Kimberly believed her parents were
too busy with other issues to worry about her, so she kept her
problems to herself.
"I felt so isolated and misunderstood," said Kimberly, who did
not want her last name used.
The world overwhelmed her. Nervous by temperament, Kimberly
became upset about countless aspects of daily life: the
horrible images on television news programs, the unattainable
visions of perfection in the movies, the self-assured attitude
of her peers.
She found so much wrong with the world, it would eventually
come to eclipse everything else in her life.
"I didn't necessarily want to die," she said. "But I didn't
want to live the life I had."
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