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 Article of Interest - Depression

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
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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 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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