It is widely accepted that around 10 per cent of teenagers have mental health problems, the majority being diagnosed with anxiety, depression, or both. Many experts believe that that figure is actually much higher, and rising: we do not really know, since no major review has been undertaken for some time (Beesdo et al, 2009).
However, we do know that NHS figures show that 12.8 per cent – roughly one in eight – five to 19-year-olds had at least one mental health disorder when assessed in 2017. This figure rises to 16.9 per cent of 17 to 19-year-olds (see SecEd, 2018).
Furthermore, of these, emotional disorders were the most common, affecting 8.1 per cent of five to 19-year-olds in 2017. And of these, anxiety-related disorders were the most common (7.2 per cent).
In further support of the pessimistic view of a continuing increase in such problems are indirect measures, such as the fact that the number of young people prescribed antidepressants has risen in recent years (Bachmann et al, 2016). Of course, it is hard to be sure what this means. Are there really more depressed teenagers than there were even a few years ago? Or has the trend for celebrities to talk about mental health issues made it easier for depressed teenagers to admit to their own problems?
Anxiety and depression: A five-part series by Dr Stephanie Thornton
Part 1: Anxiety and depression: The new normal? March 2020: https://bit.ly/2wE3Bye
Part 2: Anxiety and depression: Are they co-morbid? April 2020: https://bit.ly/3blzR7u
Part 3: Anxiety and depression: When should we intervene: May 2020: https://bit.ly/2T0KlTr
Part 4: Anxiety and depression: Managing anxiety in the classroom: June 2020: http://bit.ly/2XJXiUu
Part 5: Anxiety and depression: Managing depression in the classroom: July 2020:https://bit.ly/2YJ9DJ0
Or maybe the societal concern with mental health in the young has made teachers, parents, and perhaps peers, more alert, more likely to notice and report problems in the young.
Or has there been a change in the threshold at which doctors will diagnose depression, and prescribe antidepressants?
Whatever the contributing factors, it is clear that more teenagers today are diagnosed and treated for depression and anxiety than was the case in the past.
This is regarded as a mental health issue, with much angst in the media about the need for more mental health resources to support the young. But some experts are beginning to question whether the medical model, which views depression and anxiety as “mental illness” to be treated, is the appropriate or optimal view.
What is “normal”, and where does “mental illness” begin? There is no clear definition in psychology of where that boundary lies. What we accept as normal or identify as abnormal are as much defined by cultural beliefs and practices as by the characteristics of individuals.
Sometimes it seems obvious that an individual is ill: when subjective experience or behavioural reactions are very different from the average, for example the auditory hallucinations of schizophrenia, or the compulsive hoarding that turns a home into a labyrinth between mountains of junk.
But not everyone who hears voices the rest of us cannot hear is regarded as schizophrenic. Even in modern times, some are seen as prophets, or saints, or powerful shamans. And not everyone who never throws anything away is regarded as crazy: some curate important libraries or museums. In the case of anxiety and depression, even extreme reactions may sometimes be entirely natural and appropriate to the situation.
In fact, there is much in our current culture that might well be expected to provoke anxiety and depression in our youth. There are the perennial problems of adolescence: the challenge of becoming independent from parents, of finding a place in the peer group, of dealing with rivalries, jealousies, sexual misadventures, bullying and the like, of finding an adult identity.
But today, our adolescents are confronted with a new range of extra challenges: the personal issues, from self-presentation to bullying posed by social media; the ubiquitous and ever more easily accessible dark news cycle forecasting doom and gloom from apocalyptic climate disaster and extinction to terrorism and war, economic and social disaster, a media repeatedly depicting theirs as a “lost generation” who will not enjoy the benevolent earth, let alone the house ownership, the affluence, the pensions, the jobs or job security taken for granted by previous generations (the broadcasts of the Second World War are remarkably upbeat, by comparison). The young live in a 24/7 world with no down time from these stressors. From many points of view, anxiety and depression are the natural reaction.
Some experts are suggesting that anxiety and depression are so common in our youth, and so understandable, that we should accept them as normal. They argue that it is wrong to always medicalise anxiety and depression, that to do so is disempowering and potentially damaging, and fails to send the important message that sometimes, depression and anxiety are the natural, healthy reaction to difficult circumstances and not an illness (Furedi, 2003, 2016).
These experts argue that all of us are going to encounter stressors in adolescence and throughout life. Some will deal well with this, gaining skills, insight and maturity from the challenges. Others will be overwhelmed.
They suggest that rather than waiting to pick up the pieces when children are overwhelmed (though obviously, we do still need to do that, unmanaged anxiety and depression are noxious in themselves, and can lead to more serious mental health problems), we should be looking for ways to help all our young to confront stress and manage their emotions effectively, especially the painful emotions of depression and anxiety. But how?
Emotional education
Emotional education for all. Some parents are very good at allowing their children to feel and express their emotions – from joy and excitement to fear, anxiety, anger and grief.
Such parents generally are also good at helping their children to learn about these powerful emotions: accepting them as normal, and supporting the child to learn to express emotions in constructive ways, and to control them. The children of such parents learn how to manage their emotions.
Alas, some parents are very different. Their children may be punished for exuberant joy, and even more so for expressing anger, sadness, fear and other negative emotions.
Prevented from expressing emotions, their children learn to deny and suppress strong feelings but not to manage them constructively. Alas, strong emotions cannot always be denied.
These children are more likely to be overwhelmed by powerful feelings than those with more supportive parents. Can schools compensate, helping all children to accept and manage strong emotions?
In infancy, such tuition is only effective if it is “hands on”, personalised and individual. But adolescence opens up new possibilities: group discussions offer the possibility of raising the issues, opening up new perspectives and sharing the challenges.
Coping strategies
What about strategies to suggest to the young in coping with strong emotions such as anxiety and depression? Experts suggest:
- Name the feeling: Am I feeling angry, afraid, anxious, depressed? Undifferentiated arousal is harder to deal with than a named emotion (or set of emotions).
- Accept that emotion: If that is what you feel, that is what you feel. Teenagers may try to refute strong emotions, trying to make them simply go away. But this will not work: denial never does, really. In fact, it makes things worse, and cuts off the possibility of addressing the cause of the emotions in a constructive way.
- Express emotions: Do not bottle up your emotions. Cry, or talk about it with someone you trust. Expressing emotion can in fact make such feelings more manageable. Some experts advocate writing it all down until one feels more in control, and then throwing the paper away (deleting the file) as a way of letting go. Any way of expressing strong emotion may be helpful, so long as it does not harm the individual or anyone else.
- Find healthy ways of coping with problems: A key part of this is putting life in perspective: recognising which problems one can try to fix, and which simply have to be accepted. Either way, learning to nurture oneself is vital to coping. When emotions threaten to overwhelm, exercise can help: a run or a brisk walk, for example, can both distract and increase the endorphins that offer a natural counter to stress. Singing, particularly with others, can have very beneficial effects, as can a long soak in a hot bath, or having a hug.
- Dr Stephanie Thornton is a chartered psychologist and former lecturer in psychology and child development. To read Dr Thornton’s previous articles in SecEd, go to http://bit.ly/2o1BVxK
Further information & research
- Bachmann et al: Trends and patterns of antidepressant use in children and adolescents from five western countries 2005-2012, European Neurosychopharmacology, 2016.
- Beesdo, Knappe & Pine: Anxiety disorders in children and adolescents: developmental issues and implications for DSM-V, The Psychiatric Clinics of North America, 2009: http://bit.ly/2sRmcFf
- Furedi: Stop medicalising pupils’ normal tensions and anxieties as mental health conditions, Tes, February 2016: http://bit.ly/2Mgt7zI
- Furedi: Therapy Culture: Cultivating vulnerability in an uncertain age, Routledge, 2003.
- SecEd: One in eight students have a mental health disorder, official NHS figures confirm: November 2018: http://bit.ly/2QbgUi3