#StayingBotheredStories: Barry Fell, Executive director of Telos, on "The Squeeze" and Teenage Mental Health

Barry Fell, Telos Utah | Teen Mental Health.JPG

Barry Fell, Telos

Staying Bothered about Teenage Mental Health and “The Squeeze”

My name is Barry Fell, and I am staying bothered about teenage mental health by educating the masses on the adolescent phenomenon that I call The Squeeze. My organization, Telos, is on the frontlines treating teenage boys who are victims of it. Let me explain….

A young man named Paul is struggling a few weeks into his 10th grade school year. He starts to shows signs of irritability, withdrawal from his family, begins overeating and then stops playing on his club baseball team. His parents are confused because he loves baseball and is one of the better players on the team. The family realizes that something is amiss and seek professional help because any attempt to address concerns with their son is met with resistance. The teenager is yielding a great deal of unhealthy power around the home and every family member finds themselves walking on eggshells. With reluctance, the young man agrees to go to therapy and the counselor quickly diagnoses Paul with depression. The counseling begins to target the negative thinking, poor self-image and the withdrawal from the family. Eventually, medications are prescribed by the local MD and the family watches and waits. To their disappointment, nothing really changes. Eventually, things take a turn for the worse. As the school year progresses Paul now starts to feign illness to avoid class. There seems to be another set of symptoms surfacing. Wednesday nights are particularly hard because Paul always seems to have a bad headache. It starts to become predictable. Mother anticipates that on Thursday morning Paul will want to sleep in claiming his head is thudding with pain. Both parents come to the conclusion that Paul is anxious and is trying to avoid something at school on Thursdays. Again Paul’s therapist does the best she can to teach Paul about how to soothe when distressed, but Paul has no real interest in the therapy. What he really wants is to go back in time when school seemed a lot easier both socially and academically. Paul’s therapist recommends that Paul is not motivated to do therapy and eventually the sessions come to an end. Paul is no better, his school absences are racking up and the family is at a loss as to what they should do next.

Missing the Mark

Why did Paul not respond to therapy and the medications? One reason could be down to Paul himself. Perhaps he was not motivated to get better. Maybe, he didn’t have the insight into his own problems. Or what if Paul wasn’t competent at implementing the new skills that his therapist trained him on? Therapy needs all three ingredients: a motivated, insightful, and competent Paul if it is to have some type of impact.

What if the problem was the therapy itself? In this situation, the therapist chose to treat anxiety and depression because those were signs and symptoms that Paul manifested. One has to ask though: what is causing Paul to suffer from depression and anxiety?  Although depressive episodes and anxiety can exist without no rhyme nor reason many suffer from these conditions because a stressor has caused them. The mental health field, like the field of medicine, can be guilty of treating symptoms without adequately exploring the cause of the symptoms. For example, it is winter and an old lady sees a doctor because she has a chesty cough. After the initial assessment, the patient is diagnosed with bronchitis and is prescribed some antibiotics. After she picks up her medicine she goes home to her cold, damp apartment. What the doctor doesn’t know is that the old lady is experiencing financial hardship and can no longer pay her gas bill, therefore her gas has been turned off. This patient needs a lot more than medicine, she needs the department of human services to assess her comprehensively. The bronchitis is the byproduct of a much deeper-seated issue. There are many Paul’s who are in our public and private schools. Over the last decade, we have seen a dramatic rise in anxiety in high school students. Teens are suffering and we would be foolish to not look at the cause.

An Increase in Pressure

One of the questions we ask families who are entering the treatment process is, “What are you hoping your child will achieve in our care?” Multiple parents will put better grades at the top of the wish list. Academic success is one of the measurements we use when measuring individual growth. We are at a point where it might be the most important benchmark. A student in our care complained to his parents because his older brother had made exactly the same mistakes as him, yet he was never sent to treatment. Does his parent's response represent the values of mainstream America? They explained that his brother never went to treatment because his erratic behaviors did not affect his GPA. What a stunning rationale. The American dream has predescribed rungs on the ladder including a need to attend a competitive college which is preempted with a successful high school experience - and so the pressure begins. Granted, many thrive from in the pressure.  They feel the squeeze and fly out of the top of the pressure cooker and soar to great academic and then professional heights.  But how many are falling out of the bottom? AP classes were once an anomaly but now they are the new norm. Research shows that homework volumes have increased over the last number of years. Teenage free time is consumed by extracurricular activities. The days of simple play and hanging out has been replaced with social media. Things have changed and the teenage casualties would suggest that it might not be for the better. We have seen a steady decline in resilience with today’s generation but how much of this is down to adolescent years been crippled with too much pressure? Outside pressure caused by societal and familial expectations is one aspect worth considering, but there are other cause and effect patterns that can be easily missed.

Exposed Learning Weaknesses

The human brain is made up of both strengths and weakness. We often don’t realize either our strengths or our weakness until we are placed on a stage where they are exposed. Einstein said, “Everyone has genius inside of them but if you judge a fish for its ability to climb a tree it will spend its whole life thinking it is stupid.” Weaknesses are irrelevant when they don’t get in the way of everyday living. A salesman who is brilliant with people but useless with numbers has nothing to worry about unless his boss asks him to serve as the firm’s accountant. Let’s get back to Paul and seek to discover the “root” of his mental health issues. Like many of his peers across the nation, Paul’s learning style has been exposed. Microsoft computers will not process Mac software. Paul’s brain is not processing all that is required from him in the academic arena. Have you ever been in class or a job that simply made you feel incompetent? Many of us have experienced workplace tasks or the occasional class that we couldn’t compute. Student’s like Paul are not struggling in one or two classes they are struggling in nearly all of their classes. A common struggle is misunderstanding subject matter. The left side of the brain typically is where logic and reasoning occurs while the right side of the brain is where creativity occurs. One student in our care had great strength on the left side. He thrived with sciences and math but his weak side, the right side, got exposed with subjects that required writing skills, especially creative writing. A writing assignment paralyzed him. He would just stare off into space having no clue how to even start. He was labeled by one of his teachers as lazy and eventually stubborn but those labels were far from the truth. The real problem was that the way his brain processed information was not conducive with the way he was being asked to learn. Of course, homework assignments were left undone because his brain kept drawing a blank. He started to feel shame because he felt stupid and then eventually other symptoms began to emerge. Guess which ones? That’s right - anxiety and then depression.

This analogy tells the story of Paul. Notice how a processing deficit detonates other mental health challenges. Let’s take a closer look at how the first domino effects the rest.

Dominos 2 & 3: The connection between processing disorders and biological disorders

When a student is in an academic environment that is not conducive with his learning style and then he is given assignments to complete in what feels like impossible subjects, the most common disorder to surface will be anxiety. The stress is caused because the student knows he will be unable to fulfill the assignment. The common story for many is that the anxiety ramps up as homework deadlines draw closer or test days are around the corner. The way the student’s brain is hardwired prevents him from understanding and now that confusion triggers a chemical response in the brain which causes anxiety. In simple terms, the anxiety manifests itself mentally, usually through chronic worry and then other physiological symptoms appear. When the brain is obsessing, worrying and ruminating for sustained periods it eventually fatigues. Anxiety is often wasted mental energy. It produces no productivity. The irony is that the anxious brain is often working so hard but producing very little output. The result looks like this:

Depression is a form of brain fatigue. When the brain exhausts itself the adolescent symptoms include: irritability, withdrawal, poor sleep, poor eating habits, anger outbursts, feelings of hopelessness, apathy, low motivation, sadness, and fatigue. For many like Paul, depression is the result of an anxious brain which has run out of steam. Paul lacked the motivation to go to school in the first place because the subjects seemed so hard, but now he has lost his last ounce of drive because depression has taken it from him.

Domino 4: The connection between biological disorders and self-esteem

One of the most troubling symptoms people with depression suffer from is the voice of self-loathing that doesn’t seem to turn off. American Idol hosted the infamous Simon Cowell who was known to not pull punches when criticizing the show's contestants. Many sufferers of depression report that they have their own personal Simon Cowell living inside their head constantly watching and pointing out every mistake no matter how minor. This, of course, takes its toll and for some, it can, unfortunately, trigger suicidal ideation. The internal critical voice corrodes the fabric of self-esteem. Corrosion also occurs when a student experiences no daily successes. When academic and social victories are few and far between the depressive symptoms start to become more intense. Most young people get a sense of self by comparing themselves with their peer group. The Paul’s of this world feel inadequate as they convince themselves that no other kid in the school is in the same boat. Of course, what Paul does not realize is that he is comparing his weaknesses with other student’s strengths and the other kids like Paul are silent sufferers. A constant voice of self-loathing, no daily victories to hang your hat on and the feeling that you're alone in your suffering are the ingredients to zero self-esteem.

Domino 5: How is Paul going to cope?

We are now beginning to see why Paul is anxious and depressed. When it comes to coping, no matter what the problem is, how we cope is either black or white. We are going to choose adaptive or maladaptive coping. In our experience in treating students like Paul poor coping is the lion’s share of the problem. Exposed hard wiring weaknesses that trigger anxiety, depression and then effect self-esteem is hard for any teenager to deal with. When the coping is maladaptive then a barrel of fuel is added to a fire that at one time may have been extinguished if understood by the family, school, and professionals. The strategy that students like Paul use can be explained in one word - avoidance.

Avoidance comes in many forms, we will name the three most popular strategies that we treat every day:

Substance Abuse: Pot and alcohol are popular for students who are suffering from anxiety and depression. Both substances are available and affordable. Marijuana is known to induce relaxation. It makes sense then, as to why anxiety sufferers would find it appealing. The question becomes will the user become dependent on it? Of course, frequent pot and alcohol use can lead to addiction. If the student does become addicted the substance use becomes its own Goliath. For many, drug use is a secondary issue. Potentially, it can extinguish when the student is in an academic environment that does not apply overwhelming pressure.

Gaming, pornography, and technology: These forms of coping are more popular than substance abuse. When the brain is in a state of depression, the pleasure seekers in the amygdala look for quick dopamine fixes by gravitating towards stimuli that instantly gratify. Gaming and pornography do just that. Research has shown that both gaming and pornography can be as addictive as cocaine. The majority of teenagers in America are equipped with a smartphone, tablet, gaming console and/or personal computer. These privileges have become “rights” for the millennial adolescent. Some box themselves into a cocoon of dysfunction by spending hours and hours on their technology refusing sometimes to leave their bedrooms for days because they feel like they can access the world at the touch of a button. Why enter the real world to socialize when the cyber world requires much less interpersonal skill? Why go to a school where you feel like a nobody when the gaming world brings you a sense of victory making you feel like a somebody?

Emotional eating and sleep: Sugar and carbs are another amygdala pleaser. We have seen many who turn to food as a comfort. The byproduct of poor health ends up becoming another self-esteem killer. Oversleeping is a cheap, easy way to turn away from problems - hence it becomes a popular form of avoidance for students like Paul.

The solutions students use to fix their problems is the equivalent to trying to stop a flood with a fire extinguisher. Treatment providers end up hacking at branches by the time this treatment profile ends up in their care. The roots that created the problems in the first place (hardwiring, anxiety, depression, etc.) can sometimes be overlooked because the branches seem to smother everything else. It takes a savvy clinician to peel back the branches and take a deep look inside the ground to discover how this messy growth all started.

Domino 6: Final domino falls - the family

Many parents in the United States would read about Paul and know exactly what it looks like when the final domino falls. Many of the parents we interviewed describe a similar story. They experience a shrinkage in influence. Their ability to discuss problems with their child diminishes usually because the child ends up avoiding the crucial conversations. Feelings of fear and hopelessness creep in as the family watches their child slowly self destruct but they feel helpless in doing anything to stop it. Parents then engage their own maladaptive coping such as avoidance through the workplace and enabling/rescuing. Typically, fathers do the former and mothers do the latter. Most mothers do not want to do the heavy lifting for their child but they feel like they have no choice. We find that most parents are doing the best they can with the resources they have and the circumstances they are under. The bottom line is that usually, the family needs more resources. Hope is found when the parents commit their child into the care of a professional team who understand all 6 dominos and know how to treat them.

Team SB