Depression in Teen Girls:  A Psychologist Comments

When Illness Strikes in a Family

  "I used to be strong and independent and everyone relied on me when they needed something. But now that I'm sick, my children have to take care of me!"  This woman is a mother with two teenaged children, who now has end-stage renal disease. Her words reveal the way in which one person's medical illness can disrupt an entire family.

 As a psychologist, I work with the Columbia University medical team treating people who are on chronic dialysis. Patients often ask me why they need to meet with a psychologist when there is nothing wrong with them mentally. I tell them that the only thing truly wrong with them is that they have failing kidneys, but that having a medical illness is stressful or even traumatic and that my role is to help them to anticipate and adapt to the psychological issues that will surely arise.

Life with a chronic illness is tough for both the sick person and those who are deeply connected to her. But important psychological experiences often go unacknowledged - we all defend against scary feelings. In being hidden they become their own source of anxiety as people try to cope with feelings they have barely recognized. It is important to tend to the ongoing internal experiences of everyone in the family so that they are better able to adapt and work together, so that needless stress is not created, and to create a level of contentment as individuals.

Patients and families generally want to be helpful to one another, but when a mother who has nurtured her children now needs those children to give her medication, or when a teenager struggling with physical and social problems must take a back seat to the parent's urgent illness, difficult feelings arise. Further, when there is a serious illness, patient and family worry about their own suddenly uncertain future as fears of death loom and need to be addressed.   

 One dialysis patient with a very loving and supportive family confided in me, with some mixture of anger and despair, his thoughts of killing himself. He felt he was a burden to his two adult children who shouldered the responsibility of taking care of him. He wished for his own death, he said, because he felt his children resented his dependency on them and would be happier without him. This very proud man felt demeaned in his own eyes and believed others must feel the same way about him.   

Feelings not addressed often have negative consequences..  Caught up in his own inner turmoil, this man became irritable and difficult to be around, refusing to be helped or to go to his doctors' appointments.  Although he did not say so, I sensed that beneath the surface was a lot of unexpressed rage at the disappointing course his life had taken and the helplessness that went along with it. Any reminders of his current decline--doctors, medicine, and caregivers-- he either avoided or attacked. Thoughts of suicide enabled him to feel he could at least control whether he lived or died.      

 His family did become angry and resentful of him, of course, but not for the reason he thought. They were angry with him, not because he was sick and had lost his independence, but for just the opposite reason. They resented that he refused to accept the reality of his sickness and the fact that he really did need them. It was not his physical situation but actually his struggle with his emotional reactions that was the family problem. 

 Over time, as he was able to speak about what things were actually like for him, he was able to tolerate the deeper level of feelings--the sadness and the anger--that he had been running away from.  Being able to finally mourn and accept the losses he could do nothing about enabled him to take more control of what he could affect. He came to see that he was making others feel as angry and as helpless as he was and was making himself much more of a burden when he rejected their help.

 While difficult, health crises and the disruptions they create can challenge people to grow and families to become closer. It is at these difficult times that people discover resources within themselves and within their families they never knew were there.   

   Maureen O'Reilly-Landry, Ph.D.        

Adolescent Withdrawal

I am often asked to consult with parents and schools about adolescent issues. A recurring problem is the sometimes sudden, inexplicable and moody withdrawal of teens from activities in which they had previously and characteristically shown a great deal of enthusiasm for social involvement.  While in some kids this might reflect the emergence of a serious depression, it's common enough to consider it as a normal developmental condition. When kids show reluctance, disinterest, and disengagement from activities that we know would enhance their lives, how do we make sense of this?  Parents often describe this type of change in their teenagers, and tell me that they feel powerless to intervene, both in their attempts to stir their kids' diminishing interests and to remain informed about the changing peer groups.

It's next to impossible to force a teenager to take on interests and activities outside of their regular academic life.  Parents often find themselves insisting that their adolescents sign up for an after-school club or sport, but that doesn't guarantee genuine interest, involvement or cooperation on the teen's part.  In fact, it might actually have the reverse effect and create a more oppositional reaction.  This is not uncommon; there are many adolescents who seem to lack a "passion," or some interest or endeavor about which they feel unqualified enthusiasm.  So often, I hear parents wish for something, anything that would capture their child's imagination and energy. 

I would suggest that a lack of passionate interest in an activity or field of interest in adolescence should not be interpreted automatically as a fault, a failing, or even as a depression.  Kids are flooded during their high school years with endless variations on the question of "what do you want to do with your life?" "Where do you want to go to college?"  "What will you be when?"  This is particularly true in academic settings where kids have already demonstrated promise and talent.  Sometimes kids put the brakes on the rush to grow up.  They are not ready to become adults with fully formed notions of the future and express this by turning down, or even turning off, their avowed interests and enthusiasm.  This is a "good" hedge against uncertainty, but mostly a temporary solution. Adolescents can benefit from hearing parents and other adults in their lives make supportive statements about the kind of future we imagine them pursuing.  What we know about their strengths and past interests might suggest some general directions.  An adolescent's cold ear of seeming disinterest is not necessarily a deaf ear; kids listen carefully to what their parents say and they store away adults' visions of them, particularly the ones that speak of hopefulness and encouragement I sometimes catch wind of this in  adolescents' cynical reports of their parents' insistent nudging and pushing to do better school work.

Parents worry as they watch their teens gravitating to new groups of friends about whom they know little. When this happens, they feel that same sense of helplessness and marginalization as when they try to encourage outside activities. Conventional wisdom would suggest that parents find ways to get to know these other kids better by asking to hear more about them and inviting them to their homes to "hang out" but many teens might see hanging out in their parents' presence as the last thing they might want.  I coach parents to read the secondary signs of their teen's choice of these peers. What effects can be noticed from these recent social connections? Does hanging out with them lead to a decline in his or her other responsibilities in school or at home? Does her mood or behavior change when she gets home?

That is, are there signs that new social contacts serve a function for greater independence or, in contrast, greater withdrawal and disinterest.  In adolescence, the peer group reigns supreme and can serve a very important role in adolescent development, but also can reinforce negative pulls of disengagement and alienation. Returning to the earlier point about withdrawal as a defensive stance against the pressures to mature, some kids cling tenaciously to their prerogative to secrecy about their peers as one more way to shy away from the pressures and competitiveness of future-oriented, achievement driven surroundings.  They will need a good deal of patience and gentle coaxing to help them through these early stages of uncertainty.

In conclusion, I have tried to expand our appreciation of a more normal process in which adolescents react to mounting, formidable pressures by "not knowing" and being unsure, even to the point of decreasing their previously active interests.  Similarly, I've tried to give a perspective on many parents' concerns about their teen's changing peer group affiliations and suggested ways in which parents can be supported in their parental concerns to support their teen's independence while also remaining vigilant and involved.


Larry Zelnick, Ph.D.

About Our Authors

Susan B. Parlow, Ph.D., Editor in Chief;
Sharon Brennan, Ph.D., Issue Editor
Roanne Barnett, Ph.D., Don Grief, Ph.D., Maureen O'Reilly-Landry, Ph.D., Nicholas Samstag, Ph.D., Janet Tintner, Ph.D., Editorial Board;
NYSPA, Division of Psychoanalysis

With special thanks to the Psychoanalytic Society of the Post Doctoral Program in Psychotherapy and Psychoanalysis at NYU, for initial funding.