How do we deal with our seriously distressed children and adolescents? Adolescents are in a period of seeking autonomy and self-determination. These qualities can aid them in becoming agents of active transformation in their own lives. For one to recover from distress they are in need of being able to regain hope and to have an effective exercise of their free will. (Breggin, 1996). Adolescents based on their experiences formulate thoughts and feelings and begin to create values and meanings for themselves. Those adolescents who are suffering from serious emotional distress have become lost on this path to finding meaning in their lives. Once this occurs, they begin to develop anguish and self-defeating responses to life. This creates in them anxiety and despair leading towards what some would call ‘madness’ (Breggin, 1991). These adolescents must learn to feel empowered once again, and not to feel labeled as an ‘it’, not to be viewed through the lens of their particular diagnosis and categorization they have been ascribed. These adolescents need coaches and individuals who will aid them compassionately and empathetically in navigating and negotiating through life’s stresses. The therapist and others must look upon the distressed adolescent with dignity. To look upon the adolescent through ‘scientific’ or ‘objective’ means leads us to the tendency to diagnosis and control the person, to impose our own abstract and potentially oppressive category upon them and to manipulate the outcome. Physical interventions, such as psychotropic drugs, restraints, and enforced confinement to mental hospitals or residential treatment facilities are a part of this desire to control rather than truly aid and come to an understanding of the distress the adolescent is experiencing (Breggin and Breggin, 1993, a&b).
Psychotropic medications with these seriously distressed individuals only deal with symptoms, they blunt certain functions to make the person more tolerable and amenable to societal expectations. Psychotherapy, on the other hand, focuses on the subjective changes in patient’s feelings and on actual changes in lifestyle or conduct of life (Fisher & Greenberg, 1989). Based on the viewpoints of biopsychiatry, adolescents who are medicated and placed in mental hospitals are labeled as improved when they conform to hospital demands or receive discharge. However, what is not examined is, how do the patients themselves actually feel? An estimated 180,000 to 300,000 young people a year are placed in private psychiatric facilities. These children and adolescents often feel powerless in these placements. But as mentioned above, it is the need for feelings of empowerment and hope that will lead to a genuine recovery from distress. Psychologist D.L. Rosenhan lead a study where ‘pseudopatients’ had themselves admitted to psychiatric hospitals to experience them first hand and report on this experience. Rosenhan reported in an article appearing in the January 19, 1973 issue of Science, “Powerlessness was evident everywhere…He is shorn of credibility by virtue of his psychiatric label. His freedom of movement is restricted. He cannot initiate contact with staff, but may only respond to overtures as they make. Personal privacy is minimal…” With children and adolescents it is easier to rationalize away their rights and control becomes more arbitrary and complete (Breggin, 1991). Psychiatrist Peter Breggin states that in such an environment ‘it is hard for a child to resist feeling spiritually crushed, abandoned, and worthless under such conditions. With a less formed sense of self than an adult has, a child is less able to resist the shame attached to being diagnosed and labeled a ‘mental patient’. Children may also find it much harder to conform to institutional life. They are naturally energetic, rambunctious, at times strident, often noisy, and resistant to control. If a boy doesn’t conform, he is considered ‘ill’ and can be subjected to physical restraints, solitary confinement, and toxic drugs. (Breggin, 1991). It should be mentioned that the drugs commonly used for severely distressed adolescents are the same as those used for adults, most frequently the neuroleptics. These medications are reported to cause lack of energy, painful emotions, motor impairment, cognitive dysfunction and tend to ‘blunt; the personality of the treated patients as well as having a risk for the development of tardive dyskinesia, a permanent and debilitating neurological problem (Gualteri and Barnhill, 1988). These drugs subdue the adolescent into conformity by blunting the brain, but never do they teach the child how to develop meaning, how to cope, nor do they allow the adolescent to express his pain and emotional distress that is within. The adolescent is merely sedated to make his behaviors more manageable to adults. The adolescent learns nothing.
The adolescents who are suffering from severe emotional distress are in conflict. They have internalized feelings of guilt, shame, anger, anxiety, and numbing. These adolescents instead of coercive and intrusive ‘treatments’ need the ability to find a safe place where coercive power is replaced by reason, love, and mutual attempts to satisfy their basic needs. These adolescents because of their distress have broken away from the accepted realities, they have sought to recreate their existence, for some a more primitive existence (Schilder, 1952). The feelings of anxiety that an adolescent may experience are linked to a fear of being and belonging (Stern, 1996, pg. 12) Depression, mania, and anxiety are all linked together and are indicative of trauma. The adolescent being a shattered person seeks an escape by altered perception. We must begin to realize that all behaviors and experiences have meaning, even those things that may appear the most ‘odd’ to us. The symptoms labeled to be schizophrenic exhibited by certain adolescents in distress ‘may be understood as manifestations of chronic terror or defense against the terror (Karon, 1996). This is often expressed as anger, loneliness, and humiliation. The therapist and others must convey to the adolescent that he wants to understand, that the client is helpable, but it will take hard work (Karon, 1996). The therapist must forge an alliance with the adolescent, aiding them to understand the real dangers and to be able to develop appropriate coping mechanisms. These adolescents are often viewed as dangerous themselves but the majority are not. They need to be hard, and forging this alliance will give them the needed voice leading to their recovery.
Hallucinations that are experienced by the seriously distressed adolescent are actually repressed thoughts and feelings coming outward, the unconscious into the conscious. Delusions are the adolescent transferring experiences from their past without having the awareness that it is past (Karon, 1996, pg. 36). The therapist can guide in interpreting the meaning of these hallucinations and delusions and once the adolescent is gently approached with their underlying meaning, these events can dissipate. Delusions are also connected with an attempt to find a systematic explanation of our world, to find meaning. A person who has experienced severe distress has lost this meaning and thus develops unusual ways of seeking to make sense of their experiences and the world around them (Karon, 1996, pg. 38). The therapist can gently call the adolescent’s attention to inconsistencies but at the same time respect their vision. Laing commented that he once met a girl of seventeen in a mental hospital who was terrified as she felt the atom bomb was inside her. This was a delusion, yet Laing noted that there are those statesmen who threaten the use of doomsday weapons and they are deemed 'normal' yet are far more dangerous than many who are labeled 'psychotic'.
Laing noted some of the dynamics at work in causing individuals to retreat into psychosis. One, he refers to is the 'double bind'. In this pattern, an individual's feelings are dictated to him and the sense of individual feeling and decision making is taken from him. Another factor is meta-rules where a child is expected to follow a particular rule however this rule may not apply to siblings or the parents do not abide by the same rule. An example would be a child being told to not be aggressive where the parents interact aggressively with one another. Mystification is the process that Laing points out where false appearances are given to a child. In this, situations which are out of control are presented as having never happened. An example of this would be a child witnessing a situation of domestic violence in the evening, to arise in the morning with his parents sitting at the table for breakfst together and denying that the child ever witnessed anything. This creates enormous confusion in the child as they begin to question their experiences and the reality of them. Collusion is another concern which can lead a person towards retreat into psychosis. This is basically the family seeking to preserve an image to others of appropriate functioning when in actuality the family is dysfunctional. The child is expected to behave in certain ways so as to not reveal the dysfunction.
The results of a psychosocial approach to those with severe emotional distress has been proven to be more effective than the current biopsychiatric methods as evidenced by a study by Loren Mosher, MD where he took schizophrenic adults who were on either very low doses or no medication, and offered them a ‘safe place’ with non professional staff residing with them and sharing in their daily experiences. A 2 year follow up of these patients noted higher levels of success and progress than their counterparts who were subjected to neuroleptics and psychiatric hospitalization (Mosher, 1996, pg. 53) The model known as the Soteria project was based on principles of growth, development, and learning. All facets of the distressed person’s experience were treated by the staff as ‘real’ (Mosher, 1996, pg. 49) Limits were set and mutual agreements made with the patients if they presented as a danger to themselves or others. Such a model could be adapted to use with adolescents, offering them the need for compassion, empathy, and finding that ‘safe’ place, restoring within themselves a feeling of worth and dignity, that will lead to their ability to address the issues of their distress and traverse towards recovery.
For many children and adolescents who are undergoing serious emotional distress, there is the problem of loss of meaning. That is, that emotional distress is intimately linked with existential concerns. Laing (1969) comments that the 'mad things said and done by the schizophrenic will remain essentially a closed book if one does not understand their existential context." It is necessary for us to grasp the experience of the person, to connect in some way with this experience. Laing(1969) states that if we look at "actions as 'signs' of a 'disease', we are already imposing our categories of thought on to the patient...if one is adopting such an attitude towards a patient, it is hardly possible at the same time to understand what he may be trying to communicate to us." Laing argued that there is also a concern about ontological security. The person is seeking to 'find themselves' in a world of confusion and despair. Thus, as Laing has noted we are to engage in a process of understanding but go beyond in respecting the uniqueness and difference of the person who has undergone loneliness and despair. These children and adolescents are questioning their sense of security and their very existence. What is life, and what has it become? The confusion from traumatic experiences causes them to question their sense of self and who they are, what their identity is, and where they are to go. Some children and adolescents become so immensely confused that they seek to retreat. The language and actions which appear delusional to others may be the only way to have semblance of control over a world that is out of control for them. The loneliness and despair may become translated to a lack of self worth, and a desire to be apart from their bodies. For some, the conception of death may become much easier to grasp than a life they deem not worth living. Therefore, self-destructive tendecies can arise.
The child may become caught into a desire to retreat from a painful life yet fearful of what is to come. There may be the desire to be recognized and to have attention, but this is immersed with the fear of what this attention may bring. These children are filled with anxieties, hurts, and a lack of awareness of their own identity, and their sense of being. They may desire relationships, but are uncertain of with whom to build relationships, lacking trust they may be fearful of being hurt, and may even fear being loved. They may lack the skills to initiate a relationship. Therefore, it is necessary to build a non-judgmental alliance, to take the various actions and behaviors as a sense of the child or adolescent communicating with us in possibly they only means they have available.
Dan L. Edmunds received his Bachelor of Arts from the University of Florida. Edmunds completed his Master of Arts from the University of Scranton and his Doctorate of Education from Argosy University of Sarasota. Dr. Edmunds serves as clinical director for the Pocono Equestrian Center, is on the Board of Advisors for the Citizen's Commission on Human Rights International, and is a clinician working with private agencies.