February 28, 2009

Teenager, Failing and Depressed

Once you make it to your late teens, your parents occupy an odd place in your life. You’re still dependent on them for many basic things, but you don’t want them interfering in your affairs. Parents often have a more difficult time with this separation. They know that they are providing many things, and they feel that it’s appropriate to receive something in return. What, exactly? Love and affection, respect, courtesy all must be earned, and cannot be bought with room and board. Those of us who have been in the working world and have worked for mercurial bosses know that we don’t respect people just because they are in some kind of supervisory position. (At Harvard Business School, they taught about leadership by showing the movie Twelve O’Clock High—a fabulous movie to see for any reason and an effective teaching tool for this, too.) I’ve known him and his family for about 10 years.

His mother called me last night, worried. She said that there was a major blow up with J, and he said he needed to ‘go for a walk.’ He left the house several hours ago and isn’t answering his cell phone.

About 5 years ago or so, when he was 12 or 13, his parents divorced. He was the only child who seemed to be reasonably OK with this at the time, since he wasn’t getting along so great with either one at that moment. But he started getting a little more introverted at the time, until one night he took off. His parents were naturally very concerned, and the local police found him some hours later nearby. He said at the time that he just needed some privacy, and he didn’t know why everyone made such a big deal out of it. His parents brought him to me. He explained that he just needed a break from things going on at home. I worked out a plan with his parents. I gave him my home and cell phone number. I told him that if he needed to get away again, he should call me at any time, day or night, and I would come at get him and take him to Denny’s or someplace where I could call his folks and let them know he was all right, and then he and I could talk and work out a strategy that could help him. He found this helpful, he said. It was like a relief valve.

In general, I think every teenager should have at least one, maybe several, safe adults. Adults who can let them vent, or just accept them when their parents have pushed them into a corner. It could be lifesaving.

When his mother called back, he had returned. He wouldn’t talk to her but she suggested me and he agreed to come the following day.

He sat in the room with me. I told him that his mother had called me, and I told him everything the mother had told me. He said that he was in a deep hole academically. Though he was a senior with excellent grades, and his college applications were already out, he has not been doing his school assignments and is in danger of failing several classes. I asked how that could be possible given his record. He started to cry. He had been cutting class, not handing in his work, not participating in class when he was in class. I didn’t press the issue, which I thought was tangential, even though he and his parents thought it was the center of the problem. He knew that eventually there would be a reckoning, specifically when his midterm grades were given to his parents, but he couldn’t deal with this. As the semester went on, and he got further and further behind, it seemed more and more impossible ever to catch up, so he had no choice but to let this crash happen even as he saw it approaching. His grades came out, his parents confronted him, he admitted not doing the work and lying to them about it, and his parents grounded him for a long time, to learn a lesson about lying to them and to get him to focus on his work.

I told him I wanted to change the subject. I asked and he told me that he was also neglecting his friends, even spending less time with and attention to his girlfriend. He said, “I’m not doing any of the things I used to enjoy. They just don’t mean that much to me any more.” He wasn’t doing new enjoyable things, either. All of this coincided with his academic slide.

He denied feelings of overt sadness, and denied thoughts of self-harm. I explained that weeping 17-year-old young men have a hard time convincing me of their blissful happiness. Indeed, what he described so eloquently is called anhedonia, a state of indifference to pleasurable activities. It’s a sign of depression. I told him that I didn’t think the academic problem was making him depressed. It wasn’t his fault, I said. The depression had caused the academic problem.

We needed a plan. First, let’s try to treat the depression. I discussed medication with him, and we agreed on a prescription. It offered the best chance of relief in a reasonably rapid time frame. Next, I offered to intervene with the school, but he said this wouldn’t be necessary. He was already negotiating a make-up schedule for the work he missed. Next, a frequent schedule for follow up. Though I suggested he try to find a therapist he can trust and talk to, I wasn’t going to wait for that to kick in. Whenever I start someone on medication, I see them at least once a week. So he’ll be back next week with a progress report. Finally, I told him I would call his parents and ask them to un-ground him. He is punishing himself for this mess much more painfully than anything a parent can devise. And at his age, a major source of support is his friends. Now, at this troubled time, he needs them more than ever. His parents should embrace their help.

I discussed with him explicitly what I would like to tell his parents when I called them. We agreed on a plan. When I spoke to his mother, she was OK with the plan. I’m awaiting a call back from his dad.

J told me that he felt much better after the visit. I think it’s because at least there’s now a strategy to get through the crisis. It won’t be easy—he has a lot of work to do. But his parents are behind him and I’m behind him.


  1. Reading this sheds so much light on my own experiences as a teen. Of course we all feel so alone as adolescents - like we are the only ones who have ever felt these intense feelings. Funny how we are all so similar in that unique identity!
    So much easier to get through it and to learn from it with the support of family and friends.
    Thanks for the post.

  2. In a world of such fast paced lives, it is humbling to read about you taking time to provide unconditional support to this young boy. It seems the boy just needs someone who is neutral and to give him a bit of attention and respect, I commend you for being that person. I think it is especially difficult as a teenager to find a adult to talk to beyond family and friends.

  3. Wow, this child is so incredibly lucky to have you as a doctor. I'm blown away.

  4. I completely agree with you about every teenager having a "Safe adult" to turn to. In fact, I think every individual (child, teenager, or adult) should have someone they can talk to freely. Growing up, I never really had such a figure in my life because, unfortunately, my doctor never reached out to me the way you reach out to your patients.


Please let me know what you think. Do you know a child or situation like this?