How do we address the needs of 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 a feeling of autonomy. 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’. 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 understand the experience of the person. 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 led 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.
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.
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 is 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. 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 two-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). In 2010, I developed a brief therapeutic community project similar in scope to Soteria which also showed that recovery is indeed possible without resort to often toxic psychiatric drugs and through intensive caring, compassion, patience, and understanding.
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 as well as discovery.