Two weeks ago a 12 year old named Jane came in to say how depressed she was. Most 12 year old girls will articulate the following story 99 percent of the time:
I think I might be gay/depressed/anxious/worried/scared or said the wrong thing on a group chat. I’m afraid my parents will kill me. I can’t sleep. I am on my phone all the time. I’m bored. I feel a conflict with one/both my parents. Something is going on at home/school that I cannot deal with. I have uncomfortable feelings. I think about what would happen if I was no longer here.
All these things are items we can deal with in therapy. By including the parents or school we have an even better chance of addressing them. These symptoms are not a strange black hole, rather, they are what therapists to teens and young adults encounter every day. If you identify where the depression is coming from, you can work with that. It might have a beginning, middle and end. But if it’s an alien feeling without basis, it’s more alarming. If an older teen can express her thoughts, she can also change them. If a 12 year old can describe her thoughts but feel powerless to overcome them, that’s trickier. If a kid has “passive suicidal ideation” it is different than one who says, “I have a plan…” Assess, diagnose, trust, differentiate, refer and relate, repeat. We have a Masters degree for a reason. It’s not hokus pokus; it’s carefully putting aside our own worst fears to hold, hear and protect others.
Jane was different.
Jane was so young to be describing her pain in such an adult manner. It struck me as odd. Her descriptions of a dark cloud that entered her world with no notice and hung around were bizarre. Coming out of nowhere, her depression deepened. She wasn’t herself anymore. She was terrified and crying out for help. Her parents were unaware. They were surprised when I pressed for a psychiatric eval on one so young.
The word “idiopathic” sprung into my head. This psychological jargon is usually off-putting to kids, so I rarely use it. However coming from nowhere was what was so striking about this case. No history of trauma except a difficult divorce and a parent’s chronic illness. These would be reason enough for a child to feel dysthymic, another catchy phrase meaning “depression lite” – however there was more to it. The kid simply could not shake the darkness. Lost interest in everything and was crying to me for help. She was brave enough to say just how weird (foreign?) it was; even the therapy wasn’t working. I pushed harder to go to the hospital. I instructed her not to be scared; we would try everything to help.
The hospital was a disaster.
In and out like a factory – didn’t admit her. Waste of time. And yet, they did send her to another inpatient facility where she ended up spending 10 days and getting on medication, with intensive DBT. I have yet to hear from the parents. But the hospital social worker called to tell me how well she was doing and thanked me. She said Jane was an unusually bright kid and a good move on my part. Hopefully she will return to our therapy more capable to move forward.
According to WebMD,
- Genuine depression is by no means unknown in preteens.
- “As rare as it is, there is a group of school-aged kids — and even a few preschoolers — who do experience full-blown depressive episodes,” Koplewicz says. “It is one of those times where it is not a parent or an environment that has done this. It is a predisposition, the same way some kids have autism or learning disabilities or a full-blown gift for music at age 5 or 6. It is purely a DNA blip.”
The striking thing was the intensity, severity, age and style. Her rigidity didn’t look like other young kids. She was just as surprised as everyone around her – where the heck was this coming from? Without any obvious family history, triggers or trauma it would be a guessing game, a chemical imbalance, a hereditary mystery. But we are here to help. Don’t underestimate us. We are not only kind; we must think on our feet and use profound life experiences to have the judgment to proceed. In other words, therapists are more than nice ladies. They must be intelligent. We study human behavior, dig deep within ourselves and put our own feelings to the test without judgment. We absorb and communicate at the highest levels possible. Yes, we also laugh and cry and connect. Looks easy. But it’s so much more. By pushing past Jane’s terror, parents’ denial, strange onset and a high level of distress both mine and hers, we were able to get help as quickly as possible.
Some are not so lucky.
Next time you think of it, thank your therapist for being smart. It counts.