The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™

Recent emails from adolescents grappling with ongoing depressed moods, if not clinical depression itself, reminds me that the Fall school season is lurking, if it hasn't already started.  I'm not surprised.  A significant change in one's routine, e.g., of schedule, social roles and task-emotional demands, often is a catalyst for bringing to the surface psychic turmoil churning below.  Of course, if one is continuously fighting off or blocking out strong feelings of anxiety or dark mood clouds, the prospect of managing school performance or peer pressure is daunting at best, threatening or humiliating at worst.

And perhaps the saddest part of my teen correspondents' plight is the perception that they cannot turn to their parents for guidance.  These youngsters believe (rightly or wrongly, though I suspect the former too often applies) that, in some fashion, they will be told:  "Oh, everyone goes through depression in adolescence…It's just a phase…Don't make such a big deal of it…Stop feeling sorry for yourself…Just pull yourself together…Life is rough - deal with it!"

Sounds like a dysfunctional home front, frankly.  Reminds me of a pompous State Department Manager who challenged me during a workshop, pointedly asking:  "What do you call it if you don't have any stress?"  My immediate reply:  "Denial!"

I don't know about Mr. Bluster, but I suspect a number of the parents of these teens are:
1) struggling with their own depression or alcohol-related conditions,
2) avoiding memories of depression in themselves or family members growing up, and/or
3) so stressed out by day-to-day living that they cannot take on any more pressures.  A child struggling with depression becomes too burdensome or "too whiny."

Under a siege or state of helplessness and feelings of worthlessness, the child shuts down (becoming invisible or putting up a false front) or erupts.  Stress smoke signals include an inability to concentrate or fighting at school, shoplifting, bingeing, acting out sexually or, even, numbing the pain through cutting (and not just classes) or other suicidal gestures and acts.

When feeling so isolated or alienated, what is a troubled teen to do?  Consider "The Stress Doc's Survival Tips for the Vulnerable, Depressed Student":

1.  Trust Your Gut.  A chronically stressed individual probably knows in his or her heart, if not the head, the difference between moodiness and ongoing depression.  Despite what others around you may be saying, your pain is real.  Unlike the emailers, even most teens, not just some family members, try to deny or ignore the seriousness of this depressed state for fear of being labeled "crazy" or emotionally "weak."  While melancholia or anxiety are exacerbated by prolonged or dramatically acute stress -- for example, a rape -- clinical states are often associated with:
a) abandonment by a parent, premature death of a significant other or childhood abuse, for example, an ongoing pattern of verbal, physical or sexual mistreatment and/or
b) a family history of depression, that is, there's a genetic predisposition which when combined with ongoing distress induces a damaging change in hormonal or biochemical levels of functioning.

But even clinical states of depression or anxiety do not mean you are crazy or you are worthless.  It means, presently, you don't have sufficient bio-psycho-social support or resources to regain mind-body-spirit equilibrium and to engage productively and playfully in your designated social roles. 

Consider this analogy:  If you were a mind-body car, depression is being two quarts low on oil.  Despite sensing some impairment in functioning you continue driving yourself around.  You avoid going into a gas station to get your full complement of oil.  (Now maybe if you repair the leak in the oil case, you won't need to resupply but one time.)  Escapist behavior, not getting your vital fluids checked (as well as other systems that may have been affected by the oil seepage) is self-defeating.  Over time, this draining/avoiding pattern may be a sign of or catalyst for being out of control, a "mechanical" breakdown, i.e., some so-called craziness.

2.  Seek Out a Trustworthy Adult.  If you have really made several attempts to talk with your parents and they can't or won't be the gas station attendant or mechanic, look elsewhere.  Try enlisting an ear from adults in your family or home environment, that is, do you have a close relative?  Perhaps there is a parent of a friend you might confide in, or a spiritual advisor.  Hopefully, these adults help reaffirm that agitation or depression is a real medical, psychological and social-family condition (not "just in your head").  And perhaps they can advocate for you with your parents.  But remember, many adults do not fully understand the nature of clinical conditions like depression.  They don't understand how a child can have a false self; how he or she can present a seemingly normal, i.e., moody, if not happy, front to the outside world while one's true self is seething, withering or choking inside.

3.  Call a Crisis Hotline.  Sometimes it's easier to connect anonymously with a counselor, especially when struggling with feelings of shame or inadequacy.  It's why teens email me or find a website like "The Bright Side" such a safe haven.  But when the black hole pain doesn't go away after a couple of weeks, go beyond the virtual.  Consider calling your local hotline to connect with someone who likely understands your complex situation.  This crisis specialist will help you begin to sort out your emotionally entangled or seemingly overwhelming life.  Such counselors know face-to-face resources and may even provide tips on how to approach defensive or disbelieving parents or other adults.  But first and foremost, hopefully, you will talk with an adult who seems trustworthy.

While this is unlikely, you may feel an adult you are confiding in is trying to take advantage of you.  This can occur with questions that feel too prying or invasive (and the adult won't back off even after you ask him to).  Real discomfort and fear can also emerge in an in-person situation if the person with who you are sharing engages in touching that you find uncomfortable.  Again, if the person does not respect your boundaries, report this experience to an adult you trust.  And, believe me, I know such a step takes uncommon courage.

4.  Talk to a School Counselor.  While school may be the latest stress trigger, sometimes the feared situation can become "the pass in the impasse."  You just might find a trusted and knowledgeable adult in the role of guidance counselor, school social worker or, even, a past teacher.  Don't wait till grades are faltering or failing to reach out.

Again, while we often believe our plight or circumstances are unique (to some extent they are, of course) that no one can understand, these professionals likely have grabbed the arm of other drowning or suffocating students and pulled them out of agitated or depressive quicksand.  These individuals also have the authority and responsibility knowing you are hurting to call in your parents, explain your situation, recommend individual and/or family therapy or, if necessary, recommend a consult for medication. 

And meeting with a psychiatrist to evaluate the appropriateness of medication does not mean you are crazy.  Remember our "two quarts low" example?  Sometimes a brief trial of medication can help rebuild the energy and capacity for concentration that you need to tackle various schoolwork, home and social demands.  And once you've experienced some clarity, if not mastery, the vicious cycle can gradually be replaced with a naturally vital one.

5.  Make a Stress Buddy.  Whether you are ready to reach out to an adult or not, forging a friendship with a peer with whom you feel safe, with whom you can share your strengths and insecurities is key part of growing up.  Of course, this is difficult when feeling way depressed or stressed out.  Still, there is likely one other student in your classes or in the cafeteria with whom you can walk those mean halls together.  (You don't have to be a social butterfly.  Again, just as you must use judgment in deciding whether an adult is trustworthy, the same for a prospective close friend.  The wrong person or gang can drag you deeper into the abyss.)

Perhaps this person can be a homework buddy as well.  When we are having difficulty concentrating or are feeling isolated, just the presence of a friendly face across a table can help us focus.

6.  Begin an Exercise Program.  You and your "study buddy" will eventually need a stress break.  Going for a walk, jog, bike ride, rollerblading, etc., is a great way to also alleviate tension.  Non-stop exercise for 30 minutes releases mind-body natural mood enhancers and pain relievers called endorphins.  While endorphins won't cure major depression, they will provide some relief -- they produce a calming effect -- from preoccupation and moodiness.  Your world seems less chaotic.

Also, when everything seems bleak or uncertain, an activity like exercise creates a success ritual.  Brisk walking or jogging two miles provides a beginning and end point for a tangible sense of accomplishment and control.

7.  Discover a Hobby or Creative Pursuit.  Hopefully, if you've begun to implement the above strategic steps, you are starting to sense some sunlight is breaking through the black clouds.  Use this light to explore new hobbies or interests, or even old ones that you have lost touch with in your darkened fog.  Actually, people with moody, depressive conditions often have the psychic raw material that fuels creative expression -- painting, music, poetry, theatre, dance, etc.  Transforming one's pain into a novel or imaginative product or process definitely helps escape, at least for a time, one's burdensome or vulnerable state.

Of course, it's more than an escape.  A conscious and unconscious mind when creatively engaged is able to shape, even play with, that heretofore-amorphous smothering mush or maelstrom of hormones and feelings.  Channeling emotions of hurt, helplessness and humiliation into an artwork or story in which we leave our own mind-body imprint yields uncommon satisfaction and pride, as well as a sense of hope.  For a moment we have become transcendent:

For the phoenix to rise from the ashes
One must know the pain
To transform the fire to burning desire!

And when we capture our uncommon essence -- strengths as well as weaknesses -- in some harmonious whole, then others can see, hear or taste (cooking can be another creative endeavor), can understand and empathize with and, maybe, learn from our plight or pain.  Talk about coming full circle or a sense of rebirth.

8.  Write On.  While mentioned briefly above, writing doesn't have to be creative to be helpful.  Journaling can be a very therapeutic window into our psyche and soul.  Research has shown that when people write out or write about issues bothering them -- capturing both their emotions and analyzing the tension-inducing factors -- the process helps people step back and examine their tumultuous life from a more calm or less frantic perspective.  Problem solving options arise from the page.  And, bottom line, these writers report being less stressed.

9.  Join or Create a Support Group.  One of the wonderful things about the Internet is there are many opportunities to discover and possibly connect with kindred spirits or, at least, peers in a similar boat.  There's a chat group for almost any imaginable issue.  (Again, caution is advised.  Look for a chat group with a mature, if not a professional, facilitator.)

Of course, don't be limited to just virtual support.  Schools, community centers, "Y"s and religious institutions often provide venues for group discussion and supportive problem solving.  The 12-step group Alcoholics Anonymous, for example, has a group called Al Ateen, for children impacted by the drinking of an adult family member, or who are grappling with their own substance abuse issues. 

For teens struggling with depression and, not surprisingly, feeling self-conscious, opening up in a public forum may seem hellish.  I just know that my years in group therapy, which began just a few years past adolescence, provided immeasurable help in gradually coming out of the depressive closet.  Even if you don't say anything, you will learn much and feel considerably less isolated by listening to others' stories, trials and small triumphs.

10.  Life As an Evolutionary Achievement.  Alas, evolving from childhood to adulthood is often a time of many trials and traumas, tears and tantrums.  And adulthood is hardly a piece of cake.  But meeting challenges, developing behavioral, cognitive and emotional skills, forging peer friendships and adult relationships that support our climb up the mountain of self-identity, skill-based competency and psychological resiliency are some of the most rewarding aspects of life.  And the climb sometimes can feel like two steps forward, three steps back.  Yet, with the right guidance and our own persistence we are often surprised by how far and high up we can go with our so-called "damaged goods"; we marvel at how wide the horizon from this hard-earned vantage point.

As the famed discover of one of the cures for the dreaded polio disease, Jonas Salk, observed, life is not about perfection or straight line progression:

Evolution is about getting up one more time than we fall down; being confident one more time than we are fearful; being trusting just one more time than we are anxious.

Surely these are words to help us stand up, reach out and bravely engage with the depression, school and family battlefronts.  With the above ten tips, surely these are words to help us all…Practice Safe Stress!

Mark Gorkin, LICSW, "The Stress Doc" ™, an international speaker and syndicated writer, is America Online's "Online Psychohumorist" ™ The Doc runs his weekly "Shrink Rap and Group Chat" on AOL/Digital City DC Stress Chat .  See his award-winning, USA Today Online "HotSite" -- www.stressdoc.com Stress Doc homepage (recently cited as "comforting" resource in a National Public Radio feature on "Bad Bosses").  Email for his monthly newsletter recently showcased on List-a-Day.com.  For more info on the Doc's "Practice Safe Stress" programs, email stressdoc@aol.com or call 202-232-8662.

(c) Mark Gorkin 2002
Shrink Rap ™ Productions