I met Naman in 2012. He was accompanied by both parents. They said he had “always been a problem child.” He had had to change schools four times in ten years because school managements found him “disruptive and a bad influence on other children.”
He was now 19-years-old and had a “serious drug problem.” He stayed in his room all day, going out in the evenings for “weed parties.” His parents wanted him to stop using drugs and start going to college, hence the hospital visit for a consultation.
I had a session with the boy alone. The points that stood out in his version of his life were: His parents’ relationship had been through frequent rocky patches, causing him a lot of anxiety throughout childhood; his mother was always on a short fuse and whacked him frequently for little transgressions, while his father usually yelled at him and called him a loser; at every new school he had had difficulty adjusting; no effort had been made to find out the cause of his disruptive behavior in school; he had been enrolled in a Business Management course in June, 2011, because his father assumed that Naman wanted to continue the prosperous family business.
Writing was Naman’s real interest. He had enjoyed English and History in school and done well in the IGCSE (International General Certificate of Secondary Education) exam in tenth grade. His parents had made the decision to send him to a CBSE syllabus school in the 11th and 12th grades, and he had somehow acquiesced. He had found the courses boring and had soon lost sight of where he was headed career-wise. Then came the admission to the Business Management course.
This youngster was depressed but it did not appear as such, because he was so lost. He had no hope of changing the course of his life and had given up trying. He didn’t even cry anymore because, as he asked with a wry smile, “what’s the point?”
He had been reading philosophy on the internet in his quest for meaning and had found some sort of an anchor in Albert Camus’ premise that life is inherently absurd and should not be approached rationally, and lived as though it is. So he had accepted that his life was an absurdity and he had no choice but to live it out with no expectations.
He said he was “not a logical and scientific type, more a creative and intuitive type”, but had tried to pretend for a bit that academic achievements were very important. It had not been possible. He said he envied studious kids who loved science and immersed themselves in preparing for entrance exams to engineering colleges. Sometimes he wished he could be like them, but knew he could not.
We decided to hold off antidepressant medications as he was willing to talk things out and had the bandwidth to discuss things in abstract terms.
By the third session, Naman’s mask of indifference slipped as he began to acknowledge how he had let things slide by his inaction. This uncovered his underlying depression. I started him on a standard dose of a mild antidepressant that would also control the anxiety that accompanied his insights.
At the fifth session he told me he had made a decision to drop out of the business course and apply to a Liberal Arts college to major in English. He soon left the city and I did not meet him again. The plan had been to refer him to a clinical psychologist for therapy to help him overcome the longstanding vulnerability generated by adverse childhood experiences, unlearn maladaptive coping strategies, and gradually put better ones in place.
Youngsters with histories like Naman’s are not unusual at all. Their problems appear to be a result of constant stress in some form or the other, through their early years.
A certain amount of stress while growing up is normal. It makes people resilient and more able to cope with stressful situations in adult life. Constant stress, though, can make relatively permanent changes to brain circuits in the hippocampus and amygdala, and make them vulnerable to stressors years later. A child may outwardly seem to adapt and get used to longstanding stress, but is left vulnerable to depression in response to stressors later in life.
Another factor contributing to depression is genetic vulnerability. People with certain genotypes are more likely to develop depression when exposed to too many stressors, while other genotypes make people more resilient.
Depression is a product of nature plus nurture. Even a genetically vulnerable child can grow up to be strong and resilient if his or her childhood is free of large amounts of stress. Conversely, a child born healthy can grow into a depression-prone adult if exposed to continuous stress, which could be what happened with Naman.
Antidepressants reduce depressive symptoms and anxiety. They also, to some extent, are said to repair nerve cells damaged by chronic stress. A short course of medication, along with psychotherapy, helps lost and depressed people like Naman chart more meaningful courses for their lives, thereby reducing the occurrence of depressive episodes.
In this series Dr Shyamala Vatsa highlights the fact that teenage changes can mask incipient mental health problems. These articles show how early symptoms of mental disorder can be taken for ordinary teenage behavior. As illustrated by the stories of young people who have suffered unnecessarily, it is important for friends and family to recognize when a behavior is outside normal limits, and seek help before things spin out of control.
Dr Shyamala Vatsa is a Bangalore-based psychiatrist who has been practicing for over twenty years. If you have any comments or queries you would like to share, please write to her at firstname.lastname@example.org