What’s Really Happening with the Mental Health Crisis Among Adolescents? Part 2

Answer: Again, it’s troubling but perhaps not for the reasons you think…

*What’s Really Happening with the Mental Health Crisis Among Adolescents? Part 1 focused on how adolescents talk about their diagnoses on and off social media. To some, romanticizing diagnoses and making light of psychiatric crises is a good thing—a sign of decreasing stigma and evidence that adolescents find community and support online. To others, it’s alarming and sheds a peculiar light on the current mental health crisis. (Note: an adolescent is now thought to be anyone between the ages of ten and twenty-five.)

I recently attended a mental health conference, and one of the speakers on the youth panel was Martin Rafferty, the CEO of Youth Era. Youth Era is an impressive organization that offers an abundance of youth-centered services: drop-in centers and crisis support (in Oregon), virtual 4-day trainings for young people to learn how to support themselves and their friends, peer support on Twitch, virtual one-on-ones (limited to certain counties), positive posts on Instagram, chat on Discord, and so much more. What’s most impressive about Youth Era is that trained peer support specialists moderate its outreach efforts. Peer support specialists are those with lived experience of mental illness who’ve recovered and are trained to help others move toward recovery. (That’s not the case with Youth Era. Read on to find out why.) In other words, Youth Era offers young people ways to get guided help.

(If Youth Era’s mission speaks to you, you can donate here.)

At the conference, during the Q&A, an audience member asked Rafferty what young people think of the diagnoses they’re given. Rafferty replied that young people love diagnoses.

I wanted to know more. After the conference, I emailed Rafferty to ask him to clarify. Here’s his response:

[T]there is an extreme ownership and celebration of the positive parts of a diagnosis.

If anyone knows what young people are thinking, it’s probably Rafferty. This statement seemed to imply that young people are, in fact, adopting their diagnoses as identities.

(I asked Rafferty what the “positive parts” of a diagnosis are, but he didn’t respond to that question. Certainly, some people view certain diagnoses as positive, e.g., some members of the neurodiversity community.)

Rafferty’s response saddened and worried me. I received my first diagnosis when I was barely in my teens, embraced it as part of my identity, and ended up in the mental health system for twenty-five years, suicidal and without hope of recovery.

I’m not a parent, but I saw that I was (perhaps) making a classic parental mistake: equating my experience to adolescents’ experiences today. I tried to imagine how maybe embracing a diagnosis at a young age before the brain is fully developed when they still can’t make adult decisions and without knowing much—if anything—about the diagnoses they’re adopting could lead them to have a full life. Maybe young people are onto something.

But diagnoses have a backstory. Psychiatric diagnoses come from a book: the Diagnostic and Statistical Manual of Mental Disorders (DSM). Unlike most disorders in medicine, they aren’t based on science; they’re hypothesized was of categorizing aspects of the human condition (thoughts, feelings, and behaviors) when they present dysfunction. But no biological markers can distinguish between what’s “normal” and what’s a sign of dysfunction or illness. No blood test, x-ray, or biopsy can show a person has the diagnosis given; based entirely on self-reported symptoms and the opinions of clinicians, researchers, and mental health professionals.

That said, diagnoses are useful because we use them, and many people find relief and solace in their diagnoses. But there was more in Rafferty’s email:

For the generation we are working with, the concept of recovery hasn’t been embraced, actually it’s been disavowed. From my experience, this generation refuses to have a mental health diagnosis to be classified as something to overcome…and in place of recovery, the pursuit of finding coping mechanisms to handle one’s negative “symptoms.”

(The ellipses indicate the one sentence quoted above. I didn’t alter Rafferty’s email in any other way.)

How could young people not want to get better? How could they want to see themselves as having a diagnosis when they could possibly get well? Even if they embrace the “positive parts of a diagnosis,” they’re still thinking of themselves as sick and limited with no hope of changing that.

After all, recovery—full recovery—from mental illness—even serious mental illness (psychosis, mania, suicidality) is possible:

• Among adolescents who suffer from acute depression, more than half never experience another major depressive episode again.

• A 2020 study showed that anxiety disorders have a complete recovery rate of 40 to 72 percent.

• In eating disorders like anorexia and bulimia, full recovery is shown to be 62 percent and 68 percent, respectively.

• Childhood ADHD has a full recovery rate of 40 to 50 percent. One study showed that 65 percent of adolescents diagnosed with ADHD no longer met the criteria ten years later.

• Studies show OCD is curable in children, who often grow out of it without treatment.

Here’s more on recovery from psychiatric illness featuring the esteemed Rob Whitley, assistant professor in the department of psychiatry at McGill University and a research scientist at the Douglas Hospital Research Center:

I kept trying to understand why a young person wouldn’t at least try to recover. To be fair, recovery isn’t well-publicized. During my twenty-five years in the mental health system, not one clinician offered it to me as an option. In all my training as a peer support specialist, I haven’t spoken to a single person who was told about recovery by a clinician. That said, I have spoken to clinicians who say they talk to clients and patients about it.

Also, recovery isn’t cool right now; diagnoses are. TikTok therapists advise about them, and TikTok videos convince teens they have rare ones. They’re romanticized on social media and elsewhere, with some earning the reputation of  being  “cool” and “trendy.” Self-harm has been glamorized on Instagram and normalized on Tumblr. In a Vogue video, Kylie Jenner hears from a clinician in real time that she has social anxiety. News blogs encourage us to self-diagnose via symptom checklists. Anxiety and depression are merchandized.

Christina Caron’s New York Times piece, “Teens Turn to TikTok in Search of a Mental Health Diagnosis” echoes Rafferty’s words but in a way that doesn’t feel as hopeful. It covers a lot of ground, primarily about how teens are self-diagnosing and adopt symptoms based on TikTok videos. That is, of course, simplifying both Caron’s article and the situation. But Caron interviews sixteen-year-old Ronan Cosgrove:

[Cosgrove] said that among some of his peers it has become trendy to identify with a mental health disorder. For them, he added, it is considered a personality trait rather than something you want to heal.

“On TikTok they show ‘Oh, I’m this, and look at how cool I am,’ and then people will look up to those people — and it’s just so skewed and not, like, reality,” Ronan said. “It’s so easy to get roped in.”

Ultimately, adolescence is a crash course in mental and emotional distress. Still, I don’t doubt that some young people are very ill and desperate (see the comments in part 1 for an eloquent quarrel with what I’m saying), many are struggling, and the mental health crisis is real. The crisis was declared by The White House and the U.S. Surgeon General. It’s said to have been building since at least 2016, so we can’t just blame the Covid-19 pandemic.

But it leaves me wondering: Even if we did a better job of publicizing recovery, would young people even listen? What will they be like in five, ten, or twenty years? What will happen if they continue to reject recovery and believe that difficult emotions, troubling thoughts, and unwanted behaviors are always symptoms?

There isn’t an easy solution. One step is educating the public—particularly adolescents and parents—about the complex nature of psychiatric diagnoses. (There are many books on the subject: psychologist Lucy Foulkes’s excellent Losing Our Minds: The Challenge of Defining Mental Illness; psychiatrist and former Chair of the DSM-IV task force Allen Frances’ mea culpa Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life; and my own Pathological: The True Story of Six Misdiagnoses.)

We know recovery typically occurs when the patient or client engages in a partnership with the clinician and doesn’t sit back as the passive recipient of care. That can’t happen unless both parties are open and knowledgeable about the benefits and disadvantages of diagnoses and treatments.

Another solution may come from funding organizations that foster recovery and provide supervision in their youth programs, unlike the free-for-all on social media. You Matter is a blogging platform for adolescents ages 13 to 24; it was started and is managed by the National Suicide Prevention Lifeline. OK2TALK encourages recovery; its Tumblr feed is a safe space for young people to share their stories of mental distress, health, and wellness. The Youth Mental Health Project supports and empowers families to better care for the mental health of adolescents; the organization also promotes recovery.

I’m sure other youth-oriented organizations endorse the U.S. Substance Abuse and Mental Health Service Administration’s (SAMHSA’s) call to move our mental health system away from the maintenance and biomedical model that says we can’t heal to a recovery model that knows we can. If you’re aware of any such youth organizations, please post them in the comments below.

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For more on what we should be talking about, i.e., mental health recovery, read Cured: The Memoir.

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