Year by year, there are more and more suicide attempts among young people, and the number of children and adolescents who self-harm is increasing. Why? [BOOK FRAGMENT]

– I often hear from young people in my office that they like to party – says Cezary Żechowski, a psychiatrist for children and adolescents. When the parents are not home, they have parties that attract a lot of people. There is alcohol and psychoactive substances, there is sex, all kinds of experiments. Sometimes it is damaged, sometimes it is stolen. Then there is cleaning, covering up the traces. Parents come back and usually have no idea what was going on in their house.

1. The statistics are very disturbing. The number of mental disorders and suicide attempts is increasing among adolescents
2. Parents not only work more, but also experience enormous stress related to the insecurity of their professional situation. Today, they can devote much less attention and time to children than in the past – explains Dr. Żechowski
3. I have been working as a child psychiatrist for thirty years and I used to ask young people often: “What is your hobby?” In reaction, I often see surprised eyes and hear: “I’m watching something on the computer.” “Well, different sides. Different things”. Lack of specific interests translates into worse social functioning
4. The psychiatrist also explains that mental illness in young people is usually triggered by psychoactive drugs. “Their availability has increased significantly, especially afterburners, which are very, very dangerous,” he explains
5. The interview is an excerpt from the book «Psychiatrists. Secrets of Polish cabinets »Ewa Pągowska, who was released at the end of October by the Znak publishing house
6. You can find more such stories on the TvoiLokony home page

Experts sound the alarm that the number of mental disorders in adolescents is increasing. One in five teenagers has mental or behavioral problems. Police statistics show that there are more and more suicide attempts in this age group in Poland. What it comes from?

There are several reasons for this. The first is the great social change that has taken place in recent years. Parents not only work more, but also experience enormous stress related to the insecurity of their professional situation. They struggle to somehow control this fluid reality in which they live, to gain some sense of security. Today, they can devote much less attention and time to children than they used to.

When I was a teenager, my parents did work shorter hours, but I don’t remember that they were too close to me or my peers.

But they were present. It is important to know that there is someone at home to turn to if necessary. The children played in the courtyards, and in the houses surrounding them there were always adults who looked out the window from time to time. There were stronger ties between the neighbors. Someone has always had an eye on these children – theirs or someone else’s. British psychoanalyst Donald Woods Winnicott has often emphasized that it is something else to play when the mother is present, even occupied with her duties, but nevertheless devoting some of her attention to the child, and something else when it is playing completely alone. In the former case, the child may be aware that it is in the mind of a loved one all the time, which gives a great sense of security. The second situation breeds uncertainty and fear. Another reason for today’s problems is the tremendous increase in learning requirements.

Even if a young person is getting along with it, the stress level that comes with it is enormous! There is no time for rest, relationships and fun, which at this age is mainly about creating something new, entering groups, for example theater groups, developing interests together, setting up music bands, pursuing passions. I have been working as a child psychiatrist for thirty years and I used to ask young people often: “What is your hobby?” It was their favorite question and it helped to establish a better relationship with them. It made teenagers feel like experts in it. It has been different for the last ten years or so.

How?

In my reaction, I often see puzzled eyesight and hear, “What are you talking about?” When I explain that about interests, what they do in their free time, young people say, for example: “I watch something on the computer”. I ask, “But what do you choose?” “Well, different sides. Different things”. So I ask about music, about my favorite artists and I hear: “I can’t name any band because I listen to different bands.” People who have somehow shaped interests and pursue their passions belong to the minority. Today we know, and it was contributed to by the research of the American neurobiologist Jaak Panksepp, that fun, hobbies, interests and passions are very important factors in the formation of a personality. Animal studies have shown that those previously deprived of play had poorer neural networks in the brain responsible for social functioning. Panksepp believed that if her need was not met in her childhood, he would speak up later anyway.

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How?

According to him, the neuronal system responsible for play can also be stimulated by taking psychoactive substances. Following Panksepp’s thought, it can be said that if someone did not save himself in childhood, and thus did not have the opportunity, for example, for free, creative, socially accepted play, which sometimes took place under partial supervision of adults and some of its dangerous elements were corrected, then in adolescence, he may have a greater need for psychoactive substances. Indeed, the number of young people who accept them is increasing. I often hear from young people in my office that they like to party, and there is nothing wrong with that, but in some groups the fun looks like rapper Mata in Pathointelligence. And that’s when the problem arises.

How exactly does this game look like?

Exactly how he sings about it.

He sings, among other things, about drinking alcohol before class, about casual sex, also in a threesome, about taking drugs from his parents, playing poker for money, taking heroin and cocaine, and smoking marijuana. Is this what the young people are telling about?

Some people do. They say they work as hard as they do in a corporation. And then, when the parents are not home, they throw parties to which a lot of people come. There is alcohol and psychoactive substances, there is sex, all kinds of experiments. Sometimes it is damaged, sometimes it is stolen. Then there is cleaning, covering up the traces. Parents come back and usually have no idea what was going on in their house. How the fate of these young people unfolds depends to a large extent on the dose of their experiences of this kind.

How do you help addicted teenagers?

I do not deal with addiction treatment. My role is to make a diagnosis, assess how serious the problem is, whether we are dealing with incidental use of psychoactive substances or with addiction. It is important to assess whether the young person has any other disorders, such as depression or drug-induced psychosis or ‘legal highs’. Only then can you decide what kind of help you need to provide, for example whether you need treatment at an addiction treatment center.

Have you come across a situation in which psychoactive drugs activated a mental illness?

Ma’am, I see this all the time. The availability of these drugs has increased significantly, especially afterburners which are very, very dangerous. However, I would like to go back to the point where addiction develops in a young person. The first contact with drugs or legal highs may be an experiment. However, if at some point a teenager loses the ability to regulate feelings through relationships with others and stops talking, confiding, and seeking support from others, he may begin to cope with difficult emotions by adopting various measures. Relationships then lose their importance, the young man realizes that he can take some substance and he will feel good too. For a short time, he does not have to seek support from others.

Especially since this search can be very difficult. Also because building a relationship takes time, and there’s not enough time.

This was clearly demonstrated by the last year’s study I co-conducted with the psychotherapist Hanna Pinkowska-Zielińska. We wanted to find out what the youth were doing during the teachers’ strike. I talked to younger teenagers from a small village in the Kuyavian-Pomeranian Voivodeship. One girl said, “I was able to devote my time to my little sister. I took care of her and saw her take her first steps. ” Another recalled: “I could visit my dad. I rarely see him because he lives in another town. ” One boy said, “My dad is a farmer and I was able to help him cultivate the field. I drove a tractor with him. So what did the youth do with this free time? She turned to what she missed most, i.e. relations with her loved ones. And it was a shock for us because we thought that she would only use smartphones and sit on the internet.

Social media, smartphones, computers and the internet are also often blamed for the increase in mental disorders in children and adolescents.

I do not consider the impact of new technologies to be unequivocally negative. There are studies that show that they also have a very positive function. Thanks to various communicators, young people can stay in touch with each other. If something is wrong with your teenager, their friends have a chance to notice it quickly. For example, they can ask on Messenger: “Where are you?”, “What’s the matter with you?” The young man has a chance to gain support. Of course, it happens that he experiences exclusion and hate on social media. It is also dangerous that smartphones have eliminated boredom, and she played an important role. She showed that time flows, has some value, she allowed herself to meet her thoughts and the thoughts of other people. Today, in smartphones, people are looking for respite, rest, entertainment and stimulation.

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And they find them.

To paraphrase Marx, it can be said that smartphones are opium for the people. Another reason for the increase in mental disorders among adolescents is what many therapists pay attention to, especially those from the mainstream of systemic psychotherapy. They say the microsystem always recreates the macrosystem. The former is, for example, the state. The second is family, school or peer group. We have an image of the macrosystem in the media. If there is a language of hate, competition and aggression, then in our microsystems we immediately begin to imitate it, for example, youth copy brutal language. Let me give you an example from my childhood. I have often watched on TV Cobra². The protagonist was a detective who impressed me very much. In one episode, he kept answering silent calls. Finally he said into the receiver: “Speak up, you motherfucker …”. The next day a friend came to see me. While we were having fun, the phone rang. I picked it up, asked “Hello?” But no one came forward, so I quoted a detective from Cobras. My friend’s father spoke up, introduced himself and asked if his son was with me. I dropped the scared receiver. I was terribly ashamed.

You have copied the macrosystem.

Yes. Today’s wave of hatred and hatred at the top of the government is moving downhill in no time. Families, minority groups and young people become victims. Bullying, or bullying peers at school, is a powerful source of problems. People who have become the object of insults, scapegoats, sometimes come to me with very serious post-traumatic disorders.

What are they saying?

Ma’am, they don’t say anything. That’s the problem that they don’t say anything. A child or young survivor of bullying usually does not come to their parents, psychiatrists, psychologists or teachers and does not confess that they have been the target of bullying. Why? Because he is ashamed.

What? It is not she who should be ashamed!

She is ashamed that she has let her parents down. A teenager wants to be an adult, to become more and more competent in various fields, to have an increasing range of autonomy. If he thinks he has failed in a task, such as building relationships with peers, he considers it a failure. He is terribly ashamed. And this feeling is strongest precisely when the child has been the target of the abuse. He says nothing to anyone, but he begins to have anxiety or depressive symptoms, and stops going to school. Occasionally psychotic symptoms may appear. A psychiatrist or psychotherapist must first create a sense of security for the young person so that they can start talking about these experiences.

What does such a conversation with a teenager look like?

When he comes with his parents, I ask him, “Can I only talk to you first, or would you prefer that we talk to the parents as well?” Some young people really want to know their version first, listen to them first. In others, however, the level of anxiety is so high – because, for example, they have been harmed by an adult – that being alone with a psychiatrist in the office turns out to be too difficult for them.

People who have become the object of insults, scapegoats, sometimes come to me with very serious post-traumatic disorders.

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Let’s say a teenager only wants to talk to you.

I start by asking, “How can I help you?” Quite often I hear, “I don’t know,” and then say, for example, “So how did you get here?” There is an exchange of views. “Mother brought me.” “So you didn’t want to come here?” “Well, I didn’t want to. I do not have any problem”. “OK I understand. What worried my mother? ” “He says I don’t go to school.” “And how is it really: are you walking or not?” “Come on, sometimes I go.” And then we can usually start talking about his problem. But it happens that he replies: “Ask your mother,” and then we invite mother to an interview. And if he doesn’t want to say anything or even be in the office, I only talk to my parents.

What happens when you see the necessity and possibilities of helping a teenager, but he definitely refuses?

If there is no threat to health and life, I tell him what my offer of help is. If he comes to the conclusion that I can be of use to him, he has a path to my office

open face. It wouldn’t do any good to put pressure on you. However, if I see a serious threat, I send him to the hospital. Suicidal thoughts appear quite often in adolescents. They do not necessarily have to be dangerous, but if they are accompanied by deliberations on how to commit suicide, or even a young person is planning it, i.e. we are observing the so-called suicidal tendencies, we must intervene. Especially if we know that he is taking psychoactive substances, has no support in his loved ones or is very closed and does not want to share his experiences.

In what other situations, apart from life-threatening, a young person is referred to a psychiatric ward?

Are we talking about an ideal situation?

Yes, because we all know the real thing. The problem with the availability of places in hospitals is so great that a child whose condition is not life-threatening may wait up to 720 days to be admitted.

Apart from life-threatening situations, patients should be referred to a psychiatric ward, if there is a threat to their health, and outpatient care does not bring results, the patient or his parents do not cooperate in the treatment. Sometimes only observation in the ward allows to establish the correct diagnosis. On the basis of contacts with the patient, for example, once every two weeks, it may seem that he is depressed, and in the hospital we see that he is depressed for an hour or two a day, and besides, he runs around the ward smiling.

Parents are often afraid to put their child in a psychiatric hospital. Especially since there have been reports recently that things are going very badly in some establishments. Public opinion was particularly shocked by the report on the children’s ward in Józefów. The journalist described very bad conditions and a terrible way of relating to patients. To put it mildly.

We should be grateful for this article, really. Although I would disagree with many things, I do not know personally the ward that was described, but the message is valuable that conditions in psychiatric hospitals can be very difficult, there is a shortage of staff, the situation is crisis and changes are necessary. However, I have a feeling that they are already happening, and the emerging Mental Health Centers, which are part of the ongoing reform of psychiatry, are an example of this. They will give a chance to provide faster and more comprehensive help.

There are also accusations in the text that patients are being given inappropriate drugs, in excess and without consulting their parents.

We have algorithms of conduct developed by teams of experts. These algorithms are based on research and clinical experience. We follow them when prescribing medications. I really don’t see psychiatrists administer drug therapy in a way that jeopardizes patient safety. I would compare arousing fear of drugs to the actions of anti-vaccines. Failure to take antidepressants can sometimes result in the patient trying to kill themselves. Today, psychotherapy is idealized and I say this to you also as a psychotherapist. Meanwhile, it is not a panacea, and can even be harmful. Studies show that in twelve percent of patients it leads to a deterioration of their condition. Really, sometimes you can’t procrastinate with taking more serious measures. At the beginning of my work, I was treating a patient with a severe form of catatonia – she froze for many hours in one position and could not take food or liquids. Everyone urged me to use electroshock, and I protested, “How is that? It’s inhumane, ”although the literature showed that in the form in which they are used today, they are effective and safe. It almost ended in a disaster. Fortunately, I changed my mind and after three treatments, the catatonic symptoms began to subside until they finally disappeared.

Is it true that antidepressants can increase the risk of suicide in people under the age of XNUMX?

At the beginning of the XNUMXst century, it turned out that some of the most commonly used antidepressants of the latest generation may increase the so-called suicidality in young people, i.e. anxiety associated with suicidal thoughts and a tendency to self-harm. It also turned out that the companies researching these preparations did not provide all the results. It was a shock. Many psychiatrists then gave up administering these drugs to people under the age of eighteen. However, later research showed that it was this decision that led to an increase in the number of suicides. Therefore, expert committees chose the preparations that are the safest for young people and recommend that parents and children be warned that suicidality may worsen at the beginning of pharmacotherapy. It is then necessary to be more careful.

Year after year, there are more and more suicide attempts, but also – as the research of the Empowering Children Foundation shows – the number of children and adolescents who self-harm is increasing.

It seems that self-harm may be a symptom associated with personality disorders, especially borderline personality disorder. It is associated with disturbances in the regulation of emotions and attachment. Stendhal wrote in one of his books that the power of a child’s power lies in his crying, but if this cry is not heard, the child begins to hurt himself. So perhaps this is some old evolutionary mechanism for attracting the attention of an important person in English security provider, that is “the one that gives a sense of security”. This person can be a parent, but also a friend.

But the teenager hides his wounds, does not show them off.

Well, of course, he hides it, but for a time. Someone will eventually notice them. And then we are generally very concerned. Self-harm also has other functions, such as relieving tension. Physical pain can reduce psychological pain. Over time, the way you feel the former may change so much that it becomes enjoyable and becomes a kind of stimulation, especially when endorphins are released to relieve pain. You can even get addicted to it.

Can teenagers say why they are doing it?

Usually they just say: “I felt terrible” or “I was down” – it’s more or less a relationship. But there’s always some untold story behind her, so I ask, “When did you get this down?”, “What were you doing then?” Then I ask what happened before, and it turns out that, for example, my friends organized a meeting and did not tell my patient about it, but posted a photo on Instagram. When she saw them, she felt very bad. Very often, rejection or exclusion – real or imagined – provoke self-aggression in adolescents.

But it is said that the most difficult thing to help are adolescents who suffer from eating disorders, such as anorexia, because a young person refuses to help.

I cannot say that some disorders are more difficult to treat than others. It all depends on the specific person. Sometimes he is in a very difficult situation, he does not want to help himself, we see that he is headed for some catastrophe, and we are helpless. Indeed, in anorexia nervosa, the symptoms are often egosyntonic, that is, “self-conforming”. This means that a person who suffers from anorexia considers the symptoms of this disorder to be good and does not want to get rid of them. Anyway, hunger can turn into a pleasant feeling over time, start to stimulate the reward center. All of this actually makes eating disorders difficult to treat, but many patients have been able to help. Family therapy is especially effective, but that does not mean that parents are responsible for these problems.

And you can often meet with such views.

Yes, this belief is so common that the American Psychiatric Association has given very clear guidelines not to blame parents for eating disorders. He considers it counterproductive. One anorexia researcher noted that there is not much evidence that eating disorders are caused by parental actions, but there is much evidence that it is difficult for a child to recover without parental involvement.

I have the impression that today parents are often blamed not only for their children’s bulimia or anorexia, but also for all mental disorders.

The closest people, such as the family or teachers, are usually blamed for the problems. On the other hand, in our offices, we most often encounter a lot of suffering, a great anxiety of parents, we often see those who are really caring and devoted. So I am against telling them that they are angry, hard-hearted and just picking on this child.

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