Posted on October 19th, 2022

We’ve long known that suicide can be contagious without quite understanding how or why. In my practice as a psychoanalyst in New York, I recently worked with a 13-year-old girl whose friend had committed suicide during the pandemic and who had begun to feel suicidal herself. Teenagers are notoriously suggestible to peers, who buffer their nascent sense of self, so the 54 percent increase in suicides in the 10-to-24 age group between 2007 and 2020 is a serious cause for alarm.

Listening to my patient, it was a question about an unpredictable future that seemed most salient in her suicidal ruminations. This girl, who I will call by her first initial, B., to protect her privacy, spoke passionately about climate change, about racism and inequality, about all the “mental health” issues of her friends who were on this medication and that medication, and had eating disorders, attention disorders, self-harming behaviors and depression. Her burgeoning sexuality was also greeted as a threat — how can I be a sexual woman in this environment? Yes, the pandemic exacerbated a groundless feeling, but the way adolescents investigate their world for its failings means they touch an open wound in this country: What happens when we realize the escalator — so crucial to the American dream — didn’t go anywhere (and maybe never really worked, at least not for many)?

B. also spoke to the contradictions of her parents, who seemed unhappy in their work, in their role as parents, in the privileges accorded to them, along with those denied to them, and were enraged by the political environment on all sides. Yet, she proclaimed, they were pushing their daughters toward the same kinds of achievements and the same lifestyle, and any sign of negative emotion from their children was seen as an attack, as if they were pointing out that the life they were given wasn’t any good, when the reality of everything these parents said pointed to the fact that, well, life wasn’t so good. Why, she proclaimed, would she want any of this, and why do they want her to pretend as if she wants it? “They don’t even pretend they want it, really!” she exclaimed.

On first glance, this feels like your age-old adolescent trying to define a personal space away from their parents’ values, attentive to the hypocrisies of any family, and time and place. What felt new was how quickly this became a fantasy of withdrawal, as if she couldn’t sustain a sense of self or place. B. wants to move to the countryside and raise dogs: “beautiful, innocent, fluffy dogs, just like mine!” She doesn’t want to work, or make money, or have children, or be with anyone really.

While she took on the sweet air of a much younger child, it didn’t take much to hear the depression. Many adolescents I see immediately want to exit the world stage, as if all options are already on the table, played-out, disenchanted, and the only choice is to disappear, or take medicine, get famous, detach — other versions of disappearing, suicide being the most extreme.

Article after article shows us that America’s teenagers aren’t doing well, without putting their finger on what is wrong beyond issues of individual “mental illness” and the usual bugbears trotted out — social media, video games, the weakening of the family unit. But what are the teenagers telling us is wrong? We seem to have forgotten that adolescents are lightning rods for the zeitgeist. They live at the fault lines of a culture, exposing our weak spots, showing the available array of solutions and insolubilities. They are holding up a mirror for us to see ourselves more clearly.

In 1950, the psychologist and psychoanalyst Erik Erikson theorized that the danger for American adolescents was “diffusion” when they needed identity. Deep down, he felt Americans lived a series of extreme contradictions between the “open roads of immigration and jealous islands of tradition, outgoing internationalism and defiant isolationism; boisterous competition and self-effacing cooperation,” to name a few, only loosely held together. Our identity isn’t grounded in accrued cultural sensibilities but rather the unstable ideal of being able to choose in any direction, at any moment.

This defiantly active personality could quickly give way to depressive withdrawal, and when that failed, psychosomatic illness, delinquent behavior and psychosis beckoned, Erikson surmised from his work with patients in the hospital. He worried about the series of huge changes in a given life in America that would only be exacerbated by globalization, emancipatory and technological revolution, in a young country. How would the American adolescent fare?

Society, he wrote, must lighten the conflicts for our children through a promise of security, identity and integrity that allows for true spontaneity and flexibility that alone can keep a person intact. While Erikson always felt to me very much of his time, a kind of midcentury pragmatist who was a tad patrician — something that has always rubbed me the wrong way — returning to his thought lately has felt revelatory, almost prophetic.

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“Attachment is confusing,” a 14-year-old told me. “I start crying but feel nothing, literally nothing, which is weird, and then find myself telling myself, ‘You’re a teenager, teenagers are confused, and anyway, don’t get attached to anything, it’s all going to change.’ But then I think of the changes coming and I feel exhausted before really knowing what I want.” She is so articulate about herself, more than I could have been at her age, or even twice her age. I marvel at her capacity for introspection, which makes it hard to see the source of her confusion, including the extent of her youthful naïveté.

When B. spoke about her gender identity, something suicidal broke through. The pressures, contradictions and vulnerability of being a girl felt too much, and she would double over in my office saying she had her period, as if to demonstrate something unbearable about verging on womanhood. Identity seemed to name a point of the utmost pain and confusion. Identity politics — so fraught on both sides of America’s political divide — wasn’t the cause of B.’s pain. In fact, identity politics, too, is born from the suffering our adolescents pinpoint.

Freud felt that adolescence was the decisive time for separation, establishing the differences between generations, as each adolescent confronts the realities of adult life for the first time. The danger for this age group is getting swallowed up by their families or by the flimsiness of group psychology before they’ve established a “trial” identity. Adolescent crisis, he wrote, “may also be looked upon as an attempt at cure” that “ends often enough in a complete devastation.” One is only properly psychiatrically ill on the other side of adolescence, which seems to shuffle us into various forms of neurosis and psychosis. Most psychotic breaks occur during or in the years following puberty.

“I looked in the mirror and I couldn’t recognize myself,” a 17-year-old patient explained to me after going to the emergency room for an episode of extreme depersonalization. After this breakdown, something in her gave way to somatic issues — she was then diagnosed with irritable bowel syndrome — and she suffered recurrent anxiety and panic attacks. I’ll call her by her first initial, too, A. After a couple of years of therapy, A. gained some ground articulating the desires that scared her and were causing diffusion.

Her identity felt attacked by what felt outside of its scope: What if she was gay? What if she was more like her parents than she thought? Did she feel more like an American or did she feel closer to the country where her parents came from? Why couldn’t she do the things she most wanted to and seemed to give way so easily to things she didn’t want to do? These questions were asked through actions — sex, drugs, failing to do her work, doing her work to the utmost perfection — but also as a relentless internal attack: “Where is your sense of self?”

On the other end of the spectrum, one can often find in the stories of adolescent, mostly white, male school shooters the same set of difficulties swimming around identity, a self that is falling apart, an internal attack that is cured through imagining an external one, and saddest of them all, cries for help before the act that remain unanswered: The 15-year-old who is accused of killing four students at his high school in Oxford, Mich., in 2021, wrote in his journal: “the first victim has to be a pretty girl with a future so she can suffer like me.”

I find myself trying to allay teenagers’ inner voices, slow down their rush to action, give room to their anxiety, and buy time to explore what are invariably complicated feelings about themselves and their world, without believing I have any answers. But don’t we live in a country full of aggressive, blaming speech, a preference for quick solutions, and the reduction of real impasses to superficial actionable items, disavowing anxiety while sowing confusion?

A. wants to be an artist and she has a special talent for it, but when her sense of self feels so precarious, how can she willingly choose a precarious profession? It’s as if she is asking a question she was forced to ask her entire life and that certainly is part and parcel of the unresolved conflicts her parents had as immigrants to the United States. But truth be told, we all have these questions about how precarious life has to be in this country, how to live with the hopelessness about the future that is emerging and how all of this is coming up against the pursuit of self and freedom so celebrated in America. Adolescence, then, is not only an attempt at a cure. It is the chance we have for finding one, not only for them, but for all of us.

Original article: What Teenagers’ Mental Health Can Tell Us About America