Our Youth are NOT OK: A Clinical Example

A teenager was referred to me with the question from their family doctor asking if they were experiencing a psychosis. What I discovered was a young individual who was so deeply depressed, that they began having strong beliefs that they were broken, defected and unlovable. Sometimes, when these thoughts are so rigid and unchangeable, coupled with the weight loss from not eating and the withdrawal from the world, a depression can look like a psychotic disorder. This is what happened to this young person.

But why they stand out to me, is in all the way they blend in. They are a classic representation of what our youth face today, and why a mental health crisis looms in their midst.

This patient, whom I will call Brynn, remembered being social and doing well at school until the pandemic. They were in high school and had friends in their neighborhood. They looked forward to the future and was establishing their identity. Brynn says the first year of online school was not so bad, though they suspect this was when they started to become depressed. With all their siblings moved out of the home and socially distanced, and a very busy single mother, they rarely saw anybody day-to-day except what was presented to them on the computer screen.

Brynn tells me how overwhelmingly despondent they would feel when they turned off the computer at the end of each day. Having not talked to a soul, utterly alone, day in and day out, staring at the same 4 walls. Brynn tells me how that was its own kind of torture. They are not sure how their other friends fared, having fallen out of touch with them and Brynn started feeling like their friends were better off without them.

This was their life until Brynn graduated. There was a ceremony but Brynn did not attend. What for? They did not feel they had accomplished anything. I saw them 1 year later, severely suicidal and filled with self-loathing. They did not have a job, they did not have any friends, they were not leaving their bedroom. I am broken, Brynn concluded. They believed they were nothing, and that it was their fault.

What Brynn could not know, and I could only appreciate after meeting them and reflecting on my own youth, is the necessity for an adolescent to be in-person with their peers. Brynn had 2 online friends they had made, and with whom would play videogames. This was not enough. An adolescent brain needs social connectedness like our lungs need air. The adolescent brain is primed for connection, and figuring out how one fits into social groups as a proxy for society at large. These brains are ready, hungry to learn how to have conflict and how to compromise. Most importantly, the brain is figuring out how the adolescent belongs with others and how they stand apart, keys to finding independence outside the family unit.

So when we cut off the social connectedness in young adults, we cut off their purpose for being, which is how to become whatever they are meant to be next. There is a whole generation of adolescents, now in their 20s, trying to figure out how they matter. It is no wonder they are anxious and depressed in unprecedented numbers.

And Brynn coped with how many cope nowadays. Brynn started to use marijuana. With the legalization of many drugs, it is our youth that carries a disproportionate burden of the negative outcomes.

I am happy to report that Brynn is doing better now, but it is still very early in their recovery. They have started medication, but the biggest change to their confidence and self-concept was participating in recreational groups in person with their peers. I am so blessed to work in a team and in a clinic that offers this kind of service. Just last week, Brynn turned to me with a smile on their face and remarked about how easy it was to talk to others and how unprepared and surprised they were about that. It is this intervention above the others that has started to fundamentally shift how responsible they felt for their own suffering. I know this because I had been the individual therapist for Brynn in the 6 months preceding, and I tried as I might, Brynn held firm that they were to blame. But with their peers, Brynn started to feel like they were all rowing in the same boat, trying to get to the same place, together.

Through Brynn, I appreciate how necessary in-person friendships are to young people. How young people need to know this at a time when more in-person meetings are being pushed online, and participants replaced by AI. How technological advancement has made life easier in many obvious ways, and despite this I am confronted more and more in my office by those of us who can not keep up. Self-diagnosis is an increasing phenomenon in physician’s offices. The most common ones in psychiatry at this time are autism spectrum disorder and attention deficit hyperactivity disorder, conditions that fall under the category of neurodivergence. It is worth noting that these diagnoses primarily affect where technology have hindered us most: social interactions/reading social cues and focus/attention/impulsivity.

My interpretation for this sociocultural trend of identifying with neurodivergence is that an increasing number of people are essentially saying, “I can not emotionally and cognitively function in the world as it is today. I need a diagnosis to recognize and explain why I am different, and why I feel I am not ok.”