When a teenager tells you about their mental health issues, you need to listen to the expert – himself | Saretta Lee
I am an “expert”. At least in the sense that as a mental health physician, I’m asked to give expert advice, included in expert advisory panels, and if I testify in court, that’s considered testimony expert.
But when I see young people in my daily work helping them with their mental health, it becomes clear to me who the real “experts” are.
Annie*, for example, came to see me for a difficult situation. She was at school and suddenly felt terrible. She said she couldn’t breathe properly and her heart was racing. She felt numb, had pins and needles in her hands, and felt like she was about to pass out.
She told me she didn’t want anyone to notice, so she went into the bathroom where she felt more and more like something terrible was going to happen. Maybe a heart attack – her chest hurt. She couldn’t get out of the bathroom because she was crying. She had had episodes like this for a few years, but this was by far the worst and she was afraid that something was seriously wrong. It became more and more difficult to go to school or even go out with friends.
Annie saw her doctor who said it was “just anxiety”.
The doctor told her she should avoid going to hospital when this happens because the tests are unnecessary, expensive and unnecessary for anxiety. She received a prescription for a drug.
When she Googled the pills she had been given, the search results showed them to be antidepressants.
Her depressed friend had gained a lot of weight from the medication and it seemed her personality had changed. Annie said she didn’t want that: “I don’t want to be medicated for the rest of my life.”
She felt even more anxious and depressed about herself. She felt judged because she admitted to drinking and trying drugs at parties with her friends. She regretted being honest about it because she thought it stigmatized her – even though she thought that sort of thing was pretty normal for someone her age.
She had actually quit drinking and was afraid of what drugs might do to her heart. She was afraid to go out and even afraid to exercise in case it hurt her.
Annie had a different story of herself to tell when I saw her and lots of questions about why this was happening. She felt like she was not the person she was treating and didn’t know where to get help.
That week, I also saw Justin*, a young man in trouble with the law. He had had a difficult childhood and discovered that the streets – and a group of young people in similar circumstances – were safer than at home. He was charged with breaking and entering. He looked stressed, he couldn’t sleep, couldn’t sit still, and had trouble talking about himself. He found it particularly difficult to talk to people in positions of authority. He relied on drugs to sleep, feel good, and block bad feelings.
These two teenagers had very different backgrounds and experiences, but neither could easily put into words what was going on with them.
They looked unhappy, miserable. Sometimes they would shrug their shoulders, look away when spoken to, and fidget.
But when I was wrong, they both made it clear to me by either shaking their heads or saying a firm “no”. If the answer was yes, they usually gave more information. They both tried to help me understand. And I didn’t feel like they were lying or hiding the truth when I tried to see their world.
Annie has panic attacks, panic disorder and agoraphobia – avoidance of places that could provoke an attack. Justin has ADHD and is on the autism spectrum. His anxiety comes from trying to fit into a neurotypical world. He also suffered trauma and had to fend for himself from an early age.
Everyone has their own story. As a medical professional, I try to use my training and experience to examine their history against the mental health research evidence. Then I try to tell them their truth within that framework. Between us, we check which parts seem to match, and we examine the aspects that can be reversed by treatment. We talk about the pros and cons and all the potential side effects.
Sometimes it takes time and a lot of confidence to find the way forward.
Annie and Justin had already received labels and prescribed treatments. They didn’t agree with those, and they didn’t follow them. First we needed an agreement.
In the end, I discovered that every teenager’s “expert” is themselves. To be effective, it is first my job to listen to them.
In Australia, support is available at beyond the blue at 1300 22 4636, safety rope on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Spirit is available on 0300 123 3393 and ChildLine on 0800 1111. In the United States, Mental Health America is available at 800-273-8255.
Dr Saretta Lee is a psychiatrist from Sydney
* Annie and Justin are fictional amalgams used to illustrate many similar cases