When a teenager tells you about their mental health issues you have to listen to the expert – themselves
I am an “expert”. At least in the sense that as a specialist medical doctor in mental health I am asked to give expert advice, included in expert advisory groups, and if I give evidence in court, it’s taken as expert evidence.
But when I see young people in my day-to-day work to help them with their mental health it becomes evident to me who the real “experts” are.
Annie*, for instance, came to see me about a distressing situation. She was at school and suddenly felt really unwell. She said she couldn’t breathe properly and her heart was racing. She felt numb, had pins and needles in her hands and felt as if she was about to pass out.
She told me that she didn’t want anyone to notice so she went to the bathroom where she increasingly felt like something terrible was about to happen. Maybe a heart attack – there was pain in her chest. She couldn’t come out of the bathroom because she was crying. She’d had episodes like this on and off for a couple of years but this was by far the worst and she was scared something serious was wrong. It was getting harder to go to school or even to go out with her 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 tests are unnecessary, expensive and unhelpful for anxiety. She was given a prescription for a medication.
When she googled the tablets she was given, the search results showed they were antidepressant medications.
Her friend with depression had gained a lot of weight on medication and it seemed like her personality had changed. Annie said she didn’t want this: “I don’t want to be medicated for the rest of my life.”
She felt even more anxious and low about herself. She felt judged because she had admitted to drinking and trying drugs at parties with her friends. She regretted being honest about this because she thought it stigmatised her – even though she felt this sort of thing was pretty normal for someone her age.
She had actually stopped drinking and was scared of what drugs might do to her heart. She was scared to go out and even scared to exercise in case it harmed her.
Annie had a different story of herself to relate when I saw her and lots of questions about why this was happening. She felt as if she wasn’t the person she was being treated as and she didn’t know where to get help.
That week I also saw Justin*, a young person in trouble with the law. He’d had a rough childhood, and found that the streets – and a group of young people in similar circumstances – were safer than home. He was on charges of breaking and entering. He looked stressed, he couldn’t sleep, couldn’t sit still and found it hard to talk about himself. He found it especially hard to talk to people in positions of authority. He relied on drugs to sleep, to feel OK and to block out bad feelings.
These two teens had very different backgrounds and experiences but neither could easily put into words what was going on with them.
They looked unhappy, miserable. They sometimes shrugged, looked away when spoken with and fidgeted.
But when I got it wrong they both clearly let me know with a shake of the head or a firm “no”. If the answer was yes, they usually followed up with some more information. They both tried to help me understand. And I didn’t feel they were lying or hiding the truth when I was trying to see their world.
Annie has panic attacks, a panic disorder and agoraphobia – avoidance of places that might bring on an attack. Justin has ADHD and is on the autism spectrum. His anxiety comes from trying to fit into a neurotypical world. He has also experienced trauma and had to fend for himself from a young age.
Each has their own story. As the health professional, I try to use my training and experience to consider their story against the evidence in mental health research. Then I try to speak their truth back to them within this framework. Between us, we check out what parts seems to fit, and we look at aspects that can be reversed by treatment. We talk about the pros and cons and all potential side effects.
Sometimes it takes time and a lot of trust to work out the way forward.
Both Annie and Justin had already been given labels and prescribed treatments. They didn’t agree to those, and they didn’t follow them. First we needed agreement.
Ultimately, I’ve found that the “expert” on any adolescent is themselves. To be effective, it’s my job first to listen to them.