 Professor Richard Friedman, psychiatrist at Weill Cornell Medical College is the latest expert to finally explain the erratic, “crazy” behavior of teenagers. You may have read his opinion piece in this past Sunday’s New York Times. I hope you did. I hope you paid careful attention to the way tidbits of medical research are served up as revelation: signs of promise for a better tomorrow.
Generally, it’s the newest batch of MRIs that are said to deliver us to new heights in our understanding of human behavior, levels of knowledge previously out of reach, beyond the scope of basic human experience. If you are a believer in such epiphanies, you may be clinging to Dr. Friedman’s article with great hope. The subtext is that we now know that the brain’s “reward center” matures earlier than the prefrontal cortex. Of course neuroscientists have been talking about this idea for well more than a decade, but that doesn’t stop doctors and news media from collaborating to create the sense that something is “new.” And why should it? We are infatuated by the idea that science can deliver us from ourselves. The New York Times is only trying to be sensitive to our deepest emotional needs. Who cares that the news is old news, it’s hopeful, damn it! Besides, it pokes at our own anxiety, reminding us that even on Sunday, there’s something to worry about. Sigh. I struggled to find anything in Dr. Friedman’s well-meaning article which was actually new or useful. Those of us who have been in the trenches working with executive dysfunction have known for years that the amygdala, the brain’s gateway for emotions, overwhelms the inhibiting capacity of the prefrontal cortex in many, many adolescents. We have known for even longer that making a distinction between ADHD and anxiety in adolescents is a difficult differential diagnosis. It seems to be Friedman’s intent to make the case that the role of anxiety and fearfulness have been understated with respect to the adolescent years. Yet I can’t think of a single soul who doesn’t associate anxiety with adolescence. Who doesn’t make this connection? Do we need MRIs to show us that teenagers, as a group, have higher than average anxiety and fearfulness? It also seems to be Friedman’s intent to discount the role of adolescent psychology, relative to the importance of anomalies in brain development. For example, he states, “Until very recently, the widely accepted explanation for adolescent angst has been psychological.” (Note the set-up phrase, “until very recently,” used to suggest the unveiling of a great new medical finding.) He goes on to say, “teenagers face a number of social and emotional challenges, like starting to separate from their parents, getting accepted into a peer group and figuring out who they really are.” And then, he trenchantly concludes by saying, “It doesn’t take a psychoanalyst to realize these are anxiety provoking transitions.” No, but in all likelihood it takes someone with some psychological sophistication to understand the nuances of this anxiety, such as where it comes from and how to connect with teenagers in such a way that allows a doctor to offer meaningful and sustainable help. In a style that has become familiar in this genre of journalism, the article indicates that cognitive behavior therapy (CBT) alone is not sufficient to treat the anxiety of adolescence. In discussing the pros and cons of therapy vs. medication, Dr. Friedman follows the commonplace dichotomies of this type of journalism. We never get to the core questions at all. It seems we should hope for an even better medicine that can somehow, some day relieve teenagers of their anxiety and fearfulness – no matter the state of the world they live in. You can probably tell I’m irritated by this sort of writing. I hope you are too. I hope that you, like me, believe you have a right to something more. For all I know, Dr. Friedman may be a highly effective psychiatrist and one of the most sought after doctors in his region. I am in no position to doubt his clinical capabilities. But I do believe that being given a major platform like the Sunday New York Times, for an article such as this one, is a public disservice. It is a disservice in the sense that it fails to dig for any deeper explanation of the very topic it purports to explain. How can we write an article on adolescent anxiety and fearfulness, without substantively addressing any of the possible psychosocial causes of this anxiety? Here’s how: a writer asserts that these emotional experiences are primarily the effects of brain development that have no meaningful psychological origin. Give me a break! Are we to understand that adolescent anxiety is just the same as it has always been? That there’s nothing unique about contemporary fear and anxiety worth addressing, for the unique ways in which it now affects adolescent development? I cannot accept that, and I hope you won’t either. In a decade of economic and ecological devastation, existential despair about the poor return of education, electronic isolation, and a jobless future, what practical things could there be to worry about? I wonder, hmmm. Mostly, the real causes of anxiety are too complex and time-consuming for our short attention spans. Sadly, they involve a complexity that is beyond the scope of most doctors’ and therapists’ clinical orbit. This is not what clinicians like to think about, and generally not what we talk about when we are in session with young people. But it is what we should talk about. If there were broad public understanding of how to actually have meaningful conversations with teenagers, journalism about adolescence would have a whole different feel. It would link hope to understanding and connection, more than MRIs. Divisive Thinking The prescriptive psychotherapeutic treatment is almost always CBT, but that is because CBT is the most widely studied and researched. It is more difficult to research interpersonally-based therapies, or therapies that emphasize the importance of insight and connection. These types of therapy are not operationalized with the same consistency, from one therapist to the next. Consequently, the efficacy of the therapist is sometimes understood to be related to her or his charisma and ability to connect, rather than mastery of a set of discrete therapeutic skills. None of this is, of course, a logical argument for why therapists of various approaches cannot be effective. In my professional career I’ve been challenged to work with intensely depressed and acutely anxious adolescents in hospital settings, clinic outpatient settings, and in private practice. Throughout, I’ve never discounted the value of psychotropic medications. I believe that these medicines can improve, and sometimes save, lives. However, I also believe that adolescence is not merely a phase of life to be coped with, as though surviving the turbulence of the teenage years, by taking sufficiently effective pharmaceuticals, delivers one to adulthood where life is more trouble-free. Adolescence is more complex than that, as is any phase of human life. If we really want to make strides in helping adolescents, we need better, smarter ways of talking to kids. The bottom line is that current treatments for troubled kids come up short. Preposterously short for a culture that claims to be as sophisticated as our own. Not only should the Cornell Medical College realize this, but so should The New York Times. Within Dr. Friedman’s article are the typical warnings about psychostimulant medication used to treat ADHD, which may indeed increase anxiety and fearfulness. But the way such insights are presented, including Friedman’s reference to “Newtown and Aurora,” increases angst rather than reassurance among readers. It begs the question as to what is the real purpose of an article such as this one. Could it be a circular process of warning, advice, and alarm? That would certainly hold reader’s attention, wouldn’t it. It seems to me that the real beneficiaries of this journalism are media, medicine, and pharmaceuticals. Young people, themselves, are merely a prop for admiring how good adults are at science, innovation, and reportage. In my view, The New York Times is the paper of record in the United states. For that reason, I want the paper to take some responsibility for presenting medical research in greater context. I want a more balanced public discourse about how to treat young people for conditions that are not only affecting their brains, but also their minds, and dare we say spirit? I’m impatient for a dialogue that is more transcendent, more worthy of a human life. Do you want this too? More ideas on youth: If you find value in this newsletter I would like to invite you to visit my blog ideasonyouth.com. I began the blog so I would have an opportunity to communicate more often, and about a wider range of topics. I have included posts on practical advice, and as is my passion, conversation about the purpose and direction of youth. So much is happening in our world with respect to kids, families, and schools. I hope you might take the time to communicate with me via my blog. It is a privilege to share these ideas, and I thank you very much for your time and attention! Parent Coaching The nature of my clinical approach is somewhat unique, and I find that parents in different parts of North America want to partner in helping their children and teens. To that end, I am able to do parent coaching via telephone, email, or Skype. In some cases, it works well when families can visit for an initial meeting, and then follow-up as noted above. (401) 816-5900.
On Purpose Before Twenty is published by Four Corners Pressand can be purchased worldwide. “Fascinating and deeply moving.” Deborah Meier, MacArthur Award Recipient, NYU Steinhardt School Senior Scholar |
