Newspaper articles and other media sources referencing teenagers and their ongoing struggles are common enough (e.g. Five Things Adults Get Wrong about Teens, by Rachel Vail, The Toronto Star, October 13, 2014), as are those citing more serious issues (e.g. More Canadian Girls Inflicting Self-Harm, Hospital Admissions Double, by Tristan Simpson, November 18th, 2014, The Globe and Mail). Parents are rightfully worried and concerned about how to tell when it is time to be really worried, when the troubles they are seeing in their children are representative of more serious signs of emotional disturbance. The youngsters in the latter category are the young people whose emotional lives, and in many cases actual lives, are seriously at risk. I am referring to those teens who should not be left alone with the unreal hope that they will simply “…grow out of it”.

Each developmental period has its own special characteristics and each has its own special contribution to life and development. In adolescence, there is a new and particular kind of stress, whereby the earlier ways of being male and female are put under a different type of pressure. Some adolescents are unable to feel that they have the means within themselves to manage these pressures, and as a result, are unable to maintain an adequate level of equilibrium. The way in which the troubled adolescent gives expression to his or her struggle, and the accompanying internal stress and turmoil, varies a great deal. Some become withdrawn or socially isolated, while others may for example, engage in self-harm, act out violently or aggressively, develop serious substance abuse issues, eating disorders, debilitating depression and anxiety, or become promiscuous or feel overwhelmed by other sexually-charged conflict. A suicide attempt in adolescence represents a sign that there is a massive distortion related to ones’ feelings about oneself. In these instances, the young person has lost touch with his or her mental life. These ‘signs’ or outward indicators are given impetus by the need in the teenager to keep out of consciousness the feeling that something is seriously wrong. When I refer to these signs as indicators of adolescent or ‘teenage breakdown’, I do not mean a ‘nervous breakdown’ as it is commonly understood, but rather something more specific. This is not a transitory crisis, but literally a breakdown in development. Hence, a suicide attempt (as opposed to passing and temporary ideas about suicide) in adolescence is always a sign of serious breakdown requiring immediate help and psychological treatment.

Signs of developmental breakdown are a signal that something must be done now and urgently. By taking teenagers’ concerns seriously we can provide an opportunity to intervene. Even if the despair and conflict with which the teenager has been struggling subside, my experience is that it invariably shows up again, usually during later adolescence or early adulthood, but certainly during adult life at some point. Many serious later ‘disorders’ can be prevented if we act by responding in a timely manner, seeking out good professional help when we suspect or worry that an intervention is required.

Andre Picard’s article (Globe and Mail, December 2, 2014), A Scourge in Need of a Strategy, highlighted, in his words, “…shocking findings about how Canada treats anorexia and bulimia”.

Picard is right when he points out that eating disorders can be the, “…most deadly” affliction and he goes on to state that, “…between 10% and 15% of young women hospitalized for treatment of anorexia and bulimia will be dead within 10 years”. While the numbers quoted vary, there are estimates that between half a million and a million Canadians are struggling with an eating disorder of some kind.

Picard notes that this is the most neglected and misunderstood condition and he also emphasizes that the problem is made worse by protracted wait times for treatment due to the fact that few hospitals have the resources to offer care. As well, he points out that psychological treatment offered in the private domain typically represents the only option but can be too costly for a lot of people.

Adriana Barton’s article published earlier in the year, What if Anorexia wasn’t a Disorder but a Passion? (Globe and Mail, Life Section, September 15th, 2014) features Dr Louis Charland, who argues intriguingly that eating disordered patients are actually caught up in what she describes as the grip of  a, “…dark passion”. Charland explains that patients somehow become fixated on an ‘idea’, such as ‘I am too fat’, and that idea becomes the organizational focus of the passion, which in turn prompts broader patterns of thoughts and behaviour to support the now ‘fixed idea’. Soon the passion becomes integrated within rational thought and a belief system whereby the person becomes a, “…slave to passion”. Dr Russell Marx, cited in the same article, supports Picard’s contention with the sombre assertion that if Charland is right, it is indeed the most deadly of passions. Although more common in young girls and women, we know now that eating disorders affect all ages and, as Picard asserts, an estimated 10% of patients are male. I would suspect these numbers are higher because we traditionally see less boys and men presenting for treatment.

In another article in the same newspaper (What its like to live with an Eating Disorder), Kyla Fox (Globe and Mail, Life and Arts Section, September 15th, 2014) makes a very important point, asserting that manipulating food and the body serves as a necessary distraction from deep rooted, seemingly out of control emotions and life circumstances. It is the ‘distraction’ that offers the sadly perverse ‘reprieve’ from the real turmoil with which sufferers are struggling. Similarly, in my experience working with these particular patients, many of them, and young people in particular, express conflict through the manipulation of the body. Expanding on Kyla Fox’s observations, I have found that there has usually been a loss of faith somehow for the patient in the reliability of human relationships. Although I find in the course of therapy, that the need for a relationship is still evident, it remains sequestered or hidden. The world of the eating disordered patient is a closely guarded, sealed-off area and very difficult to access without necessary longer-term therapeutic work. In this regard, I agree with Dr Charland in that this sealed-off world can become an exclusive and much idealized passion.

Finally, Picard is rightfully critical of the government in their failure to address the issue of eating disorders as a serious mental health concern. Disconcertingly, he cites the typical case or scenario when it comes to addressing the need for action, commenting that, “…committee recommendations” often represent little more than, “…indifference and platitudes”.

J. M. W.  Turner, Snowstorm, 1842

About a year ago, I clipped an article from The Toronto Star (Marcia Kaye, Sunday January 5th, 2014) on a review of Scott Stossel’s book, “My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind”. Stossel points out that an estimated 4o million North Americans have an anxiety disorder in any given year and one in four will suffer an anxiety disorder at some point in their lives. He also suggests that the true numbers are a lot higher since a lot of people press on without mentioning the symptoms to his or her family physician. According to Leyla Sanai’s article in the UK Independent, (January 10, 2014), Stossel first saw a psychiatrist at age 10, since when he has tried 27 different medications not to mention a number of therapies in an effort to assuage his anxiety-related problem.

Feeling now, at the start of a new year and due to the fact that we are unquestionably living in anxious times, the moment seems right to revisit the concept that reflects a treatment orientation from a psychoanalytic perspective or, in particular (despite Stossel’s stated reservations about his own experience with a variety of different therapeutic approaches), how I would approach a patient and their concerns about anxiety.

When a patient uses the word ‘anxiety’, it is usually an attempt by the person to give a name to a feeling. In this sense, I believe that there is a need to find a language that connects in some way to that particular person’s frame of reference. Indeed often, in the very first session, there is the germ of everything that will appear as the central or critical problem of the treatment;  it’s just the case that up until now the person struggling with anxiety has not been able to find a way to resolve an internally based conflict. Anxious feeling states once expressed in words, invariably become far less overwhelming, representable in the mind and hence far more understood and acceptable to the self. It is not uncommon to find that some people live their lives in disregard of their internal world and the part played by the unconscious life. Sometimes an individual will be afraid of entering this space, to find a way out of his or her difficulties, but within the therapeutic process something is awakened and discovered and one can no longer pretend to oneself that it does not exist. I find that people need help in unlocking the door to this unexpected world so that they can discover its’ presence within themselves. While anxious states in some people clearly reflect multiple causal factors, I think that the key in many cases is in helping the patient find a way to de-codify the meaning and give language to something previously experienced as elusive and unrecognizable.