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 Some become withdrawn or socially isolated, while others may for example, engage in self-harm, act out violently or aggressively, develop serious substance abuse issues, eating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.

Psychoanalytically informed treatment can be beneficial to most people. For example, it can provide relief from the troubling symptoms of anxiety, depression and other life-disrupting concerns. You might, for instance, be plagued by private rituals, compulsions and repetitive thoughts of which no one else is aware. Alternatively, you might be living a constricted life of isolation and loneliness, or feel incapable of getting close to others. In some cases, as a result of destructive patterns of behaviour, you may have experienced repeated failures, particularly in key areas such as work and love.

As an alternative to more simplistic, short term interventions, psychoanalytically-oriented therapy can be a particularly beneficial treatment option for individuals managing high stress-related worries or concerns, typical of those confronting busy professionals in their work or lives generally. Despite relative satisfaction and success in their lives, individuals fitting this category may nonetheless be suffering disruptive symptoms that restrict choices and other opportunities for pleasure. Hence, certain people may choose to seek out this treatment approach because other interventions have not resolved their problems or, at best, only temporarily so.

In working with a psychologist who is also an internationally accredited psychoanalyst, patients can be confident that they are being treated by a uniquely trained mental health practitioner. Psychologists with this extra level of expertise have not only completed the rigours of their own professional training (i.e. an extensive graduate program in clinical psychology), but also at least 4 years of additional training in psychoanalytic theory and clinical practice. In particular, psychologist-psychoanalysts, trained under the auspices of the Toronto Psychoanalytic Society and Institute have received the most rigorous training available. This particular training leads to membership in both the Canadian Psychoanalytic Association and International Psychoanalytic Association (the world wide umbrella organization for the training of psychoanalysts). In summary, people undergoing psychoanalysis or psychoanalytically-oriented therapy can feel confident that practitioners with affiliation to the International Association meet the highest training standards available for this particular treatment.

Robin Williams’ recent suicide prompted an enormous reaction from the general public, evoking a variety of opinions and perspectives. Locally, Carly Weeks, (Globe and Mail, August 15th, 2014) rightfully asserts that there are no easy answers to understanding suicide and that we are often left at a loss as to try and understand why someone would take their own life. She cites Dr Martin Heisel, a researcher at the University of Western Ontario who emphasizes the fact that, “…there are variety of factors” that go into a individual’s death by suicide, and rarely just one consideration.

Weeks states that the vast majority of those who die by suicide have some form of mental health difficulty, with depression being the most frequently occurring syndrome. As David Gratzer (also The Globe and Mail,  August 15) points out, many people carry with them on a daily basis, the burden of depression, anxiety, addiction or other some the debilitating affliction. Michael Redhill’s poignant commentary on depression particularly caught my eye (The Globe and Mail, August 16) and is a particularly personal account from the perspective of an “artistic mind”.

Instead of avoiding talking about depression and suicide, Heisel, (from Week’s article), rightly stresses the importance of speaking about depression openly, that  helping a person express how she or he feels is critical. As a psychoanalyst listening to people talk about suicide I feel that it is vital to listen with an attitude of equanimity, non-judgement, seriousness and patience. I think that the capacity to listen to a patient verbalize suicidal feelings or ideas can actually strengthen the boundary between thought and action. In my mind it is important to give the individual (implicit) permission to express the powerful emotions that are threatening from within. In particular, I have found that this can help improve a person’s capacity to understand his or her inner and outer realities.

In circumstances where matters are thought to be getting more out of hand, often as a result of the patient becoming too depressed to communicate or indeed making practical plans for committing suicide, it is important that the individual be actively protected. However,  I always feel that such behavioural limit setting should be combined, as much as possible, with a continual emphasis on understanding and on attempting to uncover the potential meanings of impulses and actions. Otherwise, I feel that a patient can get  the impression that I’m only interested in his/her behaviour and not the subjective distress that underlies it. At times we, as psychoanalysts dealing with suicidal patients,  should realize that there are situations when one to one psychotherapy is simply not enough to contain the psychosocial distress involved. Hence, I might deploy adjunct measures including, amongst other things, the enlistment of family members’ help.

Stephen Grosz’s book, The Examined Life – How We Lose and Find Ourselves, is a wonderful read for anyone who has ever contemplated psychoanalysis or deeper insight-oriented therapy, but I would also recommend this book to anyone who is generally curious about the perplexities of everyday life and human behaviour. There are several excellent reviews of this book worth reading including one from “The Independent Review” The Independent and another from The New York Times.

Grosz’s chapter titles are immediately attention grabbing: “How praise can cause a loss of confidence“, “Why parents envy their children“, and “On not being in a couple“, to name a few.  The stories he tells connect the past, the present and the future and demonstrate that inner change is possible. Mr. Grosz quotes Isak Dinesen, observing that “all sorrows can be borne if you put them into a story or tell a story about them”. He adds that  stories can help us to make sense of our lives, but that if “we cannot find a way of telling our story, our story tells us — we dream these stories, we develop symptoms, or we find ourselves acting in ways we don’t understand.”

Grosz’s book also highlights is the fact that psychoanalysis goes against the grain: How on earth in our virtual world of speed, tweeting and texting and other sophisticated means of communication can a person take the time to drop everything 3, 4 or 5 times a week to lie down on a couch for almost an hour and attend to what is going on in his or her inner world? If efficiency is defined as doing the most in the least time, the slow pace of analysis seems almost mad or at least a little absurd.

How can people with no experience of analysis imagine what happens in it. There are some kinds of knowledge that can be taught and others that are discovered by personal experience, and I think psychoanalysis falls into the latter category. However, in making use of beautifully written and deceptively simple human stories, Grosz’s book manages to at least convey some of the nuanced complexities of psychoanalysis.

Grosz, is a practicing psychoanalyst, a teacher at the Institute of Psychoanalysis and in the Psychoanalytic Unit at University College London.

Erin Anderssen’s article in last Friday’s (July 13th, 2012, Focus Section) edition of The Globe and Mailfocusing on men’s general aversion to psychotherapy immediately captured my attention. Entitled,“Why guys won’t get off the couch – to get on the couch“, the piece is well written and comprehensively researched. The writer highlights the fact that men are far less likely to seek out therapeutic support when they experience distress. She also points out that symptoms often manifest in a very different manner in men. For example, men tend to report feeling “stressed” rather than “sad” or depressed. Men are also more likely to be aggressive or irritable, turning to alcohol, drugs or over-working as a means of managing their problems.

Most importantly, the article notes that misconceptions about therapy often deter men from calling a therapist. Indeed, a man I recently spoke to inquiring about therapy expressed concern about whether therapy would in some way “change” him.

I try to work with the underlying belief that what people (men and women) really want is to become more and more faithful to who they truly are! For men, in particular, I have found that once they begin to incorporate this sense within themselves, it is easier to accept the evolution that is inherent in their personality as it develops. I think that once men begin to get more genuinely in touch with their own personal values, they become better able to acknowledge their own resources.

While men are more likely at first to keep their distress to themselves, I find that pretty soon they are able to convey these feelings to me and in this way they acquire a greater capacity to be more genuine and true to themselves.

Of course there are different approaches to therapy and the choice depends on a series of factors. Also, it is not easy for men to form a true picture of what therapy is like (…how can it not be caricatured?).

While I work in a psychoanalytically-oriented manner with my patients, it remains difficult if not impossible to summarize succinctly the sheer quality of the actual process. If I could briefly highlight one aspect that I facilitate in my own personal work with men, it is that I try and help them ‘unlock a door’ to their internal world. It is this unsuspecting world and in discovering it’s presence within them that they can find a level of comforting coherence in their lives.

Globe and Mail, August 31, 2011

The Globe and Mail recently published (August 31, 2011) an article by Andre Picard (their Public Health reporter), entitled, Mental Health Strategy Doesn’t Go Far Enough. In this article, Picard discusses Canada’s confidential and long-anticipated draft for its mental health strategy. The article explains the need for a strategy and its purpose, and  notes that Canada is the only G8 country without such a strategy. To this end, I think the article is useful.  However, while Picard is very well intentioned, one can’t help but notice that his major criticism of what is in the draft is directed at what he describes as the lack of funding devoted to brain research and traditional psychiatric ways of treating the more serious mental health conditions. He doesn’t like the strategy’s focus on a ‘recovery model’ (the notion that people will get better with support) in mental health…he would prefer one that focuses more on brain science.

In respect to funding for mental health, the reality is (and this is not noted in the article) that inordinate amounts of money have been and are currently being directed towards brain research (remember the 90’s…the decade of the brain). Indeed the search for the “cause'” of schizophrenia has been going on for more years than we care to remember, and at one time or another pretty much every organ system in the human body has been cited as it’s cause.  It is conceivable that we are not even classifying this illness (or other psychotic illnesses for that matter) correctly.

The long and short of my argument is that we need to view all mental illness holistically, that the mental illnesses psychologists and psychiatrists are seeking to alleviate in people invariably incorporate a complex interaction of psychological, genetic-developmental, biological and social factors. Making arguments for discrete ’causes’, or indeed ‘leading causes’ for that matter, is reductionistic and misleading. Of course it is important to allocate funding to further our understanding of brain function, but don’t let us tow a particularly popular current line of thinking and make exaggerated claims or inferences either about what we can achieve in allaying people’s suffering from an understanding of brain function alone. Indeed, if the brain is the primary focus of our understanding of mental health,  people are likely to be disappointed.