Teen Anxiety Can Have Many Faces

Research now tells us that for many young people, anxiety and depression can be two sides of the same mental health challenge. We know that anxiety often precedes depression in school age kids. Or, as was the case for my adolescent son Sammy, anxiety can be hiding behind depression, not fully apparent until the usual treatment for depression—psychotherapy and taking an antidepressant—doesn’t quite work. In this excerpt from A Lethal Inheritance, Sammy is trying to figure out how to deal with his often baffling psychological issues. As his worried mother, I could only be of limited help—sometimes, as this scene makes clear, I actually added to his burdens.

“Mom, I’m Joining the Marines”

Sammy and I had just finished eating lunch at a café in San Francisco, enjoying a pleasant conversation. Being together had gotten easier since I’d acquired the self-discipline to stop talking about “Sammy’s problem,” unless he brought it up. After strolling around the bookstore attached to the restaurant, we went out onto the sidewalk to part ways, me to my condo, him to get on the BART and return to the house he shared with Alex. But as I turned to go, he stood still and shifted awkwardly from one foot to the other.

“Is something wrong?” I asked, ever vigilant.

He looked away and said, “Ummm . . . Mom, I’m joining the Marines.”

No. I didn’t just hear that, I thought, while my mind flooded with images of legless, lifeless boys being carried out of Iraq in body bags. The date of this conversation matters; it was May 2007; “the surge” just barely under way, with fighting at its bloodiest. I simply couldn’t, wouldn’t stand for it.

“Mom?” Sammy pressed, now making uncomfortable eye contact.

“How could you possibly do this to me?” I asked.

I’m not proud of this response; it was a low and manipulative mother ploy, but I’d panicked. “It would kill me if anything happened to you,” I said, going still lower. Then it occurred to me that my protests might be too late.

“What have you done about it?” I asked him.

“I just talked to this guy at the mall.”

“Oh, my God. You didn’t sign anything, did you?”

“No, not yet.”

By now I saw that Sammy understood what I was up to; that I wasn’t going to let up on the guilt trip, and he got pissed off.

“Mom, this really isn’t fair,” he said, giving me a disgusted, disappointed look.

“I don’t care,” I said, meaning it. “You just can’t do this to me.”

If I kept up this line of attack for too long, I risked pushing him away from me and into the arms of the Marines.

“Just tell me why you would do this?” I pleaded

And then he leveled. “I’m just sick of feeling so rotten about myself.”

“Oh, so you think fighting in an unjustified war will make you feel better about yourself?”

“I don’t know,” he said, struggling. “I just can’t keep going on like I am.”

“I understand,” I answered, trying to bring the conversation to a more positive place. “But let’s try and figure out something besides war to help you get out of it.”

“No, please . . . just let me do this,” he said, backing away, clearly not wanting to talk any longer. “I gotta go.”

“No, not yet . . . I know we can think of something.”

“Like what? I’m sick of therapy.”

“How about the Peace Corps?”

He did a double take, clearly considering the notion, then shook his head. “They wouldn’t take me. I’m a college drop-out.”

“Then something like it, for kids who haven’t graduated from college.”

He looked at me skeptically.

“Just give the whole thing a couple of weeks, and we’ll see if we can find something better.”

He sighed and agreed that he would not talk to the recruiter again; at least not until after we looked into other options. Then we hugged good-bye, and I hurried back to my condo, shaking.

After that, I scrambled, using my frantic search for something to steer Sammy away from the Marines to avoid feeling any more fear about it than I had to.

It took a few weeks (with the recruiter calling Sammy daily), but I did find something that appealed to Sammy: a group out of the United Kingdom that arranges “gap-year” volunteer projects for eighteen- to twenty-five-year-olds. Sammy signed up to help build a school and to teach war orphans in an NGO-sponsored humanitarian project in Uganda. He spent four months there in the summer and fall of 2007, and it proved life-changing in all the best ways. As Sammy explained it, helping other people who were materially so much worse off than he was got him completely “out of his head.” His tangible contributions—raising the new school building and working with the kids—had been the best possible medicine for him. Being part of a team of twelve men and women his own age also gave him something he’d been craving: that camaraderie that’s so hard for young people to find when they’re out of school and newly making their way in the world.

I’m not proud of how I got Sammy out of the Marine recruiter’s hands and off to Uganda; however, I have no regrets about making it happen. We dodged far more than a bullet in that moment. It was so clear to me that being as depressed as he was made Sammy extremely vulnerable to the fantasy that he could get “fixed” by joining the Marines and going off to war.

Sammy came back from Uganda stronger and clearer. He found a summer job in retail and a lovely girlfriend, to boot. He then thought he was ready to make a return to college. But without a medication, his fluctuating moods still subjected him to sporadic days of being down and without motivation—and that gave us both pause. That’s when he decided to try working with a new psychiatrist who put him on Zoloft®, an SSRI known to treat symptoms of both depression and anxiety. Sammy has been on it ever since, for three years now, and it works well for him.

That doesn’t mean that he doesn’t occasionally have his down days—and times when he makes things harder for himself. Unbeknownst to me, Sammy decided at the end of the last school year to take a “summer break” from his antidepressant. The thinking, he told me later, was to give his brain “a rest.” Well, it didn’t quite work that way. After returning to school, Sammy discovered there was a six-week wait to get a counseling center appointment, necessary to renew his prescription. In the meantime, he relapsed into a full depressive episode, becoming despondent and sleepless and rarely leaving his dorm room. I eventually heard about this episode when Sammy called me late one night in mid-November to say he was afraid that he’d flunked out. Fortunately, this wasn’t yet true; he was able to get back on track, make up incomplete work, and slide through.

Sammy now says that with the stress of a full load of classes in front of him, he knows he can’t afford to put his brain on another roller coaster. He’s decided to keep taking the medication so he can to hang on to the stable moods he needs to accomplish his goal. His plan, he says, is to get his BS in molecular biology, a heavy-duty academic schedule that requires wall-to-wall math and science classes with labs five days a week, with the hope of getting into medical school.

My job, I’ve now learned, is to stand back and let him learn from his own up and down experiences and then make his own choices.

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