MMA21

Britta and the Spectre of Futility – Part 1

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She is a sixteen year old girl, pretty, popular with her peers, an excellent and successful sportswoman, and a good student only two years away from graduating from Secondary School, yet she does not want to live anymore.

She researches ways to end her life on the internet. A friend in whom she has confided, convinces her to seek professional help and be admitted to a child and adolescent psychiatric clinic.

After six weeks she is discharged and referred to a day clinic for follow-up treatments for the next few months. As the first weeks pass, it becomes more and more clear from her conversations, that she sees little meaning in life, only a burden. This burden, she believes, will only become greater as she gets older. She asks: ‘What is the point if I live another seventy years, only to die? After all, what purpose will have been served?’ According to her thinking therefore, ending her life as early as possible is preferrable to living a purposeless life. 

She resists any attempt to dissuade her from this conviction. No rational arguments convince her that life does have meaning, even when promised she may have to wait until old age to discover this. Day after day she attends her sessions, follows her therapies, yet appears more and more exhausted, taking less and less interest in her surroundings, and hardly responding to the attempts of her fellow patients to console and comfort her.

During a conversation with her doctor, she admits that she constantly thinks about suicide, day and night, and has been researching ways to do this on this internet. Only the thought of hurting her parents has kept her from carrying out her plans. According to her, it would be much easier if euthanasia were legal for those unwilling to live. After all, no one ever asked if she wished to be born in the first place.

The concerned Doctor suggests that Britta be readmitted to the protective ward, to which she agrees. She seems almost relieved, relaxed, when this decision is made.

Britta cannot find an answer to the question of ‘why’!

Unfortunately, Britta’s inability to find meaning in her life is shared by many young people who, despite attaining relative success at school, having close circles of friends, and coming from stable and ‘normal’ family environments, still suffer the same experiences of futility and depression. They share the same thoughts that life is not worth living, and have no answer to the question of why they feel this way.

A new phenomenon? Is the Corona epidemic responsible for an increase in depression, since the restrictions imposed on society have increased the impact of isolation on young people, with only online interactions possible for much of this time?

A closer look at the statistics however, reveals that even before the Corona epidemic, depression among children and adolescents was on the rise. For example, the number of recorded cases of depression doubled in Germany between 2009 and 2019. Having said this, there was a definable increase in the incidence of recorded depression amongst younger people during the Corona epidemic, attributable to the isolation from their peer groups and friends. Such human contacts are so essential for building and maintaining self-esteem.

For young people, even devoted and committed parents are often not a substitute for the physical contact with friends and peers. We note that an important life lesson experienced during puberty, is the gradual ‘detachment’ from, and reliance upon, the parental ‘home’. This natural process can be seen at work through the increasing ‘distance’ that develops between young people and their parents, while at the same time there is an increase in the influence of peer groups and their opinions. The ‘mirror of the outside’ gains in importance!

Social Interaction Helps

It is known that social interaction, exchange, and affirmation between people, counteract depression. They awaken feelings of connectedness that convey meaning, security, resonance and self-efficacy. The young people experience that their actions have impacts in the outer world. They do not experience themselves as passive and helpless, but as alive and creating. All this then gives them a sense of purpose and fulfilment. Their self is thus strengthened and prepared for life.

How can it be then, that this fundamentally positive sense of self is denied to some? As can be seen from Britta’s example, even those who seem to have everything, can be affected.

But we can see how at risk especially, are those young people who have experienced a very difficult or traumatic environment in their youth, who also may be rather shy, and have little self-worth. The Covid contact restrictions will have potentially given such young people a legitimacy to withdraw, so that they gradually ‘unlearn’ many of the positive social skills developed through contact with their peers.

Another potential stress factor experienced by adolescents is the instability of friendships at this age. Long standing friendships can often break up, which can weaken mental resilience, especially during puberty.

The physical changes of the body during this time, can also cause previously unexperienced insecurities in many children and adolescents. They often compare themselves with the ‘perfect’ images presented on social media that act as role models, and against whom they perceive themselves as imperfect and often unattractive. If several of these circumstances do come together, they can influence these young people so that they gradually come to trust neither their bodies nor their souls; they have then literally lost themselves and feel increasingly isolated and lonely.

A self-reinforcing cycle can then often develop; as self-image erodes and confidence dwindles, a withdrawl from contact with friends and the world at large can follow, only increasing the feeling of isolation, loneliness and imperfection, leading to a downward spiral of ever increasing withdrawl that only reinforces the low self-esteem.

One comforting piece of good news in all this is that depression has a good prognosis in children, as well as adolescents, over the long term.

Nevertheless, depression in children and adolescents is a serious and growing life crisis. It is therefore extremely important that this issue be recognised, and that the warning signs of suicidal tendencies be taken seriously. It must also be pointed out that, according to a study conducted in 2001, suicide was at that time the second most common cause of death among younger people (in Germany), after accidental death.

In the so-called pre-suicidal phase, those affected often experience a deterioration of rationality, and emotional stability, with suicide presenting as the only solution. For carers, it is important to recognise the early warning signs, and despite possible resistance, to continually seek dialogue with the sufferer, and to reiterate the positive elements they may no longer see. If necessary, action can also be taken, even if against the younger person’s will, if they need to be protected from themselves.

(To be continued in Part 2)

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