The mysterious death-trap of youth

Spadefuls of worldly advice are no substitute for a listening ear. We have to learn to hear what depressed teeenagers are telling us and not dismiss their pain as 'just a phase'. Fiona Malcolm reports

When the senior Liberal Democrat MP Alex Carlile put his career on hold, to devote himself to the well being of his severely depressed 15-year-old daughter Ruth, describing this as "a difficult decision which, in the end, made itself", most of us applauded his sense of responsibility. But there will, inevitably, have been mutterings in some quarters that these days far too much fuss is made of teenage angst, considering that 50 years ago no one had even heard of adolescence.

Such cynicism is misplaced. There are a horrifying number of young people out there, wandering in a private wilderness. Many thousands of pounds are being invested in research which will try to discover why a significant minority of British teenagers are distressed enough to feel that life is not worth living, and killing themselves as a result.

Statistics held at the Trust for the Study of Adolescence point to a 70 per cent increase in suicides in the 10 years up to 1994 among boys and young men between ages 13 and 24. The Samaritans offers other chilling figures. Every two days in this country, five people under 25 commit suicide, and in a year, 19,000 attempt it. Casualty departments are dealing with 44,000 admissions for self-harm in under-25s each year, including overdoses.

"Young men, particularly, are devising extremely well-planned and effective means of killing themselves," says Eddi Piper, co-ordinator of the Adolescent Mental Health Training Initiative, based at the Trust for the Study of Adolescence, "and it appears that alcohol very often plays a part. It would be foolish to generalise about what drives a teenager to despair, but what does seem clear is that the incidence of repeated suicide attempts and bouts of self-harm is reduced if the young person feels that he or she has been listened to. Adults feel the need to do something, or to provide something, and go on missing the messages. It's listening to them, on their terms, which counts."

Adolescence is a place from which most of us were glad to escape and which we have no desire to revisit. Having sailed away from the confusion and intensity of emotion into the calmer waters of compromise and disillusion, we are, apparently, very bad at picking up on the vital clues to symptoms of serious depression in teenagers, and we recoil if invited into our children's private hell. Suddenly, a cuddle and a piece of sticking plaster is no longer appropriate. Our own pain rekindled, we make frantic efforts to soothe, by offering spadefuls of worldly advice and a spattering of adult cynicism. It is rarely what they want to hear.

"Depression in the general population is no more common than it was 30 years ago," says Professor Sir Michael Rutter, head of the Medical Research Council Child Psychiatry Unit, "But its incidence among teenagers and young adults has increased greatly. Research is going on now as to why, but there is no doubt that family breakdown plays a part; not just divorce, but the general levels of discord and conflict among adults.

"Young people are also spending a prolonged amount of time in education, which is mostly a good thing, but it means they are financially beholden to their parents at a time when they supposedly have more freedom and choice than ever before. As the number of available jobs for the unskilled has dropped dramatically in the past 30 years, the numbers of teenagers taking and passing exams has gone up, so the pressure to attain has greatly increased. Many feel that they have nowhere to go without a good set of qualifications."

Added to that, he says, setting up home with a partner while still in your teens is not a recipe for lasting bliss. "More and more young people are living together, but the rate of breakdown is very high, with all the confusion that surrounds it." And since most of the figures include the 20 to 25 age group, teenage unhappiness is lasting well into adulthood, with all the attending implications.

"Adults are not very good at reading the signs of serious disturbance in their children," says Professor Rutter. "Moodiness is part of adolescence, but parents need to respond to any signs of impairment." So when does door-slamming, holing up in the bedroom for the entire weekend, and communicating in monosyllables turn from antisocial behaviour into something more serious?

"Look for sudden, uncharacteristic changes in patterns," says Eddi Piper. "If friendships suddenly change or go sour, if strange eating habits develop or great weight loss or gain begins to feature, be vigilant. A death or a broken relationship, particularly if contact is lost with someone who was very important, can trigger a downward spiral, as can loss of trust in someone, or the realisation that a cherished dream or ambition can never be realised. It's far too easy for adults, so distanced from their own adolescence, to dismiss the intensity with which teenagers experience these things. They don't know what to do with these feelings, or where to take them, because they don't yet have the life experience to be philosophical."

Paul Farmer from the Samaritans echoes her thoughts. "The suicide of Kurt Cobain and the disappearance of Ritchie James Edwards of the Manic Street Preachers struck an enormous chord. We were contacted by Melody Maker magazine because it had a flood of letters from distressed and suicidal fans who felt they had lost a close friend and a role model. It is difficult for adults to understand that a single event of that kind can be the most important experience in a young person's life, something they feel they will never recover from."

Eddi Piper trains people who work with adolescents - teachers, doctors, nurses and social workers - to be more receptive to problems. "Those particularly at risk statistically include young people in prison, those living in isolated rural areas, young Asian women caught between two cultures, teenagers struggling with their sexuality, and those who have, or think they have, a serious illness. There are many teenagers who sail through, but there are many others who feel hopelessly isolated, don't know where to take their feelings, and cannot communicate with either their parents or their peers.

"One of the things I try to get across is that, if a young person talks about committing suicide, the idea that he or she is unlikely to attempt it is a myth. The reverse seems to be true, and one of the times to be most vigilant is if the clouds suddenly seem to lift. Coming to a decision to commit suicide makes people feel better, strange though it may sound."

She is communicating her ideas at multi-disciplinary conferences all over the country. The project has just received Lottery money to involve and train teenagers to train the adults. "The idea is that they will have a chance to put forward their own views on mental health. Just how much remains in the adults' minds afterwards remains to be seen," she says.

The caring professions may take time to listen, but what of the multinational corporations that spend billions devising ways to part teenagers from their money by creating unrealistic longings for the accoutrements of a so-called perfect lifestyle? Perhaps if more effort was put into exposing the cynicism with which every area from the music industry to soft drinks and cosmetics manufacturers views their young consumers, the scales would fall from the eyes of young people everywhere. It won't happen, of course, because the main sources of information are television and magazines, committed to suck in as much advertising revenue as possible in order to survive. It's a mad world. No wonder our children are going bananas.

'I cut myself to feel alive. The pain reminds me that I exist'

Christina, 17, was three weeks into training as a dental nurse when she lost her temper with patients and was asked to leave her job. She has just taken her GCSEs, but feels there is no purpose in continuing with her education and sees no prospects on the job front either. She feels she has been depressed since the age of 11, when she started secondary school, and can see no way forward in the immediate future.

"Aggression is my main problem. That's the form my depression takes. When I go down, it's like I've been shoved in a cupboard and someone's locked the door and they're outside laughing at me, and then the anger kicks in because that's the only way I can ever get out.

"I used to get pushed around at primary school because I was skinny. After a while I decided I wasn't taking it any more and I started hitting out. Then, shortly after I started secondary school, I was assaulted in an alleyway by boys on bikes. It happened again, only the second time they took my money, too. And I started getting taunted at school about my shape again, how I was anorexic, which I'm not, so I just got angrier and angrier.

"I discovered cutting at primary school. We'd get a needle and stick it through the top of a finger, then in an arm. I found that you could go in quite deep before it really hurt. When I got older and more unhappy, I started doing it on my arms, legs and stomach. More recently I've done it around my wrist and inked it like a tattoo.

"I don't do it so much to release anything as to make myself feel I exist. It reminds you that you're there when it starts to hurt. It makes me feel awake and alive, because sometimes I feel I'm above the ground and I don't really exist. But I have stopped doing it so much. I used to have to do it, but I feel it is more under control now, which is good.

"I went to the doctor at one point and he gave me pills for going to sleep, pills for waking up, pills for calming me down, pills to make me happy. It was a joke. I did sleep, but otherwise they didn't work, and when I said I wasn't going to take them, he said I was refusing to be helped.

"He did refer me to a counsellor, who was nice, but her style wasn't any good for me. She kept telling me to imagine myself in a bubble floating round the room. She was trying to calm me down, but that is not what helps me. I need to blow my top, and I expect people to yell back, but she was trained to be all quiet and not to react the way I wanted her to. I used to end up screaming at her, when that was the last thing I started out wanting to do. She said I needed more serious psychiatric help. In other words, she thought I was mad.

"The best help I had was when they started an assertiveness group at school to try to bring together kids they thought had problems. We had an adult counsellor, who was great, and I could talk to people my own age, and because we all had problems we supported each other and no one went blabbing about things outside the group. Otherwise I couldn't relate to my own age group. I hated the fact that most people my age thought I was a freak. I never cared what adults thought of me, but I did care what the kids thought because I didn't want to be like I was.

"I can't talk to my family, and there are lots of things I don't tell my mum because she gets upset. There's been a lot of trouble with school. I've had a serious go at teachers and then been threatened with expulsion, but it didn't happen in the end. The deputy head thought she was god, but she left.

"Whatever you do or say, no one takes you seriously. You're just a mixed- up teenager, not a real person. I can't stand these sitcoms when you see the stereotype of the screwed-up teenager behaving really badly and it's supposed to be hilarious, and my mum says, 'Oh, that's how you're going to end up. You're going right downhill.'

"I admit I don't really know what I want. Sometimes I want people to yell back at me, sometimes I want a hug. Sometimes I want to be left alone and then I want help, but I get really worked up when people stick their noses in my business.

"I've got to get through this and I think I will. The obvious thing is to look for another job, but I know I've got to get myself sorted out properly, otherwise I'll get the sack again, because I don't like being told what to do and I lose my temper. It all seems pretty pointless at the moment. It isn't easy to get jobs, they don't pay much and I'm not interested in doing A-levels. It's not an option. I've definitely had it with education.

"I've got a couple of good friends. One of them comes round every morning and drags me out of bed, and I don't mope around the house all the time. I drink and have taken the odd gram [of speed], but otherwise I don't do drugs. I get drunk and come in late, and that causes more problems. Every time I go out I say I'm not going to do it this time, but then I do.

"I've started writing stories and I'm going to send them off to people so I am doing something, but otherwise everything seems pretty pointless."