I I’m an expert”. At least in the sense that as a mental health doctor I am asked for expert advice, I am included in expert advisory groups, and if I testify in court, it is taken as expert evidence.
But when I see young people in my daily work to help them with their mental health, it becomes clear to me who the real “experts” are.
Annie*, for example, came to see me because of a distressing situation. She was at school and suddenly she felt very bad. She said that she could not breathe properly and that her heart was racing. She felt numb, she had pins and needles in her hands and she felt like she was about to pass out.
He told me that he didn’t want anyone to notice, so he went to the bathroom where he felt more and more that something terrible was about to happen. Maybe a heart attack, there was pain in her chest. She couldn’t get out of the bathroom because she was crying. She had had episodes like this off and on for a couple of years, but this was by far the worst and she was afraid something serious was wrong. It was getting harder and harder to go to school or even hang out with her friends.
Annie saw her doctor, who said it was “just anxiety.”
The doctor told her that she should avoid going to the hospital when this happened because the tests are unnecessary, expensive, and of little use for anxiety. He was given a prescription for a medicine.
When she Googled the tablets she was given, the search results showed them to be antidepressant medications.
Her depressed friend had gained a lot of weight on medication and her personality seemed to have changed. Annie said she didn’t want this: “I don’t want to be medicated for the rest of my life.”
She felt even more anxious and depressed with herself. She felt judged because she admitted to drinking and trying drugs at parties with her friends. She regretted being honest about this because she thought she stigmatized her, although she felt that this kind of thing was quite normal for someone her age.
In fact, he had stopped drinking and was afraid of what the drugs might do to his heart. She was afraid to go out and even afraid to exercise in case she hurt him.
Annie had a different story of herself to tell when I saw her and a lot of questions about why this was happening. She felt like she wasn’t the person she was dealing with and she didn’t know where to get help.
That week I also saw Justin*, a young man in trouble with the law. He had a difficult childhood and discovered that the streets, and a group of young people in similar circumstances, were safer than his home. He was charged with trespassing. He seemed stressed, couldn’t sleep, couldn’t sit still and found it hard to talk about himself. He found it especially difficult to talk to people in positions of authority. He relied on drugs to sleep, feel good, and block out bad feelings.
These two teenagers had very different backgrounds and experiences, but neither could easily put into words what was happening to them.
They looked unhappy, miserable. Sometimes they would shrug their shoulders, look away when they were spoken to, and fidget.
But when I was wrong, they both made it clear to me with a nod or a firm “no.” If the answer was yes, they usually followed up with more information. They both tried to help me understand. And I didn’t feel like they were lying or hiding the truth when I was trying to see the world from him.
Annie has panic attacks, a panic disorder, and agoraphobia: she avoids places that could trigger an attack. Justin has ADHD and is on the autism spectrum. His anxiety comes from trying to fit into a neurotypical world. He too has experienced trauma and had to fend for himself from a very young age.
Each one has their own story. As a health professional, I try to use my training and experience to consider your story against the evidence in mental health research. Then I try to tell them their truth within this framework. Between us, we check which parts seem to fit together and discuss which aspects can be reversed through treatment. We talk about the pros and cons and all the possible side effects.
Sometimes it takes time and a lot of trust to find the way forward.
Both Annie and Justin had already received labels and prescribed treatments. They did not agree to that, and did not follow them. First we needed an agreement.
Ultimately, I’ve found that the “expert” on any teen is oneself. To be effective, my job is to first listen to them.
In Australia, support is available at beyond the blue 1300 22 4636, Life line on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and ChildLine on 0800 1111. In the US, mental health america is available at 800-273-8255.
Dr. Saretta Lee is a psychiatrist from Sydney.
* Annie and Justin are fictional amalgams used to exemplify many similar cases
