Posted on Wednesday 29 June 2016

    ad·o·les·cence   [ad-l-es-uh ns]
    noun: adolescence
       the period following the onset of puberty when a young person develops from a child into an adult.
Home after a long bus ride on a choir trip, she was in an agitated state. Apparently one of the neighborhood girls had been telling increasingly exaggerated tales, stories our daughter knew were untrue. "She’s just a liar! Why does she do that?" And nothing we said made a dent in her consternation.

The next day, we were on the front porch and my wife mentioned another neighborhood kid, an adopted girl who was headed for trouble. She’d announced to my wife that she’d met her "real" mother who was a "street walker" – this time something we knew wasn’t true. Our daughter, piped up from across the porch where she had seemed lost in a magazine and said matter-of-factly, "Oh she didn’t really meet her real mother. That’s just what she wishes was true," and returned to her magazine. But there was more to come.

On the weekend, she decided to go sailing with us – a rare treat in an age where being with friends had moved center stage. It was a good sailing day, and we’d had a fine adventure getting tangled up in a regatta of smaller boats – "gnats!". We were on a long tack back to the dock when she announced out of the blue, "All lies are wishes. I think I’m right about that." It was said as a challenge, so we joined in the game. We offered counter examples that she shot down with increasing confidence. "I’m telling you, I’m right about this."
We usually think of adolescence in terms of puberty with its physical, emotional, and identity changes:
    pu·ber·ty   [pyoo-ber-tee]
    noun: puberty
       the period of life when the sexual organs mature and he or she becomes able to have children
But there’s a concomitant cognitive leap that’s every bit as dramatic. Piaget described it as a move from Concrete Operations to Formal Operations, focusing on the use of logic and classification. But it’s more clearly described as the acquisition of the capacity for abstract thought. So the arithmetic of elementary school gives way to algebra, where a symbol like X can be any number. Or the jump from a book report that says "Black Beauty was very black and pretty. That’s why they called him Black Beauty." to one that says "Black Beauty is a story about a horse’s encounters with cruelty and kindness." It’s the cognitive leap hopefully illustrated in my daughter’s reflections on the meaning of lies [she was thirteen].

With the acquisition of meta-thought [abstract reasoning], the adolescent finds him-or-her-self in a new world [or an old world with a new look]. They may not yet have a knowledge or experience base, but they can think as well as their parents, and seem to know it ["I’m telling you, I’m right about this."]. And they can drive parents to distraction with their endless arguing and logic games. Little wonder Anna Freud pointed to rationalization as the primo defense mechanism of adolescence. But beyond that, they now can see our flaws and foibles and gladly point them out if given half a chance, as the former authority of parenthood fades.

Erickson described the developmental task of adolescence as identity formation. The adolescent’s abstract musings quickly turn to the question of "What am I?" Blos described it as the second separation/individuation [the first being the coming into personhood at age two]. And like the two year old’s "No" as the harbinger of change, the adolescent often starts the identity process with something similar, the rebellious "I don’t yet know what I am, but I’m sure not what you think!" And there may be any number of trial identities before one fits. In my vignette about my daughter, the first girl [the "liar" on the bus] is now a successful gay married woman and I suspect her self-important exaggerations at thirteen were related to not knowing how to fit into the culture of the time. The second girl did go on to prostitution and other such, dying in her late twenties from a unintended narcotic overdose during a relapse – all in spite of her parents somewhat heroic attempts to turn things around. With the identity comes the related character or personality formation. In adolescence, all of those character traits that seemed kind of fluid in childhood begin to condense into the a predictable and fixed set of ways of doing, being, and reacting that we call the person·ality.

And finally, there’s interpersonal life ["… a rare treat in an age where being with friends had moved center stage"]. The adolescent drifts away from family life into that place of their own called adolescence, where the people that matter are peers [and the dominant culture is guaranteed to differ from the teen culture of their parents]. Even for the introvert who stays apart, peers remain the audience being played to in the mind. Adults think of it as a phase they’re going through on the way to a place in society, but for many occupants, it feels like [and may actually become] a final destination. In the finale of the classic teen musical "Grease," they sing exuberantly "We’ll always be together" – which is rarely true in fact. Yet for many, it’s etched in memory just as the song describes it. If you don’t know that, go back to your high school reunion and be awed by the floods of memories and emotions.

So what’s a quasi-psychodynamic overview of some broad issues of adolescence doing here in the middle of a blog about corruption in Randomized Control Drug Trials? I try to stick to that topic, even though I’m really speaking in my second language [mostly acquired in my latter years]. But as I’ve read all these RCTs about antidepressants in youth, I’ve had a growing frustration which came to a head with the PSYCHIATRICNEWS article about Karen Dineen Wagner’s remarks at the recent APA meeting [see a blast from the past…].

By my read, adolescence is a critical crossroad in development. It’s a period when change is in the air, a time with an opportunity to set right the unnecessary baggage carried forward from childhood. It’s also a time with its own shoals and pitfalls that may become incorporated into the adult personality structure and carried forward for a lifetime. Some change in adolescence is luck – an encounter with a teacher, a reparative friendship, a romance, and a myriad of other possibilities. But other adolescents flounder helplessly – developing symptoms, acting out, acting up, withdrawing, becoming depressed – signals for needed help.

Reading about Dr. Wagner’s talk about treatment [Child Psychiatrists Look at Specialty From Both Macro, Micro Perspectives] that only addressed the use of the antidepressants [which are hardly robust, more likely closer to inert in adolescents, and can be dangerous] or CBT [useful for some cases where you can find a C that needs some BT], and making arguments based on her tainted RCTs from ancient history [that we’ve been over a gajillion times], I got pissed off. Surely there’s more to say about adolescent mental pain than that, particularly by the President Elect of the American Academy of Child and Adolescent Psychiatry. When my kid gets depressed and I don’t know what to do, I want her to see someone who knows the landscape of that place called adolescence frontwards and backwards; someone who has taken the time to learn how to be invited inside its borders where parents are rarely allowed to go; and someone who will help my child find out where her unique tangles are and help her find a way to get on a road that can lead to a fulfilling adulthood [if that takes some pill, fine, but please hold the generic alogrithms!]. I couldn’t think of any way to say that except to speak in my native tongue…
    June 30, 2016 | 8:34 PM

    Hehe. I read so infrequently, but I saw the word “adolescence” and had to check for stories. Bingo! Also, I forgot to call you back.

    July 1, 2016 | 6:23 PM

    Abby is the now grown up daughter in the vignette…

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