the teen mental health crisis and me

Today’s McKinsey Daily Read – “Getting to the bottom of the teen mental health crisis” – landed in my email inbox this afternoon, and it was chilling for me to read. From the article:

Worldwide, at least 200 million children and teenagers struggle with a mental health disorder. And in the US, around 17.1 million young people have a mental health disorder by the age of 18.

Girls, in particular, are really in crisis. According to the CDC [US Centers for Disease Control and Prevention] report from earlier this year, almost 60 percent of US teen girls said they felt persistently sad or hopeless. And one in three seriously had contemplated attempting suicide in 2021. That’s almost a 60 percent increase from the decade before.

Halloween with my friend Danielle (not pictured, my hot pink cast and broken right wrist), Fall 2003.

My first memory of feeling consistently and overwhelmingly off was in 2003. I was 13 and in 8th grade, my last year at St. Philip Neri School, the small 35-kids-to-a-class parochial school that I had attended since kindergarten in 1995. My older brother, both my best friend and my idol growing up, had left home that September for his first quarter away at college, the delicate balance of our family unit now off its axis. I was navigating the emotional extremes of my first boyfriend, then mourning the loss of the tumultuous 2-month, primarily AIM-based relationship. And, most tragically for a 13-year-old girl, I had to get braces.

That year, I played on an especially intense and dysfunctional club volleyball team. We practiced three times a week after school in Berkeley, about a 30-minute drive each way from my home. Every other afternoon, I felt a terrible gnawing expand from the pit of my stomach – what I can now identify as extreme anxiety – as I sat in the car listening to rage-filled rap music in silent dread while my mom drove toward the U.C. Berkeley campus.

In hindsight, I can see the many, many reasons that life felt especially overwhelming for me then, inclusive of but also far beyond the stresses of unnecessarily intense youth volleyball.

I can also see a still-younger six-year-old girl weeks from starting 1st grade, who had just lost her dad – my hero and pillar of strength – after watching him fight, then falter to, a brain tumor over the prior nine months. At that age, I had absolutely no mechanism to process, or even acknowledge, the depths of my fear, my confusion, or the all-encompassing pain of what I had experienced. I don’t remember feeling much at all about my dad’s death throughout my youth, almost as if it was all some hazy, distant, yet matter-of-fact bad dream.

But unprocessed pain doesn’t just go away because we would prefer that it did. My grief began to rear its head come adolescence and continue to compound upon itself in the years that followed. Outwardly, I tried so hard to present as successful, fine, easy, good; internally, I grappled with big feelings that I could only interpret as proof of my irrefutable, inherent wrongness.

My 1st grade school picture, Fall 1996. My dad died that August.

Today, I view my fluctuating mental health as something that just is. I operate under the assumption that I will always have to manage my brain mindfully, no differently than if I had a chronic physical condition. I expect that there will be ups and downs as life ebbs and flows. It might feel especially hard at times, but I have the confidence that comes only with bouncing back from so many deep lows to know that I am, and will be, okay.

I only have this perspective after many years of trial – and lots and lots of error.

I think about today’s teens and all of the fear, uncertainty and chaos that they have had to endure through the pandemic years alone – and what a significant point in time and proportion of their lives those years represent. Paired with the general angst and discomfort of adolescence, the preexisting genetic and social barriers they may face and the other macro trends mentioned in the article – social media, stigma, global conflict – and it is obvious that overwhelm and despair are potential, even likely, outcomes. Like me, our teens are responding rationally to that which is deeply irrational.

From my 8th grade graduation book, Spring 2004.

I am deeply concerned, but I am eternally optimistic. I believe in humanity’s ability to solve problems of its own creation.

But, per the data, the current approach is not working. Trauma is connected, contextual and ongoing, not a single variable that can be isolated. The answers, like the trauma, will be complex and hard, not simple and binary. As a society, we are failing our young people by looking only at them, the individual children presenting with symptoms – which for me, were unhealthy coping mechanisms that manifested as unhealthy behavior. We must also acknowledge, address and solve for the root causes of so much universal, systemic pain.

Teens today, likely more familiar with mental health conceptually than I was at their age, are still working with an incomplete and insufficient set of tools. I felt very adult at 13, but I can understand clearly now that I was just a kid. As an adult, I can see all of the advantages that I have today that I didn’t have then, or even through most of my twenties: a fully developed brain and body; financial independence; a career; the freedom to manage my own daily schedule and commitments; medication; a better understanding of the world and of myself.

I have also spent countless hours with therapists, psychiatrists, doctors, family, friends, teachers, mentors, coaches, books, podcasts and my own thoughts, desperately trying to make sense of my life in the hope of just feeling better some day. In addition to will and patience and blind faith, this required huge amounts of time, access to resources and flexibility. I have worked harder on healing than anything else in my life, but I can also recognize the massive amounts of good fortune that enabled me to do so – good fortune that is not the norm for many, and certainly not for a teenager.

On January 15, 2020, I became an aunt and was changed forever. My nephew entered the world right on the precipice of COVID-19 ending life as we knew it. My niece joined him a couple years later. Through them, I get to re-experience the sheer exhilaration they have for life itself: their awe at the mundane, their uninhibited giggles and guffaws; their tenderness in close proximity with their tantrums. They live each moment as it comes because they know no other way. I am reminded that so much of life’s whimsy and thrill lives precisely in the unknown, which makes it feel less suffocating, if only temporarily.

I spent most of 2020 by myself, first in my fifth floor, prewar walk up apartment in New York City as the always-on city shut down virtually overnight, then back on the West Coast after life brought me back to the Bay. Alone with so much swirling darkness but also so much literal and figurative space, I began to capture short iPhone videos from my daily walks and socially distant meet ups with friends and family. At the end of the year, I compiled them into a video for my Instagram friends set to a cover of “What a Wonderful World” by Louis Armstrong with a reflection on the intense duality of the year.

The song has always been bittersweet for me; it was my dad’s favorite song, and it played during the processional at his funeral. But equal to the anguish of losing him so tragically, too soon, is the beauty of knowing that he saw the complicated, sometimes inexplicably awful world through the same glittery, hopeful, love-filled lenses that I do, and that my niece and nephew do, too.

My dad and me celebrating my 4th birthday, March 1994.

If I had the choice, I would choose for my dad to be here, to have always been here. But it was never my choice, a reality that has taken close to 30 years for me to believe not just intellectually, but emotionally and bodily and spiritually. Inexplicable things that aren’t supposed to happen happen every moment of every day. That reality – that so much of life is outside of our direct control – was too much to grasp at six, at 13, at 25.

I had to survive in the best way that I was able, and sometimes, the best way that I was able was not the best way. At times, it felt like I was feeling my way through the darkness all alone, destined to be lost forever. Now I can see how much I had oversimplified my experience and written off so much that was good, externally and internally to me, and how critically hard I was on myself for so long simply for being human.

I can also see that even in the depths of my loneliness, I was never alone. When drowning felt imminent, I always knew that there were so many people who loved me, who were rooting for me, who needed me in this world, the way that I needed my dad. They and their love kept me afloat – often imperfectly but in the best way that they were able – so that I could spend all of my limited reserves on holding on to the last vestiges of light.

I am stronger for enduring, but we have to do better for today’s children. The next generation has to believe that a better and brighter future can exist for them, too. No one can do it alone, and – like it did for me – it will take time, resources and many frustrating setbacks. These are very hard problems.

But we have to do something. It is imperative that we begin to recognize and treat childhood trauma and teen mental health not only as individual ailments, but also as a rapidly advancing global public health crisis requiring collective, and urgent, action. The lives of our most vulnerable are at stake. Continuing to look away is not a viable path forward.