Medium 9781780491806

The Late Teenage Years

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The problems which the individual has to deal with in adolescence are qualitatively different from those of childhood; they are related in particular to the adolescent's reaction/responses to the physical development of his/her sexual body, and the changing relationship to the parents and to the world in which he/she lives. We have to take into account the revival of infantile conflicts and the newly emerging sexual and aggressive urges and experiences, both of which have to be integrated by the adolescent so that a new equilibrium can be created. The adolescent finds himself in the very difficult position of having to make all these readjustments whilst he has to deal with the subsequent conflicts and anxieties. The earlier passionate mixture of love and hatred that characterizes the attachment and dependency on the parents must now be renounced until the adolescent reaches a point at which it is possible for him to confirm his own identity and find new love relationships. These must neither be based too much on repetition of previous early attachments, nor be entirely and exaggeratedly opposed to them. It goes without saying that none of this can be achieved without much upheaval and experimenting. The step from adolescence to adulthood is complex and involves not only the individual's emotional experience, but also the continuous input, reactions from the world in which he/she lives. It is these interactions that are described and discussed in this book.

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Chapter One - Normality and Pathology in Adolescence

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CHAPTER ONE

Normality and pathology in adolescence

The subject of this chapter presents us with a problem, as it is very difficult to state at any stage of adolescence what is normal and what is not, and this does not change during the last phases of this process. The question of what is right and what is wrong during this developmental stage continues to be a controversial one. In this chapter, therefore, we want merely to try to facilitate an understanding of what could be considered normal and abnormal developments, as well as to suggest some basic and necessary criteria for the assessment and comprehension of the main aspects of mental and emotional functioning during this phase of life.

To begin with, the classical stages no longer seem to apply; we now see a prolongation of adolescence well beyond the age limits which were usual until recently. For family and social reasons young people take longer to leave home and, therefore, to achieve one of the most important tasks of the last stages of adolescence: the physical as well as emotional separation and independence from the parents. On the other hand, with the greater sexual freedom that adolescents now enjoy, and under the pressures of certain politicised sections of society, we sometimes see what we call a foreclosure of the adolescent process, particularly when the sexually confused young person unconsciously and prematurely chooses a perverse solution. This may be difficult to assess but we must recognise it, because of its prognostic indications and because of the implications and risks of a fixed perverse development, whatever this perverse development might be.

 

Chapter Two - Depression and Anxiety in the Older Adolescent

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CHAPTER TWO

Depression and anxiety in the older adolescent

Introduction

“Depression and anxiety to some degree are ubiquitous in adolescence and can be regarded as part of normal adolescent development” (Winnicott, 1965).

All adolescents go through phases of depression and anxiety which are evoked predominantly by feelings of uncertainty about their capacity to become autonomous individuals. The sense of uncertainty about the future also contains feelings about the loss of the safety of childhood. The developmental task of becoming an independent individual is related to the process of separating internally and externally from the childhood relationships of dependence on the parents. The adolescent normally needs to find other figures of identification and role models to help him manage his conflicts over dependence, hence the importance of peer relationships, the extended family, and the parents of friends. Continuing conflicts about dependence on parental figures are likely to create feelings of inner distress, which are easily externalised in diverse ways and at different moments; this process can intensify depressive feelings and create a great deal of anxiety about the future. One of the ways in which this may be expressed is through aggressive attacks on the individual's own body, a behaviour which is usually also connected to intense feelings of shame. An alternative mode of expression may be through displacement of these aggressive feelings onto other figures, more often than not parental substitutes, but also peers. This is further complicated by the fact that the adolescent easily displaces not only negative but also positive feelings which can lead to idealisation of others in the external world. To some extent this idealisation is very much part of the early and middle phases of adolescence; for example the preoccupation with pop stars and film stars. But in the later phase of adolescence these idealisations are usually transformed into ambitions and aims which are more related to the individual's interests and capacities.

 

Chapter Three - Academic Failure

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CHAPTER THREE

Academic failure

Academic failure and, to a lesser extent, lack of enthusiasm vis-à-vis their children's studies, is one of the great parental preoccupations during most of the period of adolescence. What to advise parents in such situations is always a difficult and delicate matter. It is, of course, their duty to encourage their children to study but it is also our duty to make parents aware of a few facts.

Is adolescence the ideal period of life to learn and to apply oneself to formal academic studies? We do not think so. In order to understand why, we need to remember what happens during the first five years of life, what happens to these children as they gradually progress through the main developmental phases: oral, anal, urethral, and phallic. Not only do we need to think about what happens to children but also what happens to their relationships with those around them: parents, siblings, nannies, and other important relatives such as grandparents, uncles, aunts, etc. As has been already described by our colleagues in the precedent volumes in this collection, this is not an easy period, and its culmination is certainly difficult—the Oedipus complex and its resolution are the equivalent of a most tempestuous love affair, one that is bound to have an unhappy end. Afterwards, things change drastically and, after the storm, calm arrives. What follows is known as the latency period and it is the one during which the child is more receptive to teaching and the period during which he is more keen and ready to learn. Most of his psychic energy has been withdrawn from the previous “childish” areas of interest and he is now invested in learning about everything in his new, ever-wider world. At this stage, children become difficult prospective psychoanalytic patients, as they do not wish to look back, but they are, by the same token, ideal students, as their thirst for knowledge intensifies. Adolescence is exactly the opposite of latency! Nothing could be more different, and we shall now try to remind ourselves, grosso modo, of the main aspects of the adolescent period.

 

Chapter Four - Aggression

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CHAPTER FOUR

Aggression

Aggression is part of human development from the beginning of life and as such we can talk about it as an instinct. Aggressive tendencies of all sorts constitute a considerable proportion of human behaviours, of human drives. These tendencies are necessary for us to go forward in life, to achieve, to survive. In this sense we can talk of the energy that constitutes normal and constructive aggression. Aggressiveness may also be a reaction to frustration and be aimed at overcoming such frustrations. Defensive aggression is a normal response to another form of aggression, namely violence or external attack, whilst pathological aggression is aimed at destroying others or oneself and is the main essence of unjustified violence. In adolescence aggression acquires a particular character and function which, by its urgent presence, causes confusion and concern among young people or to the adults around them. At this point of adolescence the character of aggression changes, as now the young person has a body that allows him to carry out damaging and destructive acts of aggression which can no longer be easily controlled by adults.

 

Chapter Five - Drug Abuse

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CHAPTER FIVE

Drug abuse

Problems of substance abuse can occur at any level of society and affect all socio-economic groups. It is the interaction of cultural, environmental, and constitutional elements with the conscious and unconscious forces operating within the individual who becomes an addict (or, in other words, the interaction of his inner and external worlds) that contribute most significantly to the creation of this condition. Whatever the reasons and circumstances surrounding the young person who uses illegal drugs and/or alcohol, parents must be in no doubt as to the seriousness of their children's predicament. Drug and alcohol abuse are an indication of psychological distress in need of remedy.

The adolescent who struggles with emotional conflicts can find himself in the very difficult position of having to make all sorts of readjustments and having to deal with the subsequent new conflicts and anxieties. When things go wrong, adolescents may be unconsciously compelled to develop psychological and/or physical symptoms in their attempt to look after themselves. When the resources of his internal world fail him, the adolescent often seeks solace in external consolations such as drugs, alcohol, sexual acting out, or delinquent behaviour. Dependency on substances or on pathological conduct becomes the only means of having a sense of belonging; and we then see completed in adolescence an unresolved pathological process that started in childhood, when dependency on those around the child did not offer the necessary feeling of safety. We frequently notice that dependence in the young person is accompanied by a crisis. For the youth, childhood has passed, but adult life in the future cannot always be seen clearly. The greater freedom and opportunities to act upon instinctual drives that adolescence offers are not always accompanied by a satisfactory sense of independence and self-sufficiency nor by a greater tolerance of the dependence on their parents as is the case until adulthood is reached.

 

Chapter Six - Severe Mental Illness

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CHAPTER SIX

Severe mental illness

The most common mental illnesses manifesting at this time are schizophrenia, anorexia, and bulimia; schizoaffective disorder may also appear. Drug-induced psychosis and suicidal depression are discussed in other chapters but also need to be borne in mind when thinking about severe mental illness during this important developmental stage at the threshold of adulthood. A thorough psychiatric and psychoanalytically informed assessment is extremely important in order to avoid misdiagnosis and to offer the right treatment to these adolescents and to manage them appropriately: their present and future lives are at great risk.

Late adolescence is a time when symptoms of schizophrenic illness may appear, but one of the difficulties for the psychiatrist is that its symptoms are not the same as in the older adult; this may lead to psychotic symptoms being missed or being over-diagnosed. We do not think a definitive diagnosis should be made at this stage as symptoms may be misleading. It is very important in those cases in which a diagnosis of schizophrenia is being considered, to assess if there are signs of foreclosure of the developmental process of adolescence as well as to examine the state of reality testing; that is, of the adolescent's capacity to distinguish fantasy from reality (or to question the validity of his perceptions of external reality). An adolescent who cannot differentiate reality from fantasy or who is unable to question his perceptions is quite likely to be ill. This state of affairs is very different from the much more fixed character of adult psychotic states: there is an important difference between those states and the distortions due to the developmental process of adolescence. Psychotic, or apparently psychotic, symptoms in adolescents tend to be more fluid, not fixed as they are in adult psychosis; psychotic symptoms may also be induced by drugs (such as amphetamines) in predisposed individuals and such episodes of psychotic illness need to be distinguished from a more chronic illness process. Another important difference is the reversal, during adolescence, of the pathological process, something that does not occur in the case of well established adult psychotic illnesses. Of course, it may well be that by the end of adolescence an ongoing psychotic process has been established, but this is not necessarily always the case and such an outcome might be avoided if the symptoms/condition are noticed early enough and properly treated.

 

Chapter Seven - The Therapist's Angle

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CHAPTER SEVEN

The therapist's angle

It is rare to find ourselves facing a situation which, in spite of its difficulty, so strongly stimulates the interest and psyche of the professional as happens when we treat adolescents.

This is the sub-specialty which most requires a dynamic understanding of psychic life, a point of special interest to all those who are interested in the subject of mental health. Although it is true that for a deep understanding of our psychic life psychoanalysis seems to be, amongst the various psychiatric approaches, the most ambitious, many of us believe it to be indispensable for working with adolescents of all ages. We wish to draw the attention of those interested in working with young people to some of the difficulties we encounter during this turbulent period in the life of a human being. The difficulties we refer to are not only those of young people but also (or perhaps, even to a greater extent) our own. No other field in psychiatry lends itself, to such an extent, to the acting out of our psychopathology. The adolescent is subjected to so many inner and outer pressures that he can hardly contain them by himself and in himself (as is the case for an adult) or tolerate the restraining steps offered by the world of adults (as is the case with children, for obvious reasons). Projective mechanisms play a very important role in this phase and those of us who are involved in this work are familiar enough with the phenomenon of “infection by the adolescent”.

 

Chapter Eight - The Parents' Angle

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CHAPTER EIGHT

The parents' angle

A. H. Brafman

The move from adolescence to adulthood is enormously dependent on the social class and the cultural background of each particular individual. In many cultures marriage is an engagement that characterises adulthood, while in others some religious sects see women as fit for marriage from early adolescence, or arrange marriages for their sons whatever their age. Moving out of the parental home is another landmark that in many cultures represents a change from adolescent dependence to adult self-sufficiency and independence—and yet, it is very common in our present British society for the young adult to continue to live in his parents' home. The capacity to earn a living and become self-sufficient is probably the main factor that leads to an acknowledgement of the individual having reached adulthood. However, for many years, as Erikson (1965) pointed out, university studies represented a “moratorium” that society offered those adolescents who needed some time before taking the plunge into the wider adult world. These examples are quoted in order to illustrate the difference between the individual's experience of himself in the world and how his family, peers, and society in general view his developmental achievements.

 

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