The Sound of Silence

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We often use the word inspiration when talking about people we admire, a fitting accolade we think when we look upon their lives, their work and their deeds. In truth I think we use it a little too often or at least in a way that robs it of any real power. An important aspect of the word’s meaning after all is to make someone feel they want to do something…that they can do it. If I sound self righteous have no fear as I too am guilty of this. I don’t often yield to this call to action and so use that word in place of it. And this is why I want to mention one chap and one small ‘inspiring’ talk about mental health, one that truly makes me we want to do something. The gentlemen in question is Dick Moore and he has lived his truth. His crusade to help the mental lives of young people was launched from the devastation of his son’s suicide, a fact he talks about with heartbreaking candour. As a parent no words can adequately convey the horror of this or the strength it must take to relive this event time and time again in the service of strangers.

It’s a little bit of a task to distil such an insightful lecture into a series of salient points, but I will try. Hopefully, it will be of interest to those of you that do not have time to listen to the full 45 minute lecture. It is a cautionary tale of systemic failure in the recognition and treatment of adolescent mental health. This failure permeates all aspects of public services, health included. It runs from pre-school to university and is all underscored by a general lack of public awareness. Dick Moore has sympathy for this state of affairs, imagining the beleaguered local GP that is expected to engage, diagnose and treat a previously undisclosed mental health complaint in a little under ten minutes, despite in all probability having no mental health training at all (statistics put this at approximately 50%). To this end he is an advocate for the Charlie Waller Trust, which endeavours, with courses like mental first aid, to educate our GPs and our teachers in recognising the warning signs.

There were many examples in the talk of what shape this training might take, but one simple tool he had been shown was a points based questionnaire. Although it had just seven questions, he argued that even starting with just this could aid an individual in assessing the mental and emotional development and health of their child. Much like the Glasgow Scale assesses the severity of a coma it does a broad stroke job of flagging up potential mental health problems. The beauty of it is the deceptively simple nature of its questions and its ability to facilitate mindful consideration of how your child relates to the world. But perhaps its greatest utility lies in the fact that we often might suspect something is not quite right, but we don’t know what questions to ask. I urge you to check it out online.

Dick Moore’s discussion of the adolescent brain should be mandatory for all parents, not so much because it has all the answers but rather because it acts as a springboard to a criminally overlooked period of human mental and emotional development. So often this time is dismissed as a ‘phase’, something that ‘will pass’, but the terrifying truth is that 75% of all mental disorders develop in adolescence. The plasticity of the adolescent brain and its ability to be shaped by its environment is without doubt one of the greatest periods of imperilment in a human’s lifespan. We are held captives to a unreliable and chaotic despot…our brains. The amygdala, the ancient seat of our emotions, is firing away chaotically like some super cell electrical storm, whilst the prefrontal cortex, the bit that reasons and does the whole Spock thing, is undeveloped and unable to cope. It would probably surprise you to know that this bit of the brain does not reach maturity until almost twenty-five (it can even be longer). If this were a planet no rocket ship in its right mind would land there. One American neuroscientist eloquently captures the potential for calamity here, remarking that ‘The key task of adolescence is to make high risk decisions with poor judgement.’ This statement encapsulates everything we, as parents, instruct our children not to do. But this is how they learn. Fortunately, there is a safe infrastructure at school and in our homes to modulate, punish, reward these urge, to help mould them into something productive. What then happens however when they strike out on their own? At University, to take one example, this support system is no longer in place. They are untethered and floating free. That can be frightening indeed.

It can seem, given the above, that our brains are poorly designed, but there is method in this madness. Consider the dangers of the natural world, like a venomous spider or snake. If a child took the time to mediate its response through all the brain’s systems it may well be too slow to react. The milliseconds it would take to navigate the route from the amygdala to the prefrontal cortex to brain stem could well seal its fate, which in this instance is a pair of fangs in a juicy thigh. Consider, however, the route from amygdala ( an immediate fear generated response passed down in our DNA) to brain stem and you just bought yourself some vital time to escape. The later developed structures, in this instance, are less beneficial to our immediate survival.

The point in all of this is that the adolescence brain is strewn with barriers. These are surmountable and even beneficial to building resilience, but they also have the potential to deviate an individual from a healthy emotional path. There is a growing body within the psychiatric community that now believe that the greatest threat to self-esteem is the first two years of puberty. This is vital, as self-esteem is arguably the most important building block of mental and emotional health. Adolescence is a time of enormous change in which we become aware of our maturing and developing self-image. We have to cope with our sexual maturation and the enormous responsibility that it brings. We strive to cut our dependence on our parents whilst simultaneously fearing precisely that, a curious Orwellian double think that makes us unsure of ourselves and what we want. Freedom is exciting, but it is also frightening. In all of this we must build resilience, we must embrace the fear in order to conquerer it.

I suspect to some that the foregoing line sounds a little bit like something Mr Miyagi might utter in the Karate Kid, but consider something I have touched on before, the Helicopter Parent. They are that vicarious driven beast, the over-bearing, ever-watchful parent that micro manages every aspect of their child’s life. Mr Miyagi would not be pleased with them. This approach will not mitigate the perils of adolescence, it will only exacerbate them. It will not ensure a successful adult, it will inhibit and damage them irreparably. Our children need to experience disappointment and success on their own terms. Stress and anxiety are a part of life and they have a role to play, but it is a a delicate one. If there is no anxiety, it might be that there is no perception that things matter. Take examinations, for example. They are not life and death, but perhaps there should be some impetus to at least try and do well. Too much anxiety however, and it may tip the balance and become its own beast. Acute stress disorders are on the increase in our children. Regulation is key.

Avoiding stress inducing situation or triggers is not the solution. We must build resilience and mindfulness into our parenting handbooks. We must tread that line between space and intervention. It’s how we help our children process and manage their feelings and reactions which is key. We must be mindful and respectful, separate yet ever lovingly present.

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