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A Diagnosis is Devastating for Teens Struggling to Be Cool
The diagnosis of a mental illness in a teenager is often the result of a long process. As a family, you may have endured school meetings, testing by the school psychologist, appointments with your family doctor, referrals to a specialist, and then multiple visits with a therapist before actually seeing a doctor. Phone calls to an insurance company, notes home from teachers, and perhaps even suspensions for behavioral issues may have prefaced the diagnosis. As a parent, as difficult and upsetting as hearing the diagnosis may be, relief and a sense of handling things often accompany the label. With a label can come a plan.
For your teen, though, the diagnosis may well be a touchpoint for denial. Let’s take a closer look at the “whys” and “hows” of the denial process for teenagers with mental illness.
Developmental Issues and Illness
The creation of an identity is the primary developmental task faced by teenagers. Some therapists refer to this as the “tyranny of cool”: being cool is probably the single most important factor in most teenagers’ lives. But who defines cool, and how that definition shifts and changes, can be exhausting and intimidating for most teens. For a healthy teen, simply trying to navigate public school without getting beat up by upper classmen or teased by girls that weigh less or have smoother hair is a full-time effort. Creating an identity – a “persona,” if you will – helps teens deal with these challenges, and also leads them out of childhood and into adulthood. The creation of an identity is a critical step in personality development and helps pave the way for all adult decisions: life partner, career and values.
The extreme clothing, hairstyles, and fashion “accoutrements” such as tattoos and piercings are an outward expression of this – it is important for teens to distinguish themselves as separate and independent from the adult world. At the same time, the reliance upon their peers for helping to co-create and delineate their identity is key. Adults are “tainted” during this phase, and the creation of identity is often helped by countering or challenging adult norms, styles or values. Think of it as, “I figure out what I am by knowing with some certainty what I am not.” Figuring out what I am is critical to teens and no matter what they come to be, “cool” must be part of it.
For most teens, illness of any type is just not cool. For some, they are able to do a “badge of honor” spin on illness or any other form of “otherness” and flaunt it. However, more commonly, illness is felt to be terribly uncool. The diagnosis is a slap in the face to a teen’s fragile self esteem and budding identity, a confirmation by the adult world that “there is something wrong with me.” For most teens, stressed and struggling to simply deal with normal developmental pressures, “there is something wrong with me” rapidly escalates into a global plummeting of self esteem and a sense of “everything is wrong with me.”
Denial as a Part of Grief
Most teens harbor a fantasy that on some level they are alone in the world and at odds with their parents, despite actually living with a loving and supportive family. The process of reaching a diagnosis often underlines this sense of “at odds” with the world, and depending upon the illness, feeling alienated and isolated may also be a part of the disease itself. Unfortunately, in most medical settings, reaching a diagnosis has been a process of focusing on everything that the teen may feel is wrong with them – a collection of symptoms, “bad” behaviors, or “bad” feelings that they’d prefer to ignore or downplay.
Thus, denial may come to the fore as a part of the process of grief, and can be a normative part of moving through grief into acceptance. Denial can also exist on its own, as a primitive (meaning psychologically “young” or developmentally early, not meant in a pejorative sense) defense against the pain and stress of being imperfect. How can a parent know the difference? Look for the other aspects of grieving: anger, bargaining, and depression. The variety of behaviors and emotions is what differentiates this from denial without grieving: that would look more consistent.
What’s a Parent to Do?
Continue parenting, which is to say, continue to hold limits and boundaries with love. Accept the person but reject or respond to the behavior. In real life, how does this play out? It can get messy, and it is often difficult, but in real life terms, this means saying no to things you feel your teen isn’t ready for (like staying out past curfew), and enforcing consequences when rules are broken.
Take the long view, and remind yourself and your co-parent that this phase will end; your teen will become an adult and will learn to manage illness on his own. Your job will be temporary but the diagnosis is his life. Give him the best information, support, and “foundation” now, while you can, and be ready for him to stumble now, while you are present to catch him.