Is It Trauma, a Mental Health Disorder, or Just Adolescence? ~ Some Meandering Thoughts

Oct 11, 2024- Adolescence can be difficult under the best of circumstances. True transformative processes are not easy, and struggle is to be expected. To suffer, according to the etymology of the word, is to undergo, bear, or endure. Think of the image we always associate with transformation—the caterpillar-to-butterfly process. Like the caterpillar/butterfly, the transformation wroughts beauty, and it requires an undoing of its original form to such an extreme degree that the creature is unrecognizable at one stage—just a cocoon full of goo. We call this suffering. It must be endured as it is inherent to the process of becoming.

During adolescent development this “coming undone” can manifest in a wide variety of ways, often presenting as distress, discomfort, sadness, anger, anxiety, or even depression. But does it require a diagnosis or an intervention? Whether we are sitting with a teenager or an adult with adolescent parts¹, there needs to be a place for suffering without moving to therapize, medicate, or unburden it. To do this, adolescent service providers must have a working knowledge of the essential nature of Adolescence and resources to discern what is in service to transformation and what is not. 

The growing pains of adolescence

Here’s the surprising thing—we don’t want to rescue teenagers from suffering the throes of normal adolescing. To rescue them is to stultify the transformative process from child to adult. Often from our place of care and fear, we seek to protect our kids from these discomforts rather than prepare and fortify them. Examples of distressing experiences include:

• disappointment and disillusionment;

• frustration;

• betrayal from friends, acquaintances, loved ones;

• the relevant consequences that life teaches when they fuck up;

• failure when they don’t follow through on responsibilities;

• being on the receiving end of someone’s ire when they themselves have been the betrayers, the disappointers, the frustrators;

• grief;

• the doldrums (Richard Frankl writes on the necessary doldrums that adolescents experience in his classic book on the Adolescent psyche);

• loneliness and feeling different;

• confronting the less-than-beautiful aspects of themselves, what we often call the Shadow;

• the ambivalence of shedding childhood ways while still clinging to them. 

So we support our teens as they go through these experiences by validating, scaffolding, being with them without trying to fix it, letting them know that we have their back and we trust that they have what they need to get through. We show up with Self energy, most especially Courage to support our own fears for them. 

Getting philosophical and existential

I have found in my work with adolescents that they lean eagerly into the philosophical and existential questions about life, meaning, purpose, and death. To be a memorable and respected adolescent service provider is to make space for, invite in, and entertain questions, reflections, debates, and outside-the-box ideas about what it means to be alive and human, including the meaning of suffering and trauma. I often tell my clients, We do not escape this life unscathed. It’s a cardinal rule of being born here on planet Earth. But this doesn’t mean there isn’t joy and connection. 

If there is one invaluable thing that we, as the adults in the lives of young people, can offer them it is Connection. In Joy Harjo’s evocative poem Perhaps the World Ends Here, the narrator speaks to the power of connection between children and elders:

The world begins at a kitchen table. No matter what, we must eat to live. . . .
It is here that children are given instructions on what it means to be human.
We make men at it, we make women. 
Our dreams drink coffee with us as they put their arms around our children.
They laugh with us at our poor falling-down selves and as we put ourselves 
back together once again at the table. 

From the perspective of years ticking by and life experiences accruing we know that life brings suffering and that we can’t avoid it. Pádraig Ó Tuama writes in his wise stoic poem The Facts of Life,

That life isn’t fair.
That life is sometimes good
and sometimes better than good.
That life is often not so good. 

Whether you are a parent, educator, pediatrician, coach, or even an employer of young people, there is always an opportunity to have conversations about the deeper things with kids. 

But what if it isn’t normal adolescent suffering?

The more effective question is - what if the teen is manifesting extreme behaviors in the face of their suffering? In my experience, all suffering is or can be in the service of transformation. I don’t believe that things happen for a reason, however, reason and meaning can be made from the things that happen. Life unfolds day to day, minute to minute, and despite heroic efforts to avoid it, much of life is capricious, uncertain, and far outside of our control. 

When I sit with adolescents and they tell me of their pain, it always makes sense. Always. They suffer because they feel invalidated, because they are immersed in systems that are at best ineffective and impersonal and at worse inhumane. Trauma, parents who are unable to be present to their children, and the daily stressors of schedules operating on overdrive cause reactions that are normal in the face of abnormal environments. (See The Myth of Normal by Gabor Maté for more on this.) 

The expressions of the suffering are what must be addressed. Self-harming; addiction; dangerous risk-taking behaviors; disordered eating; the inability to connect with others; etc. are examples of where interventions are necessary. 

Here are some of the tools in my toolbox regarding suffering and adolescents:

• Normalize and validate the pain, depression, anxiety, and so forth by identifying the triggers, from the personal to the global, from the individual to the political and systemic.

• Sit with kids as they attempt to bear the unbearable without trying to fix them or rescue them from the dark places. 

• Express compassion and curiosity about the stories they’re living and the stories they’re telling themselves. 

• Explore these stories in-depth, offering facets and perspectives that they may not have considered. Contextualize those stories within the mythic and archetypal, the larger fabric of the cosmos.

• Validate the feelings and motivations underlying the behaviors. I do not validate the behaviors. 

• Work with the adolescent to identify the protector parts involved in these behaviors. 

• Assess the child’s protective factors, both internal and external, and highlight these. 

• Carefully track the timing and patterns of events and behaviors, identifying signs of suffering in service to transformation, and then name those for the adolescent. I consider this to be one of the most valuable aspects of therapy.

• Be the hope merchant, lend Self energy, hold the larger perspectives—spoken and unspoken, and aim always for Courage rather than Fear. 

Of course, many of the standard treatment interventions are effective and necessary. I don’t discount or discard them. Emergent issues require immediate responses. I have found, however, that there are far fewer emergent issues than one might assume. 

Time, space, wandering and meandering, and trust in the adolescent’s process are powerful interventions in their own right. While this sounds abstract and “woo-woo,” I have worked with hundreds of teens in this way and while I don’t have a 100% success rate, the majority of kids end up having a solid bag of tools and resources to navigate the many years ahead of them. They have a strong sense of who they are, and they know how to come home to their own true Self, even if they lose their way along the way.

 ¹ In the online course Tools for the Adolescent Therapist: Internal Family Systems and Archetypal Perspectives, you can find my understanding of parts in adolescence and adolescent parts—a distinct difference.

Image by: rabbitti