"I'm sorry," you might cry over your shoulder as you close the car door. Your glance at the stranger shows the offered apology fell on a deaf ear and you wonder to yourself, "Why don't they realize I was hurting and only trying to get away from the pain? Why don't they realize my stepping on their toe was an accident? I would never ‘try’ to hurt them. I'm not that kind of person!"

You see the point, don't you? When teens begin to feel the effects of the depression and sometimes react in strange ways to deal with the pain, their actions can often be more reflexive than planned and consequently misinterpreted. They react to the pain by either trying to avoid it completely, or getting away from it once it's struck. In the process they might accidentally hurt others around them. The others might easily think the teen "meant" to hurt them. If we're not careful and observant, we might be too quick to cry, "You jerk!" as the teen runs to their sanctuary and slams the door behind them.

This heightened intensity from the illness can amplify other feelings in addition to irritability and anger. It can also amplify sadness, loneliness, and anxiety, just to name a few. This extra intensity leads to that feeling of being overwhelmed that I've mentioned before. Depressed and anxious teens are easily overwhelmed. Things that would not trigger a similar response in others set off a powerful feeling of being overwhelmed in depressed teens. That feeling of being overwhelmed is not a very comfortable experience. Do you remember the last time you felt it? Didn't it make you want to get rid of it somehow? Didn't you want to run for the car when you had the sunburn?

When a depressed teen feels overwhelmed they don't normally say to themselves, "Hmm, I think I'm feeling overwhelmed." In fact, one of the goals of therapy with depressed teens is to help them consciously identify the feeling of being overwhelmed and take healthy steps to respond. However, before they've been educated about their illness, depressed teens just know they feel something very uncomfortable and want to escape its hold. They do whatever they can to rid themselves of the feeling.

We call that act of trying to avoid or rid themselves of the painful feeling a "defense." Their favorite defense might be that flash of anger, or withdrawal, some sort of shutdown or some other form of escape like alcohol or other drugs. It's not a rational, thought-out process. Depressed teens just do it, because somehow it makes them feel better in the moment (just like you dashed for the car and stepped on the stranger's toe.) A shutdown is another form of defense. The shutdown is often the depressed teen's preferred response to feeling overwhelmed by school and homework.

Here's how the shutdown defense might go. The teen "zones out" or has difficulty concentrating in class. They miss a lot of the explanations for the homework. They go home and open the book. Then they start to realize they may not know how to do the work, or they may understand it, but it feels like there is so much homework that they will never be able to finish. The response then is usually, "I'll never be able to finish all of this. It will take forever, so why bother." They close the book, lie about doing the work when quizzed by a parent and go off to school to repeat the process the next day.

Eventually the depressed teen doesn't even bother to look at the book. They just "know" it will be overwhelming, so why bother. By the time a report card makes it home, the student is already in a deep, deep hole that further intensifies that sense of being overwhelmed. They continue to practice their defense on a daily basis because it momentarily keeps them from feeling that awful sense of being overwhelmed.

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Issue: March 2008