The kids are not alright

What is driving teenagers in India, across socio-economic groups, to anxiety and depression?

Written by Pritha Chatterjee , Tabassum Barnagarwala | Published: April 10, 2016 12:50 am
children health, child healthcare, child adhd, india children addiction, internet addiction, child mental disorders, india children mental disorders, health news, lifestyle news From heartbreak to peer pressure, many factors culminate in anxiety for teenagers

Every day was a struggle to stay off the internet, to stop thinking about her — or to consider ending it all. From among the top three students in his south Delhi school in Class X, he barely managed 50 per cent in his first term in Class XI. He failed in physics, his favourite subject till a year ago. “I could not concentrate on anything. Everything seemed pointless. I felt sad for my parents, it felt like I was killing their hopes and aspirations…but if she did not want me, I could not bring myself to do anything,” he says.

He had “liked” her since they became classmates in Class VI, five years ago. She played basketball, a good public speaker, and had silky hair, he says. He was a plump child, who loved graphic novels, maths and science. “In short, I am a born nerd. I knew she was out of my league,” he says.

For the next two years, he nursed his crush. He started trying to lose weight. His parents were surprised when he started waking up at 5 in the morning to go jogging before school. He gave up the burgers he enjoyed. He spent a lot of time on the internet, building a “cool” profile on social networking sites. “I started listening to the music she liked, tried to improve my public speaking so I would have common interests with her. I stopped reading comics and started reading about Indian history because she told me she wanted to be a historian…everything I did was for her,” he says. He looks at the floor when she speaks, avoiding his mother’s gaze.

In Class X, she started dating one of the senior boys. He was heartbroken. But his academics did not suffer then. He says he thought if he did well, she would notice him more, maybe even consult him for her own studies. In Class XI, she moved to a different school. That is when he started tracking her on social media. He commented on every picture, was the first to wish her on her birthday and her parents’ anniversary. About six months ago, when he could take it no more, he texted her, professing his love of years. “She called me a psycho, and a freak,” he says, still looking at the floor.

That is when he took to alcohol, and then started to smoke. Waking up every day was a task. He hated meeting people. “I wanted to be alone. And figure things out myself. But I am in Class XI…I had to work on my grades. I had to study,” he says. He started walking away from the school bus stop. “The first time I did it, I was scared. Then I got used to it. Some days, I would go and drink. Or go into a cafe and read,” he says. On weekends, he would lie in bed till afternoon. “I hated the light. I wanted to sleep and sleep,” he says.

His parents realised something was amiss when they heard from his school teacher, about eight months ago. “He had not gone to school for two weeks. But he would leave home every day for school. When I asked him, he started crying. I was shocked…I just did not know how to deal with this,” his mother, who works as a financial consultant with a private bank, says. As her only son, she said she knew she had spoiled him silly. “Everyone said he was such a mama’s boy, and we were so close. I never imagined my son would not share something with me, despite all the adolescent stereotypes we hear,” she says.

Doctors have diagnosed him with depression, coupled with substance abuse. For the last six months, he has been on medication and behavioural therapy. He has also been attending a de-addiction clinic. At school, he says he makes excuses, but he knows people have “guessed”. “I am your quintessential hopeless geek lover. If I was 30, I would not be given psychiatric medication but it makes my mother happy so whatever,” he says with a shrug. He says it’s two weeks since he last browsed through her profile. “That’s the only good thing. I am getting over her. Earlier, I would check her updates 20-25 times a day. Who knows? Maybe I am a freak. I would have grown into some crazy stalker,” he says, as his mother ruffles his hair. “Stop that. You do not have to feel sorry for me,” he says sharply.

It’s the best of times; it’s the worst of times. Anyone who has been through adolescence would know it is not a time of equilibrium. From wild hormonal swings to the discovery of sexual pleasure and doubts about one’s self-worth, teenagers are vulnerable to a range of conflicting emotions. It sometimes takes a gentle push to tip over to the dark side. As India faces a crisis in mental health, a substantial chunk consists of adolescents suffering from anxiety and depression, a phenomenon that prevails across socio-economic strata.

A study published by the Indian Journal of Psychiatry in 2009 revealed that childhood and adolescent mental disorder rates stood at 12.5 per cent in the 0-16 age group in Bangalore, 9.4 per cent in 8-12 years age bracket in Kerala and 6.3 per cent in 4-11 year age bracket in Chandigarh. The overall figure in India stood between 6 and 15 per cent, the same study suggested. A Lancet study on adolescent mental health worldwide in 2007 said, “Most mental disorders begin during youth (12–24 years of age), although they are often first detected later in life. Poor mental health is strongly related to other health and development concerns in young people, notably lower educational achievements, substance abuse, violence and poor reproductive and sexual health.”

In Maharashtra’s largest state-run hospital, JJ Hospital, Mumbai, at least one teenager is brought for treatment of depression every day. According to Sagar Mundada, psychiatrist at the hospital, the reasons for depression vary. “In middle and higher income groups, we are seeing a lot of cases of teenagers troubled by break-ups or peer pressure,” he says. Teenagers from working-class families are worn down by financial instability.

For the past decade, psychiatry departments in at least three government and nearly all private hospitals in Delhi have been running weekly child and adolescent clinics. Dr Rajesh Sagar, professor of psychiatry at AIIMS, who specialises in adolescent psychiatry, says body image issues drive most of the symptoms of anger and aggression in teenagers who come to his out-patient department (OPD).

While children returning from school to empty houses or not having enough people to communicate with is a persistent feature of modern urban life, the internet has introduced another variable in this fraught equation. “With it, the whole milieu of adolescent life has changed. Teenagers want to build an image of themselves on social media in keeping with trends, and when that identity clashes with their real personality, there is a lot of psychological conflict,” says Dr Sameer Malhotra, head of psychiatry at Max group of hospitals in Delhi.

It is not just that children are growing up without extended family support, but that their lives have become too complex. The worried parents of a 15-year-old single child in south Mumbai brought him to JJ Hospital in November 2015, after his academic performance dropped from over 95 per cent to less than 65 per cent. He had become silent, nightmares keeping him awake at night. He had stopped playing or socialising and shut his parents out.

It took two sessions for therapists to figure out that he was being bullied by a senior. He was a sensitive child and had silently absorbed the threats. He had no siblings and few friends to share his troubles. According to his parents, his hands would tremble and he would sweat profusely, and he would be scared the bully might hurt him physically. The 15-year-old had a Cluster-C personality disorder, which meant he was in need of constant care from his working parents and depended on them for support. In their absence, fear and anxiety led to depression. It took four months to boost his confidence. The bully’s parents were also informed.

Dr Azhar Hakim, a psychotherapist in south Mumbai who has a sizeable portion of teenage patients, believes what we know about adolescent depression is just the tip of the iceberg. He points to the paradox that while parents are more indulgent, lenient and sensitive to their offspring, it has not stopped their children from feeling more and more unloved. “Today’s kids are growing up in a vastly different cultural milieu where they are exposed to a lifestyle laid out for them by aspirational parents, where they end up being more busy than a CEO. The message being sent out to them is — ‘See what all we have done for you, see the choices and opportunities you have that we never did.’ That just adds to the pressure on children to live up to their parents’ expectation,” says Hakim.

Deepali Raskar, a counsellor at Dastur School in Pune, says she comes across nearly two or three students every week who seem to be heading towards depression. “The symptoms we watch out for are sudden aloofness from friends and family, falling grades, a dip in food intake, difficulty in sleeping and self-harm, among others,” she says. She believes children are being forced to fall back on themselves when they are not always emotionally equipped. “Many students carry house keys to school as both their parents are working. When the child reaches home, he/she is all alone. They have their lunch alone and then head for tuition or other classes. They are completely on their own, not every child can deal with that,” she says.

For parents, dealing with depression involves unlearning many things about parenting. It has been a difficult journey for the mother of a 13-year-old, who is a Class VII student at a public school in Delhi. Every Wednesday, she picks her daughter from school and drives 15 km from south to east Delhi. The school knows that she is being ferried to Bharatnatyam classes but for the last six months or so, she has been coming to meet her doctor. “I would have taken her to a hospital right behind my house, I know a senior consultant there, but our neighbours and friends might get to know about her illness. She is so young, I have to protect her,” says the woman, a marketing executive from Gurgaon.

The teenager is being treated for anorexia nervosa, anxiety and aggression. It started last year, with a call from school. She had passed out during an assembly session. “We conducted a series of tests and found out all her blood indicators were haywire. She had not had her period for a month. She was losing too much weight too soon,” her mother says. She had lost weight, from 65 kg to 50 kg in two months. Her parents scolded her and insisted she get regular about meals. Her mother stopped allowing her to have dinner in her room, “When I told her to eat in front of me, she started crying. She would eat one roti and then disappear into the bathroom,” her mother recalls. Each time, she would force herself to puke what she ate. When her parents were asleep, she would weigh herself to ensure she had not gained anything from her “fake” meals, as she describes them now.

She had to be hospitalised a month later, when she weighed 45 kg. That was six months ago. Now the weekly OPD “sessions” involve she and her mother taking turns with the doctor for about 15 minutes each, and then a 5-10 minute joint session. Her grades are improving. She still weighs only 53 kg, and is particular about her exercise regimen. “I was always thinking about food. I saw people on the streets and wondered what they had eaten to stay thin or fat. I was angry at myself, at my mother for being fat,” she says. Her mother is shocked. “You never told me this,” she says. Every day has been a discovery about her daughter, she says.

*****

The lazy stereotype about mental illness being a poor little rich kid’s problem is a distortion of reality. Doctors say while awareness about teenage psychiatric diseases has improved across social and economic strata, the motivation in poor families, particularly from rural areas, to seek help for psychiatric disorders in adolescents is restricted to “preparing” teens for marriage. “Most parents from rural areas and poor socioeconomic groups bring adolescents, particularly girls, to psychiatrists only when their marriage becomes a concern. There is very little support in government schools, and symptoms are missed. Even if children face a problem, there is really no one they can confide in,” says Dr Deepak Kumar Srivastava, acting head of the department of psychiatry and in-charge of the adolescent psychiatry clinic at the Institute of Human Behaviour and Allied Sciences (IHBAS), one of the few government hospitals in Delhi to run dedicated clinics for teenagers.

On a Wednesday afternoon at the IHBAS adolescent clinic, a 16-year-old sits quietly, absorbed in a copy of Tehelka Hindi. A student of a state government school from Baghpat district, UP, in Class VII, she had stopped going to school two years ago. Her mother was surprised. Of her five siblings, including three brothers, she had been the most regular and the one who never failed a subject. “Her teacher said she was sleeping in class, or drawing flowers in her notebook instead of doing mathematics. I was surprised because she loved mathematics. Even when she was 10, she could add up numbers and helped me maintain monthly accounts for groceries and crop sales,” her mother, a housewife, said.

When her parents asked her about complaints from school, she grew irritable. But they did not pay much notice till she started behaving the same way at home. “One night, she simply forgot to make the rotis for dinner. Her father slapped her when he found out there were no rotis, and she just went out of the house at night,” her mother says. She returned home two hours later and slept. Once she left her four-year-old nephew in the fields, and returned home with the cows they had taken out to graze. “She did not remember where she saw him last. Her father raged at her again. Thankfully, we found him playing nearby,” her mother says. That is when she stopped talking to her father altogether.

About a year ago, she said she wanted to drop out of school. Her father did not protest. “I thought she is getting old, her mother should teach her housework, she will need to start a family of her own soon. Anyway, she was already the most educated girl in our family,” her father says. Keeping her home did not help. She lazed around and grew irritable at the mention of housework. Her mother brought her to IHBAS, where she was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). According to Dr Srivastav, “ADHD is easily spotted in children because of symptoms like hyperactivity and impulsiveness. But inattention, which is the most significant indicator of ADHD in adolescents, is not so easy to identify, so people often miss it.” He says a significant number of teenagers seek medical help when the disease is at an advanced stage.

“I never thought she had a medical condition. Her limbs were working fine, she did not have a temperature, she looked just fine, she did not lose any weight. I never heard of such a disease,” her mother says. She hid the diagnosis from her husband, worried he would throw her out of the house. His “acceptance” has come as the biggest relief. “I would bring her alone to Delhi every week for two years in a bus. One day, my husband followed us. I was worried he would say she was a freak and ask me to throw her out. But look at him now,” she says, wiping away a tear. Her husband, a dairy farmer has been learning to read from his daughter, she says. “But she has not forgiven him for slapping her. I guess she will some day,” she says.

Dressed in a green salwar kameez, the teenager shrugs her shoulders when asked if she feels any better after the treatment. “I can read now again. So I guess I am better. I was just angry and my mind was clogged earlier. Everyone thought it was about a boy and my father kept asking if it was a high caste boy…my parents don’t understand me,” she says, when they are called in by the doctor for a conversation.

She started writing to clear her thoughts — an idea suggested by the psychologist during a behavioural therapy session. Every night, she writes one page, and shows her week’s collection to her doctor. Topics range from the stove, a pair of her brother’s jeans she had to wash and her mother.

So why has she not forgiven her father yet? “Because I know he is bringing me to Delhi only because he wants me to be ‘ready’ for marriage. He does not know I am going to get re-enrolled at school again next year. There has been a gap, but my doctor has told me when I get better that will not be a problem,” she says. In most cases, Dr Srivastav says girls are brought by their mothers. “Fathers are usually single breadwinners and they cannot afford to waste a day’s work. In many cases mothers are scared to tell their husbands if the girls are on psychiatric medication,” he says.

Frail as they are, sometimes, teenagers can also be trusted to do the right thing for themselves. In December 2015, a 17-year-old sat at Marine Drive, when the thought came suddenly. “I felt like jumping into the ocean,” he later told his therapist.

It was not the first time. Nonetheless something must have scared him, either the crowd walking on the promenade, or thoughts of his family waiting at his home in Geeta Nagar slum, a 20-minute walk away. He did not attempt suicide that day. Instead, by December end, he mustered courage to visit Gokuldas Tejpal Hospital for counselling.

His anxiety had crept upon him during the mid-term Class X exam when his father, an alcoholic, lost his job as a private security guard. The Rs 15,000 per month income disappeared, leaving behind a mother, younger sister and jobless father to look after. “Boys react differently than girls to family’s economic stability,” says psychiatrist Mundada, who counseled the student of a government school in Colaba .

His inability to support the family led to immense frustration. He withdrew from his parents, started eating less and while he could earlier read 10 pages in an hour, it now took him one hour to read a page. As he slid into depression, he chanced upon an article on depression in a newspaper. Without telling his parents, he visited Gokuldas hospital and poured his heart out to the psychiatrist on duty. “I was surprised. A lot of people in depression do not understand or admit they are depressed,” Mundada says.

Doctors say his condition has improved. “We counselled him to not take the family’s onus on himself,” says Mundada. He is on a six-month-long medication of anti-depressants — the pills are a secret, stashed away from his parents’ reach.

(With inputs from Garima Mishra and Sunanda Mehta)

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