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I Am Not Worth Anything

By Dr. M. Hasselaar For some time Margaret has not been feeling good about herself. Although she doesn’t perceive this as a big problem, there are still enough reasons to cause anxiety. She is often sad, melancholy, tired and even has frequent head-aches. Furthermore, she finds herself looking up against everything. What makes Margaret really weary is that she feels so insecure inside. When interacting with others, she is con-stantly worrying about how others judge her. She doesn’t really dare to act herself because she is too afraid that others will think she is strange. As far as she is concerned, she would like that all to end. She would just like to get herself under control again and not always be so sad and somber. However, no matter how hard she tries, she cannot quite succeed in doing this. Depressed In the description that Margaret gives of herself, the characteristics of depression are clearly distinguishable. The most prominent characteristic of depression is a persisting somber and sad mood. With Margaret, these feelings have existed for already more than a year. If feelings of dejection and listlessness persist for at least several weeks and during most of the day, we call it depression. These feelings are often paired with a serious lack of self-worth. Margaret feels inferior and worthless. Margaret is not the only young person who feels depressed during her adolescent years. Research indicates that about twenty percent of all adoles-cents experiences at least one depressive episode before the age of eighteen. Signs For those adolescents who suffer from depression, the following list of behavioral patterns typically exemplifies the symptoms of such: • a depressed mood most of the day, nearly every day • a clear diminished interest or pleasure in most activities during most of the day • a loss of appetite or increase in appetite • significant weight loss when not dieting, or weight gain • excessive sleeping or insomnia • a variety of anxieties which mostly occur in the evening and during the night • physical complaints such as stomach aches, bowel disturbances, head aches, palpitations • fatigue or loss of energy nearly every day • diminished ability to think or concentrate • learning problems • indecisiveness • inner or outer restlessness, or the opposite: slowed movements (psychomotor agitation or retardation) • avoiding social contacts • neglecting physical appearance • radiating somberness • feelings of worthlessness • excessive or inappropriate guilt feelings • expressing negative remarks about life and self • expressing depressive feelings in journals/compo sitions • feelings of the worthlessness of life • the repeated wish, even if not acted on, to end life Margaret is preoccupied with thoughts about death. The prospect of not having to struggle any longer makes this very attractive and inviting to her. Her beliefs and her mind go against these thoughts. Although she hasn’t yet undertaken an actual attempt, she sometimes thinks about the manner in which she could end her life. In young people, depression may also be manifested in different ways. Because of this, it is more difficult to notice the depression. The behavior of these teenagers comes across as much more provocative and aggressive. It is as if they are trying to override and shut out their feelings of depression. Another explanation for this is the fact that adolescents are not able to withstand a long duration of a depressive mood. Their depressive feelings are then lived out in all kinds of behaviors to hide these depres-sive moods. These can be the adolescents who act out aggressively, frequently cut school, cause fights and other disturbances, or start abusing alcohol or drugs. Causes It is not possible to point out one single cause for depression in adolescents. Three groupings of factors can be named which play a role in the origin of the depression. They deal with different aspects that influence each other. These facts in themselves do not cause the de-pression, but the connection of sev-eral facets may very well lead thereto. *Factors within the environment Within the (fam-ily) environment of adolescents a variety of things can take place, which leave in-sufficient space for their own develop-ment. There may be other aspects, which require so much attention that there is little or no room left for the young person himself. Some examples of these are: emotional or physical neglect, rejection, setting of too high expectations, destructive criticism or nagging, lack of (healthy) expression of emotions, over-controlling or over-protectiveness, or having a parent who suffers from a (long-lasting) physical or mental illness. Margaret is continuously pondering why she has be-come depressed, until she reads an article in the school newspaper about teasing. Then she suddenly sees the paral-lel between her somber moods and the period of time in middle school when her classmates teased her relentlessly. She hasn’t wanted to think about that anymore for years, but because of what she is reading, she suddenly realizes that her negative thoughts about herself may have begun during this time. She often got to hear during this time that she didn’t look attractive and that she shouldn’t think that she had any personality either. When Margaret realizes that at the mo-ment it is true that she doesn’t think very much of herself, the stark reality of this causes great emotional pain. *Factors within the history Experiences from the past can lead to depressive epi-sodes during adolescence. Some examples of these, which can also be called experiences of loss, are the death of a parent or very close relative, the divorce of parents, or a significant relocation. Also traumatic experiences, such as ill treatment, sexual abuse, an accident, or serious physical or mental illness are events in life that later on may play an interfering role. *Factors within the teenager him/herself The manner in which an adolescent deals with experi-ences that he acquires can play an important role in the development of a depression. A teenager, who has the ten-dency to withdraw within himself, will become more easily depressed than a teenager who is more inclined to seek support from another. Also the measure in which the young person is able to seek solutions for problems (such as peer relations) himself has an influence on whether or not he will suffer depression. In a number of cases the hereditary or physical factor also plays a role in the development of a depression. This concerns a disturbance of the activity of certain areas of the brain, under-activity or over-activity, or chemical imbalances. Support from the environment For a depressive adolescent, support from the environ-ment is very important. Among other things, showing in-volvement and giving attention are good ways to let the adolescent feel that he doesn’t face things alone. Support can also be given by helping the adolescent verbalize his or her feelings. It is often weighty for young persons if very negative and somber thoughts continuously go through their minds and they can’t share them with anybody. It often provides a sense of relief when there is someone who listens to you, someone who shows understanding and gives you room to even verbalize your worst and vehement thoughts. By listening closely to what the young person tells about himself and others, it can be interpolated as to how he thinks about himself, about others and the relationship with God. There may be many extreme negative thoughts included. It can be discussed with the young person if these thoughts are true and justifiable. Especially learning to bend negative thoughts and criticisms of yourself is an important step into the direction of learning how to handle depressive feelings. Someone caught up in a depression often no longer sees a light anywhere. That is why it is also significant, albeit very carefully, to help someone see the things that are enjoyable. Sometimes it is good to do something extra or to encourage the young person to undertake something new himself. If a young person expresses negative thoughts about himself continually and appears to have lost all motivation, it is imperative to inquire if he has ever thought about ending his own life. If that has been the case, it is also important to know what the means of carrying this out would have been. These plans should always be taken very seriously. Addi-tionally, the more thorough and concrete the plans are, the more likely it is that an attempted suicide may occur. Help is necessary If there is a case of a young person with a long-lasting depression, it is important that she receives help. If a depres-sion is not treated, the chance that depressive episodes will return regularly becomes significantly greater. The young person will then develop into a depressed adult. Besides it being profitable for the future of the young person, also the concern about the young person now, especially in regard to the increased chance of committing suicide, makes recog-nizing and treating depression of vital interest. Especially in the case when a young person walks around all the time with the thought that she no longer wants to live, referral to a mental health care professional is a necessity. Dr. M. Hasselaar, Ph.D. is a psychologist and therapist, a member of the NRC Congregation in Dordrecht and an author of a number of books and articles. This selection is a translation of the article ‘Ik ben niets waard’ Depresiviteit bij jongeren GezinsGids, February 24. 2000, 52e jaargang, by Joanne Sofia Vogelaar.

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