皇家华人

If you鈥檙e ever going to experience a mental illness, it will most likely start in your adolescent years. One 2005 study found that about 75% of all mental illness starts听by age 24; another from 2003 found that this number might even start听by age 18. We have known this for some time, long before the pandemic began. Then Covid-19 erupted, triggering a fresh wave of headlines about young people鈥檚 mental health and a 鈥渓ost generation鈥�.

There鈥檚 good reason to be concerned. Initial evidence听suggests听that, in the early months of the pandemic at least, emotional problems increased on average in young people. This is unsurprising: lockdowns cause a great deal of stress for this age group, disrupting education and limiting vital contact with friends. Some young people will have been especially vulnerable, such as those who lost loved ones or spent lockdown in homes marked by conflict or violence.

But Covid or no Covid, adolescence has always been a period of heightened risk for mental health problems. To understand why, we need to think about what adolescence is actually for, evolutionarily speaking. Consider what a child is like before puberty: they are immature, vulnerable and highly dependent on their parents. By the end of adolescence (roughly听about age 24), a person can support and look after themselves, manage complex social interactions and navigate sexual relationships. That鈥檚 quite the journey. The route involves a number of dramatic, protracted changes to a person鈥檚 physical body and psychological functioning, ignited by a surge of hormones and underpinned by extensive development in the brain.

All being well, this is nothing more than a bumpy ride. But it鈥檚 this exact series of changes that can sometimes go off piste, and this can trigger a mental disorder. In the words of听one group听of researchers studying adolescent mental health, 鈥渕oving parts get broken鈥�.

Take social development. To become a fully functioning, independent adult, a person must peel away from their parents and develop intimate, complex relationships with their peers. To achieve that, they need to understand and care about what other people think and feel about them. You can do this to an extent as a child, but in adolescence these skills really pick up, as you gradually learn the intricate dance that is adult social interaction.

Typically developing teens learn how to grasp subtext and identify sarcasm, jokes and lies. They become better at identifying subtle meaning in a person鈥檚 tone of voice, facial expressions and body language, and they use this to figure out who likes them, who is flirting with them and who might be a threat. This is cognitively demanding stuff: adolescents expend a great deal of brain power thinking about their peers.

But it鈥檚 easy to see how this social focus could cause problems. For some adolescents, the tendency to think about friends ramps up a little too much, and they become fixated on what others think of them. In its extreme manifestation, this can become social anxiety disorder (Sad), which is characterised by months of debilitating worry about social interactions. Sad most often rears its head in the early teenage years; it has been called the 鈥減rototypical adolescent disorder鈥�.

There are many other examples. Thanks to their newfound biological drives, many adolescents embark on sexual relationships. Most of the time, this doesn鈥檛 cause issues, but when teenage sex goes wrong, it goes badly wrong. It can result in unwanted pregnancies or humiliating sexting incidents. Adolescents鈥� drive to try risky new things 鈥� again, entirely necessary to become an adult who understands what is and isn鈥檛 safe 鈥� can trigger any number of mental health problems, from the trauma of a car accident to substance abuse or addiction.

The growing ability to ruminate, which is necessary for learning from past behaviour, maintaining healthy relationships and developing a nuanced sense of self, can go off the rails and escalate into depression. Laid out like this, adolescence sounds disastrous: a ghost train through a haunted house, passing through an endless number of potential pitfalls and shocks.

If all this sounds a little bleak, take heart. When we talk about serious levels of psychological distress in adolescents 鈥� the level that might be considered a disorder 鈥� we are talking about the minority. For example, a study in July 2020 found that听16% of five-16-year-olds听have a 鈥減robable mental disorder鈥� 鈥� but this means 84% of participants听诲颈诲苍鈥檛听meet criteria for a disorder. As we continue the important task of raising mental health awareness, we mustn鈥檛 fall into the trap of thinking that every adolescent is in crisis, or that all adolescent pain is indicative of ill-health. Plenty of people navigate the 鈥渟torm and stress鈥� of these years without any significant emotional cost.

Of course, we need to pay close attention to the 16%, and the others who are struggling but don鈥檛 meet the threshold for a disorder. But even in the pandemic, some young people have coped well. For example, when adolescents are interviewed in detail about their experiences during lockdown, a mixed picture emerges. Many of them found it difficult, but others听eported听that听they听enjoyed听having more time to develop hobbies, or to hang out with their families and pets. For some teenagers, lockdown might actually have听谤别尘辞惫别诲听key sources of stress in their life 鈥� such as school bullying and peer pressure. When 11-16s were听asked听in July 2020 how lockdown had affected their lives, 42.8% said their life was worse, but 29.6% said there had been no change; 27.5% said their life had actually improved.

Even among the teenagers who found lockdown hard, many displayed remarkable resilience. They found ways听to adapt听to their exceptional circumstances, such as by maintaining friendships via video calls and social media, or strengthening relationships at home. In fact, some degree of stress 鈥� provided it鈥檚 at a manageable level and time-limited 鈥� can even be helpful for young people in the long run, because it provides them with the opportunity to develop coping strategies for later challenges.

Calling today鈥檚 teenagers the 鈥渓ost generation鈥� is useful to a point. It hopefully means funding bodies will prioritise research into the impact of the pandemic and what can be done to mitigate its effects. It鈥檚 useful if it means schools and universities make allowances for how disruptive this year has been for young people, and it鈥檚 useful if it means mental health services finally get the funding they need. Even pre-pandemic, too many adolescents with mental disorders were waiting听too long听to get help, or not getting help at all.

But I would urge caution. The implication when something is lost, after all, is that you might not get it back. And making any generalisation about a 鈥済eneration鈥� implies everyone is the same, when they鈥檙e not. We badly need to support those adolescents who are in crisis, and ideally, prevent them from getting to that point in the first place. We need to tackle the systemic issues that make young people vulnerable, and understand why, even before Covid-19, mental health problems in this age group were on the rise. But in parallel, we should also explore and celebrate what makes young people resilient. Yes, most mental illness begins in adolescence 鈥� but that doesn鈥檛 mean most adolescents will experience a mental illness.

This article was originally published in听听on 1 June 2021.

Links

• Original article in听
• Dr Lucy Foulkes鈥� academic profile
• UCL Department of Clinical, Education & Health Psychology
• UCL Division of Psychology & Language Sciences
• UCL Faculty of Brain Sciences