Adolescent Breakdown and Beyond

Moses Laufer

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367104900
• eBook ISBN: 9780429910630
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This is the second monograph published by Karnac Books on behalf of the Brent Adolescent Centre/Centre for Research into Adolescent Breakdown. Drawing on the Centre's unique pool of expertise in the field, this book contains papers giving up-to-date psychodynamic perspectives on adolescent breakdown by leading clinical experts. These cover a range of topics, such as the differing developments in male and female adolescents, and the particular problems of psychotherapeutic intervention with them. It also includes the proceedings of a conference on the subject held in October 1995. Here the issues of adolescent breakdown are discussed in the wider context which workers in the caring professions must consider. Overall, this volume provides a concise, contemporary overview of a topic whose importance is increasingly being recognized both inside and outside the psychotherapeutic community. Contributors: Anthony Bateman, Debbie Bandler Bellman, Gabrielle Crockatt, Maxim de Sauma, Domenico di Ceglie, Sara Flanders, Maurice H. Friedman, Christopher Gibson, Kevin Healy, M. Egle Laufer, Kamil Mehra, Joan Schachter, Nicholas Temple, Peter Wilson

Part One
The Adolescent and Developmental Breakdown

Chapter One
Developmental breakdown in adolescence: problems of understanding and helping

Moses Laufer

“Developmental breakdown” represents a concern that remains central to our work at the Brent Adolescent Centre. And this concern, which must certainly be shared by anybody who works with the troubled adolescent, can be summarized as follows: how do we know when to be worried, and when is help urgent? Implied in this is that there are adolescents who may be troubled but about whom we need not be especially concerned, whereas there is a group of adolescents whose troubles represent signs of a serious disorder or, at least, of the likelihood of severe mental disturbance in the near-present or in the future. It is this latter group on whom I would like to concentrate, because they are the ones whose emotional lives—and often actual lives—are seriously at risk, and who must not be left with the unreal hope that they will grow out of it. Our experience shows that these adolescents do not “grow out of it” but remain emotionally damaged at the least and actually develop towards mental illness at the worst, if they are left on their own. With help at the right time, we think that some of these adolescents can be helped greatly, often with the possibility of reversing the move towards the firm establishment of severe disorder.

I would like to begin with an observation that ultimately brought me to the idea of “developmental breakdown” and has, over a period of years, made me dissatisfied with the often-used explanations or classifications when describing certain serious signs of mental disturbance among adolescents. Some time ago a very simple fact impressed me, a fact that I had obviously known about for many years but one that I—as many others—preferred to deny and avoid understanding. It was this: it seemed that the reported incidence of suicide or attempted suicide increased rapidly in adolescence and, linked to this observation, it seemed also that the conscious decision to kill oneself did not exist as a “social problem” before adolescence. From this, and from our shared experience at our Centre, I realized that the same observation or question could be asked about so many adolescents: why the sudden signs of mental illness, which are diagnosed as schizophrenia; why anorexia in adolescence, and not at all the same incidence in childhood; why drug addiction in the adolescent, or promiscuity, or severe depression, or signs of sexual abnormality, or the violence that is not the result of a social norm but is given impetus by the private “voices” or by the need to keep out of consciousness the feeling of being abnormal—and the list can certainly be extended. But by saying that the list can be extended, I do not mean that we should include every form of stress in every crisis, with the likely result that we do not then differentiate between normal stress and signs of developmental breakdown. I will come back to this when talking about criteria that can help us judge when to be worried.

It was the observations to which I referred a moment ago that made me think that there are not only new stresses following physical sexual maturity but that it may well be that the period which we call adolescence is a time of special vulnerability to breakdown. When I talk of the period of adolescence, I have in mind the time from puberty to about the age of 21. I begin with puberty because it is the time when the person not only has a physically mature body but is able either to impregnate or become pregnant—a fact that must always be kept in the forefront of our thinking when trying to make any sense of behaviour, thoughts, wishes, fears, or hopes of the adolescent. I date the end of adolescence to about the age of 21 simply because it seems that it is at about this time that the person has established “predictable ways” of dealing with anxiety, and it is these predictable ways that convey that one’s ideals, or conscience, or ways of finding pleasure, are now more fixed than they were either in childhood or at puberty, together with the assumption that major changes in these areas will no longer take place.

It is during adolescence that one’s past begins to catch up with one, so to say. What I mean is that psychological life, however much we may want to divide it into periods such as infancy, childhood, adolescence, adulthood, middle age, old age, is a continuous process, but with each period having its own special characteristics and, I would say, each having its own special contribution to psychological life and development. And the special contribution of adolescence can be summarized as follows: that this is the time during which a mental picture of the person himself with a specific and fixed sexual identity, will be established.

By this I mean that this is the time during which the person will seek an answer through relationships, through various social and sexual experiences, through various educational and work efforts, to what it is that is acceptable to his conscience and ideals, and what it is that must at all costs to his mental functioning be rejected or, at least, kept away from being satisfied. I am implying by this statement that by the end of adolescence the specific sexual identity is always a compromise between what we might want and what our conscience allows us to live with.

In adolescence, the earlier values, the earlier ways of finding pleasure and of feeling cared for and loved, the earlier ways of feeling male or female, are put under a different and new kind of stress because of the presence of a sexually mature body. In most instances—that is, in development that is proceeding more or less normally—the adolescent may still experience stress, but he will finally find acceptable ways of answering his conscience and his ideals, and in this his past is experienced as an ally in the effort and the wish to proceed to adult sexual and social life.

I talked of one’s past catching up with one, and this may give the impression that I am saying that all present behaviour is determined by the past, and that one only has to hold on tight until adolescence is over and then one can get on with one’s life as an adult. Many people certainly take this view, expressed in such phrases as “he will learn as he gets older” or “if we can just help him through his adolescence, then he’ll be all right”. I take a different view; although I accept the authority of the past, I think that there are some critical events within ourselves during adolescence that make a difference not only to present and future life, but to present and future mental health, including that of illness and breakdown.

I will use my own words to describe a process that Freud considered of primary importance in understanding something about adolescence. It seems that it is during adolescence that certain creations of the mind (Freud talked of them as fantasies) become interwoven with past experience, and it is the combination of the past with the more immediate fantasies of adolescence that ultimately establishes the pathologies (he referred to the neuroses) that we see later in life. If this is so, it means then that what we learn from our adolescent clients or patients or those in our care must be taken very seriously, because the experiences of adolescence may shape our future emotional lives considerably, including our relationships to people, our pleasures and our disappointments, and our relationship to ourselves as people whom we like or hate. But, more immediately, it also means that the period of adolescence brings about changes in mental life that make the person much more vulnerable to the self-hatred and despair that we see in our work every day.

* * *

How is it possible, then, to define the difference between the stress, or despair, or hopelessness that may be part of normal development, and similar reactions that are signs of “developmental breakdown”? I should say that, when I refer to “developmental breakdown”, I have in mind the breakdown of a process of development; I do not mean to convey something akin to “nervous breakdown”, which conjures up a picture of a collapse of the nerves or sinews and which, as a phrase, has its roots in the early psychiatric assumptions of mental disorder with the idea of tension felt in the nerves or, at worst, where damage to or disintegration of the nerves was believed to be a primary contributing factor to mental disorder, with little status being given to the role of psychological conflict, regression, fantasy, and so on.

In development that is proceeding normally, a number of characteristics may be evident:

1. The adolescent ultimately knows that he has ways of feeling valued and admired without having to remain totally dependent on his parents.
2. However much he may feel guilty or ashamed of some of his private thoughts and feelings coming from his body, he can still enjoy the pleasure from these thoughts and feelings, and he can seek relationships that in part enable him to remain in touch with these feelings from his own body.
3. Even though there are times when he may have thoughts that not only shame but worry him (because of their connection to ideas of abnormality), he is also aware that these thoughts will not ultimately overwhelm him—in other words, he knows (not consciously, of course) that he does not have to remain tied to these thoughts or wishes, but he can have other sources of pleasure that enable him to want to move on to adulthood.
4. However much despair or hopelessness he may feel, he is also aware that he can rely on admiration from his own conscience to help him restore a feeling of self-respect.
5. I would like to add another, which is critical because it takes into account the view held by the adolescent about himself as a man or woman, husband or wife, father or mother: that in spite of the feelings of emptiness and the anxiety experienced in the process of giving up or becoming less dependent on the parents of one’s childhood, there is sufficient inner love for oneself carried on from childhood to enable one to look forward to the future, and it is a future that perpetuates that which is felt to be good in oneself and good in the parents of one’s past. I am implying that, without being conscious of it, the adolescent can normally look forward to the future as a time when he can make amends for his own hatreds or his own disappointments, a time when he can have the inner freedom to allow himself to forgive the parents of the past who inevitably had had to let him down in some way.

But there are those adolescents who experience something quite different, and for whom the period of adolescence is primarily a time of torment. They may seek a whole range of ways to change this feeling, varying from changes in appearance to changing the feelings that live within themselves, but inevitably with the awareness that they are unable to leave this torment behind. And, from the point of view of assessing what is going on, we need to be aware that these adolescents can only go as far as finding respite from themselves, but with their development being seriously distorted. I have in mind those adolescents who are unable to feel that they have the means within themselves to restore their self-respect, or to undo the harm that they believe their thoughts and feeling do to themselves and to others, or who are never free of the thoughts and feelings that convince them of their abnormality, or who may feel convinced that people hate them and who will then try to destroy or harm those who are experienced as being responsible for this persecution. Ultimately, the war that is experienced by the adolescent is one that always includes the sexually mature body as one of the central enemies or at least as one of the main sources of the feelings of abnormality, or of madness, or of worthlessness. These are the adolescents who, no matter what they do, are left with the feeling that the creations of their minds haunt them; in other words, it seems to them that however much they try to feel that the sources of pain or hatred are outside themselves, they are ultimately faced with the feeling that their bodies are the source of their abnormality or their hatred, and that there is little they can do about this except to capitulate to this enemy. For some of these adolescents, it is as if everything was good enough, or even perfect, until puberty, or until they felt forced to give up the perfect world of their childhood, and it is their adult sexual bodies that force them to have the mad thoughts or wishes or feelings that make them behave in ways that result in shame or self-hatred and force them to lose control of their actions.

For these adolescents, relationships to other people are disappointing and frightening, because they have to end in hatred of themselves or of the other person; masturbation, or the thoughts accompanying masturbation, cannot be enjoyed because the normal guilt is instead experienced as a confirmation that they are abnormal or dirty; closeness to one’s teacher or adviser cannot be a valued relationship because of uncontrollable jealousy or because of the doubt they have of the teacher’s or adviser’s motives, and these jealousies and doubts are then woven into their suspicions and accusations; parents cannot be felt to be interested in them, but are felt instead to be false and prying; and so on.

At the time of experiencing these feelings, the adolescent is, of course, not aware that he is reacting to his own mental distortions. At that moment his experiences are real, he does not doubt, and he remains convinced that he cannot trust, that he must not feel love, or that he must never capitulate to his body because if he does, it will take over his life and it will make him irreversibly mad and abnormal. And from the point of view of his development, there is at best a stalemate; more probably, the self-hatred and the fear of abnormality come to be woven into the image of himself as a sexual being, and the distortions are echoed in the person’s relationships, in the attitude to himself as a person who does not have the right to experience pleasure, and who is never able to get away from the conviction that the torment that he feels is of his own making and is his due. But in all this the adolescent feels that he cannot reverse this process, that he is overpowered by something from within himself over which he no longer has control. His mind and body are his enemy.

I would like to describe two adolescents whom I have been trying to help, and in whom I think a breakdown took place following puberty.

The first I heard of “Muriel” was when she telephoned our Centre to say that she wanted to talk to somebody. She had left school two years earlier when aged 16, and she had had eleven jobs since then. She had thought of getting some O-levels with the hope that she might then get a nice job. But she attempted suicide just before her O-level exams and never returned to school to sit them. She was convinced that her parents felt that she was weak and a coward, but when I met the parents, they had been very shocked at Muriel’s decision to kill herself and remained very frightened that this might happen again.

From the moment I heard of her suicide attempt, I could feel sure that she had experienced a breakdown at the time of the attempt (and very probably before), and I worked with this assumption, even though she assured me many times that everything was quite well now, that she had forgotten about the past, and that her main problem was finding work and doing something interesting. But as we talked, her recollections altered; the idealization of her past proved to be very fragile and consisted of much self-hatred, disappointment, and a long-standing belief that something was wrong with her. I will summarize what she and I were able to learn and make some sense of, and what it was that convinced me, and her, that she had experienced a serious change within herself at about the time of puberty, culminating in her suicide attempt.

Muriel first had sexual intercourse when aged 13; at the time, she felt relieved that she could feel normal, or at least not abnormal. She kept this a secret from her family and her friends. She soon began to realize that she had to have intercourse with different boys, otherwise she would feel they hated her or they might see through her façade. She had felt very alone at that time, and she hoped that a close relationship to a boy would take this terrible feeling away. But it did not do this. She connected this loneliness to the death of her dog, who had died when she was aged 8. From 8 to 13 she had not thought too much about the dog, but then suddenly she felt remorse, blaming herself for not taking good enough care of him, feeling that she would like to see him again and apologize to him for having forgotten him, and getting to the point of having to stand outside the door of the vet to whom her dog had been taken. At the time, her parents believed that this was a sign of Muriel’s warmheartedness and was “just childish” in any case; what they missed, of course, was that this was not the mourning that follows the loss of somebody whom one loves, but the first obvious sign of a blaming and self-hatred that could be considered melancholic in quality. Her suicide attempt before her O-levels was not, by any means, a sudden decision to kill herself; instead, it was clear that soon after puberty her self-hatred, residing in her attitude to her body, became intense and carried the seeds of an action that would kill what she hated.

From this, we could also begin to make some sense of her eleven jobs and her need to move from one to the next. She remembered that, at one time, she had been frightened because she felt too attracted to another girl, and had been very jealous if this girl would talk to other people at school. At first, she just hated this girl for making her feel this way, but then she became frightened that she might be abnormal in some way. She got some relief from this worry by remembering that her intercourse was quite nice, but of course missing the fact that she felt compelled to have intercourse well before she felt that her sexual body was really her own (and since then never feeling able to trust herself to be alone with her own body). But she also found that as soon as she became friendly with girls at her various jobs, she became anxious and somehow found a reason either to leave or to be dismissed.

I will come back to Muriel, but I want now to describe another adolescent, “Paul”, who was aged 17 when I first met him a couple of years ago.

Paul had come on the advice of his mother, who had been worried that Paul might well end up either badly beaten up or in borstal if something was not done to help him. My success in helping him was limited, but I want instead to concentrate here on what was going on in him and how his own inner life affected his development and distorted his life.

The first sign of trouble was when, at school, Paul became involved in fights, which then developed into his being recognized as someone to be reckoned with. He loved knowing that people were frightened of him. One day he hit a male teacher, and this ultimately resulted in his suspension. After the suspension, he hung around outside the school, and once he threatened this teacher again for picking on him. Paul was convinced that he responded only to provocation, and he felt blamed for things that were being done to him. As far as he was concerned, he beat people up and hit the teacher only because they teased him or hinted at his worthlessness.

Paul’s father had left home when Paul was aged 9, and he had never seen his father again. When Paul’s mother became very ill and was in hospital, Paul had to be taken care of by neighbours. Secretly he used to cry before going to sleep, feeling sure that his mother would die. He found himself wandering and getting lost, and, to his astonishment, he and I could convincingly see that his wandering was his dreamlike way of looking for and feeling convinced that he would find his father, something that inevitably ended in disappointment. He started boxing when aged about 14, and he became quite a well-known amateur boxer. Once, following a boxing match, he told me that, when in the ring, he wanted to kill his opponent; he then realized through our talking that the hatred he felt for his father was forcing him now to try to mutilate or to kill this enemy in the ring. And what had happened at the time when he had hit the teacher was that he had thought that the teacher was being too nice to one of the other boys, and he felt sure at the time that the teacher might be a homosexual. This distortion hid Paul’s disappointment and his feeling that the teacher no longer cared for him—a teacher of whom Paul had become very fond and whom he had valued for his fairness.

But it was Paul’s own wish for a close relationship to a man, and his own fear that he might himself be abnormal in some way, that culminated in the attack on the teacher, making him feel that he was destroying the person who might be responsible for his own feelings of being abnormal. The breakdown had taken place, I think, well before the trouble blew up at school—the early signs could already be seen in Paul’s use of fighting and beating up people, often to the point that he felt he could kill the person. The homosexual fear was intense, and Paul was able to g...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• LIST OF CONTRIBUTORS
• INTRODUCTION
• PART ONE The adolescent and developmental breakdown
• PART TWO Proceedings of conference on “Adolescent breakdown and beyond”
• BIBLIOGRAPHY
• INDEX