January 4, 2007

Adolescence.

The mere thought of it strikes fear in the heart of many a parent.
A tumultuous time of intellectual, physical and moral growth, adolescence can be wondrous, exciting … and terrifying. Teens and their parents find themselves negotiating every rule — “Sara’s mother lets her stay out until midnight on school nights!” — each desperately trying to decipher the other’s actions, a futile endeavor that often ends when the teen shouts: “You just don’t understand me!”

Yet these interactions, parents are told, are part of the normal struggle for autonomy and independence inherent in the teen years. While some of this angst can become fodder for entertainment — dramatic and/or comic — this “developmentally appropriate” stage can also trigger a host of psychological problems, particularly depression, substance abuse, aggression and anxiety.

The incidence of psychological problems in teens has been increasing at an alarming rate over the last decade, recent research suggests, especially in a specific — and some say surprising — segment of the population.

Nationwide studies of teens from upper-middle-class, well-educated families show they have some of the highest rates of substance abuse, anxiety disorders, depression and psychosomatic complaints of any group of adolescents.

In her recent book, “The Price of Privilege,” psychologist Madeline Levine explores these problems through the lens of her clinical practice and a rich body of research, offering sound guidance for both individual and cultural change. The result is a deeply compassionate, insightful, alarming yet hopeful exploration of what Levine defines as “a growing public health concern.”

Not surprisingly, in her 25 years of clinical practice Levine has always seen what she calls “a lot of unhappy kids.” But in the mid-1990s she noticed changes in her clients’ presentation. Instead of showing classic signs of depression — disregard for personal appearance, a drop in grades, a change in or loss of friends — her new patients were “well-groomed, popular, played sports and often maintained their grades, but they had a vacant, bland, anhedonic quality,” Levine said in an interview. In short, these kids took no joy from their lives.

A number of factors came together in the 1990s that set the stage for this change, Levine said, among them baby boomers having families of their own, creating a new “boomlet” of kids competing for limited space at elite schools — both public and private. And although research shows no correlation between the particular college one attends and life-long happiness or earning power, Levine said, parents developed a heightened sense that a successful life is dependent upon early achievement and the advantages of a status education.

Parenting styles had changed, as well. Baby boomers who grew up in the “do your own thing” 1960s have “more ambivalence about discipline,” Levine said. “Parents want to be friends with their kids; they can’t tolerate the rupture with their children that occurs with discipline and limit-setting.”

In addition, the heady financial years of the 1980s ushered in an era of unprecedented national wealth and a culture that glorifies materialism, which, Levine said, “encourages people to believe that happiness can be bought.” Add to this the “hand of capitalism,” seen in the developing industry that feeds on parent’s anxieties by publicizing college rankings and packaging test prep courses, college tours and counseling, and you’ve got what Levine refers to as “a perfect storm.”

In 2002, Levine had a particularly revelatory experience with one client: A teenage girl arrived at Levine’s office wearing a typical “cutter T-shirt” — long sleeves pulled down over her wrists, holes cut out for the thumbs. She spoke for a while, then pulled back her sleeve to reveal the word “empty” incised in her forearm. Naturally the girl’s self-mutilation disturbed Levine; it also, she said, “epitomized the dangerous shift I’d seen taking place, in which kids look incredibly good on the surface, but roll back their sleeve — metaphorically — and you see they’re bleeding.”

At around the same time, a number of researchers were examining thousands of affluent families across the country. Columbia University’s Dr. Suniya Luthar, in particular, quantified the very phenomena Levine and others had been observing with their own clients. As cited in Levine’s book, Luthar’s research was startling: Among teens in affluent families, girls are three times more likely to suffer clinical depression than girls from any other socioeconomic group, and boys, who tend to externalize their discontent, have substantially higher rates of substance abuse than any other group of teens. In addition, both girls and boys experience anxiety disorders at twice the rate of the general population, and approximately 30 percent to 40 percent of teens from affluent homes exhibit symptoms of “significant emotional impairment.”

The confluence of her client’s disturbing revelation and the new research “helped crystallize my thoughts,” said Levine, prompting her to explore a series of related questions: Why would affluent teens — the very kids who seem to “have it all” — be more prone to emotional problems than kids from other socioeconomic groups? What are we doing as parents, and as a culture, that drives our kids to such desperate behaviors? And perhaps most importantly, what can we do to reverse the trend?

Affluent parents often “pay a lopsided attention to two facets of development — academics and athletics — while underemphasizing other areas of growth such as social skills, altruism, self-management skills and creativity,” Levine said. Without the freedom to explore a range of their interests and abilities, teens are deprived of crucial steps necessary to develop a healthy, authentic identity.

By offering material goods to assuage problems — a practice Levine said is common among busy, often guilt-ridden parents — parents prevent their children from developing “their own inner resources for managing distress, which will provide a safety net when they are struggling.”

Without these resources in self-management, teens become anxious and therefore are more likely to resort to self-destructive behaviors — often progressing from excessive perfectionism and depression to drug use and cutting — when faced with life’s inevitable disappointments and frustrations.