By Sarah Maraniss Vander Schaaff
Imagine you are 15 and texting someone you like. Twenty minutes go by without a response. What thoughts come into your mind?
This is a hypothetical scenario in Jacob Towery’s “The Anti-Depressant Book, A Practical Guide for Teens and Young Adults to Overcome Depression and Stay Healthy,” but it is no stretch to assume it is happening right now all over the country. If adolescents are not waiting for a text, they are checking their grades online or browsing social media. Emotional resilience is tested not weekly or daily, but multiple times a minute.
Is it any wonder depression among adolescents is on the rise? Roughly 1 in 11 adolescents has a major depressive episode each year. According to the 2015 Youth Risk Behavior Survey, 8.6 percent of youth in grades nine through 12 reported they had made at least one suicide attempt in the past 12 months.
In Palo Alto, Calif., where the author, 38, works as a child and adolescent psychiatrist and an adjunct clinical faculty member at Stanford University School of Medicine, young people struggling with depression is not a remote statistic. Two suicide clusters in recent years prompted a Centers for Disease Control and Prevention investigation, and many, including Towery, wondered what they could do to help more young people. Nationwide, a shortage of child and adolescent psychiatrists — 8,300 clinicians for the 15 million children and teens who need them — long waiting lists, high costs, and a lingering stigma associated with mental illness make finding care difficult. Towery wrote a book to walk readers through the same concepts he uses with patients in private practice. Recently, he released an audio version to reach those who find reading “torture,” he said.
He hopes teens will follow along in the paperback while they listen to the audiobook. It is a good combination even for those who enjoy reading. Towery offers an honest and accessible narration, and there is something exciting about turning a cellphone into an ally in the fight for mental well-being. Having the Stanford psychiatrist’s book on your phone is akin to having a private, portable therapist in your pocket.
The example of the unreturned text message illustrates the book’s major theme: How we interpret events informs our feelings even more than the events themselves. Consider, for example, how you might feel if these were your thoughts after the described situation: They should have texted me back by now. It’s been 20 minutes! They didn’t even let me know they needed to go! Maybe they’re upset with me. Maybe they don’t like me anymore.
[Perfectionism among teens is rampant (and we’re not helping)]
In contrast, Towery writes, consider your feelings if this went through your mind: I wonder what happened to them? In general, things seemed to be going pretty well before this. I bet they had to run to class or work. Or maybe their phone died. That has definitely happened to me. I bet they are just busy right now, and I’ll probably hear from them later. I’ll go do something else, too.
Welcome to cognitive therapy, a big part of Towery’s multi-step strategy for overcoming and fending off depression. The other bulwark is behavioral therapy, which focuses on, as you might expect, behavior. To a large degree, the behavior necessary for optimum mental health is common sense: Get adequate sleep and regular exercise, and meditate daily. But these protective behaviors require great dedication and the willingness to challenge old habits and expectations. Towery gives teens clear instructions on how to do that.
It is one thing, however, to explain the strategies for creating resilient mental health. It is another to get an adolescent — or anyone in the throes of emotional pain — to integrate and utilize the tools that are proved to help. Towery confronts this head-on with the chapter “Good Reasons to Hold on to Depression.” For example, if the listener concludes he or she would rather not get rid of depression, then that decision is a choice. So, too, is a lack of commitment to changing behaviors.
The audiobook has the added benefit of conveying the doctor’s tone. He is not judgmental or even particularly impassioned explaining these options. Readers are free to choose to abandon the book or neglect its strategies. But if they are willing to commit, they need to do it entirely, essentially putting themselves in Towery’s comprehensive boot camp for mental health.
Here is where we may get into some controversy. First, you will want to listen to and read the book before you give it to your teen. You will be told it is not your job to nag or insist your teen follow through with the book, but rather to support them even when they say they need to buy three alarm clocks because the author of the book told them to. You may also want to understand the cognitive-behavioral-therapy techniques Towery teaches. Your child will have a new perspective on his thoughts and feelings, and it would behoove any parent to be well versed in these approaches.
Second, depression is serious. While we may know risk factors for suicide, not all adolescents show the same warning signs. As comprehensive as the book is, it is a long-term approach that yields benefits over weeks. A person in crisis, as Towery notes, requires immediate and in-person care. And while 5 to 10 percent of his patients benefit from integrating an antidepressant into their treatment, medication is not discussed in the book.
The most difficult part of this book is its honesty. Towery’s strategies require addressing the things that throw us off track. Remove electronics. (He explains how and when.) Meditate. (Use an app and let go of misconceptions.) Counteract the limbic system, which controls emotions, with mindful thoughts that counter our more charged reactions and entitled beliefs. Even after all the hard work, we are told to expect, “no matter how closely you follow my instructions, you will still have minutes of feeling sad, minutes of feeling worried, minutes of feeling every emotion known to humankind. This is inescapable.”
The big questions parents of teens face often relate to the dynamic of feeling simultaneously so close to, and so remote from, our children. How do we connect? How do we respect their growing sense of self? I asked myself these questions as I read and listened to Towery’s book. Would his style, intonation and willingness to explain key concepts in psychiatry with both precision and down-to-earth language resonate with adolescent listeners?
No one will doubt Towery’s deep belief that each of us has the potential to find more purpose, joy and contentment in our life regardless of external circumstances. Cognitive behavioral therapy and the TEAM therapy developed by David Burns — with whom Towery studied — has evidence to back it up. There are many reasons to believe this paperback and audiobook, together costing less than $25, can help thousands. Still, as Towery acknowledges, his system is not going to click with everyone.
Considering half of all chronic mental illness begins by age 14 and three-quarters by age 24, according to the CDC, it makes sense to give our young people more tools to better handle not only major episodes but the buildup of minor ones. I wonder what would happen if more schools included this book and audio companion on their lists of recommended summer reading. It would give young people healthier ways to relate to the world and their thoughts and feelings, and it could be done inexpensively, at their own pace. It is a remarkable opportunity for a proactive approach to mental health.
Do you think that in addition to “Lord of the Flies,” we might make time for that?
Vander Schaaff is a freelance writer. Find her online at writeonsarah.com