Dear all, as children grow older, the mental health challenges they face can also become more significant. Mental health issues among young people have risen sharply: depression, ADHD, gaming addiction, mobile phone addiction and obsessive-compulsive disorder. For her book “Between TikTok and Therapy: How Teenagers and Young Adults Overcome Mental Health Crises”, Ulrike Bartholomäus spent over a year and a half accompanying 25 young people.
These young people allowed her to look deep into their inner worlds. She held in-depth discussions with their doctors, therapists and parents. The result is a sensitive and multi-layered portrait of people who recount how they overcame their crises – and what made them strong. Here she shares her insights with us.
Dear Ms Bartholomäus, you have been supporting young people through mental health crises for 25 years. Which case from recent years has stayed with you in particular, and why?
Thirteen-year-old Georg, now a young adult, completely lost his footing in his youth. He comes from a perfectly ordinary middle-class background. For seven years, he sank into drug addiction. He fought his problems – his ADHD, his panic attacks, his depression – with weed, pills and cocaine. He stole, dealt drugs and spent time in psychiatric care undergoing withdrawal.
His family stood by him, even though there was a great deal of misunderstanding for years. On the advice of psychologists, he then lived in a youth group, where he found a social worker to whom he confided all his frustrations and difficulties. He says this woman saved him. He completed a vocational training course, thereby obtaining his vocational baccalaureate, and has now been studying at a university for a few years.
This man is incredibly intelligent, incredibly approachable and a very interesting person to talk to. It is astonishing how he managed to pull himself out of a completely hopeless situation in which almost no one believed in him anymore. But the social worker, his parents and his siblings were there for him. A story like this gives hope.
How have the problems faced by young people changed over time?
Childhood has changed dramatically. Free, unsupervised play has largely given way to over-organised leisure time with school days that are far too long. Yet when playing, children’s brains learn much faster than through supervised learning. Children practise their social skills and discover how the world works through play.
They make friends and spend time with them; they develop strong inner personalities and become resilient. They develop an inner voice telling them they can do it, because play builds self-confidence. All this happens naturally, without any formal lessons. The sense of stability within families is also eroding, for a variety of reasons. Parental separations, heavy workloads for both parents, little time for the family, a lack of weekend rituals.
Many people are very preoccupied with themselves; this applies to parents as well as young people. Yet a sense of togetherness, belonging and shared experiences shape children and young people and strengthen them. Added to this are social media platforms like TikTok, endlessly replying to messages, excessive gaming, streaming and YouTube until their eyes glaze over. TikTok turns young people’s brains to mincemeat.
What advice would you give to a teenager who can’t stop using TikTok?
That probably applies to a great many of them. Some of the young people in their early 20s I interviewed have deleted the app in such cases. Most realise that otherwise they won’t be able to limit their time on it. They also realise that it’s making them feel unwell. Younger teenagers, however, are afraid of losing their social connections as a result, since they live and express themselves through TikTok.
This is where parents come in. According to experts, they have the right to determine where their children spend their time, including online. Why do we allow this company to destroy our young people’s attention span, their ability to concentrate, and their life satisfaction?
And what if my child stops eating – do you also train the parents, because it affects the whole ‘family system’?
No. That is definitely a matter for doctors. My sister is a paediatrician in private practice; that’s how I know the procedure for eating disorders.
Paediatricians are the first point of contact for this issue. They can advise whether avoiding or refusing food is just the beginning and how parents can get their daughter – it’s usually girls – to eat better again. Or whether the disorder is already at an advanced stage. Girls with eating disorders are masters at hiding it. That’s part of the illness. They have to lie to avoid consuming calories; at least, that’s what they’ve told me themselves.
The family system is always affected by eating disorders, which means that therapy for the person affected is also required if the GP’s advice is not sufficient. If a girl, say aged 12, is not yet so severely underweight that she needs to be admitted to a clinic, then parents can still help with plenty of time and patience. This sometimes requires drastic measures.
For instance, a doctor might advise that a parent take a few months’ sabbatical to cook fresh meals that the teenager enjoys and to spend plenty of time sitting at the table during meals. If the child has already become so severely underweight that the condition poses life-threatening health risks, hospital admission will be required in any case.
What advice would you give to the mother of a boy with ADHD who plays video games all night long, doesn’t leave his room at the weekend and approaches school with the attitude that ‘just being there is everything’?
It depends here on whether it really is ADHD, and if so, how severe it is and how it manifests itself. There are very significant differences. If it is severe, I would advise the mother to take her son to see a psychiatrist who specialises in ADHD. It is important to make an accurate diagnosis here; this is not a trivial matter. Not all behavioural issues that look like ADHD are actually ADHD. After that, it may be necessary to combine medication with talk therapy. Medication can be a huge help to children at school, but not all of them need it.
At the same time, I would recommend to the mother that her son be allowed to let off steam. Kickboxing, football, indoor climbing, basketball – sports where he’s allowed to be loud and wild for a change. That’s difficult if he just plays video games and withdraws into himself. But perhaps he might be interested in something exciting that satisfies his need for dopamine: a climbing wall, a giant rollercoaster at the town fair, a go-kart track, a trip to a lake for wakeboarding, or a swimming pool with a giant slide. That’s how I would try to entice him.
It’s important that your son doesn’t always have to be well-behaved. I’d also recommend cooking rather than serving ready meals. I’d also explain why it’s important to take the pressure off the school discussion for now. When it comes to gaming, I’d use an app to limit his gaming time. After all, your son can only game non-stop if he has unlimited access to Wi-Fi.
Parents should be aware that teenagers can get round parental controls, so the system needs to be absolutely watertight. And then you have to put up with the hassle, which is the hardest part. But better a few days of bad atmosphere than a young man later on who can’t find his way out of the gaming trap. The problem won’t go away on its own.
How should a father react to his teenage daughter who smokes weed constantly, is sinking into depression, and where he wonders whether she is using weed to combat her panic attacks or whether the joints have actually triggered her mental health problems in the first place?
The first question is: where does the girl get the money to smoke weed constantly? That costs a few hundred euros a month. There’s nothing wrong with the odd joint now and then. Parents can relax about that. It’s less harmful than alcohol in excessive quantities. But if it’s constant smoking, then the situation is serious. First and foremost, the father should cut off her money supply – no cash. Full stop.
Does the girl want to buy something to eat after school? She gets a card for the bakery. A pair of new shoes? The father goes with her to pay for them, or she picks them out and he buys them online if he can’t come along. But choosing things together would also be an important point, because it’s also about strengthening the relationship. In the life of a chronic cannabis user, there must be no money lying around the flat; there are no cash gifts, not even from grandparents etc., and no access to cash gifts from any relatives.
That sounds harsh, but a long-term cannabis user doesn’t usually stop on her own. The father should also try to take the girl to a counselling centre. Many counselling services are easily accessible; for example, Caritas offers such services in many towns and cities. There is, after all, an alternative to smoking cannabis. An addiction specialist should discuss this with her. Next, it is important to address the depression. This is a chicken-and-egg problem in this case, which the father should take very seriously. The addiction specialist can also clarify this… whether the depression and panic attacks existed before the chronic cannabis use or whether they only emerged after so much cannabis had been smoked.
As a rule, children don’t discuss this with their parents, but they might with a mentor. This could be an uncle or an aunt, a godparent or a friend, a family friend. The girl’s age is important, because the earlier she starts smoking cannabis regularly, the more damage can be done to her brain, sometimes irreversibly. The father should realise this by educating himself on the matter. It is about protecting the girl, just as he protects her from other dangers.
Chronic cannabis use can also trigger psychosis and schizophrenia; this should be gently brought up as well.
I feel that we can talk much more openly about mental health issues today, yet it seems as though there is an ever-increasing need for support for young people – how does that fit together?
Mental health problems don’t just disappear simply because we’re open about them. I’ve seen this openness mainly among young people, much less so among parents. Nothing is more taboo than one’s own child’s mental illness. There may be exceptions, of course. What’s more, children rarely, if ever, talk to their parents about their problems; they want to spare them.
What is needed for a mentally healthy youth, and which factors are crucial?
Resilience is built through personal experience, through parental love, through good, reliable relationships, and by learning from an early age to tackle one’s own tasks and overcome obstacles. Children need time to play, time with their parents. The assumption that teenagers need their parents less is, in my opinion, incorrect.
Because the problems they face – social issues with friends, first romantic partners, school and their self-confidence – are enormous. It is precisely when teenagers are breaking away that they need support. When they get into trouble, they should be able to trust their parents not to get angry if they ask for help. This trust does not come about by chance, but is built up beforehand.
Creating a sense of security and safety is also the parents’ responsibility.
