Adolescent Depression

 by Ibrahim B. Syed, Ph. D. 
President
Islamic Research Foundation International, Inc.
7102 W. Shefford Lane
Louisville, KY 40242-6462, U.S.A.
E-mail: IRFI@INAME.COM
Website:  http://WWW.IRFI.ORG

In the summer holidays   between sophomore and junior years in college, Razzak was invited to be an instructor at an Islamic leadership camp hosted by a major American Islamic Organization in Kentucky. The participants in the Islamic leadership camp were all High School students coming from different parts of America and Canada. As Razzak was well experienced in Islamic leadership activities, he took it as a good opportunity in the spirit of Da'wah and Tableegh.

On the first day in the camp Razzak noticed a young boy, Ismail under the tree.  In appearance Ismail looked small and skinny.  For the onlookers his obvious anxiety  and bashfulness made him appear weak and delicate. He appeared to be suffering from Adolescent Depression

About 12 meters away, 100 enthusiastic campers were hitting bodies, playing, teasing and meeting each other. However Ismail under the tree seemed to be lost and unenthusiastic and gave the impression that he was not interested in the Leadership camp.  Razzak was almost stopped by the frantic solitude and low self-esteem Ismail radiated from approaching him, but Razzak remembered the words of the camp directors who warned him to look out for Muslim youth who might feel lonely and left out.

Saying "Assalamu Alaikum, Brother" Razzak walked to him and introduced himself and informed him that he is one of the camp trainers and counselors. Razzak asked him how he was doing.

In an unsteady, uncomfortable voice Ismail reluctantly answered "Alhamdulillah" and that he was all right.

Razzak serenely asked Ismail if he wanted to join in the activities and meet other Muslim youngsters in the camp.   Ismail softly replied, "No, this is not actually my obsession."

Razzak could sense that Ismail was feeling as if he was in a new planet, that this whole experience was far-off to him. But Razzak had a gut feeling it wouldn't be right to thrust (push or force) him, either. Ismail didn't need a vim (vigor or zest) talk, but what he needed was a good friend. After a number of quiet moments, Razzak's first contact with the boy under the tree was over.

Next day after   lunch, Razzak   was giving the Adhan for Salatul Zuhr at the top of his lungs for 100 of his new friends. The Muslim youth attending the camp eagerly prayed the Salatul Zuhr.  After the Salatul Zuhr Razzak found Ismail to be sitting alone, and staring out at the trees. Forgetting his other duties Razzak went to Ismail greeted him with "Assalamu Alaikum" and asked him  "How are you doing? Are you okay?"

To which Ismail again replied, "Wa Alaikum Assalam. Alhamdulillah, I'm all right. I am not really interested into this matter".

After this meeting Razzak realized that it is going to take more time and effort than he had thought. He was skeptical and doubted if he could change the heart of Ismail and make him participate in the Camp activities.

During the night there was a staff meeting, and Razzak made his concerns about Ismail known. Razzak explained to his fellow staff members his feelings of Ismail and asked them to give special interest and spend time with him whenever they could.

The days in the camp rolled by quickly, faster than any others Razzak had known. The camp days came to an end. Qiraat competition was the last item on the final night of camp and Razzak was presiding the function.  As the Qiraat competition was coming to an end, the Muslim youth who came from different parts of America, were doing all they could to enjoy every last instant with their new "best friends" - friends they would most likely never see again.

As Razzak watched the Muslim youth share their departure moments, Razzak suddenly saw what would be one of the most brilliant memories of his life. The boy from under the tree, Ismail, who stared blankly into the woods, was now a recitation wonder of the Qur'an. He turned out to be the best Qari among the boys in the camp. Razzak was surprised to see Ismail was sharing significant, intimate time with other Muslim youngsters at whom he couldn't even look just days earlier. Razzak couldn't believe it was he.

One month after his junior year started, Razzak received a late-night phone call that dragged him away from his physics textbook. A soft-spoken, unfamiliar lady's voice greeted "Assalamu Alaikum, and asked courteously, "Is Razzak there?"

Razzak answered, "Wa Alaikum Assalam, you are talking to him. May I know who you are?

"This is Ismail's mother.  Do you remember Ismail from the Islamic leadership camp?

Razzak remembered Ismail as the boy under the tree. How could he not remember him?

"Yes, I do", Razzak, said. "He's a very nice young Muslim. How is he?"

An unusually long silence followed, then   Ismail's mother said, "My Ismail was walking home from school this week when he was hit by a car and killed."  Razzak was stunned and offered his condolences and recited "Inna Lillahi WA Inna Ilaihi Rajioon." (2: 155)

"I just wanted to call you", Ismail's mother said, "Because Ismail mentioned you so many times. I wanted you to know that he went back to school this fall with self-assurance and confidence. He made new friends. His grades went up. And he overcame his shyness. He had so much enthusiasm in life. I just wanted to thank you for making a difference for Ismail. The last few months were the best few months of his life."

In that instant, Razzak realized how easy it is to give a bit of oneself every day. You may never know how much each signal (shrug or nod) may mean to someone else.

One should tell this story as frequently as possible and when one does, one should urge others to look for their own Ismails-the boys under the tree.

Adolescent Depression

In North America, the suicide rate for adolescents has increased more than 200% over the last decade. Recent studies have shown that greater than 20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatric clinics suffer from depression.

Depression has been considered to be the major psychiatric disease of the 20th century, affecting approximately eight to twenty eight million people in North America. Adults with psychiatric illness are 20 times more likely to die from accidents or suicide than adults without psychiatric disorder. Major depression, including bipolar affective disorder, often appears for the first time during the teenage years, and early recognition of these conditions will have profound effects on later morbidity and mortality.

Depression problems

Adolescent suicide is now responsible for more deaths in youth's aged 15 to 19 than cardiovascular disease or cancer. Despite this, depression in this age group is greatly under diagnosed, leading to serious difficulties in school, work and personal adjustment, which often continue, into adulthood.

Adolescence is always a disturbing time, with the many physical, emotional, psychological and social changes that accompany this stage of life. Adolescence is a time of emotional turmoil, mood instability, depressing introspection, great drama and heightened sensitivity. It is a time of rebellion and behavioral experimentation. Diagnosis depends not only on a formal clinical interview but also on information provided by peers, including parents, teachers and community advisors. The patient's premorbid personality must be taken into account, as well as any obvious or subtle stress or trauma that may have preceded the clinical state. The adolescent will not usually share his/her feelings with an adult stranger unless trust and rapport are established.

Symptoms of adolescent depression ¹

These symptoms may indicate depression, particularly when they last for more than two weeks:

• Poor performance in school
• Withdrawal from friends and activities
• Sadness and hopelessness
• Lack of enthusiasm, energy or motivation
• Anger and rage
• Overreaction to criticism
• Feelings of being unable to satisfy ideals
• Poor self-esteem or guilt
• Indecision, lack of concentration or forgetfulness
• Restlessness and agitation
• Changes in eating or sleeping patterns
• Substance abuse
• Problems with authority
• Suicidal thoughts or actions

Teens may experiment with drugs or alcohol or become sexually promiscuous to avoid feelings of depression. Teens also may express their depression through hostile, aggressive, risk-taking behavior. But such behaviors only lead to new problems, deeper levels of depression and destroyed relationships with friends, family, law enforcement or school officials.

Symptoms of depression in adolescents are essentially the same symptoms as in adults. Pervasive sadness may be exemplified by wearing black clothes, writing poetry with morbid themes or a preoccupation with music that has nihilistic themes. Sleep disturbance may be evident as all-night television watching, difficulty in getting up for school, or sleeping during the day. Missed classes reflect lack of motivation and lowered energy level. A drop in grade averages can be equated with loss of concentration and slowed thinking. Boredom (dullness) may be a synonym for feeling depressed. Loss of appetite may become anorexia or bulimia. Adolescent depression may also present primarily as a behavior or conduct disorder, substance or alcohol abuse or as family turmoil and rebellion with no obvious symptoms reminiscent of depression.

Suicide risk ²

Sometimes teens feel so depressed that they consider ending their lives. Each year, almost 5,000 young people, ages 15 to 24, kill themselves. The rate of suicide for this age group has nearly tripled since 1960, making it the third leading cause of death in adolescents and the second leading cause of death among college-age youth.

Studies show that suicide attempts among young people may be based on long-standing problems triggered by a specific event. Suicidal adolescents may view a temporary situation as a permanent condition. Feelings of anger and resentment combined with exaggerated guilt can lead to impulsive, self-destructive acts.                                                 

The Warning Signs ³
Four out of five teens who attempt suicide have given clear warnings. Pay attention to these warning signs:

• Suicide threats, direct and indirect
• Obsession with death
• Poems, essays and drawings that refer to death
• Dramatic change in personality or appearance
• Irrational, bizarre behavior
• Overwhelming sense of guilt, shame or rejection
• Changed eating or sleeping patterns
• Severe drop in school performance
• Giving away belongings

REMEMBER!!! These warning signs should be taken seriously. Obtain help immediately. Caring and support can save a young life.

Helping Suicidal Teens ⁴

• Offer help and listen. Encourage depressed teens to talk about their feelings. Listen, don’t lecture.
• Trust your instincts. If it seems that the situation may be serious, seek prompt help. Break a confidence if necessary, in order to save a life.
• Pay attention to talk about suicide. Ask direct questions and don’t be afraid of frank discussions. Silence is deadly!
• Seek professional help. It is essential to seek expert advice from a mental health professional who has experience helping depressed teens. Also, alert key adults in the teen’s life — family, friends and teachers.

It is not uncommon for young people to be preoccupied with issues of mortality and to contemplate the effect their death would have on close family and friends. Thankfully, these ideas are usually not acted upon. Suicidal acts are generally associated with a significant acute crisis in the teenager's life and may also involve concomitant depression. It is important to stress that the crisis may be insignificant to the adults around, but very significant to the teenager. The loss of a boyfriend or girlfriend, a drop in school marks or a negative admonition by a significant adult, especially a parent or teacher, may be precipitant to a suicidal act. Suicidal ideation and acts are more common among children who have already experienced significant stress in their lives.

Significant stressors include divorce, parent or family discord, physical or sexual abuse and alcohol or substance abuse. A suicide in a relative or close friend may also be an important identifier of those at the greatest risk. The teenager who exhibits obvious personality change, including social withdrawal, or who gives away treasured possessions may also be seriously contemplating ending his/her life.

Many more teenagers attempt suicide than actually succeed, and the methods used may be naive.  A teenager who has attempted suicide and has not received any relief from his or her impossible situation may well be a successful repeater. All suicidal behaviors reflect a cry for help and must be taken seriously.                                                                          

Physician's Role ⁵

The management of the depressed teenager begins at the first interview with the creation of a therapeutic alliance. It is important that the interview be conducted in a relaxed manner, preferably in a room other than a formal examination room. The teenager may have to be brought back the next day or on a number of successive days to adequately address problems. The physician must inspire confidence and trust, and be aware of his or her own biases. Teenagers can be oppositional and negative when depressed. They may have very fragile self-esteem and project their feelings onto the physician. It is important to understand this behavior as part of the depression and treat it accordingly.

Looking To The Future
When adolescents are depressed, they have a tough time believing that their outlook can improve. But professional treatment can have a dramatic impact on their lives. It can put them back on track and bring them hope for the future.

Suicide within Islam

"Committing suicide is a grave sin. Many scholars view a person who has committed suicide as someone who has turned his back on Islam altogether."  Muslims regard God to be the creator of life. Thus, only God has the right to end life. A manual of Shariah (Islamic law) in the tradition of Imam Shafi'i is called Reliance of the Traveler. It lists suicide as among the "enormities" of all sin:

"Do not kill yourselves, for Allah is compassionate towards you. Whoever does so, in transgression and wrongfully, We shall roast in a fire, and that is an easy matter for Allah." (An-Nisaa 4:29-30)

Narrated Thabit bin Ad-Dahhak, The Prophet said, "...whoever commits suicide with piece of iron will be punished with the same piece of iron in the Hell Fire." Narrated Jundab the Prophet said, "A man was inflicted with wounds and he committed suicide, and so Allah said: 'My slave has caused death on himself hurriedly, so I forbid Paradise for him.' " (Sahih Bukhari 2.445)

Narrated Abu Huraira: The Prophet said, "He who commits suicide by throttling shall keep on throttling himself in the Hell Fire (forever) and he who commits suicide by stabbing himself shall keep on stabbing himself in the Hell-Fire." (Sahih Bukhari 2.446).

The fate of a Muslim who commits suicide: "God will punish him by making him commit the same act of suicide, the same cycle of torture, on the day of judgment. If he kills himself with a dagger, his punishment is to sink the dagger in his heart again and again."

1. Website of National Mental Health Association http://www.nmha.org/infoctr/factsheets/24.cfm
2. ibid

3. ibid

4. ibid

5. ibid