My journey as a vocational youth ministry worker started out in 1995 with a minty-fresh seminary degree, killer guitar chops and the ability to capture the attention of even the most distracted adolescent. Overflowing with time, talent and treasure, I landed a job in a growing, affluent suburb in south Kansas City. I had every reason to feel good about my situation.The youth ministry expanded, kids were having mostly injury-free fun, and there was even some evidence of discipleship going on. I was certain I would be a “lifer” and die at the age of 73 under a dog pile of sweaty middle school kids, happy and fulfilled in my calling.
Darren made me uncomfortable. I couldn’t reach him. I never captured his gaze when I taught the group. His flat, colorless affect was marked with a perpetual scowl. My leaders tried to include him, but he always managed to remain elusive and detached. He was an apparition who materialized and vanished sporadically.
I knew Darren had serious problems at home, with a single mom and an absent father. His grades were abysmal, and there were rumors he was a pothead. I was overwhelmed and ill-equipped at the time to understand how to minister to Darren and other students like him who struggled with what I now know as the double-headed monster of adolescent depression and anxiety.
A few years later, I developed what I call a “Holy Spirit irritation.” I wanted to draw nearer to families and kids who were experiencing pain. The restlessness eventually led me on a serendipitous path toward a new vocation as a marriage and family therapist.
I still think of myself as a youth minister who works with a different set of tools. I seek to help youth workers develop a better understanding of the various aspects of mental illness and how they can be a healing force in the lives of those who suffer. My hope in this article is to share information with you that will equip you with a measure of competence and confidence as you minister to the students in your spheres who might be suffering from anxiety and depression.
Identifying Anxiety
Today’s typical school-age children report higher levels of anxiety than child psychiatric patients did in the 1950s, according to a study by Jean M. Twenge in the Journal of Personality and Social Psychology.
Anxiety is often a precursor to depression, and sometimes even seasoned clinicians have difficulty distinguishing between the two. The easiest way to describe the difference is that anxiety usually involves a marked, maladaptive stress response, while depression involves severe hopelessness and a flattening of mood.
Fear is actually a gift given to us by our Creator that enables us to respond to various forms of danger and adversity. Chronic anxiety happens when the fear response gets stuck in overdrive, causing feelings of apprehension and impending doom. Anxiety is marked by both psychological and physical symptoms and can appear in different forms, such as:
Panic Disorder – episodes often involve intense fearfulness, excessive sweating, cold/clammy hands, heart palpitations, dizziness, trembling, muscle tension, diarrhea, tingling skin, hot or cold flashes, nausea, fear of dying, hyperventilation
Separation Anxiety – excessive stress and worry about parting with a parent or caregiver—more common in younger students
Agoraphobia – an intense and irrational fear of leaving familiar surroundings like home—students may fear school or anywhere there might be a crowd
Other symptoms common to anxiety are loss of sleep, stomachaches, chest pain, abdominal pain and irritability.
Everyone experiences occasional bouts of anxiety; and normal adolescent development is marked by opportunities for anxiety, due to increasing independence, responsibility, socialization and performance pressures. The anxiety becomes chronic only when these pressures are too much for a student to bear and they become impaired in their ability to function normally. Experiences such as the death of a friend or family member, serious injury, divorce, abuse or traumatic incidents such as Sept. 11 or the Virginia Tech killings are extremely likely to create symptoms of anxiety in students.
Some of the best treatments for anxiety come in the forms of love, acceptance and community that your students, staff and volunteers can provide. But chronic anxiety demands a more comprehensive approach to healing. Treatment for anxiety varies depending on the severity and frequency of symptoms. It is always a good idea for a student with severe anxiety to first be evaluated by her doctor or pediatrician to rule out possible physical contributors. Therapy is often helpful in equipping the student to understand the nature of her anxiety and in developing the capacity to relax and cope with her problems. Other students will find benefits from short-term psychotropic medication (always provided and monitored by a doctor or psychiatrist). Ideally, these courses of medication are designed to help a student take the edge off the symptoms until she can incorporate better coping mechanisms.
Dealing with Depression
It is very important to make a distinction between adolescent depression and existential despair. Existential despair can look like depression, but it is actually a normative developmental process that most young people must pass through as they begin to answer questions such as “Who am I?” or “Who am I not?” and “Why am I here?”
Before reaching adulthood, about 20 percent of teenagers will suffer from an episode of depression, says the National Institutes of Health. The symptoms are debilitating and persistent. Teens who suffer from depression are highly susceptible to harmful practices such as substance abuse, risky sexual behavior, oppositional behavior and self-harming activities such as cutting and eating disorders.
Predominant symptoms include anhedonia (a lack of ability to feel pleasure or interest in anything), depressed mood, flat affect, plummeting grades, substance abuse, shoplifting, change in sleep habits (too much or too little), appetite changes and an obsession with death and dying.
According to the Diagnostic and Statistical manual of Mental Disorders, other symptons include:
• suicidal ideation
• plans to commit suicide or an actual suicide attempt
• change in weight (unintentional weight loss or unintentional weight gain)
• excessive daytime drowsiness
• fatigue and exhaustion
• indecisiveness
• memory loss (amnesia) episodes
• trouble with concentration
• feelings of worthlessness, self-hatred or sadness
• excessive guilt
• oppositional behavior (missing curfews, violence, unusual defiance)
• mood changes associated with change in the seasons
Initial treatment for depression—like anxiety—should be holistic. In addition to medical evaluation, family therapy can beparticularly helpful in uncovering the causes of depression in teenagers. Exercise and nutrition should also be encouraged, because depression is a physiological and chemical condition as well as an emotional and psychological condition.
There is currently a great deal of controversy revolving around the question of whether teens should take antidepressant medications. The FDA released a study in 2003 that outlined a disturbing correlation between a teen’s risk of suicide and the popular antidepressant medication Paxil. (As this issue was going to press, the FDA was expected to release an updated study.) Whether this is a reality or not, it is always a good idea to pursue medication as a means of treatment only after other attempts have failed to make a difference.
In my experience, depressed teenagers are able to experience a great deal of initial relief just by talking honestly about the way they feel with a non-judgmental, available person. That person can be you! You can become a healing presence for students in their darkest moments. Just make sure you are thinking critically about the other resources they will need when their symptoms become acute.
Whenever you observe the symptoms of anxiety or depression in the teenagers with whom you work, always remember that what you are seeing is most likely only the tip of the iceberg. Symptoms bubble up from, and point toward, powerful undercurrents that exist in students’ interior lives and perhaps family dynamics. These undercurrents include themes of grief, loss, betrayal, abandonment, bitterness, family secrets, abuse, poverty, trauma, emotional numbness, role confusion in parents and substance abuse in the family.
Working with Family Systems
In order to successfully navigate difficult student problems such as anxiety and depression, every youth pastor must also become a family pastor by default. A student’s family system is the most powerful shaping force in his life. Having worked in both church and school environments, I have observed that parents become easy targets for criticism when their weaknesses emerge or when their children become symptomatic. I’ve been guilty of it myself.
If we want to have the mind of Christ, we must believe that parents are doing the best they possibly can. Get a mental picture in your mind right now of the most irritating parent with whom you come in contact. Got it? Now, identify three things that are admirable about that person. This exercise can change the nature of the way you interact with people. It will help guard you against defensiveness and avoidance in your ministry approach. It works for senior pastors, too.
Parents are information junkies. They want to hear about how their kids are doing. You and your volunteers will experience a surge of energy in your ministry when parents feel you are attentive to their children’s development. Don’t hesitate to set up meetings with parents whose kids are struggling. Treat them as the experts on their kids (they are), and let them know you want to be a resource to them. Resources you provide could include special outings with their students, notes and words of encouragement or referrals to outside helpers when necessary.
When students become symptomatic, their symptoms are often speaking for problems in the family hierarchy. When talking with parents, don’t be afraid to ask them about the health of their marriages or about the stressors they are facing as adults. You will gain a tremendous amount of insight into the lives of those families, and you will be better positioned to help them.
Finally, pay attention to your own interior life and your relationships. No one is immune to the ravages of anxiety and depression, and anyone whose vocation involves serving others in their times of need is especially vulnerable. Learn to receive comfort as you extend it to others.
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Grant Wood is a licensed clinical marriage and family therapist, specializing in adolescent behavior. He is in private practice in Overland Park, Kansas. Prior to his work as a therapist, Grant was a vocational youth worker and worship leader for 10 years.
