The Dirty Little Secret

Woman making silent gesture

Many of my childhood friends were active in sports and some of them broke a bone or two in the process. I remember autographing their casts with well wishes such as, get well soon or sorry you got hurt. As parents, we know that if our children have a fever, it is best for everyone if they stay home. Physical illness is a natural and expected aspect of life. My friends did not act ashamed or secretive about having their casts signed, and kids view a fever like a snow day with plenty of rest and chicken-noodle-soup. In most cases, there is very little shame, or secrecy attached to physical illness.

In the world of mental health, the opposite is true. Individuals tend to conceal their depression, anxious thoughts, or self-defeating beliefs. Often, they prefer to work out their personal problems in private. Therefore, much of my work, by law, is confidential.  My professional standards require that I adhere to the promise “what is said in here, stays in here.”

When people come to see me, they are usually not proud and have no visible casts or fevers to prove that something is wrong. In fact, most of my client’s are mandated by the court system or social services and have drug, behavior, and academic problems. Many of the youth I treat, believe that people who have to see a counselor are crazy. However, I share with them that counseling is better described as a resource to keep you from going crazy.

As professionals, parents, and others who care about youth, it is important that we pay as keen attention to their mental health needs as we do their physical health needs. Undetected and untreated mental illness can lead youth down the road to delinquency or provoke self-harming behavior. Since mental health problems are not always as obvious as a bloody nose or a broken bone, it is important that we know the signs. Teens may not want to open up and discuss it, but if they are struggling their behavior will eventually reveal the presence of mental unrest.

Below are five major signs that may indicate a need for mental health treatment or evaluation.

  1. Withdrawal– isolation from family and friends or from activities that are typically enjoyable is an indication that something is out of the norm.
  2. Extreme changes in mood– everyone experiences and expresses anger, sadness, anxiety and fear at some point. However, if a young person has frequent and intense outbursts or changes in their emotional state, it is a strong indication that he or she is experiencing some type of distress.
  3. Poor concentration/attention– if a young person begins to have extreme difficulty staying alert and focused, it is possible that something more prominent is occupying their mental space.
  4. Use of substances– often youth who are experiencing a mental disturbance will attempt to self-medicate with marijuana, alcohol or other substances. At best, these drugs provide an immediate but temporary relief that can lead to drastic long-term consequences.
  5. Changes in eating and energy– sudden changes in eating and sleeping habits can reveal that something is mentally amiss. If a youth starts eating more or less than usual or sleeping more or less than usual, it could mean that their mental state is beginning to impact their physical health.

As a culture, we often treat mental illness like a dirty little secret that we strive to keep hidden until something extreme and even tragic happens.   After a murder-suicide or school shooting, it is too late to begin to ask what went wrong or what was wrong with the person who perpetrated the act. The more we talk about the realities of mental illness and the fact that in many cases it is treatable, the more we can relieve the stigma. If we notice the five signs above or other behavior or attitude changes in youth, it is important that we begin the conversation about how they are doing. These conversations are keys to helping raise a culture of youth who are healthy both physically and mentally.

For more information about mental health and treatment consult the information and resources on these sites:

American Counseling Association                              

American Psychological Association                           

National Association of Social Workers                      

American Association for Marriage

and Family Therapy                                                     




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