Of all the high schools on the North Shore that have attracted national attention, only one is virtually unknown to the public. With no sign, no chest-thumping banners proclaiming athletic or academic prowess, even the neighbors are unaware of its existence. Yet every day its presence saves lives, the students say.
For 12 years, that has been the mission of the Evanston Northwestern Healthcare Adolescent Day School. Long before the complicated subject of teen emotional disorders burst into the national spotlight in highly atypical incarnations–school shootings in Littleton, Colo., Springfield, Ore., and elsewhere–the day school has provided a safe harbor for depressed teens who are struggling to learn while maintaining their emotional equilibrium.
Tucked away on the second floor of a nondescript Glenview office building, this is not a psychiatric unit or a drug treatment center–although many of the students have battled those demons as well–but a fully accredited high school, with algebra and term papers. But there is little of the pain of the typical high school experience: There is no cafeteria to sit alone in, no lockers to be slammed up against, no towel-snapping jock culture or rigid caste system of cliques from which to be ostracized.
More Top Picks Best Gazebos
At a time when the demand for alternative programs is escalating, schools like this one are extremely rare, expensive and labor-intensive. Even in the Chicago area–home to some of the most prestigious university psychiatric departments in the country–the number of places where severely depressed youngsters can receive an education in a therapeutic setting can be counted on one hand.
Certainly the challenges to success even in such an indisputably high-quality program illustrate the complexity of the malady among teens.
“Anytime I wasn’t sleeping, I was in hell,” said J., 16, who suffers from severe depression and can’t remember a time when she didn’t feel lonely.
Her friend, also a junior, chimed in: “The worst is when harassment spread to my family, like the time some kids dumped regurgitated food on our car.”
Between them, the two girls had run through every conceivable educational configuration–from boarding school to home school–with little to show for it but a blinding sense of worthlessness.
That all changed, however, when they arrived at the school. With just 20 students, it is one of the area’s most elite schools: no sign, no listing in the phone book or directory assistance. Each year, only half the applicants are admitted, yet many keep their affiliation a secret. And while it draws almost exclusively from the North Shore, this educational institution has little in common with its highly competitive neighbors.
Ata school for the emotionally fragile, the goals are considerably humbler, but infinitely more complicated: to bestow self-esteem, to learn how to handle stress, to become productive members of society and to ensure they can’t harm themselves or others, said Dr. Louis Kraus, Evanston’s director of child and adolescent psychiatry.
Indeed, while other high schools measure their success in the number of state sports titles and National Merit scholars, the staff trots out different statistics. In 12 years, they’ve lost only one student to suicide. One too many, of course, but rather remarkable considering that almost all the students have a history of severe depression or bipolar disorder. Many have already attempted suicide; or have taken up “cutting” or sniffing inhalants or whatever form of self-destruction is currently in vogue, while families lurch from crisis to crisis.
“When I got him into the program, I realized that I was no longer scared of the phone,” one mother said. “It was the first time I exhaled in months. This is as good as it gets.”
And even then, there are no guarantees.
Only 25 years ago, it was widely believed that children couldn’t be depressed because they lacked psychological maturity. Today, about 1 in 10 teens will experience some form of depression or bipolar disorder, according to the American Academy of Child and Adolescent Psychiatry.
Because of advances in brain science and breakthroughs in medication and psychotherapy, doctors have more tools in the arsenal than ever before. Millions of people with depression lead normal lives with the right treatment.
Yet barriers to care such as stigma, accessibility, cost and a shortage of skilled professionals still loom large, keeping half of those with emotional disorders from ever getting the help they need, according to the first-ever Surgeon General’s Report on Mental Health, released last year.
Locally, the wait for teens to see top mental health professionals can exceed six months–if they can get an appointment at all–and prescribing psychiatric drugs has become a booming business even for preschoolers, even though their long-term effects on developing bodies and brains have never been documented. The first large-scale study of teens and the newest generation of anti-depressants– the selective serotonin uptake inhibitors (SSRIs) better known by the brand names Zoloft, Prozac and Paxil–only recently got under way.
Experts say depression is on the rise and occurring earlier. Whether the numbers reflect a real increase is open to question. Are doctors becoming better at diagnosing the condition? Or are we less tolerant of behavior quirks? Are we too eager to turn every behavior quirk into a full-blown psychosis, ready to be probed?
Even though much remains unknown, over the last decade researchers have learned that depression is a sign of an imbalance in brain chemicals called neurotransmitters and that genetic factors can put some more at risk than others. The earlier the disease begins, the more devastating it can be, just as juvenile diabetes is a more virulent strain than the adult-onset variety.
Gender plays a part too. Before age 12, boys and girls are affected equally. Then, with the passage into adolescence, twice as many girls are diagnosed with the illness, a pattern that will continue through middle age.
Environment also is closely linked, because the susceptibility may lie dormant until triggered by external factors. But a divorce in the family, a break-up with a boyfriend or a college rejection letter generally can’t cause a bout of the illness.
However, few have the time–not parents, not overwhelmed school personnel and certainly not clinicians under relentless pressure from managed-care companies to boost the bottom line–for the painstaking, delicate task of separating ordinary teenage volatility from brain wiring gone awry.
When it comes to treatment for “children and teens, we only have beginning clues,” said Dr. Myrna Weissman, professor of psychiatry at Columbia University’s College of Physicians and Surgeons in New York. “We are where we were with adult depression in the 1970s.”
End of self-assurance
Sitting in a cramped office at the North Shore school, one 15-year-old–dressed preppily in a T-shirt and khaki pants–described her early years as “really well-adjusted.” Then, with the onset of puberty, something happened, A. said, and the self-assured girl vanished into a brooding young woman “who thinks too much.”
To these roiling emotions, add the pressures of high school and making new friends. As a freshman, she attended a vaunted private school in the city, commuting from her North Shore home by train, “which made me feel like a miniature adult.” Her parents transferred her to a nearby suburban high school, but by then, all she felt was a numbing emptiness.
She defies every stereotype of mental illness: exceedingly bright, exuberant and talented enough to have appeared on the Goodman Theatre stage. But she’s also on lithium, which alleviates explosiveness, and has done several stints at a psychiatric hospital.
After a week or so, when they’re stable, the kids usually return home. But without a transition school placement to provide scaffolding, all the medications, talk therapy and nurturing evaporates. Plunk them down in the same environment, experts say, and it isn’t a matter of if a crisis will occur, only when.
“I hated everything about high school. The way it crushes your spirit, the impersonalness, the hurriedness, the way you feel totally invisible,” said A., drawing her knees to her chest. “In a traditional school, the popular kids can relax, but 99 percent of the rest of us can’t. Here, everyone cares about you, so your troubles just sort of melt away. The last month and a half is probably the most relaxed I’ve felt about school in my entire life.”
And if such a place didn’t exist?
“Oh, that’s easy,” she says matter-of-factly. “I would have killed myself.” Before the day is over, it would be a sentiment that is echoed repeatedly.
Rise in teen suicides
It is a misconception that suicide is rare among teens, that it comes out of nowhere, that there is so much that researchers don’t know.
In truth, doctors know a great deal. That it ranks as the third leading cause of death among teens and young adults. (More die from suicide than from cancer, heart disease, AIDS, pneumonia and influenza combined.) That suicides among 15- to 19-year-olds have more than tripled over the last four decades, soaring from 2.7 per 100,000 teens in 1950 to 10.5 in 1995, according to the most recent data from the Youth Risk Behavior Survey of the Centers for Disease Control and Prevention.
Clinicians also know that major depression and suicide are inextricably linked. More than one out of three kids with the diagnosis attempts to take their own lives, according to University of Pittsburgh researcher Dr. Maria Kovacs. In 1997, some 5,000 U.S. high school students made attempts that were serious enough to require medical attention. Girls try more often, but boys–who usually choose weapons over pills–are more successful.
And the heartache doesn’t end with puberty. New research tracing the arc of depression over time shows that it can recycle again and again, inflicting psychological scars that last a lifetime. Teens with the illness are twice as likely to turn into depressed adults and 14 times more likely to attempt suicide over the course of their lifetimes, according to a study by Weissman and nine colleagues published last May in the Journal of the American Medical Association.
Yet, for all the research, depression and suicide remain stubbornly entrenched.
“The growing gap between available services and the need for care makes the mental health of children and adolescents probably the most neglected of health-care needs in this country,” said Mark Weist, an associate professor at the University of Maryland School of Medicine and a member of the Children’s Congressional Caucus.
Stress factories
In the year since the slayings at Columbine High in Littleton, Colo., Americans have searched for an answer to vexing questions: Why do high schools–especially resource-rich, homogeneous suburban institutions –breed so much pain? Who are the ticking time bombs? And, without an X-ray or a biopsy, how do we pinpoint them before they go off?
More Top Picks Air Conditioner
If there is any Columbine legacy, it is that it sparked a dialogue, previously confined to mental health circles, Kraus said.
“It got all of us talking about what we will tolerate in terms of bullying, prejudice and scapegoating. People here are more apt to call now and say, `We have the same demographics as Columbine. We’re a community at risk.”‘
It can take years for an outcast to grow isolated, for anger to fester and harden and turn into violence. But in today’s super-size institutions with enrollments of 2,500 or more, school personnel are stretched too thin to be diagnosticians in all but the worst cases, said Kevin Dwyer, head of the National Association of School Psychologists.
The association recommends a ratio of one social worker for every 750 students and one psychologist per 1,000 students, but many school districts don’t employ any psychologists at all, Dwyer said. “That’s nothing more than institutional child neglect.”
While only a fraction will actually commit violent acts, when you add an accumulation of other risk factors such as negative media images, drugs, access to weapons or being branded “a reject” just one time too many, the risk increases exponentially.
Dan Meehan, a social worker who has been at the day school since its inception, cites the accounts of videotapes by Eric Harris and Dylan Klebold, made with rage at full boil, before their suicide mission at Columbine.
“When you listen to what the boys are actually saying, it’s `No one actually let me belong. That they made fun of how I looked, my face, my hair, my shirt. I moved a lot. I never felt connected.'”
Keeping kids from falling through the cracks, though, is a labor-intensive proposition. The per-student expenditure of $25,000 for the Glenview school, which is about four times the state average, is paid by the teens’ home school districts, and even then it doesn’t cover the entire tab. Evanston Hospital makes up the difference. Admission requires the recommendation of a psychiatrist, plus the home school district must sign off on the arrangement by agreeing that it is unable to accommodate the teen’s special needs or provide the necessary services. To force some school districts to pay, parents sometimes take legal action. Despite all the hurdles, twice as many kids apply as there are slots.
The faculty consists of four teachers, four case managers, a psychiatric nurse and two child psychiatrists, all of whom work together to oversee the educational and therapeutic needs of students during their stay, which can last anywhere from six months to two years.
Whatever the title, the work is personal and intimate because a staff member gets to know the student’s fears, hopes, dreams and a flood of other feelings that people usually turn inward.
There’s little here that resembles the students’ former schools, which is precisely the point. Eavesdrop on a conversation and you’ll hear kids debate the merits of Zoloft versus Prozac. Or the practices of one psychiatric hospital over another (“Didn’t you just hate the way they’d go right to the restraints?”)
“Regular” school doesn’t have an administrator like Carol Hynes, a registered nurse whose official nametag says “clinical coordinator,” although “Mother Hen” would be more accurate. While school nurses cannot dispense so much as an aspirin, Hynes can administer a variety of psychiatric drugs should a student suffer from an acute anxiety episode.
They also don’t have teachers who are willing to bag the lesson plan when the mood isn’t right. “Sometimes, I’ll just look at them and sigh, `It isn’t a math day, is it?”‘ said Annali Duffin, who teaches four classes, ranging from prealgebra to calculus.
The schedule also includes daily meetings with social workers and weekly family therapy sessions. And while there are troubled families, there are also an equal number of “Leave it to Beaver” parents, whom the students readily praise for their support. “I’d be pretty upset if my kids did this to me,” admitted D., a senior.
For their part, the parents are grateful for the school’s existence, even as they mourn its necessity. While there are myriad settings for kids with physical maladies, behavior problems and learning disabilities, finding a placement for a kid whose emotional thermostat is broken is far trickier.
Increasing the number of such programs was one priority cited by Surgeon General David Satcher in his recent report on mental health.
Until that happens, though, the choice is limited, as J.’s parents discovered when they found no vacancies. Desperate and with just a few days before the beginning of the school year, they ended up sending her to a special needs high school in Carbondale. Two months later, she was back home.
D., an honor-roll student whose SAT scores are among the highest in the nation, struggles with depression. He attends the therapeutic school and then shuttles back to his regular school, which not only allows him to seamlessly participate in extracurricular activities but is so accommodating that some kids are unaware that he spends his day elsewhere.
He doesn’t advertise his mental illness, but he isn’t ashamed, either. “When someone says, `You’re so smart, what do you have to be depressed about?’ I usually tell them that I’m smart enough to know I have a problem and I’m dealing with it.”
A self-confessed perfectionist, D. always struggled with some feelings of sadness and anxiety, but still managed a veneer of normalcy. But at the end of his junior year, feeling swamped by his emotions and uncertainty about the future, he became paralyzed, unable to get out of bed. All summer long, he went through the usual regimen of hospitalization, medication and therapy. Everyone, D. included, thought he’d land on his feet and return for his senior year. But by the third day, he was weeping uncontrollably. “I’m trying to viewing this as a bump in the road,” he says gamely.
Now, instead of applying to Ivy League colleges, he is considering a post-high school program in Boston that allows students to ease into work and living on their own.
His parents are warm, thoughtful people who still seem a little stunned by their sudden immersion into the mental health system. While the primary objective is for D. to get well, said his mother, it’s painful to accept the diminished picture of the future, to reconcile the snapshot that all parents carry in their heads with reality.
“Luckily, you start stepping down gradually, in little half-steps,” she said, the words sticking in her throat. “If it happened all at once, I don’t think any of us could get out of bed.”
Room to be different
The 20 kids at Evanston Day School all referred to themselves as “different,” a difficult label to wear in hallways that embrace conformity.
In a few years–and with the right interventions–their doctors hope they’ll be able to choose from a broad spectrum of environments. Perhaps the fidgety and frenetic ones will wind up making millions in the trading pits; the sleepy ones will find jobs where they can clock in at noon, and the loners may shine as artists.
Still, there will never be enough slots in alternative institutions to accommodate all the social pariahs, never enough compassionate teachers to send them out into the world with a stronger sense of self or lunchroom monitors to stop the taunts and the bullying. Rather than wring our hands and wonder why teens have changed so much, it is more instructive to ask why school has changed so little, experts said.
“There’ll be less violence when we make school a more supportive place,” said Meehan, who wears a gray ponytail and a tranquil demeanor. “In a climate where inclusiveness and cooperation is woven into the fabric of daily life, there’s less of a chance of a Columbine happening.”
Despite the national debate sparked by school violence, Meehan doesn’t expect to see an overhaul any time soon. We’ll do the easy stuff–the metal detectors, the dress code and the security guards, he said, but we won’t do much to alter the culture. Frank DeAngelis, Columbine’s principal, acknowledged as much as his school’s own new security system was being installed:
“I think where the money needs to be spent is educating our students about tolerance, about respecting one another, about communication,” he said.
That’s especially true in the nation’s highly competitive communities, where the focus is on the stars “and no one can just grow up to be a mailman,” Meehan said.
“All that sorting, ranking and weighting means someone has to be No. 1 and someone has to be 700, and that takes its toll.”