My son would rather die than go back to school. What did we do wrong?

For a teenager, depression might present with behaviour change. FILE PHOTO | SHUTTERSTOCK

My son was suspended from school for allegedly leading a strike. He says he would rather die than go back to school. What did we do wrong?

Starting from the beginning, neither you nor his mother probably did anything wrong, and in all probability, we are here dealing with depression in adolescence, a common condition often missed by parents and teachers with each blaming the other for failing the child in some unspecified way.

Unlike depression in adulthood, the adolescent often presents the depressive illness without the typical adult symptoms of low moods, feelings of hopelessness and worthlessness, which, in the adult are present almost every day most of the time.

For the teenager, depression might present with behaviour change for example, as in the case of your son, trouble with authority at school.

It is also possible that he has other symptoms that could be confused with behaviour changes so common in adolescence.

Extreme tiredness, lack of sleep or even too much sleep as seems to be the case with your son.

A bright adolescent whose school performance begins to deteriorate for no apparent reason must be examined for depression, as should one whose appetite has changed and become too high or too low.

A few months ago, we saw a 16-year-old boy, sent to us by the school principal to examine what in the letter he described as one “of the brightest boys in Form three”.

The boy had been found with three rolls of cannabis and had in the preceding few months shown a steady deterioration in his class performance.

In Forms one and two he was at the top of the class with straight A’s and in the few examinations before the referral, he was a D student.

This dramatic change did not make sense to the experienced headteacher and hence the referral.

When we saw him in the first instance, it was clear that the student had lost a great deal of weight, was poorly groomed and appeared sad and spoke with a low tone.

He admitted to having had the cannabis at school stating that when he smoked, he was able to concentrate on his studies.

He had been observed to have been moody at school with frequent anger outbursts and had been involved in two fights in as many weeks.

He had been to see the school nurse for unexplained pains and aches all over his body and an examination had not established a cause for these symptoms, he was given some painkillers which he said had not helped.

On physical examination, he was a rather thin and wasted young man who had multiple cuts to his wrists and inner thighs.

Asked what had caused the cuts, he confirmed that they were all self-inflicted. He further explained that the sight of blood and pain gave him some relief from the emotional pain he was experiencing.

He had on two occasions attempted to kill himself by taking an overdose of some of the medication prescribed for his mother for hypertension.

He was admitted to the hospital as an emergency, because of the risk of suicide given the recent attempts.

During therapy sessions, the depth of the depression as well as the duration of the condition became more evident.

For several months, he had felt alone, dejected, and rejected first by a girl he liked, then his parents and siblings seemed not to care and finally, his friends at school as well as the teachers all made him feel like a reject.

As a boy, (he said) he cried only at night in his room always wishing that death would come to him quickly and without pain.

He remained in the hospital under treatment for two weeks, and on medication and therapy, the depression lifted and he was soon back to school and once again a few months later at the top of his class and had no urge to take cannabis.

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