Living Struggling for Sanity

By Anastasia Toufexis

The dozen telephone lines at the cramped office of Talkline/Kids Line in Elk Grove Village, Ill., ring softly every few minutes. Some of the youthful callers seem at first to be vulgar pranksters, out to make mischief with inane jokes and naughty language. But soon the voices on the line -- by turns wistful, angry, sad, desperate -- start to spill a stream of distress. Some divulge their struggles with alcohol or crack and their worries about school and sex. Others tell of their feelings of boredom and loneliness. Some talk of suicide. What connects them all, says Nancy Helmick, director of the two hot lines, is a sense of "disconnectedness."

Such calls attest to the intense psychological and emotional turmoil many American children are experiencing. It is a problem that was not even recognized until just a decade ago. Says Dr. Lewis Judd, director of the National Institute of Mental Health: "There had been a myth that childhood is a happy time and kids are happy go lucky, but no age range is immune from experiencing mental disorders." A report prepared last year by the Institute of Medicine estimates that as many as 7.5 million children -- 12% of those below the age of 18 -- suffer from some form of psychological illness. A federal survey shows that after remaining constant for 10 years, hospitalizations of youngsters with psychiatric disorders jumped from 81,500 to about 112,000 between 1980 and 1986. Suicides among those ages 15 to 19 have almost tripled since 1960, to 1,901 deaths in 1987. Moreover, the age at which children are exhibiting mental problems is dropping: studies suggest that as many as 30% of infants 18 months old and younger are having difficulties ranging from emotional withdrawal to anxiety attacks.

What is causing so much mental anguish? The sad truth is that a growing number of American youngsters have home lives that are hostile to healthy emotional growth. Psyches are extremely fragile and must be nourished from birth. Everyone starts out life with a basic anxiety about survival. An attentive parent contains that stress by making the youngster feel secure and loved.

Neglect and indifference at such a crucial stage can have devastating consequences. Consider the case of Sid. (Names of the children in this story have been changed.) When he was three months old, his parents left him with the maid while they took a five-week trip. Upon their return, his mother noticed that Sid was withdrawn, but she did not do anything about it. When Sid was nine months old, his mother left him again for four weeks while she visited a weight-loss clinic. By age three, Sid had still not started talking. He was wrongly labeled feebleminded and borderline autistic before he received appropriate treatment.

As children mature within the shelter of the family, they develop what psychologists call a sense of self. They acquire sensitivities and skills that lead them to believe they can cope independently. "People develop through a chain," observes Dr. Carol West, a child psychotherapist in Beverly Hills. "There has to be stability, a consistent idea of who you are."

The instability that is becoming the hallmark of today's families breeds in children insecurity rather than pride, doubts instead of confidence. Many youngsters feel guilty about broken marriages, torn between parents and households, and worried about family finances. Remarriage can intensify the strains. Children may feel abandoned and excluded as they plunge into rivalries with stepparents and stepsiblings or are forced to adjust to new homes and new schools. Children from troubled homes used to be able to find a psychological anchor in societal institutions. But no longer. The churches, schools and neighborhoods that provided emotional stability by transmitting shared traditions and values have collapsed along with the family.

Such disarray hurts children from all classes; wealth may in fact make it harder for some children to cope. Says Hal Klor, a guidance counselor at Chicago's Lincoln Park High School: "The kids born into a project, they handle it. But the middle-class kids. All of a sudden -- a divorce, loss of job, status. Boom. Depression."

Jennifer shuttled by car service across New York City's Central Park between her divorced parents' apartments and traveled by chartered bus to a prep school where kids rated one another according to their family cars. "In the eighth grade I had panic attacks," says Jennifer, now 18. "That's when your stomach goes up and you can't leave the bathroom and you get sweaty and you get headaches and the world closes in on you." Her world eventually narrowed so far that for several weeks she could not set foot outside her home.

The children who suffer the severest problems are those who are physically or sexually abused. Many lose all self-esteem and trust. Michele, 15, who is a manic-depressive and an alcoholic, is the child of an alcoholic father who left when she was two and a mother who took out her rage by beating Michele's younger sister. When Michele was 12, her mother remarried. Michele's new stepbrother promptly began molesting her. "So I molested my younger brother," confesses Michele. "I also hit him a lot. He was four. I was lost; I didn't know how to deal with things."

At the same time, family and society are expecting more from kids than ever before. Parental pressure to make good grades, get into college and qualify for the team can be daunting. Moreover, kids are increasingly functioning as junior adults in many homes, taking on the responsibility of caring for younger siblings or ailing grandparents. And youngsters' own desires -- to be accepted and popular with their peers, especially -- only add to the strain.

Children express the panic and anxiety they feel in myriad ways: in massive weight gains or losses, in nightmares and disturbed sleep, in fatigue or listlessness, in poor grades or truancy, in continual arguing or fighting, in drinking or drug abuse, in reckless driving or sexual promiscuity, in stealing and mugging. A fairly typical history among disturbed kids, says Dr. L. David Zinn, co-director of Northwestern Memorial Hospital's Adolescent Program, includes difficulty in school at age eight or nine, withdrawal from friends and family and persistent misbehavior at 10 or 11 and skipping school by 15. But the most serious indication of despair -- and the most devastating -- is suicide attempts. According to a report issued in June by a commission formed by the American Medical Association and the National Association of State Boards of Education, about 10% of teenage boys and 18% of girls try to kill themselves at least once.

Despite the urgency of the problems, only 1 in 5 children who need therapy receives it; poor and minority youngsters get the least care. Treatment is expensive, and even those with money and insurance find it hard to afford. But another reason is that too often the signals of distress are missed or put down to normal mischief.

Treatment relies on therapeutic drugs, reward and punishment, and especially counseling -- not just of the youngster but of the entire family. The goal is to instill in the children a feeling of self-worth and to teach them discipline and responsibility. Parents, meanwhile, are taught how to provide emotional support, assert authority and set limits.

One of the most ambitious efforts to reconstruct family life is at Logos School, a private academy outside St. Louis that was founded two decades ago for troubled teens. Strict rules governing both school and extracurricular life are laid out for parents in a 158-page manual. Families are required to have dinner together every night, and parents are expected to keep their children out of establishments or events, say local hangouts or rock concerts, where drugs are known to be sold. Parents must also impose punishments when curfews and other rules are broken. Says Lynn, whose daughter Sara enrolled at Logos: "My first reaction when I read the parents' manual was that there wasn't a thing there that I didn't firmly believe in, but I'd been too afraid to do it on my own. It sounds like such a cop-out, but we wanted Sara to be happy."

As necessary and beneficial as treatment may be, it makes better sense to prevent emotional turmoil among youngsters by improving the environment they live in. Most important, parents must spend more time with sons and daughters and give them the attention and love they need. To do less will guarantee that ever more children will be struggling for sanity.

With reporting by Kathleen Brady/New York, Elizabeth Taylor/Chicago and James Willwerth/Los Angeles