Our son is depressed and aggressive, but
refuses to seek help. What can we do?
Ask Professor Tanya Byron
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How can we help,
and cope with, our
isolated, depressed
and very angry
23-year-old son? He
has written two long,accusatory suicide notes — although
he has not actually harmed himself
— during the past six months. He
refuses to seek therapy or register
with a GP.
He is handsome, intelligent, with
a good degree, teaching abroad after
university. He returned after more
than a year away due to coronavirus,
but couldn’t go back, losing his job
as a result. He blames us entirely
for what he views as this terminal
calamity. His time abroad was an
achievement, but not trouble-free.
He admitted to feeling suicidal in
one (drunken) call home. Yet he has
turned it into a lost idyll and his
one chance of success. For several
months he has not left the house.
He is increasingly hostile and his
behaviour has at times been
frightening and deeply unpleasant.
He has always been prone to
dramatic mood swings, having
spectacular meltdowns from
pre-school age, for example when it
was time to leave the park. He also
has a tendency to grab the wrong end
of the stick in conversations, using
the misapprehension as a weapon.
He had one inconclusive child
psychiatric assessment before we
moved to the countryside, when
matters improved. School seemed
fine, his anxieties more social than
academic. Then, at university, one
of his friends killed himself.
His moods are erratic, from self-
denial (refusing meals) to fury. He
has punched a hole in a door and cut
himself out of family photographs.
I take the brunt of verbal, sometimes
abusive onslaughts. He is not even in
online contact with former friends.
He takes no pleasure in anything.
His responses (“It’s too late /
Now you want to help me?”) to any
suggestion for possible training or
employment mean that we’ve backed
away from trying. The result is
stalemate; a heartbreaking waste
of his potential.
I have long suspected that he
has ADHD [attention deficit
hyperactivity disorder] and that
ODD [oppositional defiant disorder]
might have been behind otherwise
inexplicable childhood issues.
Fiona
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Your letter highlights
how incredibly painful
it is to see your child
in despair and mental
health freefall. He is
aggressive, blames andabuses you, will not accept help, and
yet needs it desperately.
Life feels uncertain and unsafe for
many people right now and that will
have exacerbated your son’s sense of
hopelessness. Like many young adults,
his transition into adulthood, already
not trouble-free, has been brutally
interrupted, and what he valued in
terms of his job has been taken away.
You describe difficulties that
began in childhood and now wonder
whether your son has ADHD — a
neurodevelopmental difficulty that
affects people’s behaviour: impulsivity,
problems with focus etc. You also
wonder about ODD: a behaviour
difficulty causing defiance, hostility,
lack of co-operation. It sounds as if
the mood swings he has had since
childhood have been triggered by
sudden changes in plans and social
and communication difficulties;
therefore, I also wonder if, while he is
bright and high-functioning, he may
struggle with autistic spectrum
differences within a neurodiverse
profile — this doesn’t mean he can’t
have a good life, but might mean, if
understood, that he, and others, can
accept and understand him better.
Certainly diagnoses might explain
why he has struggled and continues
to struggle in the way he does and he
would benefit from psychiatric and
neurodevelopmental assessments. I
understand that this engenders a sense
of powerlessness in you. You see a
problem and you want answers. His
refusal to engage in anything means
that you have all hit a wall. His
helplessness is palpable in what
sounds like a clinical depression.
There are many reasons for a person
refusing to engage in assessment and
treatment for mental health
difficulties. They can include shame,
denial, stigma and feeling emotionally
overwhelmed and resisting any
attempts to make change for fear of
failure. To make the courageous step
into acknowledging that he has
difficulties that require him to seek
support will be almost impossible,
given his very low self-esteem. We can
only want to help ourselves when we
value ourselves enough to do so.
He might also be showing what is
called anosognosia, ie an inability to
recognise one’s own difficulties as they
relate to being unwell. His refusal
of help isn’t necessarily because he
doesn’t want to see he needs it, but
because he can’t. Awareness of his
own illness can change, but any
direct attempt to get him to accept
treatment at the moment will be
futile and only enrage him further,
leading to his blaming of you for all
his difficulties.
We also cannot ignore the
loss of his friend to suicide.
I wonder whether he has had
time to grieve. Losing a loved
one to suicide is extremely
complex to process, and
friends and family can often
be left in shock and even
guilt (ie could I have done
something to prevent this?).
As he now writes his
suicide notes to you,
I wonder whether this
encompasses some issues
that relate to his friend’s
tragic death.
There is no magic
solution here, and the only
way to enable your son
to accept that he needs
support to understand
himself and find ways tomake meaningful change in his life is
to look at how you and your husband
can change your responses to him.
This begins with communication.
My advice is that you find ways to
consistently reduce the emotional
temperature around your son and
try to stabilise to a less fraught and
anxious place. This means that you do
not engage with him when he is angry
because this will only escalate the
situation, and there is no point
because he won’t “hear” what you are
trying to argue, given his heightened
state of arousal. This doesn’t mean
that you should just take any abuse
because that would then enable him to
continue to use you as his emotional
punchbag; instead, calmly and firmly
explain that you can’t remain in a
situation of aggression and remove
yourself. You might, at some stage,
consider that living together is
untenable and only perpetuates his
sense of dependency.
Obviously you must ensure that he
is not at risk of harming himself or
someone else. If he is, call your GP,
take him to A&E or call emergency
services. Your GP can also contact the
local Crisis Mental Health Team.
When there are calmer moments
where your son may have space in his
mind to reflect, I advise that you
“listen” to what he is saying. Telling
adult children what they should do
will only increase their push-back.
What your son is telling you is that
he feels out of control. He feels as
though he has failed, sees no hope and
so at times wonders whether life is
worth living. This is a desperate place
to be. He has shut down his life, has no
independence and in effect has given
up. He needs to know that you hear
that — don’t challenge or correct him.
Paraphrasing is an active listening skill
and a way to reflect back what you’ve
heard him say (even if you disagree),
and you can empathise with how
desperate he feels without telling him
how he can change it.
At the moment he simply needs to
be heard, and the way you listen will
rebuild trust and respect. If and when
he gets to a place where he begins to
see he needs more support, don’t rush
in and be that person; instead, help
him to think about who might be the
best person he could reach out to:
someone he knows, his GP, via
phone or online mental health
forums for young people such
as those offered by the mental
health charity Mind. All
conversations with you
should feel collaborative (ie,
enabling him to make the
right decisions for himself),
not instructive and
prescriptive (ie, you telling
him what he needs to do).
For your own support
try the publications at the
Mental Health Foundation:
bit.ly/35xSHZD. I wish you well.If you have a problem
and would like Professor
Tanya Byron’s help, email
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8 1GT Monday November 16 2020 | the times
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