The Times - UK (2022-05-23)

4 Monday May 23 2022 | the times

times2

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My son has severe
mental health issues.
When he was a
teenager his best
friend took his own
life. It was a huge
shock to all of us and to the school,
but our son was a pillar of strength
for his friends throughout, consoling
them before and after the funeral.
Lots of parents came to us to tell us
how good he had been at that time.
A few years later he started to
change, however. He became abusive
and angry with me and his sibling.
We found out that he had started
smoking weed and keeping bad
company. Over the past two years he
has been at university, but around
the time he left home things turned
very nasty. He smashed virtually
every door in the house and
threatened me with violence, and the
police were called.
Since then we have tried to get him
to see someone, but to no avail. He
has recently admitted he needs help.
Where do I go from here?
Constance

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I am pleased to hear
your son has
acknowledged he
needs help — that’s a
big and courageous
step, especially for one
so young, and a huge stride in the
direction of meaningful change.
It sounds like you’ve all been
through a lot — your son, who was so
traumatically bereaved and has
developed a weed dependency, and
you as a family, who have endured the
displacement of his sadness, rage and
substance misuse. Given the impact of
your son’s behaviour on the family, this
is a complicated situation that needs
careful understanding so that
everyone can feel heard, understood
and be able to realign.
Suicide is one of the leading causes
of death in children and young people.
The rate of young people ending their
own life across the UK has increased,
with young men (aged 15-24) three
times more likely than young women
to die by suicide. Year on year, the
number of children and teenagers
calling Childline (0800 1111) expressing
suicidal ideation has steadily increased.
Research indicates that after a
suicide at least six close friends and
family are directly affected by the
death, with many others also affected.
The investment and resource crisis in
child and adolescent mental health
services means there is no universal
and equitable access to services, which
reduces the opportunity for immediate
crisis intervention and for suicide
prevention, for example, via early
identification. The Royal College of
Paediatrics and Child Health has
stated unequivocally that young
people who have been bereaved,
especially as a result of suicide, and
are at significantly increased risk of
suicide themselves need extra
vigilance and early intervention.
There are two main issues here: the
impact of the suicide of your son’s
friend on him, and his dependency on

weed. They are unlikely to be mutually

exclusive, and my starting hypothesis

would be that your son’s weed use

became self-medication for his

complex grief and associated pain.

Therefore, this isn’t just about

engaging in treatment to address the

drug use, because without clear

linking to his complicated and

unresolved grief, stopping the weed

would be like kicking away a crutch

from a person who has a broken leg —

they will fall over in pain.

To begin this process it is good to set

out the landscape, and make the links

between feelings and behaviour.

Looking at studies, it is clear that

teenagers who lose a friend through

suicide are more at risk of depression,

anxiety, post-traumatic stress disorder,

increased suicidal thinking and the

associated risk of attempts, drug and

alcohol misuse (as a maladaptive

coping strategy), and violence. It is

also very clear from the research that

seeking therapeutic help in the first

year after the death is critical.

To explain why your son coped so

well after the death of his friend but

then, in effect, fell apart is to

understand the difference between

bereavement and grief. After the tragic

event, your son was bereaved and felt

shocked and sad, but managed to

honour his friend by supporting others

affected. Grief describes the emotional

cycles we all go through as we react

to the bereavement and try to

continue living without the person

we have lost. In grief, your son will

have felt overwhelmed, so to cope

he found solace in weed — to

narcotise his extremes of emotional

pain and confusion.

The other critical issue here is that

death by suicide has a profoundly

complicated impact that makes the

“normal” process of grief significantly

more complex, which is why the

resulting reaction will be described as

complicated grief or persistent

complex bereavement disorder. I

believe this underpins your son’s

challenging and self-harming

behaviour because he is really

struggling to make sense of the

loss of his friend and start the

process of recovery.

For teenagers who are

at a vulnerable stage of

development this type of loss

has a particular impact. Not

only does it require a

significant amount of life

experience to process, but it

also comes at a time of life

that feels optimistic and

where peer relationships are

the bedrock to developing

identity. This loss shakes

identity to the core and

this all happens against a

backdrop of significant

brain development where

the emotional areas are

more developed and

functioning than the

rational brain areas.

The shock is immense.

Given that young people

tend to confide in each

other more than their

S

how me a fashion editor

who denies using eBay and

— except the ones related

to European royalty

perhaps — I’ll show you

a well-dressed and savvy

fibber. From glossy

magazine editors-in-chief

to fashion cupboard flunkies, we’re all

at it. I once accidentally gazumped a

colleague on a pair of Prada trousers.

I used to shop on there every so

often for designer labels I couldn’t

afford and sell a few things from time

to time to make room. My “eBay pile”

and I have been participating in the

circular economy since way before it

was a) called that and b) woke.

From woke, however, to broke. My

family and I are far from the sharp

end of the cost of living crisis, but our

energy bills, supermarket spends and

the amount we pay for childcare have

all gone up significantly recently;

the last now costs more than our

mortgage payments each month. The

eBay pile has gone from “bit on the

side” to “additional revenue stream”.

It started small — the odd handbag

I didn’t use any more, Christmas gifts

that hadn’t quite hit the mark (shhh)

— but last week was my biggest sale

yet: the Peloton bike that kept me

fit through three lockdowns, one

pregnancy and that bit when you’ve

finished breastfeeding but are still

eating two packets of biscuits a day.

Since I came back to work, I’m too

tired to even look at it, let alone

saddle up, and it has become

something of an albatross.

They say gym memberships are the

first to go when times get tough, so

apparently are enormous exercise

bikes that take up most of the spare

room. I bought it three years ago for

£1,700 and sold it for £850 — not bad

given there’s a newer model on the

market, and it’ll cover half the

childcare this month.

A cashmere scarf, multiple pairs of

trainers, a Ghost dress I went off after

seeing Carrie Johnson wearing the

same one. I probably sell two or three

things a month, though I can see that

number going up when the bills rise

again. I’m a discerning shopper and

careful owner, so when things fall

out of rotation they’re usually still in

good nick. I don’t expect to recoup

the original cost, but my wardrobe is

always in need of thinning and it’s

handy to have money coming back in.

I’m not embarrassed, though I might

not talk about it at top volume during

a Paris couture show. Resale is the

future of fashion. Shoppers between

18 and 34 have double the number of

second-hand pieces in their wardrobes

than those over 55.

That’s why the reality TV show

Love Island has plumped for eBay this

season over previous fast-fashion

Our son’s behaviour deteriorated and he started

smoking weed after his best friend’s suicide

parents or other close adults, the

bewilderment and guilt can be soul-

shredding and range from “Why didn’t

I know?” to “If I did, why didn’t I do

more to stop them?” This leaves

profound guilt, despair and also the

uncomfortable reality of loss —

overwhelming rage. This can be

directed at the self (“I let my friend

down”) and the person who has died

(“Why did they do this to me/why

didn’t they tell me/wasn’t I enough for

them?”): these are called survivor

questions. To feel angry with someone

who is desperately loved and missed is

extremely challenging, and so can

often be repressed and instead

manifest as rage directed at others (eg

smashing doors, verbal and physical

aggression) and also at the self (self-

harm, for example substance misuse).

Alcohol, drugs and other high-risk

behaviours are very commonly used

by teens as a way of coping with a

complicated loss: this is known as

emotional self-medication. Studies

have shown that more than half of

teenagers with traumatic stress self-

medicate with drugs or alcohol to

numb pain and also to manage painful

feelings that can be randomly

triggered (eg hearing your friend’s

favourite song). Unprocessed trauma

can lurk, ready to pounce at

unexpected times, causing significant

anxiety and therefore an

understandable urge to self-medicate.

If your son is unable to learn healthy

ways to cope with his loss, he may

never learn how to grieve without

self-medicating. He needs to be

encouraged to talk, and to be listened

to with compassion and without

judgment. If he blames himself, don’t

jump in to correct him but let him

express his conflicting feelings.

However, given that his grief has led

to substance abuse, a talk won’t be

enough to keep him from further self-

harm, so you or he need to seek

professional support. He can self-refer,

his GP can refer him to NHS services,

or you can find a clinician who works

with young adults and is trained

in psychological therapies

including bereavement and

trauma and also drug use (see

bps.org.uk). A psychiatrist

may also be helpful if, while

he’s coming off the weed,

your son’s mood becomes

unstable — medication can

help to reduce the

withdrawal effects and

also provide scaffolding

for the tougher trauma

work to be fully engaged

with. There are good

outcomes if substance

abuse and traumatic

stress are treated at the

same time.

Also provide your son with

helplines for moments when he

feels overwhelmed (eg

themix.org.uk, 0808 808 4994;

Shout: giveusashout.org, text

85258). Also the charity Sobs, for

people over 18 bereaved by suicide

— uksobs.org, 0300 111 5065 — and

thegoodgrieftrust.org/find-support/

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Ask Professor Tanya Byron

My money’s buying

less. So I’m selling

my old designer

cast-offs, says

Harriet Walker

If you would like

Professor Tanya Byron’s

help, email proftanya

[email protected]

Flog it!