Claudio Mencacci is a psychiatrist, President of the Italian Society of Neuropsychopharmacology, Past President of the Italian Society of Psychiatry and President of the Technical Scientific Committee of the Onda Foundation. He has always been involved in research and treatment of the main mental pathologies: anxiety, depression, panic disorders and bipolar disorders.
He has always dedicated his efforts to the problems of anxiety, depression, sleep disorders and bipolar disorders, particularly in relation to women in the most vulnerable age groups. In 2001 she founded the Anxiety and Depression Centre at the Fatebenefratelli Hospital in Milan and in 2004 the Psyche Woman Centre at the Macedonio Melloni Hospital in Milan, the first centre in Italy for the prevention and treatment of depression in pregnancy, post-partum and climacteric.
Many young people today do not call themselves ‘millennials’, but ‘doomers’. The expression refers to the looming tragic fate (2009 crisis, welfare dismantling, global warming, two years of pandemic and now war) for young people who, beyond the possible existential pains of youth, find themselves frightened of inheriting a very difficult world. This ‘doomer’ narrative is circulating among young people, who recognise themselves in it. Professor Mencacci, how are our young people in Italy and in other parts of the world?
We have known for a long time that young people are not doing well. Already, in the last 10 years, from 2010 to the beginning of 2020, the indices of mental suffering and in particular depressive disorders had increased in the 12 to 17 and 17 to 24 age group. The arrival of the pandemic has further aggravated this condition to the extent that it has reached the figure published by UNICEF a few months ago that one in seven adolescents has a mental disorder. The other figure, published in JAMA in November last year, is that one in four adolescents has clinical symptoms of depression and one in five of anxiety. These data show that young people have good reason to feel like doomers, as they are also one of the three clusters, along with women and the elderly, who have been found to be most exposed to the pandemic condition, but also to others that are gradually accumulating.
In addition to ‘doomers’, we should also talk about ‘waterboarding’. There is, in fact, a widespread feeling of suffocation and drowning. The most serious impact has been the isolation and loneliness in which young people have found themselves, with the reduction of the spaces for socialising, and the consequent alteration of those age passages, including rituals, which are part of the transition from childhood to adolescence.
We are now in a position to see some peaks, but we also know that we are sitting on a karst river in which runs the suffering of these years of immersion in fear, in a condition of hyper-alertness, vigilance, social isolation, reduced physical activity, loneliness, excessive use of the Internet, sleep deprivation, conditions linked to aggression, exposure to cyber-bullying and family discomfort, and the growth of eating disorders. In short, a very long list.
This is an exposure to suffering that we must quickly address in order to reduce its negative impact. We know how much the onset of a depressive condition can lead to consequences in adult life, in the professional, relational, emotional and family fields. I refer above all to that condition of depression which remains below the threshold, which manifests itself as demotivation and which is not taken with sufficient attention, but which over time declines, leading to a condition of non-realisation of one’s abilities and competences and a repercussion on even a large part of one’s existence.
All these considerations make us understand how adolescents who have been in the midst of fear, hyper-vigilance, hyper-alertness, are even more exposed to the theme of uncertainty. Our brains want to perform predictive processing and are designed to solve underlying problems and minimise surprises. Young people already find themselves with little information on how to chart the future. With the pandemic came the continual modification of contexts. The result is that uncertainty is increasingly intense, but it is a feeling that we must learn to know and manage better, even if it is not easy to deal with in such an unstable environment. The issue of certainty is really a fundamental one. Teenagers feel uncertain, more than ever now that this volatile condition is much more complex because we can’t learn, can’t hit a target that keeps changing.
Many teenagers in these two years (which are continuing and have not ended) first slowed down during the first lock-down, which was like a pause where people were still singing on the balconies and there was the aura of the new experience, but then a progressive disaffection with school took over due to all those changes that have taken place in emotional and social relationships, in the parameters of space and time, in friendships, in the senses (abolition of touch). This has led to demotivation: children who no longer want to go to school because school no longer represents a point of interest or attraction. School is no longer the school of relationships and affection, in short, the real school.
DAD has left deep marks on their ability to pay attention and concentrate: first they learned to copy, then to be less curious and not to study, and lastly to be unmotivated. It is a transition where many students have been lost and are now struggling to catch up. The familiarity, playfulness and freedom of being with others has disappeared, and the longer you are away from school, the more difficult it is to be with your classmates. Everything becomes more difficult, more exposed to criticism and judgement because no ties have been created.
What can we do to help young people alleviate this sense of despair, this tragic destiny, perhaps by not using too many medicalising labels and talking immediately about mental illness as a kind of automatism that we very often see in the media?
On the one hand, it is important to keep a watchful eye on mental health and to tackle it on its cornerstone, which is prevention. I hope that sooner or later we will be able to screen those who are more exposed to depressive disorders – just as we screen for metabolic or cardiological pathologies, we should also do so in the area of mental health. We have seen that screening does not so much medicalise, but rather helps to identify situations that need to be monitored a little bit, we need to know who is more at risk. To be at risk does not mean to be medicalised, but to pay attention to situations, to stimulate all those environmental protective factors that we can manage – physical activity, stimulation in social and relational life, that linked to nutrition, rather than the attention due to the two ever-present wolves called alcohol and drug abuse. It is therefore necessary to have some tools to know how to go beyond these bottlenecks, these rocks that inevitably arise. On top of all this there are of course conditions that are beyond our management or control – family interactions, the presence of other reasons for suffering, rather than familiarity in developing psychopathologies.
We cannot do without parents for supervision (they too must learn to supervise their children’s mental health, as well as their own). There is the issue of necessary collaborative networks – teachers, community volunteers, paediatricians, pedagogues: we need them to give answers to adolescents and to build a network on which they can find footholds to go further. This is a time of incredible vulnerability and it is determined by evolution and biology: it is the time when the risk of becoming addicted to substances or behaviour is three times greater than for the rest of life. It is because the evolution of our central nervous system is so oriented and that is why it is a phase that needs to be oriented and supported.
I always say that what schools lack is education in affectivity, which means respecting others and their dignity, respecting their feelings, but also learning to cultivate kindness and empathy.
Recently I was accompanying a ballet show dedicated to depression and there was a motto that hovered over everything: “life is special, we cannot waste it and we must live it as if it were our best show”. I found this, one of the many expressions, also joyful and purposeful. The theme of this karst river that is passing under us is precisely that. Now the concept of ‘languishing’, of languishing, of feeling dull, of the sense of stagnation, of demotivation, that condition where one cannot speak of depression, resignation, indolence, has become so fashionable. But with these ingredients we will never make a show.
A condition of demoralisation, of languishing, rather than of sadness is a sign to watch out for so that it does not turn into a condition of depression with all the consequences that this brings with it because this then spreads and projects onto the rest of life at a time when it is crucial to make choices and take directions.
How can health storytelling serve to alleviate this sense of inevitability and bring back hope and create Narratives of Exit?
Learning to narrate one’s own story means putting in emotions, feelings, colours, but also beginning to have a sense of continuum. Stories very often start with ‘once upon a time…’ and of course this has very different timescales – a few years ago or many years ago, but there was always a point at which things begin. To take charge of one’s own story and to be able to write it down is one of the deepest feelings that gives and gives us meaning to the events that happen to us.
It is a bit like those tangled balls of yarn that seem so complicated to us, but there is always a common thread. And when we understand what the common thread is that links our events, that links our choices, that which leads us to gradually build our present and lays the foundations for our future, we have our exit story and it becomes a story in which we learn to get back up. When there are moments of fracture or rupture, it is always good to think that we can rebuild through storytelling, a bit like the technique of kintsugi: putting back together the broken parts and redesigning them, reconnecting them with golden threads and making what has happened to us, however apparently fragmentary, a new opportunity. At the end of the day, what is required of us is to learn to repair, and in repairing, to learn to do even better than what was there before.
The narrative could also be understood as a kind of ‘licence for life’, with which we also begin to know how to drive. It is an image that has always helped me: if I feel at the wheel of my life, I hope to be able to drive the car where I would like or at least in the direction I would like. So to be able to grasp this aspect of putting the pieces back together and learning to see them all together, to understand the direction you have taken, and in the meantime to learn to drive, that is to say to be careful and make the most of your resources, your capacities at your own speed. And then someone adds with the companion of your choice, and there’s nothing stopping you from taking a minibus!
This latest metaphor of yours of driving reminds me of what Peter Hagoort told us a few months ago. At that time we were talking about metaphors as useful tools to express certain nodes of our experience and he proposed the metaphor of flying an airplane…
Exactly. The metaphor of piloting is where the narrative creates the right mix where there is acquisition, competence, experience, control, taking into account the environment, the others, the directions, the time. There is a great condensation of the whole that helps us to grasp with a few words – driving, steering wheel – the complexity of the choices.