Important information for those who care about a young person suffering from an emotional or behavioral disorder. The Forgotten Future: Adolescents in Crisis is an important and challenging look into America's mental health crisis that tells what life is life like for our troubled youngsters. Resource lists and questiions to ask providers are included. The Forgotten Future is available at online booksellers such as Amazonlcom, BarnesandNoble.com, and many others. Visit the author's web site at Debebel.com for more information.
What follows here are the Author's Note and Introduction.
For more information on The Forgotten Future and the author, visit the author's web site at www.debebel.com
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Deborah Clark Ebel, R.N.
THE FORGOTTEN FUTURE: Adolescents in Crisis by Deborah Clark Ebel, R.N.
I came to the field of psychiatric nursing later than many. By the time I graduated from nursing school, I had already borne three children, two of whom were still toddlers. Following several years working on a pediatric medical-surgical unit, I joined the staff of a new inpatient adolescent psychiatric unit at the same general hospital.
Most of the nurses on that unit were also new to psychiatric nursing, and we learned alongside each other, growing through academic instruction and practical, real-life experiences. I discovered almost immediately that I enjoyed working with troubled youth, and I sought out every learning opportunity available to me. Since that time, I have been fortunate to have worked with children and adolescents in inpatient psychiatric settings in Connecticut, Alaska, and Virginia.
Because the stories I share are from three geographic areas which are distinct in nature, yet similar in practice, I have combined psychiatric facilities in which I have been employed into one composite hospital which I have called Oak Haven Hospital. Again, due to the similarities of policies and procedures, personnel and situations, I have attributed these to Oak Haven.
The patients depicted herein are actual and individual young people with whom I have worked, and their stories are true. They are not composites. These adolescents are some of the young people whose stories and lives I cherish and who will remain with me forever. Names of patients and staff members have been changed to ensure privacy, and in some instances the sequence of events has been changed, solely for purposes of clarity and continuity. I have no idea how many children or teens that I have worked with over the years, and I do not know the outcomes of most of their stories. Many of their names have long since been forgotten to me, but I can still hear their voices … their laughter … their crying.
Because the tragic story of Andrew McClain’s death has been widely reported in the news media, I have used the actual names of those involved. Andrew’s death played a large part of who I am today and what I think and believe about mental health care for our children.
It has been a privilege to have worked with these young people and an honor to have worked with many of the nurses, doctors, mental health techs, and other mental health workers whose paths have crossed mine. I have been blessed.
Deborah Clark Ebel
Nightmares have long plagued me. At first they were infrequent, but then they started coming two, sometimes three times a night. Some are terrifyingly real, and I find myself lost, wandering through a surreal Kafkaesque landscape. I recognize others as dreams and awaken disoriented, struggling to free myself from labyrinthine shadows between this world and the other.
Most of the dreams are about kids: kids who have been mistreated, abused, debased, or abandoned. It’s never the same dream, except for the kids’ pain. In the nightmares, I stand alone, unable to move, riveted in place. Forced to watch as adults destroy kids, as kids destroy kids, as kids destroy themselves. I am helpless to do anything, unable to save anyone.
Some of the kids are runaways; some are throwaways. There are those who have been horribly abused, and many who use drugs or alcohol or sex to avoid confronting the reality of their lives. Others are members or hangers-on of gangs whose perception of normal life includes guns and knives, violence and mayhem. These are the kids I chose to work with, kids who, in many cases, have never before had an adult look them straight in the eye and talk to them about the truths of their lives.
As a registered nurse, I chose to work with teens within a psychiatric setting. I made that decision because our children are the future of our country and because I was, and still am, concerned for all of their tomorrows.
No one ever said working with troubled teens would be easy. I began working with adolescents because I like them. I enjoy being around them. They are enthusiastic and challenging, inquisitive and energetic. They view life with a fresh and idealistic eye. Or at least they used to.
Due to their individual backgrounds and life experiences, an unfortunate number of young people today view life in a jaundiced, hopeless, angry way that in many cases includes violence, substance abuse, self-mutilation, and sexual acting-out. Society’s changing values regarding drug use, sexuality, violence in the media, and social structure are adopted, reflected, and then exaggerated by our most vulnerable population: young people with little knowledge or understanding of the consequences their choices can bring.
Nothing shocks them, nothing awes or inspires or excites them. Many have little use for heroes or respect or responsibility. They view authority with disdain and reject any notion of rules, limit setting, or self-discipline.
My perspective is obviously somewhat skewed, as my experience has been with kids in a setting distinct from that of much of the rest of society. My observations on adolescence and family life are, in many cases, profoundly different from what is encountered by most Americans.
I do not mean to imply that these troubled youngsters are typical of our youth. There are millions of children who are able to achieve, despite whatever challenges or obstacles are set before them. These young people approach adulthood with goals and ideals, respect and responsibility.
The young people about whom I am most concerned are those who have become so haunted by their past that they have developed into distressed caricatures of their former selves. Many seem to have no sense of what’s right or what’s wrong, what’s good or what’s evil, what’s honorable and what’s without integrity; young people who refuse to accept responsibility for their actions and behavior, who blame others for everything wrong with their lives and value nothing. My concern is for those who, in many cases encouraged by the media, push propriety and good taste to the edge and beyond. I fear for those teens who play a form of Russian roulette with sex, drugs, guns, and lifestyle … and in many cases, lose. If allowed to continue, this downward spiral will take a huge toll on society: financially, socially, medically and morally.
Negative media reports involving children and teenagers are always attention-grabbers, whether the child/teen is portrayed as victim or as perpetrator, and a disturbing picture emerges. The attention is usually temporary, however, as stories are told, studies are done, and fingers are pointed.
While statistics and stories fill volumes, they do not tell the whole story. Numbers do not tell the anguish and devastation in the eyes of a teenager who has been brutally raped by her father and brothers. Numbers do not explain the despair of a gifted teenager so distraught over the hostility and violence in his family that he turns a gun on himself and is left forever functioning at preschool level. Numbers do not explain the lack of remorse in the heart of a young man who callously risks the lives of all around him, solely to meet his own desires.
I have worked with these young people and others: the teenage prostitutes, drug addicts, the despondent, the abandoned, and as I have been touched by each and every one of them, I have come to question our country’s priorities. We like to speak of being a child and family-oriented nation, but we’re not. No society that allows such atrocities, which tolerates the destruction of childhood, which forgets that all children deserve a future, is child-oriented.
While I initially began writing these pages as a sort of catharsis, a way to “vent” and sort out so many emotions after years of working with children and adolescents within the mental health care system, I found the experience to be more difficult than I could ever have imagined. I found myself mentally reliving many of the events and frequently and repeatedly dissolving into tears. There had been so many times on the job that I was unable to permit myself to feel and had to work within the boundaries of my professional role that when I finally allowed myself to take a second look at the situation, it hurt to my very soul.
I found I was able to write for only very short periods. Situations were often too intensely painful for me to think about and put into words beyond considering them for a few minutes at a time. As difficult as it was for me to remember, though, it was even harder for the kids to live.What I most hope to impress upon the reader is that the lives of these young people and the attitudes and behaviors which spring from their experiences are far more commonplace than most have acknowledged or would like to believe. These are not “bad” kids. They are troubled kids. They are our children, every single one of them.
Like much of America, I used to live in a world of smiling, happy, children participating in school field trips, Boy and Girl Scouts, PTA meetings, and birthday parties. A world of kids who went to piano lessons and Saturday afternoon matinees, who had pajama parties and filled out college applications and attended school proms. The world we would all like to imagine for children. The reality, for many, is far from this. We close our eyes to avoid seeing the truth.
My nightmares continue. Perhaps I have allowed too much pain to touch me for too long. Ideally, I should be objective and distance myself from the situations I encounter without losing my concern for the kids. I suppose I could intellectualize or give less of myself, but would that help? I don’t think so. I have looked into their souls and seen their pain. I know we have let so many of them down. We gave them life, yet by not meeting the needs of our young, we are sacrificing their future.
It’s time that we reestablish our roles as mentors, teachers, nurturers, healers; time to reach out and join hands and do our jobs as real adults and as children have a right to expect.
Our children’s future must not be forgotten.
From Chapter One:
In 1999, the Surgeon General estimated that about 20 percent of children have mental disorders with at least mild functional impairment, and that between five and nine million children under the age of eighteen have serious mental illnesses in the United States. Acknowledgment of mental illness as a problem for the young, and the resulting dramatic increase in the number of psychiatric hospitalizations, has been accompanied by a change in the types and severity of behaviors for which young people are hospitalized. Even as recently as the early 1990’s facilities typically dealt with runaways, depression, adolescent behavior problems, and more moderate levels of drug and alcohol use. The more hard-core or violent patients and those with legal involvement were usually sent to public or state-run institutions. Today, however, a significant number of young people in private facilities have been engaged in illegal and/or violent activities and are in some way involved with the juvenile justice system.
And this from Chapter Six:
Kelly leaned out her door as I approached. She was chewing her thumbnail. “Debbi? Can we talk?”
She had managed to avoid me for most of the shift, and now it was half an hour past bedtime. I hesitated, but before I could answer, she added, “It’s really important.”
Many times the staff would be so involved with other assignments that the kids would get a response like, “Just as soon as I finish up here” or “I’ll be there in a couple of minutes” and then fail to get back to the patient. That wasn’t a problem if what was involved was something trivial or something the kids could take care of themselves. On the other hand, putting off someone who had something important to discuss might have the effect of turning them off completely and they might never ask to talk to any of us again.
So my deal with the kids was that if they needed me to tell me straight out that it was important. That’s why I was there. I motioned Kelly out of her room and asked where she wanted to go to talk. Would the community room be okay? All the other kids were in bed, so we would have privacy there.
She sat in one of the upholstered chairs facing me and began by telling me she didn’t know how to begin. We talked, and eventually she told me that she had lied to the drug ed group about the extent of her drug use and wanted to know how she could go back now and tell them what and how much she had really been using. She said she had lied to the group because she didn’t want to look bad.
Kelly talked about drinking and smoking pot every day. She sounded throaty and told me she had tried cocaine on several occasions. She took caffeine pills to stay awake at night and then took Benadryl to sleep during the day. Almost as an afterthought, she mentioned having used LSD three times. “I didn’t like what happened,” she said, looking away.
“Tell me,” I said. I had a hunch there was more to this than guilt over lying to the drug ed group.
“I had flashbacks,” she said, softly. She scratched the back of her left hand with her right thumb, and then studied it. “Flashbacks about the man who took pictures of me.” She looked up. “Dr. Evans says I have to talk about it, but it’s hard to talk about things like that with him. I don’t like older men, and I don’t trust them either. I get real scared when I have to sit in a room alone with him.”
Kelly told me about the flashbacks that began the first time she used LSD. She started having recurrent nightmares about the man and the pictures, and that was when she started staying awake all night and sleeping during the day. “I only have nightmares if I sleep at night. If I sleep during the day, I’m okay.”
She continued talking, explaining how her drug use had increased and how it had affected the way she lived. I asked questions when something wasn’t clear, but once she started, she didn’t need much encouragement. She told me about the nightmares and how they made her feel. Then quietly, and with great concentration, she told me about a day when she was twelve.