Pubdate: Tue, 01 Nov 2005
Source: New York Times (NY)
Column: Cases
Copyright: 2005 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Keith Ablow, M.D.
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/pot.htm (Marijuana)

SPEAKING IN THE THIRD PERSON, REMOVED FROM REALITY

Almost from the moment he walked into my office, something bothered me
about my 18-year-old patient, Mark, sent to see me by his parents
after they found marijuana and steroids in his bedroom.

He was tall and muscular, with tousled, dirty-blonde hair, outfitted
in a faded T-shirt emblazoned with the words "Sunset Strip,"
distressed jeans made to look threadbare at midthigh and along the
edges of the pockets and a 70's retro leather choker with a few clay
beads on it.

A shiny silver bolt pierced his left brow. He shook my hand and
introduced himself with a smile, then sat down in the suede armchair
opposite me, his legs outstretched, his ankles crossed.

"So tell me what's going on," I said.

"I'm in a serious jam, man," he said. "I think I need rehab to get my
life back. You know?"

He didn't sound upset about it.

"What have you lost?" I asked him.

"Got two weeks?" He chuckled.

"I'm listening."

"I don't know if I ought to head to rehab or really go deep into
analysis with you or what," he said. "Or maybe we just go the Prozac
route."

"You think you're depressed?" I asked.

"Hard to say."

He shrugged. "I'm kind of like the quiet guy who goes to the gym, you
know, keeps to himself, maybe hooks up with a girl here and there, but
doesn't make a big deal of it. He's, like, sort of on the outside
looking in, never letting anything get him too down."

Mark's lapse into the third person - "He's ... on the outside, looking
in" - helped me realize what had disturbed me about him from the start.

He seemed fake, as if playing a role. He showed no anxiety or sadness
or anger. He spoke in cliches. I'm in a ... jam. I need ... to get my
life back. Got two weeks?

His hair looked intentionally messy. Everything about him, down to his
carefully chosen, probably pricey, "worn out" clothing felt scripted.

I have treated several other teenagers this year who display a similar
kind of profound detachment from self.

It is a kind of identity disorder I believe has its roots in a society
that has drifted free from reality and is creating adolescents (and, I
would venture, people of many ages) who are at most
participant-observers in their own lives, with little genuine emotion
- - like actors playing themselves.

The signs and symptoms of this identity disorder are everywhere.
Teenagers are embracing lies on a wholesale (and retail) scale.

They not only buy clothing made to look old when it is new, but they
buy T-shirts emblazoned with logos from bars and bait shops and
resorts they have never visited, and that sometimes don't exist at
all.

More and more, they use illicit substances and alcohol to keep their
genuine feelings at bay. They use steroids (and plastic surgery) to
alter their appearances and athletic abilities. Their self-esteem
floats ever higher, untethered even when their academic performance
and family relationships and prospects for the future sink to new lows.

They pierce themselves and tattoo themselves and have sex more and
earlier, in what I see as desperate efforts to anchor themselves to
some sort of reality - the reality of the flesh.

If a teenager can feel a steel bolt through her tongue move whenever
she speaks, at least she knows she inhabits her own body, even if she
doubts her own soul.

If she can use low-cut jeans or a glimpse of thong underwear to
attract glances from boys around her, at least she knows she occupies
space and time at the center of their attention.

The soil for this detachment from self has been sown for decades,
partly by psychiatry itself.

By not opposing vigorously enough the dangerous myth that psychoactive
medications are a complete answer to depression and anxiety, we have
allowed the idea to take root that we need not heed our emotions as
evidence of life crises with real and crucial meaning, that we should
turn off our inner voices and "listen to Prozac," instead.

The growth of technology has cleaved us from the reality of self, as
well. We say that we are "going" places on the Internet without ever
leaving the room.

In elaborate Internet-based games, people pay thousands of dollars to
own "real estate" that isn't real at all.

We watch newscasters (who increasingly could double as models or
comedians) report on terrible tragedies, then shift gears and joke
about the weather or a baseball game. And we learn to mirror them, to
respond to our own losses like channels we can change.

We can wage wars that kill tens of thousands of people with "smart"
bombs. But we see little, if any, blood. And we can count the dead
between episodes of our favorite sitcoms.

We sit still for a cloudy sense of whether our president was elected
to his first term. Then the president in the television drama "West
Wing" delivers a political statement about the war in Iraq, and people
actually pay attention.

A senator appears as himself in the film "Traffic," in which Michael
Douglas is the nation's drug czar. Unless Mr. Douglas really is ...

The trouble with all this is that the truth always wins. Reality will
not be frustrated forever.

You have to pay back emotional debt, like the national debt, with
interest. A crushing major depression lies in wait for Mark, if I fail
to help him face whatever demons from the past drove him away from
reality, to drugs.

Ever-increasing rates of substance abuse and attention-deficit
disorder and depression lie in wait for adolescents emerging into
adulthood. And, in not many decades, our nation's sense of itself
will, inescapably, depend on theirs. 
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MAP posted-by: Richard Lake