What Can I Love You, Now Die Teach Us About How We Treat Teen Depression?

On July 13, 2014, 17-year-old Conrad Roy was found dead in his pickup truck: He’d committed suicide, poisoning himself with carbon monoxide. In February 2015, his girlfriend Michelle Carter was indicted on charges of involuntary manslaughter, following the discovery of texts she sent Roy urging him to end his life. In a way, it would be less frightening to discover that these two teens had undiagnosed mental health problems. But the truth — that their parents were well aware of their struggles with depression, and both teens were undergoing treatment — is far more bewildering.

A new HBO documentary titled I Love You, Now Die explores the court case that followed Roy’s tragic suicide, in which Carter was ultimately found guilty. Directed by Erin Lee Carr, the film digs deep into the psyches of both teens, providing expansive background on their mental health symptoms and treatment. At the time of Roy’s death, he had previously attempted suicide four times (coming close to succeeding at least once), and was taking Prozac to treat his symptoms. Carter (also 17 at the time of Roy’s death) had struggled with severe bulimia, regularly engaged in self harm, and had been on antidepressant medication since age 14. As of July 2014, she was still regularly attending therapy.

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Laid out, those facts paint a picture of engaged, involved parents rigorously treating their kids’ mental illness. And yet, the disparity between how the adults in Carter and Roy’s lives viewed them in July 2014 — and the reality that emerged from their private communication — is startling. That July, Roy’s father attested that his son “seemed like he was on the right track.” Roy’s mother, reflecting on the weeks leading up to Roy’s death, said: “If I knew he was feeling or thinking that way — yeah, I would have had him handcuffed [to] my car and brought him to a hospital. But he just — I just thought he was doing well.” During this time, Roy was actively planning a fifth and final suicide attempt.

According clinical psychologist and professor Risa J. Stein, PhD, this type of disconnect is not at all uncommon. When her own son was struggling with anxiety and depression, even Stein’s professional experience didn’t allow her to see the full scope of his suffering. “I didn’t realize that my son needed more help and more support than I was offering,” she tells SheKnows. “I was so invested in my son succeeding and reaching his full intellectual potential that I wasn’t paying attention to what was going on with him emotionally.” She’d assumed things would get better when he went to college. But when they didn’t, she realized how much she’d shut out.

What happened to Stein was a kind of denial: She saw the signs and heard her son’s concerns, but couldn’t allow herself to absorb the severity. Lynn R. Zakeri, a therapist in the Chicago area, notes that this denial can often happen unconsciously, as a kind of stress response to the pain of the situation. “If a parent doesn’t know their limits and they can’t handle [their child’s suffering], their own protection goes into effect: denial,” Zakeri explains to SheKnows. “It’s not in an aggressive or an uncaring way, but more in a self-preservation way.” So, how can parents fight against this kind of response? Zakeri and Stein agree that it’s all about communication: finding out how much support your child needs, and then being honest with yourself about how much you, personally, are able to give.

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Of course, there are many hurdles in place to open, honest communication between adolescents and their parents — particularly when it comes to issues like mental health.  “There is this instinct of any kid, no matter how old they are, to kind of read their parents and see what’s behind the question,” Zakeri says. When parents ask “are you okay,” their kids may say “yes'” simply because it’s the answer they know their parents want to hear, or because they know a longer, more difficult conversation might arise if they say no, Zakeri says. Parents need to build a sense of trust with their child and instill the feeling: “when my parents ask me how I’m doing, they actually just really want to know.”

This is also where setting limits comes into play: In order for your kids to be honest with you, you need to send the message that “I want to know how you are […] a million times more than I care what your answer is. I’m OK, I can handle it, you can put anything you need to on me,” Zakeri says. At the same time, Zakeri cautions, “If you know yourself and you know that you’re not […] strong enough to hear whatever they have to say, then give them the opportunity to talk to someone else.” Fulfilling your child’s need for support doesn’t mean being 100 percent of that support yourself — but it does mean giving your child the room to express their needs without worrying about how it’s affecting you.

The truth is many adolescents don’t feel comfortable confiding in their parents about this kind of thing. According to a recent study of college students Stein conducted, only 50 percent “ever share anything that’s going on with their parents.” And of the 50 percent who do, even fewer find their parents receptive. “People, my generation, a lot of them will basically just say ‘yeah that’s hormones, that’s adolescence […] it’s no big deal,” Stein shares. “Maybe it was for them, or maybe they were more significantly depressed than they remember […], but that doesn’t necessarily mean that their children aren’t experiencing something that’s significantly troubling.”

But for parents who seem completely unaware of their child’s struggles, there are more than generational dynamics to blame. Often, a child can display outward signs of success — like getting good grades or having a pleasant demeanor — while still deeply suffering. This was another issue at play with Carter and Roy: In the weeks leading up to Roy’s death, he graduated high school on the honor roll, and his dad proudly noted that he earned his captain’s license. And at Carter’s sentencing, the judge referenced that she “did well in school” as a reason he didn’t believe her mental illness was affecting her actions.

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Stein cautions against that kind of thinking: “If anything, that could be evidence of her mental health challenges,” she says. “The [signs of depression] people think to look for are the withdrawal, the crying, the grades dropping, the getting involved in drugs. What we see as much, if not more, now is that it’s the kids who […] feel a sense of achievement pressure, the kids who are making the straight A’s, who are showing up every day, the perfectionist kids.”

These symptoms of depression can end up looking a lot more like anxiety, Stein explains: “The kid is anxious that — one false move — and everything’s going to crumble.” What really ties that anxiety to an underlying depression is the fearfulness that if things crumble, that means they’re worthless. For this type of depressed teen, “their self-image is predicated on maintaining the esteem of others,” says Stein — so as soon as they lose those outward markers of success, they feel they’ve lost everything.

Of course, Stein notes, depression can manifest either way (“it’s not an either-or”). But this type of adolescent depression is less documented and harder to detect — in part because the adolescents themselves will fight so hard to keep it hidden. For some depressed people, “there’s this need to appear normal and be really polite and follow all the rules, because that’s the stuff you can control,” Zakeri explains. That’s why parents have a responsibility to push beneath the surface — something Zakeri admits takes “a lot of confidence.”

The key warning signs that parents need to look out for are hopelessness and helplessness (like the sense of being “worthless” mentioned above) — no matter what the rest of their affect looks like. “Do you feel hopeless, do you think things are never going to get better?” Zakeri poses as sample questions. According to her, it’s not the “I hate my life, all my friends suck” demeanor you need to look out for — it’s the “it doesn’t matter what I do,” the “my life is always going to be this way” that ends up being much scarier.

If you do find your child expressing symptoms like this, the impulse can often be to offer blank reassurance, something Roy recounts hearing from the people around him too. But Zakeri is adamant that this is a bad idea: “You need to validate before you reassure. Reassuring does not help with the depression,” she says firmly. “You want to be more like: ‘I get it, I understand this is so hard, and if I don’t know how to help you, I’m going to find someone who can.'”

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As seen in I Love You, Now Die, teens tend to struggle far less in confessing mental health struggles to their peers — Carter’s peers, in fact, were called to the witness stand to attest to her confessions of near-suicide attempts, delusions and self harm. We don’t know whether Carter’s parents were privy to that information (they declined offers to participate in the documentary). But her therapist’s notes from July 2014, obtained by the prosecution, suggest Carter was markedly less honest with the adults in her life. In the notes, the therapist deemed Carter’s judgment and insight good, and her behavior lacking any abnormalities. Once again, the messages she sent to her friends and to Roy told a very different story.

Stein believes we need to embrace adolescents’ willingness to confide in one another, noting that 80 percent of kids will talk to their friends before they talk to anybody else, and 81 percent of them, “if they have a friend that they think is experiencing something, will check in with that friend.” As much as parents want to be their child’s primary source of support, Stein says we need to accept that it will always be harder for a teen to be fully open with an adult. “If you have postpartum depression, you want to hear from other postpartum moms,” she offers by way of comparison. “It’s the same thing with kids.”

Many times, Stein has seen peers reach out at critical moments, taking a struggling friend to a counseling center or emergency room when necessary. The issue then comes in creating a safe platform for peers to discuss these issues: posting to social media, for example, often poses more harm than good. First, social media creates an idealized version of everyone’s lives, making those suffering feel even more isolated internally. And second, even if an online confession is met with an outpouring of support, all it takes is one nasty Reddit comment to undo everything.

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In the end, the key is really educating your child on what resources are available: from you, from other adults in their lives, from their peers and from mental health professionals. Stein believes that integrating these tools into the classroom will become a key part of mental health care for the future. We need to “[train] kids on how to discuss these things and [give] them the insight that probably everybody else in their class is experiencing this or at least has at some point in their life.” In other words, a teen’s first experience discussing mental health shouldn’t come in therapy: “kids don’t want to go to therapy, and we have to face that,” Stein says. “There’s got to be some sort of approach that comes before that point.”

Carter and Roy had parents who took their mental health concerns seriously, and sought treatment. Even so, Carter and Roy clearly had needs left unmet and were unable to find relief from many of their symptoms. When it comes to teen depression, the pain it invokes — especially in a parent — can cause others to turn away, or tell themselves a nicer story about what they’re seeing. But until we stop being afraid to look below the surface, teens like this will continue to suffer in silence. In the case of Michelle Carter and Conrad Roy, the failure to do so was a fatal mistake.

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