Peer Pressure

***My hope is that this post will help parents and caregivers better understand the role that peer pressure can play in an adolescent’s mental health crisis, especially where cutting is involved***

One of the most startling experiences during my son’s mental health crisis was the realization that within his adolescent peer group, mental illness is often viewed as a type of “club”.

As I began to move through the beginning stages of my son’s crisis, the first treatment program he was admitted to was Partial Hospitalization. This program consisted of day treatments in a hospital setting and allowed my son to come home each night to sleep. During the course of the program, the patients participated in many therapies and programs including: DBT (Dialectical Behavior Therapy) groups, family groups, and art projects. They were also able to complete their school assignments so that they did not slip behind in their course work.

Every morning, I’d drive my son to the Behavioral Health building at the local hospital and every afternoon I’d pick him up. Once or twice per week, we would have a treatment team meeting and review his progress, concerns or challenges and next steps for treatment.

There were rules in place at Partial for the safety of the adolescents participating in the program. There was to be no contact outside of Partial. No exchanging phone numbers, Facebook friending or other social media contact exchanges. And yet, within a day or so, my son was coming home with phone numbers written on his arms and hands. He also was accepting new “friend” requests on Facebook at a surprising pace, especially since he wasn’t an avid Facebook user up to this point. While it was alarming that the participants were so blatantly ignoring the rules, as my son justified the friendships, I wondered what the big deal really was.

Then I found a piece of paper folded up under the couch in our family room. Type written along the top of the page was “How to cut”. As I read on, I found that it was an instruction sheet on how to self harm by cutting including specific information on where to cut if one didn’t want to get caught, how deep to cut so as not to risk serious injury and what medical supplies should be stocked just in case the cutting went too deep or bled too much. What??? I was very alarmed. My head was spinning. I was confused. I could not figure out why someone from the program would be providing instructions on how to self-harm. In my naïve thought process, I assumed these teens would all have a vested interest in helping and supporting each other in a positive way. Boy was I wrong!

Over the next several weeks, the situation began to unfold at a rapid pace. Not only were the adolescents in the program (and eventually, “friends” made during inpatient as well) sharing self harming instructions but they were also, for lack of better definition, in a bit of a competition with each other. Comparing the proverbial “badges earned” based on the number of hospitalizations, types of medications, runaway escapades and even suicide attempts. In a way, encouraging each other to try harder to fit into the “club”.

Shortly after my son’s second inpatient hospitalization, I found that he was part of a closed/private Facebook Group dedicated to his “Hospital Family”. The intention of the group was to stay in touch with each other after discharge, to find out who was going back into the hospital, and to share and compare experiences without the watchful eyes of their parents or caregivers. It was also a place where normal teenage anxiety collided with mental health challenges and resulted in a shit storm of drama, police involvement and angst that only amplified the imbalance of an already challenging equilibrium.

Much of my son’s interaction with these peers ended shortly after his suicide attempt; at that point he was admitted into residential facilities for more than six months which resulted in lost contact with many “friends” in this group. I’m not certain if he tried to re-engage after his transition home but he was on a different path at that point and may have recognized the importance of continuing to focus on his wellness.

While this is not occurring in every instance, it is imperative for parents and caregivers to be aware and on the lookout for cases where peer pressure is influencing behaviors. Many teens who seek mental health treatment don’t feel that they fit in anywhere among the “standard” peer groups. Even though it’s very unhealthy, many of these teens are drawn to what feels like like-minded friends found within this alliance. Feeling as though they have finally found a place where they fit in, they’re unable to understand or see the risk or danger that this situation can put them in.

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