Psychological problems can spring up at any time of life. When problems develop slowly and mildly, going on for many months and years, they can be very hard to spot. In such cases, help may not be thought important nor urgent, if needed at all. In addition, early onset problems can be submerged into ordinary developmental expectations, so that troubled children are invisible if neither hard to handle nor exciting to be around.  Teen years follow of unremarkable accomplishment, and then, a future of no great promise.

Sometimes, however, an unseen thing is happening that is pathological, quietly robbing a child, teen, or adult of their highest promise, unawares. Why, in an unremarkable child or young person, might this happen?  There are many possible explanations. Below is such person as a child and a young adult, not necessarily representative of anyone except herself, though there are too many whose stories are like hers.

This is the second of a series of pieces on mental health in the U.S., emphasizing difficulties for poor persons, children, and young persons in particular. In my last piece – if I get that far – I’ll discuss some policy concerns and propose a few solutions.

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Hi, Ms. Kidspeak, she said. I would have recognized her anywhere, though it had been 8 years. Same huge brown eyes, warm olive skin. She smiled. It was Ghost, the quietest child I ever taught. She’d been in my first class as public school teacher, moving up with me as I switched from one grade to the next.

As she smiled, I realized two things: I had no happy memory of her smiling or laughing, unlike most of my former students. And second, she was lovely. I recalled her as plain. How could I have missed her beauty?

I remembered the last time I saw her, at the placement meeting where each child came in for a brief interview before moving on to middle school. Her current teachers had to recommend a placement for each child – high, medium, or low math and reading classes the next year.

Ghost had been nearly mute, tears running down her cheeks. She whispered, Am I going to pass?

We were thunderstruck, as she had never failed any class whatsoever.
 After she left, my colleague said A solid C student at best. Not outstanding, a faded little girl.

No, snapped the math teacher, She’s inadequate. I gave her a C because she didn’t cause any trouble. She is stupid, to be frank about it.  Low, low, low and slow.

The reading teacher sighed, Yes, I gave her a B because she was sweet and quiet.

I said nothing, but looked in her file. Hey, look at her first and second grade achievement scores. These percentiles are all in the 90s (Note: This means she scored better than 90 percent of the children used to design the test). She’d gotten A’s too, and from Mrs. Grinstead. Mrs. G. was a recently retired teacher of fearsome reputation.

The math teacher barked, Well, that just proves Grinstead waited too long to retire!  A’s for Ghost!  Grinstead must have lost it at the end!

But this Ghost, at 18 wasn’t that ultra quiet, solemn little girl. She talked, telling me it had been a hard 8 years, but things were good, now. In 7th grade she had been hospitalized with serious depression, and after that had therapy. After several trial and error rounds, found both meds and a shrink that suited her well. In the middle of this, she had made one attempt to kill herself. But at present, she had been free of problems for three years.  She was a freshman in the Honors program, so she had clearly done very well in high school.

What had set off these difficulties? Not abuse, nor family discord, nor trauma. Ghost had developed dysthymia, likely in elementary school she said. Given my more recent studies in psychology and my memory of her early academic success, I was sure she was correct. A bright kid had turned into an exceedingly average to below average kid. Unexceptional, even dull, I was faded, she said. My cynical colleague had been correct in terminology, if not in reasons why.

And that’s the difficulty with dysthymia, at any age, but particularly among kids and teens and younger adults. Dysthymia holds you mildly depressed, but not so depressed that you can’t function and do the basic things to carry on daily living.  Problem is, dysthymia goes on and on and on. In one good study of dysthymia in kids, the typical length was 60 months (!) for dysthymia, in contrast to major depression, which more commonly is much shorter, lasting about 6 month from start to finish. After so many years of being sub-par, the memory of better days and better living fades and can disappear.  

Parents may think Oh well, those earlier grades were easy, but now that things are tougher, he just can’t be expected to do as well. . . . Adults may think the aging process has made them lose the edge and facility they had for work and new learning when they were younger. Maybe so, but maybe it is dysthymia.

There is another difficulty. When dysthymia is not treated, it is very likely that a more severe problem will happen. A teen sinks into a major depression, on top of dysthymia (this is sometimes called “double depression”. Or the person may become very anxious, or develop some other mood-related problem. That’s what happened to Ghost.

Actually, Ghost was lucky. Her “double depression” helped bring about the discovery of her dysthymia, before it took a major hit on her academic and social life. Otherwise, dysthymia might have socked her early years of high school achievement, ending college prep for her, placing her in an educational pigeonhole in that would have severely limited her future.

I’m not suggesting that problems need to be treated by delving into the past, with the exception that for children, teens, and young persons (and any adult to reports a period of much better functioning), it is good to look back for evidence that may be forgotten. Parents and the child or teen, too, have likely forgotten the better past, in the wake of regular grades and scores that speak of now as a continuing average performance.  

And having found dysthymia, the issue is, what can we do now to make up for what was missed, even if we have overcome the dysthymia? After all, neither therapy nor meds will make up for failure to learn long division, or simultaneous equations, or the passive voice in a new language, or good social relations at the start of a new school year or new job. Repair is necessary, and may be difficult.