Two Contrasting Types of Adolescent Depression and their Treatment

I LOVED NOT, yet I longed to love; I searched for something to love, in love with loving, and yet I wanted not and abhored myself for not wanting; in me, I had a dearth of inward food, and the more empty I was the more I loathed it … And yet, wretched me, I seemed to love to grieve" (Augustine, c. 400).

The adolescent boy, who was later to become a bishop and then a saint, put the problem of ambivalence at the very heart of his adolescent depression. He wanted very much to love, and he looked about for something to love, but he could not find what he wanted, and he could not want what he found. He was deprived of past supplies, "the inward food," and remained empty and full of self-hate. Yet, he was conscious that in the midst of his misery that he was deriving some peculiar enjoyment from being depressed. Augustine was describing something of the predicament of the adolescent; caught between two worlds, he feels imprisoned, as it were, within a developmental phase.

There are no better accounts of adolescent depression than those given by gifted and introspective young people themselves. In their diaries and autobiographies, they have spoken (to quote only a few) of "the dumb and brutish trouble of adolescence," "the deadly despair and total emptiness," "the unspeakable melancholy," and "the crushing, humiliating, bleak, and desolate joylessness." One of them spoke of "the stifling sense of oppression and confinement, as if I were in a prison house from which I could not burst … I thought sometimes if only I could burst