ADOLESCENTS IN THE LINE OF FIRE: PANDEMIC AND WAR
The pandemic came and put baby, child and adolescent minds in the line of fire. New losses, deaths, traumas and mourning processes were imposed, in addition to the existing ones. And as this terrible situation is coming to an end, the start of a terrifying war strikes humanity again through new terrible psychic trauma and death. These catastrophic situations have put the adolescent psychic apparatus under severe strain.
We must not forget that the normal adolescent process is challenging, full of changes and questions that unfold a complex plot, yielding a significant psychic restructuring process. The adolescent is confronted with feelings of disorientation, helplessness, abandonment and emptiness, which will be greater the lower the degree of individuation and differentiation achieved. Fortunately, the adolescent process also includes a deep interest in discovering, growing, developing, and investing in an expanded social field; with strong desire to change and to be able to love and be loved.
Unfortunately intense psychic suffering resulting from the pandemic, reinforced some typical adolescent defences (denial, omnipotence, rationalisation, among others). Some developed denial of psychic reality and projective identifications, leading to consecutive actions in which manic defences played an important role. An increase of defiant and transgressive behaviours was observed during pandemic times (not wearing a mask, not respecting quarantine, clandestine parties, major episodes with the law and increased substance abuse). Also, psychic pain, loneliness and helplessness during the pandemic led to a virtual hyper-connectivity.
Finally, some adolescents exhibited a collapse of their defences, with feelings of emptiness, hopelessness and depression yielding an increase of self harm episodes, suicidal ideation and suicide attempts during the pandemic. According to the WHO [1] , in 2019 suicide was the fourth leading cause of death in the 15-19 age group in the world. In the USA, CDC [2] reports among adolescents aged 12-17 years, the mean weekly number of ED visits for suspected suicide attempts was 22.3% higher during summer 2020 and 39.1% higher during winter 2021 than during the corresponding periods in 2019, with a more pronounced increase among females.
Modern neuroscience shows that a quantitative or qualitative overload on the psychic apparatus has an impact on the biological matrix, interfering markedly with the development and remodelling processes of neural networks and maps. In Freud's words, an impact on the subjective representational network, encryption matrix of the psyche. The maximum expression of neural plastic remodelling processes occur in the first years of life and in adolescence. An attuned early mother-baby attachment helps develop, through epigenetic mechanisms, certain proteins synthesis that participate in the processes of emotional regulation throughout life. During adolescence, this neuroplastic remodelling phenomena perhaps could be the somatic correlation of what Peter Blos proposed as a re-historicisation, elaboration and re-elaboration process of the psychic network in order to carry out the second individuation process.
This interdisciplinary view makes it clear that subjective experience frees the human being from genetic determinism. Secure attachment affects the balance with which these somatopsychic processes develop, between the subjective representational psychic network development and the neuroplastic phenomena.
We can ask ourselves: how these traumatic events (pandemic, post pandemic and war) have inscribed, are inscribing and will inscribe in the adolescent´s subjective representational/neural network map? According to the UN, 42-66 million more people live in extreme poverty, in addition to the 386 million that already existed in 2019, contributing to a severe increase of physical/sexual abuse, cyberbullying, drug addiction, violence, and severe educational problems with consequent learning deficits observed in child and adolescent testing.
How will adolescents cope internally with an external world framed by pandemic/post-pandemic/war context? Do they have sufficient ego resources in a world where, moreover, celerity prevails? What will happen with the identificatory, disidentificatory and re-identificatory processes? And the passage from an omnipotent ego ideal to a mature, coherent and aspirational ideal of the ego? What new ideals will be developed in these adolescents? Some possible answers can be seen in the way in which many of them question how the world is run by adults, thus creating new ideals that enable them to protest certainty, hegemony and/or hypocrisy of certain adults. Greta Thunberg inspires protests in favour of environmental protection. Young influencers inspire fundraising among adults through social networks for social, health or environmental causes. Adolescents confront politicians who try to capture their votes, encouraging political ideals to the point that could turn into discrimination, xenophobia and fanaticism. Current social, economic and political crises, heightened by the war, force many children, adolescents and their families to migrate (more than four million Ukrainian war refugees, according to the UN Refugee Agency) with critical psychic traumas and complicated grief. Pre-existing mourning and trauma will be heightened by those due to the violent and traumatic loss and death of parental and familiar figures, primary support and social groups, language and cultural roots, and homes in the pandemic and in the war.
These individual and collective traumatic situations lead us to reinforce the idea of a preventive-active-interactive child and adolescent psychoanalysis. That is to say, the current need for psychoanalysts to work actively within the community, in an interdisciplinary way with paediatricians, teachers, and cultural, social, legal and governmental institutions. A psychoanalysis in the line of fire deploying all its power and resources at the service of the most vulnerable group in society: babies, children and adolescents. They are our future!
Dr Fernando M. Gómez
MD, Paediatrician, Psychiatrist, Psychoanalyst specialised in children and adolescents
Director of the Department of Children and Adolescents "Arminda Aberastury” - Argentine Psychoanalytic Association - APA
Co-Chair for Latin America of COCAP - IPA
Advisory Council Member of the Directorate of Mental Health of the Government of the City of Buenos Aires
[1]
https://www.who.int/news-room/fact-sheets/detail/suicide
[2] Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep 2021;70:888–894. DOI:
http://dx.doi.org/10.15585/mmwr.mm7024e1