You Are Her First Love, Part 2

When Allison started seventh grade, she changed schools. Her family had recently moved and Allison hated the move. When she got to her new school, she found a few classmates who shared her sour outlook on life. One kid’s father drank too much, another’s mother moved away. She and her friends got into a lot of trouble drinking and smoking dope. After several months of counseling and hard work, Allison’s parents decided that she needed to leave school—and even home—and receive treatment at a residential home for girls. She was furious. She began lying to her parents and stealing. This was particularly tough for her father, who was a new, yet highly respected, businessman in the community.

He told me he felt terribly guilty for moving his family and wondered out loud how he had failed Allison.

The weekend before she was to be admitted to the program, John did something brilliant. Painful, but brilliant. He told Allison that the two of them were going camping on an island with very few other people. I’m sure that this wasn’t exactly fun to think about for either of them, but he took charge. Miraculously, Allison packed her own things (John was expecting that he would have to). She even put her gear in the car, and off they went.

Neither spoke during almost four hours in the car. They ferried to the island and set up camp. Over the weekend they talked only occasionally. They went for hikes, made pancakes, and read books. (I’ll bet John chose an island because he knew she couldn’t run away.) No earth-shattering conversations occurred between them. As a matter of fact, John said he didn’t even approach the subject of her bad behavior or the treatment program. They just camped.

After they returned home, Allison left for an eight-month stay at the nearby residential home. She improved, her depression lifted, and eventually she pulled her life back together. Nevertheless, her early high school years were tumultuous, and John’s relationship with his daughter remained strained. But by the time she turned eighteen, their relationship had turned around. And by the time she graduated from college, he said, his friends were envious of his relationship with Allison.

When she was in her early twenties, Allison talked to her father about those difficult years. She felt guilty for causing her parents so much hurt. She told them she was sorry and that she couldn’t believe they had put up with her.

I asked her what had made the difference in her life. Without hesitation, she told me it was the camping trip with her dad.

“I realized that weekend that he was unshakable. Sure, he was upset, but I saw that no matter what I did I could never push him out of my life. You can’t believe how good that made me feel. Of course, I didn’t want him to know that then. But that was it—the camping trip. I really think it saved my life. I was on a fast track to self-destruction.”

You will always be your daughter’s first love. And what a great privilege—and opportunity to be a hero—that is.

Words, Fences, Silence, Time, and Will: What Difference Do They Really Make?

Now let’s get very specific. Before your daughter graduates from high school (maybe even from junior high), she or many of her friends will have dieted. Most girls go through a period of obsessing about their weight, and many develop full-blown eating disorders. In my experience, mothers understand why and how their daughters get wrapped up in the ultra-thin craze. Dads often scratch their heads—even as dads are crucial to the recovery process—and wonder, “What’s the big deal? Forget it, just put some food in your mouth, and get on with it.” You, men, are so very lucky in this regard. Your daughter, tormented by internal demons (in that active interior life that all girls have), can’t just “get on with it.”

Eating disorders are at an epidemic level in our country. These include anorexia nervosa, bulimia nervosa, binge eating, and obesity. The common element in each is an obsession with food: either to restrict it, get rid of it, or indulge in it. The chances are excellent that your daughter will fall into one of these categories before she graduates from high school. So what can you do to prevent any of these from happening?

First, it will help you to have a basic understanding of the etiologies of these diseases. There is no need for you to be a psychologist or an expert, but it will help if you can watch life from the eyes of your little girl: to see what she sees, hear what she hears, and understand what she feels. Is this really necessary? Yes, it is really necessary, because according to all the best scientific research, no one has a more powerful effect in preventing and helping her recover from eating disorders than you do.

Anorexia nervosa and bulimia nervosa are complicated illnesses. They are incredibly painful for parents and they are frustrating for physicians. To help you grasp what’s going on in a girl’s mind, I am going to simplify a complex issue into a few workable concepts and tips to help you protect your daughter. According to the National Eating Disorders Association, the major factors that cause eating disorders are low self-esteem, feelings of inadequacy, depression, anxiety, difficulty expressing emotions, troubled family relationships, cultural pressures glorifying thinness, and physiological or genetic factors. Of course, other factors can contribute and it’s important to realize that no two eating disorders are the same; they are as varied as girls’ personalities. Sadly, 90 percent of eating disorders (anorexia and bulimia) occur in girls and women ages twelve to twenty-five, when their developing minds and bodies are most vulnerable. It is imperative to understand that each of these diseases must be taken seriously—because they are life-threatening. Anorexia (which literally means loss of appetite) nervosa (which means neurosis) can lead to decreased heart rate, decreased blood pressure, brain damage, and heart failure. Bulimia nervosa is characterized by binge eating followed by some method to avoid weight gain: vomiting, laxative abuse, or enemas. Though harder to recognize from the outside, bulimia can be equally devastating. It can lead to rotten teeth, erosion of the lining of the esophagus, stomach damage, chemical imbalances, heart failure, and death. So if you suspect your daughter has either of these disorders, or even if your instincts tell you that she is at risk, get help for her right away.

Eating disorders are usually part of a process that starts with changes in her thinking, then in her feelings, and finally in her behavior. So let’s peer into her mind and see what she might see on a typical day, as she records it in her diary.

I go to school for my first hour class in Algebra. I’m nervous because I’m not sure if I got my answers right. The teacher calls on me to give my answers and my heart sinks. I’m frozen in my chair. Tim is sitting three chairs away and I know he thinks I’m stupid now. Or if not now, he will in a minute. Ugh, and my shirt’s ugly. I don’t want everybody to stare at it. Get up.

I get up and give my answers. Most were right. Two were wrong and everybody laughed. Why should they? I’m smarter than those jerks. I’m so glad it’s over. Anna and Jessie sat with me at lunch. They’re my best friends. I can talk to them about anything. Anna’s on my soccer team. Jessie bugs me because she only eats salad for lunch. She doesn’t put dressing on it, and I feel guilty that I do, because she’s thinner and prettier than I am. Her clothes are size 0. She’s so lucky. I don’t like shopping with her because she makes me feel fat. I guess I am. I’m a 2, but I could be a 0 if I tried.

I hate sitting next to her, and I feel guilty about that too. All the guys come up to her and drool. It’s sick. I mean, Anna’s a whole lot more fun and pretty. Maybe it’s because she’s strong and athletic. Maybe they think she’s ugly. They must. But they don’t talk much to me. I hate being shy.

I couldn’t stop thinking about the boys and Jessie. I should start eating more salads. I really would feel so much better if I lost a few pounds. I’ll start running. That’ll help.

Let’s pick up the diary a month later.

This feels great! I’ve lost 10 pounds in only 3 weeks. It’s not so bad. I run every day. I’m almost a size 0. My friends tell me I look great. I’m still having trouble with Algebra, but who cares? I read Cosmo today, picked up all sorts of good advice about what guys really like, and I felt really good. I love the clothes in Cosmo. I want to be an actress, if I could just get over my shyness and lose some more weight. I’d be really good, I know, and I’d get to wear cool clothes. I know this sounds stupid, but sometimes I like to pretend that I’m in Cosmo and that I’m being interviewed. But I’d never make it now. No way, they’re much skinnier and toned than I am. Got to keep at it.

Two months later:

I’m confused and I feel guilty. I went to this website and they said that throwing up would make me lose weight faster. I tried it. It was kind of gross. But, it’s working, so I’ll keep going. My running too. I’m up to 5 miles a day. Sometimes I like to run, sometimes I hate it. My dad’s getting on my case. What’s wrong with me, he asks? He says I’m irritable. Maybe it’s cuz I don’t have periods anymore. I don’t know. He looks at me funny. We don’t get along as well and I kinda avoid him because I don’t want him to find out about the throwing up. No way, no one can know.

Four months later:

School’s going horribly. People drive me crazy. They get on my nerves. I don’t want to go to school, but my dad makes me. He thinks I have cancer or something. I hate doing my work. I don’t know what the problem is—I just can’t concentrate. At least I’ve passed a size 0. Food tastes awful. I can’t have it. Every day I leave the house before my parents can see that I haven’t had breakfast. I don’t want to go to school. Anna and Jessie are acting weird and they don’t seem to want to do anything with me anymore. Maybe they’re jealous but why? I mean, they’re much thinner than I am. I mean, I’ve lost some weight, but if I can only get rid of the lumps at the top of my thighs, then I’ll start eating again. I can’t focus on math or science because they’re in the morning and lunch comes after. I can’t stop thinking about what I should eat for lunch. Should I use dressing? Jessie doesn’t. Nope, I can’t. I can do better than she does. I’ll just have water. Lunchtime came. Anna and Jessie came over. I wanted to run away. I hate watching people eat. They are so lucky. They can eat, but I can’t. I mean, I guess I could but I want to be different. I drank water and since I had some free time, I snuck in a run. My teacher got mad and made me go to the principal’s office because I was half an hour late to class. Who cares?

Six months later:

My dad and I got in a real bad fight. I don’t know what’s wrong with him. He doesn’t get it. I mean, what’s wrong with losing a few pounds? He won’t hug me anymore cuz he says it bothers him. I know why, I’m too fat. I flunked my French exam the other day. I hate French. I can’t wait till school’s over. I just want to be able to sleep as much as I want. I’m so tired. I better take vitamins or something. Something weird is happening. Whenever I take a shower, a lot of my hair’s coming out. My stomach hurts all the time. I guess it’s cuz I’m eating too much. Two days ago I had a salad and yesterday I had some green beans. I know I shouldn’t have. They made me have a stomach ache. I get nervous when I run too. I used to be able to run 6 to 8 miles, but I’ve dropped back to 3 because I felt this funny bump in my throat, kinda like my heart was beating up there. I can’t tell anyone I’ve dropped my mileage because they’ll think I’m lazy. I know they think I should lose a few more pounds and I don’t want them to think I’m not trying. This feels good, but it feels horrible too. I can’t stop thinking about running more. I can’t stop thinking about what I shouldn’t eat. It’s like there’s a monster in there, running my mind. I need to just sit in my room and figure all of this out.

Seven months later:

I think everybody around me is crazy, I swear. I mean, I think everybody was overreacting—especially my dad. He’s here with me every day in the hospital and whenever he sees this tube in my nose, I can tell he’s trying not to cry. This is so stupid, why don’t they just get me out of here? When they leave, I’ll turn the pump off. They’re killing me. Don’t they get it? I have to lose just a little more. My butt’s too big. I would feel so much better if they would just let me eat what I want. I keep telling them: let me alone for 2 days and I’ll eat. What is wrong with these people?

I don’t know what happened but all of a sudden black came into my eyes, my ears were ringing, and my head hurt real bad. My dad says I passed out and fell off the bed. He says that some doctors ran in and hooked me up to machines. They even put something in my mouth so I could breathe. There were buzzers and whispers, tubes and wires. Someone was shouting at someone else about an injection of something. I can’t really remember much. All I know is that they’re crazy, they’re all crazy. Don’t they get it?

That’s usually how it happens. First, your daughter will hear things. She will begin to believe that her life really would be better if she were just a bit thinner. She will ponder and think of ways to accomplish this. The thoughts won’t go away because her friends want to be one size smaller (regardless of how they look), and so will she. She believes that if she were thinner, more people would give her attention, and she’d feel better about herself. Also, since many girls fantasize about being a model, posing for magazines, and acting on television or in the movies, they put a premium on being ever thinner and more beautiful. They diet and exercise, hoping they can live out those fantasies, or at least be more like the models and actresses they admire. Everywhere your daughter turns, at school, at soccer, at home watching TV, these thoughts will be reinforced.

Now, there is nothing wrong with eating right and exercising, as long as they’re done for the right reasons and in moderation. But at-risk girls go to extremes. More than that, their characters change. An at-risk girl becomes intensely jealous of other girls who are popular and get all the attention. She thinks she’s not popular because she’s fat, or because there’s something else wrong with her. She doubts herself, is full of anxiety, and is unsure if she can ever become popular. In an effort to feel better, prettier, sexier, to become more popular and get more attention, she diets and she exercises. Then her diet becomes more restrictive, then she starts starving herself, and then she starts forcing herself to vomit.

Researchers believe that eating disorders are hard to detect because most of them are subclinical. Girls hide their eating disorders so well. Even while they are in a mental and emotional cage, stuck with obsessive thoughts and behaviors, they try to hide. It’s especially hard for dads to understand that their daughters’ addiction to starving feels so good to them. It’s not like being addicted to alcohol or drugs, which have immediate physical warning signs that addiction will lead to misery—hangovers, “bad trips,” crashes after drug-induced “highs.” Starving, at least initially, brings great rewards. People comment on how much weight girls lose, how good they look.

Here’s the good news: research also shows that you fathers, if you get involved and stay involved with your daughters, can play a pivotal role in preventing these horrible diseases, and your involvement is also crucial in curing them. Let me say right up front that eating disorders are not a father’s fault. They are complicated and many factors play a role in their appearance. But always remember that the strength of your relationship with your daughter can have a profound effect on preventing an eating disorder, curbing its progression, or healing your daughter if it catches hold.

Here are some practical things that you can do.

Make Time Count

The purpose of your time with her is to help her walk away feeling better about who she is. Research shows that daughters who feel a stronger emotional connection with their fathers feel more attached to them. And the more attached she feels to you, the lower the likelihood that she will be depressed or have an eating disorder. One study concluded, “The asymptomatic group reported the lowest levels of depression and the highest levels of paternal attachment security.”

So how do you form that strong attachment? First, when you are with her, pay attention to her. Don’t tune her out and think about something else while she’s talking, don’t ignore her when she’s sitting next to you at a baseball game, and don’t think she won’t notice if you don’t focus on her. Do activities that the two of you can enjoy together. Sure, there will be times when she’ll drag you to the mall or you’ll drag her to a car show. That’s okay. But no matter where you are, make sure she knows that you know she’s there. Ask her questions and listen to her. Girls hate feeling invisible. Without your attention, they feel unloved and insecure. Don’t make the mistake of spending too little time or paying too little attention to your daughter. You could regret it the rest of your life.

Don’t worry if your time doesn’t go smoothly. Take her for a stroll in the park. If you end up arguing about her boyfriend, that’s all right, because even arguing is a form of connection. You wouldn’t argue with her if you didn’t care about her—something she’ll recognize, whether she confesses it later or not. Arguments aren’t necessary for you and your daughter to figure each other out, but they don’t necessarily hurt either. The one rule is that when the argument is over, it’s over. Don’t pick at it. End it, make up, and move on—all before the sun sets. And then take her out again.

When you take her out, you don’t have to go far. Ask her to sit on the back deck with you, or help you in the kitchen, or work with you in the garage—even if it’s just for a few minutes. The point is, when you show a genuine interest in being with her, she feels more attached to you. So give her time and attention, and you will come to see in short order that she really feels loved by you.

Listen to Her

Girls like to talk more than boys—including dads—do. It’s healthy for girls to talk a lot, but it can be a problem for you because men are experts at tuning people out. You have a lot on your mind, you’re less verbal than women are, and all of us, particularly when we’re really busy, have a tendency not to give people our full attention.

So when you’re together, she’ll probably do most of the talking. Just listen patiently—and don’t try to fake it. Daughters can tell right away when dads aren’t listening. Exactly what you don’t want to happen—have her get frustrated, give up, and emotionally distance herself from you—is exactly what will happen if she thinks you’re not listening. Your job is to secure her attachment to you, and you do that by spending time with her and listening.

I can guarantee you one thing: if you listen to your daughter attentively for ten minutes every day, by the end of the month you’ll have a completely new relationship with her. Do what you would do naturally, as a man: spend more time listening than talking. If you listen, she’ll feel loved. You’ll be special to her because she knows better than anyone that most people don’t listen. The emotional life of kids is egocentric, and that’s where her friends are developmentally. So your daughter is dying to be heard. You don’t need to agree with her, you don’t need to have snappy retorts, and if you’re called upon to untangle some very twisted thinking, don’t worry. The very fact that you’re there and spending time with her means that a lot of her confused logic will probably resolve itself on its own.

If you stay with her, look at her, and listen to her, she’ll keep coming back for more. Her self-esteem will soar, her sense of loneliness will disappear, and she’ll become more comfortable expressing her feelings. Finally, because you, the most important man in her life, obviously like being with her, she will feel more attractive. She’ll think that boys who don’t want to be with her have a problem (because you’re smarter and more mature than they are). That’s a good attitude for her to have, and one that can protect her in the long run.

Fence Her In

Boundaries and fences are a must for girls, particularly during the teen years. Remember that whatever she says, the very fact that you thoughtfully and consistently enforce rules of behavior makes her feel loved and valued. She knows that these rules are proof that you care. Equally important, they train her to build boundaries for herself and teach her that such boundaries are necessary. From your rules (and your own behavior) she will learn what is acceptable and what is not, what is good and what is bad, and what she will and won’t do.

Many girls with eating disorders are kind, smart, and want to please others. Let your daughter know that the person she has to please is you. Let her know that your standards are hers, and that she is right to uphold them regardless of what her friends do. Guide her and help her reject harmful behaviors. Make it a habit and she will too. Girls who have been encouraged to be strong athletically, emotionally, intellectually, and physically learn to take over the role of encouraging themselves to succeed. They don’t suddenly go crazy or become weak-willed. The same is true with your daughter’s character. The discipline and standards, the fences and boundaries that you have integrated into her life will become her own.

The Importance of Words

We’ve talked about the importance of listening; equally important is what you say. What you say can actually help stave off eating disorders. Here’s the key: Listen hard and long. Then listen some more. Try to understand what she’s up against, what’s going on inside her, and what struggles she feels. Remember that when you’re a kid, very small things can seem like very big ones. Dads are important to help daughters put things in perspective.

As a father, you might see yourself primarily as a provider, but you also have a powerful role as a teacher. In fact, it’s your biggest role. So go ahead: don’t hoard your wisdom, share it with her. Give it to her in pieces, when you think she’s ready for it, when it’s relevant to whatever she’s struggling with.

Be calm, patient, and frank. Tell her that women in magazines aren’t the best role models, that people who judge everyone on their looks probably have terrible self-esteem issues. Tell her that what matters is not how thin someone is, but what her character is. And tell her what is great about her, what you like about her, what you hope for her.

Here are some extremely important don’ts. They apply to you and they apply to any close friend or relative interacting with your daughter, so feel comfortable telling other adults what they can and cannot say to her. That’s your right.

1. Don’t comment frequently on how she looks.

2. Don’t comment on your own need to diet.

3. Don’t make derogatory comments about her body. Many fathers think they are being cute when they tell their daughters they have cute butts, strong thighs, and so on. Some get quite crude and name their daughters’ body parts. Don’t. It will come back to haunt both of you.

4. Don’t comment frequently about her clothes. Yes, you should have standards for what she can and can’t wear, and about makeup. But you don’t ever want to communicate to her that appearance is a high priority. (This is one reason why school uniforms are a good idea. They set a basic standard for neatness and appearance, while establishing right away that everyone is equal and that focusing on dress sizes and styles is irrelevant.) Your daughter is just a kid and she really wants you to be happy with her. Let her know that you are, and that what matters is her, not what she wears.

5. Don’t constantly focus on the importance of exercise. Yes, healthy exercise is important, but many Americans are egocentric about their exercise. They do it because they want to look good. Be very careful.

6. Don’t make her feel she needs to do things to get your attention. Give it to her naturally, just as part of everyday life. Your daughter craves your attention and will do anything she can to get it. If you talk constantly about something, she’ll head in that direction. So be careful what themes you reiterate to her; think about where they might lead. She’s watching you, and she wants you to watch her.

The Importance of Will

Loving is hard. It might start off easy, but difficult kids, sick kids, daughters with attention deficit disorders or eating disorders can make love seem downright painful, requiring all the determination and willpower you can muster. Inevitably, there will be times when your daughter will drive you crazy, when you can’t understand why she doesn’t just stop emoting, or, if she has an eating disorder, why she doesn’t stop starving herself, stop vomiting, stop exercising obsessively, stop being sullen and snippy. But willpower tells you to bottle up your rage and frustration in bad times, just as it tells you to bottle up your private tears when you see your daughter in her first formal gown, at her first piano recital, or when another girl calls her “fatty” on the playground.

To love your daughter well, to draw her close to you, to strengthen the bond between the two of you, you must have a will of steel. There will be times when you’ll want to walk out. Don’t. Take a break instead. There will be times when you’ll want to scream. Don’t. Have a plan for when you think you’re going to lose it—and practice it. There will be times when you don’t feel like expressing your love for your daughter. But do it. It will make you both feel better.

Think about the kind of dad you want to be. Sure, it will take hard work. But love isn’t just about feeling good. It’s about doing what you don’t want to do, over and over again, if it needs to be done, for the sake of someone else. Love is really about self-sacrifice.

At the beginning of her life, she will feel your love. At the end of her life, you will be on her mind. And what happens in between is up to you. Love her extraordinarily. This is the heart of great fathering.

Ainsley's God

She couldn’t smile. She couldn’t talk and she really didn’t know my voice from anyone else’s. Aside from crying periodically and demanding food, we didn’t hear from her. Her life was about taking, not giving. But the moment I saw her, I was love-struck. She was my granddaughter.

My husband recently pointed out to me that love is very peculiar. How is it, he wondered out loud, that a small human being can give nothing but be loved so outrageously? After all, he said, our granddaughter couldn’t even return a smile when she was first born yet we were both smitten. Intuitively, I understand why we love her. We love her as we do our own children but now they seem easier to love because as adults, they give good things back to us. They tell us that they love us. My daughters call me just to see how I am and my son helped take care of me after a bad accident. Loving people who give us things seems reasonable, but how is it that we can love another person so crazily when they have nothing to give in return? I think I have a clue.

I can love my grandbaby this way because this is exactly how God loves me. Sometimes I reason that God might love me because, well, I try to make him happy. I throw him a smile. I pray and ask what He would like me to do that day. I sing a song or two in church and in my car. But when it comes down to it, no matter what I offer Him seems profoundly trivial. I can offer to write a book, but what is this to him? After all, He created the world by pressing a bit of dirt between his hands, opened his spiritual “mouth” and formed life so what can I, a tiny spec of a person give back to him compared to that? Not much. I know that it seems to us humans that we accomplish a lot. We (collectively speaking) have created ways to communicate with one another in real time through space. We have built entire cities, made men shoot through space and land on the moon and we have given ill children new hearts.

These are wonderful, but really, when we compare these accomplishments to what God can do- create light, come on. We are small potatoes. So doesn’t it seem odd that this creative, glorious God, who could love anything or anyone he chooses, would love us? Why should he love me? Better yet, if he decided to love me but I messed up, why wouldn’t he simply remake a better, nicer version of me to love? For some reason, he doesn’t. He just loves me and He loves you because we are.

Just like Ainsley is. And for me to love her, that’s all she needs to do- exist. And for God to love you and me, the truth of the matter is, that is all we need to be- alive. As Ainsley Grace grows up, I will make sure that she knows this God that I know. Because when I stare at her photo in googly-eyed adoration, He stands right behind me.

You Are Her First Love, Part 1

Thomas Aquinas regarded love as the root of all other passions—hate, jealousy, and fear—and when I talk to daughters about their fathers, the conversations are almost always emotionally charged. They adore their fathers or hate them—sometimes they do both simultaneously. Your daughter yearns to secure your love, and throughout her life she’ll need you to prove it.

A daughter identifies easily with her mother, but you are a mystery to her. You are her first love, so the early years of your relationship with her are crucial. The love you give her is her starting point. You have other loves in your life, but she doesn’t. Every man who enters her life will be compared to you; every relationship she has with a man will be filtered through her relationship with you. If you have a good relationship, she will choose boyfriends who will treat her well. If she sees you as open and warm, she’ll be confident with other men. If you are cold and unaffectionate, she’ll find it hard to express love in a healthy way.

When your daughter was born, oxygen was forced into her lungs so she could breathe. So too must love be pressed into her being if she is to grow into an emotionally sound woman.

You will naturally feel love toward your daughter—especially in those first years of life—but that doesn’t guarantee she feels loved by you. Daughters’ reactions to words, actions, and situations are more complex, reflective, and diverse than those of fathers. She will read a litany of possible meanings into everything you do. When you buy your daughter a bracelet for her birthday, you’ll think of it as a straightforward gift. But she will think of it as fraught with meaning, good or bad.

One of my standard questions when I’m examining a girl is, “Tell me who in your life loves you.” About half the girls respond, “My mom and dad, I guess. You know, they have to.” A quarter of them look at me quizzically. And the remaining quarter shrug their shoulders and say, “I don’t know.”

My observations aren’t unique. A nationwide survey by the National Commission on Children found that when asked whether their parents “really cared” about them, 97 percent of kids between the ages of ten and seventeen from intact families believed their fathers really cared. For children in stepfamilies, 71 percent said their fathers really cared. In single-parent families, the number was 55 percent.

If you’re in a stable marriage, you have done your daughter an enormous favor. But with the culture the way it is, you need to be vigilant. To be certain your daughter feels loved by you, here are some practical steps you can take.

Words

Use them. One of the major differences between men and women is how they use words. Woman like to talk; men don’t. That’s just the way it is. You might spend three hours watching a football game with your son and never say a word—and both of you would be happy. But your daughter isn’t wired like that. You have to talk to her. A good rule of thumb is to use twice as many words as you normally would, even if it means just saying things twice. Daughters can be prone to self-doubt. Pay her compliments repeatedly, so she knows you’re sincere.

When she talks, she wants you to respond. Your daughter is sensitive not only to herself, but to others, and is always asking herself: Does he like being with me? Is he quiet because he’s thinking about something? Is he angry? Is he depressed? She wants you to be happy because then her life is better. She’ll often act as your personal aide, doing what she can to improve things. You are the center of her world.

In return, you need, first and foremost, to tell her you love her. Not just on special occasions, but regularly. That might be easy when she’s five, but she needs to hear it even more when she is fifteen. She needs to hear you say it all the time. When a daughter hears “I love you” from her father, she feels complete.

But your job doesn’t end there, because her next question might be: “I love you too, Dad, but why? Why do you love me?”

You might find this exasperating, but she needs to hear the words. She wants to know why you feel the way you do, to test your sincerity. Men can find this frustrating, but I’m giving you fair warning. Girls who are seven years old might be satisfied with “I love you.” Girls of seventeen will want an explanation. She’s not trying to push your buttons. She genuinely wants to know.

So you need to be ready. Reflect on your daughter’s character, praise her best attributes, talk about her sensitivity, compassion, or courage. Your daughter will draw a picture in her mind of how you see her, and that’s the person she’ll want to be.

Be extremely careful. Many times fathers make innocent comments that are hurtful to daughters. If you comment on her weight, physical appearance, athletic prowess, or academic achievement, she’ll focus on her “external self” and worry about retaining your love through her achievements and appearance. Your daughter wants you to admire her deep, intrinsic qualities. Keep your comments positive, keep them on these qualities, and you can’t lose.

Instead of saying, “I love you because you’re so beautiful,” tell her that you love her because there is no one else in the world like her.

Expressing emotions can be tough for men. But loving people is tough. If you aren’t comfortable verbalizing your love, you can write her a letter. Girls of all ages love letters and notes. You might think they’re corny, but I guarantee that she -won’t. Ponder your love for her, write it down in a very simple way, and leave the letter on her bed, in her backpack, in her drawer. It doesn’t matter. She’ll take praise from you anywhere, anytime. If you doubt my advice, do an experiment.

Write a note affirming her in any number of ways. Leave it where she’ll find it. Then six months or a year later, go look for it. I’ll guarantee you’ll find it tucked away in a special place. She’ll save it because she wants to be connected with you and loved by you, always. Even if your feelings toward one another change as she grows older, the words on the paper won’t change. She needs these words.

Fences

In general, men are better at building fences than women are. I don’t mean literal fences, but the walls and boundaries your daughter needs around her world.

When she is two years old, you define your daughter’s territory: what is safe to do and what isn’t. You establish how she can behave and how she can’t. You create borders around her movements, language, and behavior because you don’t want her to get hurt. As she grows older you take some fences down or move them back. You give her latitude to roam, but she is always under guard. When she is thirteen, some fences need to be reinforced—especially because she might try to break them. You can’t let her do that, because she’s still a kid. And because the boundaries make her feel loved.

Daughters with a curfew know that someone wants them home and is probably waiting for them. Daughters without curfews wonder. Girls who are told to mind their language know their parents want them to grow up to be well-spoken women. Girls who grow up swearing in front of dad don’t believe that.

Teenagers often try to manipulate fathers by accusing them of not trusting them. And this kind of manipulation often works. Tell your teenagers that the boundaries you’ve erected aren’t about trust, but are about keeping them safe and moving them in the right direction. We all have boundaries that we respect because life is safer that way.

I recently spoke with Steve, a police officer in California. He can tell story after story of teens getting in trouble because their parents either were absent or -weren’t tough enough to put up the boundaries they should have.

We talked about how difficult it is for parents to be realistic about their own children. Because we want them to make good decisions, we assume they will. We want to believe our kids are stronger, more mature, and better capable of handling situations than other kids. And that’s when mistakes happen.

Steve told me that he remembered when his sixteen-year-old daughter, Chelsea, wanted to go to the movies with her seventeen-year-old boyfriend.

“I knew him,” he continued. “He was a great kid. They both were.”

He told Chelsea that she could go, but only after they had a chat. “She rolled her eyes and groaned.” He laughed. “I know she thought I was going to lecture or preach to her. So I simply said I had a few questions to ask her.

“We sat down and I asked her what she would do if her boyfriend suddenly changed his mind and decided to go to the drive-in instead of the theater. ‘I’d go to the drive-in,’ she said.

“‘Okay,’ I said. ‘Let’s say you go and he jumps out of the car, opens the trunk, and pulls out two six-packs of Budweiser. What would you do then?’ “Chelsea told me she wouldn’t drink. She got a little agitated. She told me I knew her better than that, and that she’d proven that she could be trusted. She started to get up from the table, but I said, ‘Hang on, Chelsea, we’re almost done. Only a couple more questions. Would you let him drive you home?’

“‘Well,’ she said, ‘I would if he wasn’t drunk, and if he was, I’d call home and ask you for a ride.’ She smiled and thought that was it, but I said, ‘Good. I hope you’ll always call home when you need to. But how many beers do you think would make Tom unable to drive?’

“‘Come on, Dad,’ she said. ‘It’s not hard to tell: maybe six or seven beers.’”

Chelsea’s answer, he admitted, caught him off guard. She had given the right answers all along. Then, bingo, he was reminded she was sixteen, and that meant he needed to move in the fences. Loving Chelsea meant no drive-in, no beer, but one movie at the theater, and then straight home afterward.

Fathers often overestimate their daughters’ maturity. We’re all taught that girls mature faster than boys, which is partly true. But researchers now know that some girls don’t develop adult cognitive skills until their early twenties. This is explained in an article published by The Medical Institute:

Dr. Jay Giedd, chief of brain imaging in the child psychiatry branch at the National Institute of Mental Health, has spent more than thirteen years performing MRIs and studying the brains of more than 1,800 kids. Through high-powered MRI technology, he has discovered that the adolescent brain, while fully grown in size, is still a long way from maturity.

Long after the size of the brain is established, it continues to undergo major stages of development. One of the last regions of the brain to mature is the pre-frontal cortex—home of the so-called “executive” functions—planning, setting priorities, organizing thoughts, suppressing impulses, and weighing the consequences of one’s actions. This means the part of the brain young people need the most to develop good judgment and decision-making develops last!

 According to new studies, the pre-frontal cortex usually does not reach a level of genuine maturity until someone reaches their mid-twenties. “It’s sort of unfair to expect [teens] to have adult levels of organizational skills or decision-making before their brains are finished being built,” says Giedd.

This is another reason fathers need to be protective of their daughters. Many fathers fear that enforcing rules on their daughters will only make them rebel. Some daughters do rebel—but not because of rules. They rebel because the rules aren’t balanced by anything else. Rules can’t be the center of your relationship. That’s where love comes in. But you do need the rules. I have seen girls whose parents set no limitations end up in juvenile detention centers. And I know most conscientious fathers (and mothers) err on the side of being too lax.

The risks to your daughter can be close to home. For example, no seventeen-year-old girl—no matter how well behaved—should be at home alone overnight. Why? Because other kids will find out she’s alone and come over to the house. Chances are, she won’t call any adult (let alone the police) for help—and no seventeen-year-old has the cognitive skills to make consistently good judgments. This has nothing to do with character or intellect. It’s simply too easy for a girl to assume that having a few friends over is no big deal. Sure, maybe nothing will happen. But what if it does? She shouldn’t be put in that situation.

Silence

Most daughters tell me their fathers listen better and preach less than their mothers do. But there’s a catch. It’s harder to get a father’s attention. Mothers are better at reading a child’s mood and are more likely to ask questions.

But it is your attention she wants, because she senses the strength and concern behind your silence. She senses that you are genuinely interested in what she has to say—and that makes a daughter feel significant, mature, self-confident, and loved.

Many fathers complain that their teenage daughters won’t talk to them. They’re usually wrong. It’s just that these fathers have discouraged their daughters from talking to them. Daughters won’t talk if they know the result will be only constant reprimand and correction. Daughters want their fathers to listen while they unravel their own tangled feelings and beliefs. If a daughter can trust her dad to listen, she will come to him again and again to talk.

Listening is tough, particularly when the words don’t make sense and the ideas seem superfluous. But listen anyway. Sit down. Look her in the eye. Don’t let your mind wander. And you’ll be rewarded with a daughter’s trust, love, and affection.

Time

Being a father means giving up your time without resentment. It’s hard, I know. Men spend most of their time working for someone else. When you come home and there are even more demands on your time, you might feel like distancing yourself from your own family.

Your daughter realizes this, and because she wants to please you, she might not tell you how much she needs your time. So you have to take the initiative to spend time alone with her.

I realize that many good fathers feel pressured regarding time. There isn’t enough, for any of us, and the lack of time or misuse of it causes great anxiety. We carve out time slots for our kids, and we don’t want to waste that time. We want to ensure that it’s productive and meaningful. And that only adds to the pressure.

But spending time with your daughter shouldn’t be full of pressure, because she doesn’t need you to do anything; she only needs to be with you. So don’t worry about finding activities to entertain her. She doesn’t want to hitch a ride on your golf cart. (And she certainly doesn’t want to share you with the television.) All she wants is your attention. And she needs it on a regular basis.

Many fathers are uncomfortable being alone with their daughters. One-on-one time can be tough. But if you start dad-and-daughter time when she’s young, it will bring you closer when she’s an adolescent. The rewards can be enormous. Daughters often say the most meaningful conversations of their lives were one-on-one with their dads. Keep one-on-one time simple. Avoid activities that put you in competition with your daughter. Always use this time for emotional balance, for relaxing and having fun. You can work out conflicts later.

If you think this is a waste of time, think again. One of the primary treatments for girls with eating disorders is to spend time like this with their dads. These fathers learn not to harp on problems, but to focus on having fun together, which helps daughters center themselves on this healthy relationship and disassociate their illness from who they are. Eating disorders can make girls agitated, manipulative, and volatile; they can make them lie, yell, break down in tears, and be disrespectful. In short, they can be really hard to deal with. So telling a dad to spend time alone with his daughter might not be what he wants to hear. But spending enjoyable time with her teaches father and daughter that beneath her illness, and the misbehavior it can cause, she is still a girl to be loved, and that’s the first big step toward her recovery.

“Family time” has diminished over the decades. One result of this is that communication between family members is worse than it used to be. Over the last forty-five years, the amount of time kids spend with their parents has gone down by ten to twenty hours per week. At the high end, that’s almost three hours a day gone from your relationship with your children.

For divorced parents, the challenges are even greater. And for fathers (who usually don’t have custody of the children) the time lost can be enormous. But you need to find those small pockets of time to be with your daughter. That time can make an enormous difference to her. Your physical presence alone can make her feel protected.

Some of the best medical literature about keeping kids out of trouble comes from the Add Health Study. With overwhelming evidence, the study shows that kids who feel connected to their parents (and who spend more time with them) fare much better than kids who don’t. Parents keep kids out of trouble; parental influence can be more important than pressure; and specifically, daughters who spend more time with their fathers are less likely to drink, take drugs, have sex as teenagers, or have out-of-wedlock babies. Your time with her matters.

Will

“If human love does not carry a man beyond himself, it is not love. If love is always discreet, always wise, always sensible and calculating, never carried beyond itself, it is not love at all. It may be affection, it may be warmth of feeling, but it has not the true nature of love in it.”

So spoke the great teacher Oswald Chambers at the turn of the twentieth century. Love, he taught, is a passionate feeling that needs to suffuse our relationships with others. It can’t be calculated, it can’t be turned on and off, and it has to be ever-present in your relationship with your daughter. But as a dad, you know love also requires work and recruitment of the will. Romantic feelings wax and wane between lovers. Even the most perfect love requires an act of the will. If it is to survive, it has to be nurtured, cared for, developed, and practiced. And it has to live in the real world. Real love is gritty. It sweats and waits, it causes you to hold your tongue when you want to scream obscenities in anger, and it causes many men to accomplish extraordinary feats.

As natural as the love you feel toward your daughter might be, there will be challenges to that love, from crying squalls when she’s a baby, to kindergarten tantrums, to other stresses of growing up that might show themselves in disrupted sleep patterns, moodiness, or ugly language. Your daughter, whatever her age, responds differently to stress than you do. If you’re upset, you might watch a football game, go for a jog, or go fishing. Not her. She wants to spill her tensions on you. It makes her feel better. So be ready—and don’t be surprised if she does this from an early age. Many parents ask if daughters can experience PMS before puberty. My answer is yes. It doesn’t make good medical sense, but I see it repeatedly.

It’s inevitable, too, that your daughter will go through stages. She’ll draw close to you, then she’ll pull away; she’ll adore you, then she’ll want nothing to do with you. You need to love her not only when she is your sweet, affectionate girl, but also when she’s a real pain in the neck to be around. When she’s moody, you still need to communicate with her—and you need to keep yourself from exploding when she’s disagreeable.

How do you do that? Discipline. Grit. Will. If you need to distance yourself emotionally for a time, do it. If you need physical separation for a bit, okay. But always come back. Will, patience, calm, and persistence will pay off in your relationship with her. Nothing better expresses serious love than this combination of qualities. Let her know that nothing she can do, even running away, getting pregnant, tattooing her ankle, or piercing her tongue, can make you stop loving her. Say that if you need to.

Love, as Mr. Chambers said, must push us beyond ourselves. It will jab every sensitive part of you and turn you inside out. Having kids is terrifying because parenting is like walking around with your heart outside your chest. It goes to school and gets made fun of. It jumps into cars that go too fast. It breaks and bleeds.

But love is voluntary. Your daughter cannot make you love her or think she is wonderful. She would do that if she could, but she can’t. How you love her, and when you show it, is within your control.

Most parents pull away from their teenage daughters, assuming they need more space and freedom. Actually, your teenage daughter needs you more than ever. So stick with her. If you don’t, she’ll wonder why you left her.

I know this is tough stuff. But it’s worth it. Here’s the story of one father who recruited his will to love his daughter at a tough time and won.

Teen Acting Out of Character

Hi Dr. Meeker,

I am wondering if you can help put this situation into perspective. Our eighteen year-old son is acting so out of character. This young man has been on our worship team for seven years; very obedient and respectful, etc his whole life....met a girl from Germany.

He is currently over in Germany, visiting his (first) girlfriend's family. He was only going there for thirty days, now he is there for over sixty days. He failed to inform us of this. We are in shock that his behavior is so disrespectful~! They are upset that we asked for prayer on FB because we did not know what was going on.

His girlfriend keeps telling him that he doesn't have to listen to us since he is eighteen. I know that about the law, but it is so shocking since he has always been easy.

Wondering if there are ways to approach this so that we do not hurt our relationship with our son.

Any advice will be greatly appreciated~

Anne



Dear Anne-

First of all, it sounds like you have raised a terrific son if this is the first time that he has challenged you. So take a deep breath. It sounds to me like your son has fallen in love and his feelings are taking over. Since this is his first girlfriend, it's not uncommon for boys (even young men) to fall hard. And- he's probably listening to the advice of his girlfriend because he is in love. But there are a few things that you should do.

He is eighteen and you need to let him know that you respect him as a man, not a boy. He probably feels as though you want to control him and he's bucking that. This is normal and the best thing to do is to give him the sense that you are willing to give him some rein. Let him know that you understand and respect that he is in love. But you also need to tell him that he needs to communicate with you adult to adult because you will worry about him.

Second, putting a prayer need on Facebook is a big NO-NO! You need to honor his privacy. If you are having issues with him, those issues should stay between you and him. Putting something like this in FB is humiliating and makes him feel like a child and it breaches confidence. If you want prayer for him, go to a few close friends and ask for it but only go to ones who will honor confidences. I would apologize to him for posting something so private.

All communication should be through private phone calls or Skype. Avoid email or texting because too much can be misunderstood. When you do communicate, you need to do a lot of listening. Let him know that you really want to understand why he's staying over there so long. And also let him know that you really want to understand why he's acting so out of character. Reach out to him repeatedly with the intent of hearing what he has to say, not with the intent to straighten him out- this will only make him pull away.

Legally, he can stay as long as he wants. But from a family relationship standpoint, you need to still let him know that you love him, respect him and if he chooses to stay there he is fully responsible for making his way financially. You will not send him money.

This is a tough situation but I want to encourage you that if you and he have a solid foundation to your relationship, just stay the course and he will come around. You must be loving, patient and firm. Let him know that you are very disappointed that he doesn't want to tell you what's going on but he may be doing this because he's afraid that you will either not listen or reject him. I understand this because you disagree with him. So let him know that you will always be there for him and that you want to understand. Also- tell him that you want to get to know his girlfriend. Would he bring her to the States?

I guarantee that if you change some of the dynamics of your relationship with him and begin to treat him differently, he will respond differently. It's tough, but you can do it.

Meg Meeker

The Emotional STD

Suicide is the third leading cause of death among young people ages 15 to 24.

AS A DOCTOR, I CAN PROBE, CULTURE, prescribe antibiotics, and aggressively treat and track contagious STDs. But depression is different. It’s more elusive, yet equally, if not more, dangerous. It can come and go, or it can settle in, making itself so comfortable in an adolescent’s psyche that it’s nearly impossible to extricate. There, just as many STDs do, depression causes permanent damage that may not become apparent for years. To many teenagers, depression can make them feel as though another entity has moved into their body, taking over everything they think, feel, and do.

For the thousands of teens I’ve treated and counseled, one of the major causes of depression is sex. I consider it an STD with effects as devastating as—if not more—HPV, chlymadia or any other.

Just ask any doctor, therapist, or teacher who works closely with teenagers and they’ll tell you: Teenage sexual activity routinely leads to emotional turmoil and psychological distress. Beginning in the 1970s, when the sexual revolution unleashed previously unheard-of sexual freedoms on college campuses across the country, physicians began seeing the results of this “freedom.” This new permissiveness, they said, often led to empty relationships, to feelings of self-contempt and worthlessness. All, of course, precursors to depression.

Teens are particularly vulnerable to the negative effects of early sexual experience because of the intense and confusing array of emotions they’re already experiencing. Adding sex to the picture only makes those feelings more intense and more confusing.

Like most STDs, depression remains hidden and underdiagnosed, even though its prevalence among our teenagers has skyrocketed in the past 25 years, paralleling the rise in STDs. We don’t know exact numbers because so many of its victims can’t put a name to their feelings, while too many adults pass off depressed behavior in teenagers as part of “normal adolescence.” Other teenagers are so depressed they lack the energy or desire to seek help. For while physical pain drives patients to physicians, emotional pain keeps them away.

SKYROCKETING RATES

Still, the numbers we do have on depression in teens are terrifying. According to Dr. John Graydon, professor of Psychiatry and Neurosciences at the University of Michigan, one in eight teenagers is clinically depressed and most teens’ depression goes undetected. Because the rates of completed suicides among adolescents have skyrocketed 200% in the past decade, suicide now ranks as the third leading cause of death in teenagers, behind accidents and homicides (both of which may involve depressed adolescents, who often drink and engage in violent behavior to anesthetize their depressed feelings).

Also frightening is the fact that teens today are more likely to succeed in killing themselves when they try. One study found that completed suicides among 10- to 14-year-olds increased 80% from 1976 to 1980 and 100% for 15- to 19-year-olds.From 1980 to 1997, the rate of suicide increased 11% in all 15- to 19-year-olds, 105% in African-American teen boys, and a startling 109% in 10- to 14-year-old children. Even more sobering is the fact that for every adolescent who succeeds in committing suicide, 50 to 100 attempt it. In fact, a 1995 study found that a staggering 33 out of every 100 high school and middle school students said they’d thought of killing themselves.

One-third of our adolescent population has thought of killing themselves!

This statistic terrifies me, as it does countless parents, teachers, and grandparents in the country. Indeed, many experts on adolescent suicide and psychiatric illness refer to this dramatic increase as “a national tragedy.”And I strongly believe, as do many of my colleagues, that the situation is much worse, that depression is highly underdiagnosed in teens. The bottom line is that depression has invaded millions of our teens. And that’s just what we see on the surface.

I believe even more strongly that there is a correlation between the explosion in sexual activity and the epidemics of STDs and depression in our teenagers. I know this because of what I’ve heard from the thousands of teens I’ve counseled over the past 20 years, and from my own experiences raising four children. What I hear and see is that sexual freedom causes most of them tremendous pain. Now, research is just beginning to show a correlation between teen sex and STDs. One study shows such a strong link between STDs and depression that the authors advised all physicians to screen every teen with an STD for depression. I go one step further—I screen all sexually active teens for depression, STD or not.

We already know that adults with STDs struggle with depression, guilt, and feelings of isolation and shame. And we know from several significant research studies that the breakup of teenage romantic relationships often leads to depression and alcohol abuse. One study of 8200 adolescents, ages 12 to 17, found that those involved in romantic relationships had significantly higher levels of depression than those not involved in romantic relationships. “Something about dating and dating relationships can be toxic to girls’ health,” says Susan Nolen-Hoeksema, Ph.D., a psychology professor at the University of Michigan in Ann Arbor, and an expert in adolescent depression.

DARLENE’S STORY

Consider Darlene, a 17-year-old patient of mine who sank into a deep depression after her first sexual encounter with her ex-boyfriend. I first met Darlene when her parents brought her in because they were concerned about her behavior. She came at their prompting, but also because she, too, felt she needed help. This is unusual. Most teens (even depressed ones) are dragged in by their parents; few come of their own accord.

During that first visit, I spoke with her and her parents together. Darlene said she preferred that her parents stay in the room at the beginning of our discussion. I was pleased about this, because that showed she had a healthy, open relationship with both of them.

I learned during that first appointment that Darlene had broken up with her boyfriend of two years because she felt, as she said, that she’d “outgrown the relationship.” After a one-month hiatus, she visited him on an impulse. They began talking and, “...before I knew what was happening, we were having sex.” Afterward, she said, she was furious with him, but even more angry at herself. I asked why she felt so angry at herself. She said she’d promised herself that she only wanted to have sex in a deeply felt, meaningful relationship, and that this encounter had happened without much thought or feeling, with someone she had already broken up with. She felt she’d let herself down. “And I didn’t even like him that much,” she said, crying. I was touched to see her father reach out and hold her hand.

At the time, Darlene had told her mother what happened, and together they went to a local pregnancy counseling center where a blood test confirmed she wasn’t pregnant. A few days later, she told her father what had happened and he, too, responded with great sensitivity and compassion. “My mom and dad have been incredible,” said Darlene. “I just don’t get why I’m so upset. They didn’t yell at me or anything. They’ve just been loving me. I can’t believe I was so stupid.”

But in the weeks after the incident, Darlene began withdrawing from both her parents and her friends. She became angry easily. She slept during the day and stayed up late at night—all unusual patterns of behavior for her. She even wanted to drop out of the basketball team, her favorite sport. When her parents saw Darlene’s behavior worsen rather than improve, they brought her in to see me.

During that first visit, I confirmed their suspicion that Darlene was seriously depressed. I hooked her up with a good counselor, but still saw her weekly for the next few months to make sure her depression was lifting. During these months, I realized that Darlene’s depression resulted from unresolved grief related to a deep sense of loss. Loss of her virginity, her self-respect, her parents’ respect, her sense of control over her behavior, and her commitment to herself. She felt so overwhelmed by these losses she didn’t know how to process them and bring them to resolution.

Even though her parents said they forgave her, she didn’t believe them. How could they forgive her when she couldn’t forgive herself?

Many advocates of sexual freedom among teens would argue that she was overreacting. They would say that her real problem was that she valued her virginity and her commitment to it too much. They would say that her parents set her up for depression because they didn’t teach her that sex is normal for kids her age. That if she would only accept this “reality,” she wouldn’t feel any real losses. Finally, they would insist she has nothing to forgive herself for, because she didn’t do anything wrong. And that this is a lesson her parents should have taught her.

But there’s no arguing with a person’s feelings. I believe Darlene’s feelings needed to be acknowledged by an adult whom she respected and to whom she listened. That’s exactly what her counselor, parents, and I did over the next months. We helped her recognize her losses, validate them, and grieve them one at a time. Then we worked to help her to forgive herself. As she resolved each loss and forgave herself, her depression lifted and her “normal” life returned.

Darlene was lucky. She got help before her depression dragged her down so deep she drowned in it. Millions of kids never get that help.

SEARCHING FOR PROOF

Given stories like Darlene’s, why doesn’t research yet exist linking depression to teenage sexual activity? Three reasons.

First, these twin epidemics have come upon us so quickly there simply hasn’t been time to conduct the studies. But I don’t need to wait for formal studies to affirm what I already see—and my observations are not isolated ones. At pediatric conferences many of my colleagues report the same thing: increased post-traumatic stress disorder in sexually active teens.

I also make the link between sex and depression when I look at our world today from a bird’s-eye view. Consider that life in the United States is relatively stable, with a historically high level of economic abundance. Why should our children be so depressed? And why should so many of them be thinking of killing themselves? Consider the words of Armand Nicholi, M.D., a professor of psychiatry at Harvard Medical School, and an expert on adolescent psychiatric problems: “When future historians study American culture,...they may find it perplexing and paradoxical that during an era of unprecedented leisure time and prosperity, millions of adolescents used psychoactive drugs to alter their feelings and to escape their environment. That each year, during an era of unprecedented openness and frank discussion of sexuality, hundreds of thousands of unmarried teenagers became pregnant and experienced an abortion; and that during an era of unprecedented scientific discovery and opportunity, thousand of adolescents both attempted suicide and succeeded in killing themselves.

Second, in order to conduct studies on the link between teen sex and depression, we would have to start with the hypothesis that, perhaps, indeed there is a link—something that many funding institutions are not willing to do because it opposes more liberal views about teen sex. It’s difficult, if not downright unpopular, today to take a stand that questions whether sexual freedom is good or bad for teenagers.

Third, there’s a great deal of money at stake. If solid research finds that sexual activity in teens leads to depression, it would force many businesses to take a hard look at advertising and the media in general. Businesses would need to look at how sex is used to sell products to the teen demographic group, which today has perhaps the largest buying influence in the history of our economy. To put it simply, the business of selling to teens relies on sexual messages.

We have more experts, more research, and more sophisticated antibiotics, antivirals, and antidepressants than ever before in the history of our country. We understand psychological illness, adolescent behavior, and parenting strategies, yet we’ve never had as many depressed teens and adolescents as we do today. Why is depression so rampant? Why is teen suicide exploding to the point that it’s called a national tragedy? Because our teenagers are hurting and are lonelier than ever before, and because so many stimuli encourage them to find solace for their loneliness and hurt through sex. This doesn’t take their hurt away, it only makes it worse.

SEX AND DEPRESSION

Sex and depression present a kind of chicken-and-egg conundrum. Studies find that kids who are depressed gravitate toward sex, since sex acts as a drug, numbing a hurt, filling a void, keeping their minds altered, if only for a moment. But sexual activity also leads to depression.

It’s important here to understand the psychological roots of depression. In teens, depression is a prolonged state of grieving. Normally, one goes through a series of stages in resolving grief: denial, bitterness, anger, sadness, and acceptance. But if, for some reason, you experience hurt or loss and you don’t go through this grieving process, depression can result.

For instance, a teenage boy may feel terrible sadness because he just broke up with his girlfriend, but he doesn’t allow himself to exhibit that sadness for fear that someone (mom or dad perhaps) will notice and make fun of him. Or an adolescent girl who had sex and now feels guilty and confused may not allow herself to acknowledge these emotions, pushing them deep inside where they fester into depression.

This refusal to grieve takes the form of an unpeeled onion. The outer layer is denial that there is any problem, loss, or hurt. This is the most visible layer, and is obvious when teenagers insist I’ve got them figured all wrong, that they aren’t depressed.

Beneath this layer of denial lies bitterness and anger. This anger stems from a sense of loss, and, as we’ll see later, there are numerous losses associated with sex. For instance, there is the loss of self-respect. Even if a teenager is mature enough to recognize this loss, if he doesn’t move past the stage of anger to sadness, where he can grieve this loss, he may become “stuck” in anger at himself.

Or a teenage girl may experience loneliness and a feeling of betrayal after a sexual relationship. If she fails to grieve those feelings properly, she may turn her hurt and anger inward, becoming “stuck” in persistent, unresolved anger and exhibiting harmful behavior, lashing out, stealing, engaging in self-destructive behavior (sex, drugs, alcohol). It may look like rage, but it is also depression.

One classic example of how kids turn this rage inward is the preponderance of body piercing. Punching holes in intimate parts of their bodies, such as their lips, tongue, belly button, or even vagina, sends a message to the world: “I am hurting this intimate part of myself because I don’t like who I am.” When girls pierce the sexual parts of their bodies, their labia and nipples (some so severely they’ll never be able to nurse a baby), they’re saying: “I am cutting on my womanhood. This is anger turned upon the self.”

Beneath this anger often lies sadness. It’s much safer and easier to feel the anger, I tell teens, than it is to feel this sadness. Anger lets energy out, whereas sadness only consumes energy. When you’re sad, you want to be comforted, and too many teens have no one to comfort them. So they keep their sadness to themselves. The hurt stays like a crusted-over abscess on their hearts. Then they become angry with themselves because they’re sad (irrational, yes, but this is teenager thinking), and angry with their family and friends because no one will help them get rid of their sadness or their anger.

At the center of this onion of depression is a hole—the empty space left when that which was so precious and prized is taken away. And, as you’ll see, much is lost when teenagers have sex before they’re ready. These losses are substantial, and can be devastating to the teenage soul.

Loss of self-respect. While many teenage boys claim sex is fun, just as many admit (if given the opportunity) that they lose respect for themselves after a sexual encounter. Some may boast about their sexual exploits and appear on the outside to have gained self-confidence. But others admit to me in private that something changed inside them after they started having sex. They have less self-respect, having given up their sexual intimacy to someone they didn’t care deeply about. Many also struggle with the feeling of loss of control during sex—control of their emotions and control of their bodies. Some teens become annoyed with their female partners for having so much influence over their emotions. Other boys don’t like losing physical control of their bodies during orgasm. Experiencing an orgasm may be embarrassing, particularly if they don’t know the girl well. She may make fun of his penis or ejaculate, or they’re left open to criticism for premature ejaculation, which can be emotionally traumatic. With one disgusted look, a girl has the power to slice his manhood in two. This can have devastating effects on teenage boys, who need a healthy view of their masculinity.

Girls have the potential to feel an even greater loss of self-respect. Part of the problem is that American girls are at times poorly versed in setting physical boundaries. They’ve at times failed to learn to protect their bodies. They’re encouraged to expose every inch of skin they can get away with (think Britney Spears). In doing so, girls are taught that their bodies are not worth protecting. Self-respect issues arise when a girl feels that she’s surrendered control of her body to her sexual partner. If her partner fails to receive what she gives with the respect and awe it deserves, she feels hurt, disappointed, embarrassed, and cheated. When she turns these feelings inward upon herself, the end result is depression.

Loss of virginity. I believe that protecting one’s virginity is hard-wired into our psyches, much as self-preservation is. We don’t train ourselves to respond this way, we are born with it; it’s part of our “fight or flight” response. I believe that preserving our virginity is one part of what we are naturally conditioned to protect, because I have witnessed hundreds of teens grieve the loss of their virginity. Intuitively they know that their virginity is something special. It is private and it is deep.

Proof of the unique and valuable nature of one’s virginity can be seen in kids who are sexually abused. Every young child, adolescent, and teen I have cared for who has been sexually abused hates talking about it. Psychologists and psychiatrists universally accept the fact that most kids who have been sexually abused won’t readily admit that sexual violation has occurred. Teens will admit when their feelings have been hurt or if they have been physically hit, but they don’t want to admit to sexual violation. Why? Because their virginity and their sexuality are separate from their feelings or their bodies. Virginity is more special.

Think about this for a moment. If a girl didn’t value her virginity highly or feel that it was unique, why wouldn’t she openly discuss it? The very fact that something extremely precious has been taken away or violated is one of the reasons kids of all ages keep sexual abuse a deep, dark secret. And the fact that lifelong pain ensues when sexual boundaries are crossed, or when virginity is wrenched from a child in a manner that makes her feel helpless, gives testimony to the incredible value of virginity.

Some might argue that losing one’s virginity voluntarily, as with teen sex, falls in a different category. Certainly it does. But the inherent value of virginity remains the same. If a teen surrenders it voluntarily, she knows that she has given a part of herself that occupies a place of extraordinary prominence in her being. So even when a teen surrenders virginity voluntarily, the loss is still great. And it is still deep.

Finally, many teens want to protect their sexual innocence. This desire stems from a natural one to keep oneself separate, to erect healthy boundaries around one’s body. Teens want privacy—private conversations, private thoughts, private behaviors. This is natural and it is intuitive. So, too, is their sense of privacy surrounding their sexuality. And at the core of this sexuality is their virginity.

But in the midst of the flood of sexualized messages from media, this natural mechanism of privacy preservation is broken down. These media messages train teens to tear down healthy boundaries to their privacy, their sexuality, and their virginity. This can cause tremendous distress and even depression for teens.

Loss of trust. Unless teens have sexual encounters strictly as a form of “fun,” it’s quite possible they may lose trust in their partners. They may begin sex because it is fun, but realize afterward that it involves much more serious feelings than they anticipated. For whenever teenagers expose private parts of themselves (emotionally or physically) during sex, they are exhibiting great trust in their partner. If this results in a pleasant experience, their trust grows, but if it ends badly, their trust is destroyed.

For instance, during sex, a boy may tell a girl she’s lousy, fat, or inexperienced. When this happens, her trust in him that he will make a very serious encounter “safe” is destroyed. Trust is also harmed when teenagers spontaneously end sexual relationships for seemingly no reason, or when they see their partners moving on to other sexual relationships. Or when they hear gossip in the halls about private moments they shared with another.

This loss of trust after the intimate experience of sex can be emotionally devastating. Think about it. Teenagers often seek out sex because they need another person to respond to them consistently, with positive feedback. Take the teenage boy, for instance, who is athletically clumsy, perhaps kind of nerdy. He hesitates to let even his parents see his real feelings because he fears they will ridicule him. He tries to protect himself (quite reasonably) by staying quiet. But he desperately wants and needs to know if he’s got a normal masculinity.

The best way to find out, he reasons, is to have sex with a girl. So he tries it. When he does, he is, in essence, “showing” her his masculinity, strutting before her like a male robin preens and struts before his mate. When she fails to applaud him for his sexual prowess, the shape of his body, etc., then the trust he placed in her is lost. She blew it, just like all the rest, not giving him what he needed, letting him down. Since he’s so egocentric, he reasons that the problem must be with him, not with her. Since she let him down, he really is a jerk and a nerd. He pushes those feelings deep inside him, where they fester, leading to depression.

Loss of expectations. As seasoned researcher and psychiatrist Helene Deutsch wrote in the 1960s, when the sexual revolution was just taking off, adolescents “suffer from emotional deprivation and a kind of deadening as a result of their so-called free and unlimited sexual excitement...the spasmodic search for methods by which to increase the pleasure of the sexual experience indicates unmistakably that the sexual freedom of our adolescents does not provide the ecstatic element that is inherent—or should be—in one of the most gratifying human experiences.” Once they find the sexual experience doesn’t meet their expectations, she goes on to say, teens all too often turn to drugs and show an increasing interest “in sexual perversions,” resulting in what she refers to as the rise of “psychological disaster” in teens.

I call it the result of smashed expectations. For quite often, teenagers build up the sexual experience in their minds, expecting it will fill their emptiness while meeting their needs for love and acceptance and belonging. For instance, teens often use sex as a way to fill the void of loneliness that results from a broken family. All too often, however, those expectations are never met, leaving teens with a grinding emptiness, resulting in frustration, agitation, and depression.

I saw this happen to Andrew when he was 16. He’d been my patient for several years. His mother brought him in because she suspected he was depressed. His grades had dropped and he didn’t want to go to school. Andrew was a talented artist, and his mother noticed that the drawings scattered around his bedroom had dark and gruesome themes. As I began treating Andrew for his depression, he revealed that ever since his father left the family when he was 6, he worried about his mother. “She cries a lot,” he said, and this upset him terribly.

His father was basically absent, and his refusal to send Andrew’s mother money to help pay for his clothes, books, and expenses also upset the boy. Sometimes the father called, sometimes he didn’t. Andrew never knew what to expect. “I just wish my dad would disappear for good,” he said angrily, fighting back tears. The relationship, such that it was, just hurt too much.

When he was 11, Andrew said, an older boy had raped him. The experience left him confused, embarrassed, ashamed, and too afraid to tell anyone. After that, he said, he distanced himself from other boys, preferring the company of girls. At 14, he began having casual sex with girls. “I needed to figure myself out,” he said. Was he gay or was he straight?

But I could see past that. I knew that by having sex with girls, Andrew was really trying to find acceptance of his masculinity, relief from his loneliness, and, quite simply, some love and affection. It was so obvious to me, because when he described what he wanted from sex, he suddenly jumped to talking and crying about his father. About how he was never around. About how disappointed his father must be in him, because otherwise his dad would come around more. Now he was sobbing about how desperately he wanted his dad. His body language regressed, he drew his knees to his chest and hugged them. Then he began asking me over and over why his father did that. “Did what?” I asked.

“Why did he hurt us so bad? What did I do wrong? Why did he leave us?” Suddenly I realized that Andrew was back in his house watching his father pack his things and leave. The tears and facial expressions made me understand that he was in excruciating pain. There it was. The center of the onion of depression, the layers peeled away. He wanted his dad back. He wanted his hugs, his voice, his affirmation that he, Andrew, was okay. Sex, in his mind, was a way to get those things he’d never received from his father.

But sex never delivered. It only made him crazy and eventually depressed. Why? Because Andrew lives in a culture that teaches him that sex is pleasurable, exciting, and full of promise. But the reality is vastly different. In my experience, it’s far more disappointing and frustrating to teens than it is pleasurable. In fact, I’ve asked hundreds of teenage girls whether or not they like having sex, and I can count on one hand those who said they did. Once they confront their smashed expectations, many teenagers feel something is wrong—not with sex itself, but with themselves. So they try harder to make sex “work,” to make sex provide those things they think it should: intimacy, love, trust, acceptance, appreciation of their masculinity or femininity, relief from their loneliness. When it doesn’t work, millions of teenagers, like Andrew, assume something is wrong with them, and turn their anger and hurt inward, resulting in depression.

Andrew was able eventually to understand his feelings and his behavior better. The process took several months, but he learned that sex couldn’t give him what he needed from his dad. To the contrary, it only crushed his sense of self-respect and self-worth. But he also learned he could work on developing good male friendships to alleviate his loneliness. When that happened, he found his sexual desire diminished. He still wanted it, he said, but he didn’t “need” it. He was experiencing healthy sexual desire outside of emotional voids.

Freud called this cycle repetition/compulsion, in which we repeatedly return to certain behaviors such as sex, drugs, or drinking to get something that continually eludes us. When we feel empty, we return to a place in which we hope to find some relief or satiation of our desires or needs. Even when our behavior fails to satisfy those needs, we return again and again, trying harder to find what doesn’t exist.

This is what teenagers often do, turn again and again to sex, hoping to find something that doesn’t exist, sinking deeper and deeper into depression.

THE SPECIAL LOSS OF DIVORCE

One of the greatest losses our teenagers feel is the loss inherent in divorce. When parents divorce, children experience both the physical loss of a parent and the concurrent feelings of abandonment and lack of control. Some teens can handle the death of a parent better than they do a divorce. At least, they rationalize, there is no choice in death.

As I’ve seen in my practice time and time again, divorce loss often propels kids into early sex. Let me explain.

We’ve seen this situation feebly played out on television countless times: Teens feel a large, undue responsibility for the divorce of their parents. It matters not how many times their parents reassure the teen that he or she is not responsible for the divorce. It’s part of how a teen’s mind works. A teenager’s own adolescent self-centeredness and sense of power will negate rational thought, leaving him with pure emotion. As these losses accumulate, some require serious grieving.

Teens who have a good support system and a strong sense of connection with their parents or other adults are able to grieve losses to resolution. They allow themselves to feel their sadness, anger, and hurt, and even talk about them to friends and adults if they believe that their feelings will be respected.

Healthy parents are crucial to this process. We are the ones who provide the safe environment in which teens can feel and resolve their emotions. We need to be on the lookout for losses that occur in our children’s lives so we can help them work through loss and resolve their hurt feelings.

But too often, teens suppress their emotions because they are simply too afraid to let them show at home. As children in our society grow into adolescence, they experience the loss of a sense of being protected, loved, and cared for.

Let’s face it, too many teens are ignored in our culture. Within their own community, it seems everyone is too busy for them. Sometimes their doctor barely has time to talk to them; often both parents work and are too tired to talk when they come home; teachers are stretched thin by overcrowded classes; and psychiatrists have three-month waiting lists. I believe this generation of teens is the loneliest generation in the history of our country. Some parents push them away with the excuse that their kids need to become independent and world-savvy, when, in fact, parents just want their own lives. Kids require energy and patience, which many parents are often too tired to provide.

Too often, kids have no one with whom to figure out life, no one with whom to communicate their anger, sadness, or even the emptiness that life can bring. For teens to acknowledge that they never felt genuinely loved, never experienced healthy intimacy with a parent, and that no one of significance in their life really values them, would cause their world to cave in. Thus, they stuff it. They get stuck in depression. The onion stays unpeeled, an abscess at the center of their soul, waiting quietly for someone to prick it open and drain it.

That’s when teens turn to sex, an action that relieves the momentary isolation, but which often leads to more loss in an endless cycle of emotional angst.

THE TRIUMVIRATE OF DEPRESSION

When I counsel teens who are depressed, I try to help them view themselves as whole people who have three dimensions—physical, psychological, and spiritual. I often explain that depression may start in one dimension and then spread to another.

The physical roots of depression generally stem from low levels of various neurochemicals, such as dopamine, norepinephrine, and serotonin. These chemicals play critical roles in the areas of energy, emotions, sensations, and cognition. Nerve endings in the brain release these chemicals, also called neurotransmitters, and they circulate throughout brain tissue until other nerve endings take them back up, similar to the way you suck up soda through a straw. If they aren’t released in sufficient amounts, or are taken up too quickly before the brain has a chance to use them, depression can result.

I try to explain to teens that these physiological changes are completely real and completely out of their control. Just as someone with diabetes suffers from low levels of insulin, those with depression have altered levels of neurochemicals. No one asks for diabetes, no one asks for depression. Sometimes it just happens.

Serious depression can be caused by these imbalances, and for these types of illnesses, drug therapy is often the answer. But for the majority of physically healthy teens, this is not the cause. And unless I see clear signs of acute, long-term depression, we don’t go the drug route.

The second dimension I talk about is the psychological, which I described earlier as “peeling back the onion.” It’s the layers of our subconscious, and as they emerge, these layers define who we are. In the case of depression, our psychological well-being depends greatly on how we handle denial, bitterness, anger, and other emotions as we move toward acceptance of difficult losses. This, as you’ve likely noticed, is a big part of the counseling I do.

What I haven’t talked about yet is the spiritual component. I believe that addressing spirituality for teens is good medicine. And I address it here because the depression that comes from the losses teens feel that are associated with sex are similar to those associated with spirituality. In other words, sex is a spiritual experience.

SPIRITUALITY AND DEPRESSION

Teaching teens that there is a dimension of life that we cannot see is easy. Intuitively, they get it. They know that they are deeper than just flesh and bones, and they appreciate it when an adult affirms this. In fact, one of the most delightful aspects of talking with teens is hearing them develop deeper and more abstract thinking. They wonder out loud about the meaning of life and the existence of God. When I ask them about spiritual issues, most love talking about it. It makes them feel smart and adultlike. So I probe and ask questions and they open up.

Most teens admit they believe in a god, either because of upbringing at home or through their church. They have an involvement, a relationship with a “Father above.” Teenagers like the idea of being able to trust in a higher being when they experience difficulty doing things on their own. God becomes their safety net, their power source, the one who takes over when they mess up. I’ve treated many really troubled teens who straightened out their lives and discovered and developed an abiding relationship with God, in whatever way each individual teen perceives this.

But teens who have a vibrant relationship with their God then turn away from it, in response to loss, anger, or hopelessness, for instance, often fall into depression. Philosophers and scholars call this a “spiritual depression.” The teenager recognizes that something important is spurned and is now lost to them. As with other losses, their failure to grieve, or to renew this spiritual relationship, causes them pain. As a physician caring for the entire patient, I must be sensitive to a patient’s perceptions of the world in which they live, how they view the workings of that world, how this creates their own type of religion, and how this all makes sense in their relationship with God. Then, I must be able to help repair those losses if I can. Often, I’ll suggest that teens get counseling not just from psychologists, but also from family and religious leaders.

Many teens describe sex as being spiritual. I agree with them. Sex is sacred and something extraordinary, during which a connection occurs beyond human comprehension. If they believe this is true, then sex indeed is something to be protected and cherished because it affects the spiritual dimension of their lives. Thus, when sex goes awry (or causes pain), that pain affects their spiritual life.

UNCOVERING DEPRESSION IN TEENS

Many healthy, normal teens will experience one or more episodes of brief depression during their adolescence. This happens for a number of reasons, including hormonal fluctuations, major life changes, and small and large losses. Understanding what happens during adolescence (as described in Chapter 10) will help you recognize normal changes in your teens as they occur, and become aware when something is really wrong. For while healthy, emotional upheaval in a teen can mimic depression, there are some major differences you should be on the lookout for.

Age-inappropriate behavior. It’s normal for teenagers to act their appropriate age one day, then act years younger the next, then swerve back again. But when a teenager’s behavior regresses and stays regressed for two or more weeks, there’s cause for concern. For instance, a teen who normally likes going out in the evenings with friends, but stops, instead heading to bed early, may be depressed. Sometimes, depressed teens may even ask to sleep with their parents, particularly if they are experiencing anxiety. This is particularly common in girls who have been sexually assaulted or raped. They’re seeking safety, but they’re also exhibiting regressive behavior.

Emotional outbursts. As teenagers’ hormones fluctuate wildly, it’s normal to see occasional emotional outbursts and temper tantrums. These episodes may last a few days, then suddenly disappear. But depressed teens become angrier and angrier, and show more frequent outbursts that don’t go away. They consistently erupt over small things, becoming irrationally angry and viewing the world only in black and white terms. For instance, while a healthy teen might argue with a sibling over sharing clothes, fighting only for a few minutes, a depressed teen might start crying, screaming, and even flailing her arms and legs. She might devise a scheme to retaliate later on and physically hurt her sibling, clearly displaying anger disproportionate to the conflict.

Sinking self-esteem. It’s normal for a teenager’s self-esteem to drop in early adolescence as they leave behind what they know (childish ways of thinking and acting) and venture into new, unknown areas. They want to behave like grown-ups and think like older teens, but they don’t have a clue how to do that. So they feel insecure because they don’t know who they are or where they’re headed. But as maturity sets in and teens recognize new strengths, they begin liking themselves again and their self-esteem rises. Depressed teens, on the other hand, never like who they are. They see themselves through the dark glasses of depression, and feel negative about everything they think, feel, and do—most particularly, about themselves.

Frequent shifts in friends. Normally, teenagers expand their circle of friends and are part of one, two, or three groups. Although they may leave some friendships behind, they typically carry a few good ones forward while making new friends who have different interests and qualities. But when teens are depressed, they often completely cut their ties with old friends while forging relationships with kids they’d never have been interested in a few months earlier. This sudden transition to completely new friends is a sign of trouble.

Everyday changes. Other warning signs for depression include changes in eating patterns (lack of interest in food, or constant eating), changes in sleep patterns (never sleeping or sleeping all the time), and consistent changes in clothing and grooming styles, including tattooing and body piercing.

Actually, one of the best ways to determine whether your teenager is depressed is to simply ask. Kids who are really hurting, those who feel engulfed in a black cloud, yet who have a decent relationship with you, will tell you how they’re feeling.

Like the cute 17-year-old who came into my office recently for a checkup and cheerfully chattered on about her involvement in sports, choir, and a host of other activities. When I asked if she felt happy about life in general, however, she burst into tears.

For the next ten minutes, she sobbed out the fact that for the past several months she’d been worried that she might be seriously depressed. She’d seen an advertisement on television for an antidepressant medication, she said, and when the announcer read out the symptoms of depression, she realized she experienced every one. We talked for a while and she was clearly relieved by our conversation. As it turned out, she’d been experiencing a mild form of depression that didn’t require medication. Simply talking it out was enough.

This is common in teenagers. I’ve found that teens love talking about themselves and their feelings if they genuinely believe that you can offer them some relief.

So, if you’re ever worried that something is wrong with your son or daughter, start by asking. You’ll be amazed. They may just start talking. And that’s when you need to listen.