Suspended Sentence

by Janice Morgan

  Part of this was regular teen angst, but there was another angle to it, a class identity angle. Instead of seeing his move to the city as one expanding his worldview—and his options—Dylan saw this move to a rental house in Berea a lot like the divorce, as a further sign of his life being disrupted, of him falling into a déclassé zone. Our house in Kentucky had been far from fancy, but it was new and special in a way the rental house in Berea wasn’t. To him, living in the older suburb seemed like a big step down. He hadn’t had the chance yet to see how the northern lake city of Cleveland would reinvent itself, how the derelict downtown would be transformed into interesting new museums, markets, nightspots, parks, refurbished neighborhoods. All that was still to come. At age fifteen, Dylan could only adapt to his changed circumstances as he saw them, but he was resisting, too. Inside, he maintained a solid nostalgia for Croftburg.

  During that year in Berea, moments of open conflict erupted between Dylan and his dad, the same as I’d experienced. Mike caught Dylan smoking weed and came down on him about it. Dylan exploded; for him, marijuana was the way he was keeping himself under control. Who was his dad—or anyone else—to tell him otherwise? Sure, it was illegal, but he knew there were plenty of people working their way around that one. Then came one nasty incident when Mike “got in his way.” Mike told me about it. He’d had to confront Dylan about smoking a joint or some other infraction. Dylan lost it. He picked up his dad’s CD player and crashed it on the floor, then he crossed over to where his dad was standing and pushed him roughly backward, where he hit his head against a wall. When, not surprisingly, Mike received a cut on his head, Dylan immediately apologized and helped him with the wound. After the dust settled, Mike had to work out a plan for Dylan to contribute toward replacing the broken CD player—more computer tutorials downstairs to earn the money. It wasn’t unusual for the teen to take his anger out on objects: over the years, he’d graduated from busting up pencils to more significant objects like trophies, answering machines, phones, lamps, car door handles, chairs. This latest incident, though, was a frightening example of how Dylan’s explosions could physically harm one of us. It could have been me; it could have been a teacher or any authority figure telling him he couldn’t do what he wanted to.

  Mike now knew what I’d discovered. This was a fractious kid who was getting seriously out of control. Somehow, he’d have to be reined in or he’d be in jail. Mike took Dylan to counselors; Dylan agreed to attend anger-management classes. They discussed thoroughly his need to manage his white-hot temper. What amazes me now is that no one suggested that he get a mental health review. In 2002, such reviews for teens were not common. Who suspected that this oppositional behavior might be caused by an insidious illness called bipolar disorder? Instead, people talked about “bad” kids and “good” kids. Behavior problems were cases of “flawed” character, bad parenting, or both. As a parent, if your kid “acted up,” you applied “tough love”—that and maybe a strong dose of Ritalin—then popped some tranquilizers for yourself.

  Toward spring, Mike and I both wondered if Dylan’s underlying anger was due, at least in part, to the Big Move to Cleveland. His dad took him to counseling sessions, tried to work with him, asked him about the next school year. How did he want things to go? It came out that Dylan wanted more than anything to return to his hometown. Mike thought hard; it was not an easy proposition. Dylan had three more years of high school left. Yet if Dylan felt more positive, things would go more smoothly. Perhaps he could consider moving back to Croftburg, renting a house there. Dylan would be back with his old friends, back on familiar turf. His mom was there and could help out. Would it be worth the sacrifice for him? Mike didn’t know but was willing to try. He asked me to help him locate a suitable house. Late that summer, they moved in, just in time for another school year at the local high school.

  At first, the move back appeared to be a wise decision. Once again, Dylan had his regular pal, Lonnie—the nice one—to do things with, girls once again calling at all hours. He was doing his schoolwork, maintaining his curfew, doing chores. Things seemed in balance, more or less, as far as we could expect with a moody, difficult teen. Both of us parents attended regular counseling sessions with Dylan. In the counselor’s office, everything seemed so manageable. Mr. Evans had a good rapport with Dylan, could take things in stride, break down a contentious area, and suggest ways for us to reach a compromise. I remember thinking, “I bet this will work out.” But not for long. During that first fall of tenth grade, several incidents occurred, ones that were far more serious than anything else that had yet happened.

  One evening, Mike called me over to their place because Dylan was late for curfew (again), and he wanted us to have a three-way talk. Not long after I arrived, Dylan came in, feeling fine—too fine, in fact. He was stoned out of his mind—eyes glazed over, words slurring in the simplest of sentences. We grounded him, talked to him, but I’m not sure anything got through that night. On other occasions, though, he could still be perfectly calm and reasonable. Between scenes like this, we could still go out and have dinner together with good communication. At times, Dylan could be perfectly self-reflective. What he said, though, was disturbing.

  He talked about feeling anxious, feeling sometimes depressed, like he couldn’t do what he needed to at school because he couldn’t focus. He talked, too, about having racing thoughts—sometimes he couldn’t slow down what was going on in his head. In late October, Mike took him to see a doctor who prescribed the antidepressant Lexapro, which Dylan started taking every day. In return, Dylan agreed to give up marijuana. In general, though, he made light of any problems. Mike and I were worried but remained optimistic. Truth is, we were confused; we had no explanations. We didn’t know what it was, exactly, that we were up against. There were still good days, too, and it always seemed that there was one more option we could try to stabilize the situation.

  During the fateful months of November and December, within only a few short weeks, Dylan managed to accumulate several charges. First came the fourth-degree assault charge brought by another boy’s parents after a school fight. According to Dylan, it all started when a kid misinterpreted something he’d said in the lunchroom and punched him. We told him we were glad he’d restrained himself and hadn’t punched back. The situation seemed to calm down over the weekend, but the following Monday morning, as soon as Dylan saw the boy again, his rage flared and he retaliated. Another fight ensued, along with an assault charge. A week later, Dylan shoplifted a pair of shoes by walking out in them after trying them on (which he agreed was a completely stupid thing to do). Not long after, he was charged with possession of marijuana and a glass pipe when an officer stopped a vehicle in which he was a passenger. In yet another incident, he got into an altercation with some other boys at Lonnie’s house when he was taking down a tent they’d been camping in, which resulted in the police being called. Riled up, Dylan was in no shape to talk calmly to the officer and answer questions. Instead, he became confrontational and did the unthinkable. He actually fought with the first officer, and it took two other officers arriving on the scene to subdue him. Of course, he was charged with resisting arrest. When his pockets were searched, the police found a pocketknife and some pills. By now, Dylan was getting a reputation with the city police. They learned never to approach him alone.

  In the last, decisive incident, Mike, Dylan, and I were having an evening together in December. I was visiting because Dylan had just turned sixteen. He and I were sitting at the computer together, discussing which songs to burn onto a gift CD for Christmas. The next thing I knew, Mike and Dylan were in the kitchen, and an argument was flaring. Mike asked me to come, and I could see that Dylan was in a rage. I found out later that it all had to do with Dylan horsing around, but it was too forceful for his dad. The efforts Mike made to ward him off made Dylan see red. Coming into the kitchen, I tried talking to him to get to calm down, but it soon became clear that wasn’t going to happen. Instead, his rage escalated.
I was genuinely scared of impending violence and called 911. I didn’t even speak, just held the phone. The dispatcher could hear the shouting, the threats pouring out. Dylan was using his imposing physical strength to push his dad into a corner.

  Before long, three or four policemen were knocking on the door. They knew all too well who they were dealing with by now. His dad and I watched in stunned horror as the officers loomed over him. We were afraid that, though vastly outnumbered, he would fight them—but thank God, even in his anger he must have had some shred of rationality telling him it was impossible to resist this time. I still remember that as they handcuffed him and led him away, he suddenly looked so alone and fearful of what would happen. He actually called out for his dad, as if he were a little kid again. Things had turned radically wrong—and it happened in just a few seconds. Such confusion and anguish for all of us! We didn’t know what to do; it was devastating. Dylan was on his way to jail and then to the juvenile detention center in a neighboring city. This was the last straw.

  In Juvenile Court, the judge in our county ordered a psychological screening for mental health issues. “It’s unusual for a young person to have this many charges in one month,” she said. No kidding! I was given a list of psychologists to consult. Since it was very near Christmas by now, Mike had returned to Cleveland to be with Linda and the rest of his family up there. Now the ball was back in my court. We had until January 5 to get some results to show the judge. I spoke on the phone with my dad in North Carolina, who encouraged me to seek the best specialist I could find. He would pay. I made an appointment with Dr. Barnard, juvenile and forensic psychologist at Vanderbilt Medical Center. Then I made special arrangements with the court to pick up my son from the detention center at 5:00 a.m. before driving two and a half hours to Nashville. We had just one day to have the screening, then I’d drive him back. Dylan was quiet for most of the trip, probably still half asleep. I remember his face when we were both having breakfast before our appointment at Vanderbilt. “I think I’ll always be in jail,” he said despondently. “I’ll always be locked up.” I told him no, it wasn’t always going to be that way. The information the doctor would give us was going to help. Meanwhile, I didn’t feel even half as confident as I tried to sound. Would this screening help or wouldn’t it?

  Later that same day, after a round of independent interviews and separate in-depth questionnaires, we received the first hint of a diagnosis. Dr. Barnard spoke to both of us individually, then together, and said that he was fairly sure that Dylan had all the signs of a disorder that he called cyclothymia. It’s an old word for a mood disorder; it could be something like pre-bipolar, specifically for an adolescent.It didn’t matter what you called it, he said; the term referred to a cluster of psychic phenomena that affect behavior. It was characterized by racing thoughts, quick changes of mood and energy level—the feeling that you were invincible and on top of the world for a while and then, a few days or maybe hours later, a sense that you were doomed and would always be depressed. Those patterns, which sounded so familiar, were part of the exaggerated mood shifting so characteristic of this psychic condition. There were also times when the person experienced fuzzy cognition, could barely think his way out of a cardboard box. Other times, thinking would be extraordinarily quick and focused. It was an intense, chaotic situation for a person to deal with.

  There would be biorhythmic disturbances, too—sleep was affected, for example. At times, a person with a mood disorder would need to sleep hours longer than usual; at other times, they could barely sleep at all. This also sounded familiar. In hearing this, I recalled how years ago, Dylan would have such trouble falling asleep sometimes, and then on those occasions when he woke up at night, he seemed so distressed and had great difficulty falling back to sleep afterward. Another symptom could be panic attacks, anxiety out of control—these could frequently occur along with this disorder, too. I could never understand where they came from. But Dr. Barnard pointed out that a person experiencing some psychic anxiety could, on occasion, feel like he was experiencing something much more physical, more intense, almost life-threatening, affecting breathing and heart rate. At times, the person could fear he was going to have a heart attack. I thought of the times Dylan had told me or his dad that he needed to go to the emergency room. We’d taken him there, too, because it was the only way to calm his distress. The doctors never found anything wrong, but just going through the check-up was a way of coping with the situation.

  The combination of all these symptoms could certainly make a person highly reactive, afraid first and foremost of losing control. Dr. Barnard quoted Hagop Akiskal’s article on pre-bipolar indicators in children and adolescents for us, stating that “intermittent intense emotionality” was one of the hallmarks, and under that rubric, “irritability that could degenerate into explosive anger” stood out for Dylan. This last part correlated with his recent episodes edging into violent behavior.

  Alone later that evening, I looked up more information on the internet. “Cyclothymia” didn’t sound too bad, but from what I could find online in late December 2003, “mood disorder” and “bipolar” did. Especially when I read about outcomes for people who had these disorders. Bipolar was designated as one of the most debilitating mental illnesses anyone could have because it affects emotions, energy levels, reasoning, impulses, and decisions. What part of your life would NOT be affected by those? Not to mention it was a lifelong condition. This illness impacted a person’s ability to hold a steady job, to have long-term meaningful relationships, and to keep personal finances in order. Reading more, I then came across the psychiatric term “co-morbidity.” The technical meaning is having two or more co-existing illnesses, a primary one and then another linked to it. For example, a mood disorder and anxiety, augmenting distress. Another typical combination would be a mood disorder and substance abuse leading to addiction. Today, the preferred term is “dual diagnosis,” but back then, the earlier word etched its skull and crossbones on me as I finally closed the internet pages for the night. Co-morbidity: how could anyone recover from that? Yet, Dr. Barnard had been calm; he was knowledgeable. He said there was no cure, but treatment was available. His counsel for us would come in a follow-up report.

  After putting together the results of the separate interviews (including a phone interview with Dylan’s dad) and the psychological survey questions all three of us answered, Dr. Barnard and his accompanying psychologist sent a full report to Mike and me several days later. We studied it with interest, and since Dr. Barnard invited our comments or corrections, we each sent those, too. I felt reassured by their professionalism. I spoke to Mike and my dad about what we’d learned. The written diagnosis didn’t sound nearly as frightening as what I’d read online. At least there was a name for this strange phenomenon we had been dealing with all along, not knowing what it was. A mood disorder. I believed that Dylan had always lived with this, but that in his teens, the condition had become much worse, much more pronounced. The diagnosis was scary but it was also, at the same time, a relief.

  I remember when Dr. Barnard spoke to Dylan and me after the consultation, he said not to put too much stock in a specific term. In an e-mail to us, he wrote that “psychiatric diagnoses are not cut in stone.” Nonetheless, data from the screening provided a better understanding of the cause for the behaviors—and a treatment. He expressed a hope that Dylan would get the help he needed to deal with his behaviors and his moods. Dr. Barnard’s final comment in his e-mail comforted all of us: “The main purpose of this report is to convey to the judge that Dylan has some significant (and treatable) mental health issues. Your main goal is for the judge to allow treatment to occur (whether it’s outpatient or residential) rather than place Dylan in a juvenile detention facility.” Amen!

  When I told my dad about Dr. Barnard’s report, he remained thoughtful. He hoped, too, that now that we had some kind of professional diagnosis, Dylan could receive the treatment he needed to regain his health and get his life b
ack in order. As we were talking, he made a comment: “All this makes me wonder how many other people who are locked up now in the prison system have some similar kind of mental illness.”

  Probably quite a few. During the time my son was detained in a juvenile detention center in Kentucky, an important study was being carried out by the national Office of Justice to find an answer to the very same question. Researchers visited a series of representative state and local jails as well as federal prisons from 2002 through 2004 to interview inmates about their mental health. The data was compiled in a written report, “Mental Health Problems of Prison and Jail Inmates,” from the Bureau of Justice Statistics, published in 2006. In it, more than half of all state, federal, and local jail inmates reported experiences within the twelve months prior to their arrest of what clinicians would consider mania, severe depression, anxiety, or a psychotic disorder. These self-reported symptoms aligned with criteria described in the then-current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The study also reported high levels of prior substance abuse within this same population of inmates with mental health problems—nearly 75%.

  Similar studies of youth in contact with the juvenile justice system during this period yielded comparable information. In 2007, the National Center for Mental Health and Juvenile Justice published a report stating that close to 70% of such adolescents had a diagnosable mental health disorder that hadn’t been found or treated yet. Of those, 20% had a disorder severe enough to impair their daily ability to function in social settings such as school. The underlying problem could be a psychiatric illness, or it could be a reaction to trauma or abuse that the child had suffered and needed help to surmount emotionally. Following the pattern of jailed adults, 60% of this population also had a co-occurring substance use disorder—their attempt to cope. Studies like these launched efforts to provide communities with a blueprint for policy changes. The goal was for youth with antisocial behaviors to be directed to mental health assessment and ongoing care before they got locked up for serious incidents. Needless to say, the challenge continues.