The Saint-Thomas d’Aquin high school in Saint-Jean-de-Luz “is trying to resume normal life” this Friday, February 24, two days after the death of a Spanish teacher killed by a student who was charged with murder and remanded in custody. He will be imprisoned “in a place whose destination must be kept confidential”, indicated his lawyer Me Thierry Sagardoytho. “It’s an establishment that will take into account both its youth, and the care it needs.”
According to the prosecutor, the boy “put forward a small voice that speaks to him […]who incites him to do evil and who would have suggested to him the day before to commit an assassination”. He nevertheless considered that in the current state of the investigations, the minor “appeared accessible to criminal responsibility”. Because if a first psychiatric examination revealed “a form of reactive anxiety which could disturb his discernment” and “elements of depression”, “no mental illness such as schizophrenia, manic state, melancholy or mental retardation, nor acute psychiatric decompensation” were detected at this time.
L’Express: In the drama of Saint-Jean-de-Luz, where a young man stabbed a female teacher in class, the prosecutor evoked a context of depression, with a suicide attempt, the taking of antidepressants but also the fact that this young person said “hearing voices”. However, the expert who examined him found no mental illness. Does adolescence represent a particular period with regard to these pathologies?
Professor Antoine Pelissolo: It is always very complicated to give diagnoses at these ages. Any disturbances can be very momentary, and everything can change very quickly. Hearing voices is obviously not at all trivial, we think of auditory hallucinations or a syndrome called “mental automatism”, which presents an alteration of thought and identity, with delirious flashes, verbal hallucinations, and psychotic symptoms. But it is obviously very special. Sometimes, children or teenagers can present perceptions which resemble small voices, but it is not that which can explain a passage to the act.
Be that as it may, in general, there are really very few diagnoses in adolescents faced with this type of symptom. They can be the sign of entry into schizophrenia, or into bipolar disorder, or even nothing at all if the crisis turns out to be temporary. Most often, we have no certainty, and we can be mistaken, because the symptoms that appear at this age do not allow us to direct towards one pathology rather than another, and they can also disappear on their own with the weather.
In general, are there nevertheless early signs that can alert those around you?
In at least half of the cases, we observe prodromes, that is to say behaviors which, in retrospect, are considered to correspond to a certain dysfunction. The problem is that these symptoms are very common. It can be stress, anxiety, depression, social withdrawal, estrangement from others or sometimes even quirks of attitude or talk. At that age, all of this is fairly commonplace, so it’s difficult to be able to say for sure that it’s something serious. But fortunately, any anxiety or depressive disorder at these ages does not lead to serious pathologies or acting out.
Identifying these disorders remains essential, however, because even if there is no progression towards a severe mental illness, they show suffering to which an answer should be provided. Hence also the importance of screening and support for these children and adolescents.
But the means are lacking for this…
They are of course very insufficient. Today, the parents tell us that there is a year of waiting to make an appointment in a psychiatric center! This screening can also be carried out in first intention by general practitioners or school medicine. But we can clearly see that at each level there are bottlenecks. There are too few doctors, nurses and psychologists in schools. Teachers regularly tell us that they see students in difficulty: they spot them, but then they don’t know where to direct them. Solutions are limited.
And for two or three years, the difficulties have increased a lot: the frequency of suicide attempts has doubled, 20 to 30% of young people have depressive symptoms, compared to 10% to 15% before the health crisis. There has been a major increase in suffering since the Covid, and unfortunately it continues when we could have hoped for an improvement now that the worst of the crisis is over.
Indeed, the crisis seems behind us, at least for the moment, but despite everything you still make the link with the Covid?
Absolutely because with the pandemic, there may have been a lot of ruptures, disrupted projects, changes in social ties, difficulties in families. And other crises have been added. We therefore have before us a generation weakened by the accumulation of numerous problems.
Can this background of malaise also lead at one time or another to an increase in psychotic disorders?
These are two quite different things. So I don’t think we’re going to see an increase in these unrest beyond what we might expect outside of any pandemic context. This is not what will create the disease. However, the accumulation of stress factors in the broad sense can be a trigger for psychotic disorders in people who present a prior vulnerability to these pathologies, and who would have decompensated anyway at one time or another. For example due to an additional difficulty, or the consumption of cannabis or other drugs.
On the other hand, this context specific to the increase in psychological suffering that we are witnessing can lead to other consequences, depressions, addictions, which must be taken into account.
Is this tragedy, in Saint-Jean-de-Luz, likely to push the authorities to put resources back into the mental health of young people?
It is truly regrettable to have to rely on such dramatic cases in order to be able to talk about these subjects. And unfortunately, I’m quite pessimistic: beyond the emotional impact, we know that really significant investments would be needed, and the political will isn’t there yet. So I’m afraid that once the news is exhausted, the subject will once again be postponed.