Writing on suicide, I have to write something on depression……Depression is the common cold of the therapy room… a densely entangled ball of wool. There exists after all, a whole Encyclopedia on depression (It is old, but yes, it does exist).
Here are some thoughts on depression in children. These are the things that I would look for to start out with, when I see a child. The youngest child whom I saw in practice, who was clearly depressed, was two and half years old. I have seen babies in public who look depressed, but I do not see children under two in my practice.
- Children are highly susceptible to the moods of their parents. Here is where fathers seem to have as big an influence as mothers. Moods, including depression and anxiety, are contagious. This truism, which we all now from experience (try living with a person with somber mood for a month, and see how you feel) , is often neglected when we reflect on children. Too often home atmosphere gets factored out of genetics. We know today that a gene is not a stand-alone act: A gene requires an environment to be triggered. One of the very first question that I would ask is, “Who else in this family is sad?”
2. The eyes of a parent and the tone of voice when they look at a child, the ways in which a child is touched, all these are live-giving or life-robbing forces. Irritation, criticism, longing, dread, sadness and dismissal – these are all purveyed through our senses. So is acceptance, gladness, enthusiasm, affirmation, challenge, joy, security.
3. From the age of nine, children are increasingly susceptible to the opinions of their peers. Tweens and adolescents have an intense need for peer friendships. To have this need met (really, it feels like an innate drive), is as vital as food and water to the human. Without it, we are cast out in limbo. Having no friends is being out in the darkness and the cold.
4. Depression in children, much like in adults, is linked to insufficient expressions of autonomy and competency that are being blocked in some way. Sometimes this is due to overprotection, sometimes to an authoritarian environment, sometimes simply to a collapse as a result of negligence. This means that trust in the self as a potential change agent as well as in significant adults to be able to help us, is broken.
5. On Coping well, or not coping: People who cope well, become problem-solving when in distress. Those who don’t become emotion-focused. Interesting finding this, especially at a time when so much emphasis is placed on emotions. The capacity to make a plan, is key to experiences of self-determination. Self-determination/Autonomy/ Competency these are all room-mates in the headspace of a resilient child (and adult). This is why both overprotection and authoritarianism are so harmful; they rob children of a multitude of experiences of self-discovery, that lead to competency.
And of course this is tricky: Children who get too much power too soon, are typically anxious. It is truly a matter of Goldilocks and the three bears: Not too much and not too little. I have written extensively about this in my previous blog on Will, Power and Motivation..
And by the way.. Children who are bullied are typically children who overreact to small slights. This sets them up for increasingly bigger slights.
Why do you all tease that child so much? “We can’t help it, he responds so well!” (Two boys, aged 11, in reaction to my question. This finding has been replicated in research).
6. Like adults, children with persistent low mood have repetitive negative thinking habits, with self-blame and feelings of inferiority topping the list. Once these thoughts become embedded, they take on a life of their own, affecting not only mood, but also physiology so that a downward spiral occurs, with e.g. lowering of Dopamine and vitamin D levels, making an upward curl increasingly impossible. If these thought patterns persists over time, bizarre thoughts begin to develop and a child moves into the psychiatric realm.
7. I wrote about the research findings on the influence of internet use on mood in my previous blog (Suicide and Children).
8. The death and absence of a parent or a sibling, child abuse (physical and emotional) , domestic violence, pathology in a parent, severe neglect ,and the stressors of poverty all take their toll.
The two and half year old:
His mother suffered from unresolved trauma and grief. As a child she had suffered serious, longterm trauma. This mother was a competent person who had risen above her circumstances. Yet, when her first child was born, this brought back all the horrific memories of her own childhood. She loved her baby, but at the same time was overwhelmed by it. She had coped until now by controlling and structuring her life in a disciplined and focused manner: As long as she was in control, she could control the past. Well, we all know, that there are few things in life as unpredictable and fluid as a baby. And the more you try to control a baby, the worse they can become. (That is, if they do not collapse; giving up exploration and resistance). So here we had a sad mother with a sad baby.
On the upside
The younger the child, the faster the restoration of joy can be. The simple act of a parent taking care of their own needs can free a child almost instantaneously.
Having adventures together (canoeing, sailing, hiking, camping, fishing, hunting), and finding interesting things to do (joining a museum club, building a shack in your back yard, sewing outfits for a doll, making picture books, baking scones), all these can make a significant difference in children’s lives. Much easier than with adults!
A child who is not popular at school, can gain enormously from doing well in an after school activity. Many a child has been saved by karate and music.
A note on finding a good Psychologist
It is of course important not to overreact to normal unhappiness in a child (see note on overreactions above!). It is normal to feel aggrieved if you are left out of a team, or have been on the receiving end of nastiness. Important is to be able to bounce back after a short period of time and to gain some skills in the process.
However, a persistent low mood, that does not seem to lift easily, with positive periods seeming to be short-lived, requires assistance. The same goes for withdrawal and aggression. Consistent aggression is as much as sign of depression in a child as is withdrawal. Now I immediately need to write that all of us who work in the field are familiar with ‘false brightness”. This is the child who is ‘always jolly’, who masks deep despair behind a mask of fake joy: It is typically the clown, the joker, the one who laughs too loud too often, who dismisses any negative feelings, hiding behind a mask of pretend happiness.
A good child psychologist will include parents in the process. Will help you to see and to understand and to respond in different ways. Will give you “homework” to do, will not pathologise your parenting, but help you to make sense of how you and your child can be different together as well as apart, so that life can be better for both of you.
For this is true: Without each one of us responding differently, no difference is possible.