What's the angle?
Beardslee is a psychiatrist in Boston, specializing in child psychiatry, who also teaches at Harvard. He views depression as a complex disease, like heart disease, that has many causes, risk factors, and treatment options. His book is steeped in the case histories of families where one or both parents have severe episodes of depression, and his advice is based mostly on the experience and research of his team at Boston Children's Hospital. His goal is to help the whole family deal with depression and come out stronger on the other side.
What causes depression?
In his section on the causes of depression, he describes depression from a biological and chemical point of view - trouble with neurotransmitters, like serotonin, in the brain; diminished blood flow in certain areas of the brain; oversecretion of hormones from the hypothalamic pituitary system (disturbance in the fight-or-flight response system). He doesn't say what causes these things.
How do you treat depression?
With all available resources! And keep trying until you find something that works. "While our objective reality may be to prevent depression, our method is to promote resilience." He writes that with regard to children, but he seems to apply it to parents as well.
Specific treatments he mentions are cognitive therapy, cognitive-behavioral therapy, medication, and interpersonal therapy.
What are the risk factors for depression?
- mood disorders in the family
- loss of loved one
- chronically dissatisfying job or relationship
- chronic medical disorder
- suffering or witnessing abuse or violence
- having had depression before
- tendency to brood or ruminate
- recurrent sense of helplessness and hopelessness (isn't that one of the symptoms of depression?)
- being female
- living in poverty
- depression in one or both parents
- alcoholism or anxiety in parents
- other difficulties or developmental delays in early childhood
Beardslee is full of encouragement for parents, and full of examples of parents who have been floored by depression yet continue to be loving, dedicated parents. His number one advice is to get help, quickly; use all the resources available to you - medication, therapy, friends, religion, family.
The next step is to talk about depression - "break the silence" - within the family, beginning with a planned family meeting. What is depression? What does it feel like? What's been going on for the parent? How do the kids feel when the parent is depressed? What questions do they have? Let them know that they are not to blame. Let them know that they can ask questions about the behaviors, the disruptions, and the treatment. Keep the conversation lines open.
This will begin to create a new family story, a mutual understanding, that includes the depression episodes, but isn't silently dominated by them. The parent's mental health crisis is part of a larger story.
Then Beardslee turns to resilience, building strengths and building on strengths already present. He highlights several keys for a child's resilience when a parent is depressed:
1. To understand depression, to have a realistic idea of what they are dealing with.
2. That they are not to blame.
2. To develop and maintain positive relationships within and without the family.
3. To develop strategies to deal with the effects of the parent's depression.
4. To develop and maintain positive activities outside the home.
5. To reflect on what they have gone through, and what the family has gone through.
6. To know (especially through experience) that their actions make a difference in their own lives.
Comparison to The Depths
Beardslee's definition of depression is different from Rottenberg's (disease vs adaptation), but his vision of mental health is similarly holistic and bold. The goal of treatment should be well-being, in the individual and the family. "The health of the child is inseparable from the health of the parent."
For many of the parents in Beardslee's case histories, "breaking the silence" and helping to develop the resilience of their children was a major part of their own recovery. They were able to connect more deeply to family members, and were able to see their depression in a broader, more optimistic family story.
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notes
- while our objective reality may be to prevent depression, our method is to promote resilience
- being able to construct a meaningful story together
- family treatment 6 steps
- sharing a history together
- apply knowledge of depression and resilience
- address needs of the children
- plan how to talk to the children
- break the silence together as a family
- continue the family dialogue
- signs of depression start as extensions of normal feelings...symptoms tend to appear gradually
- there's less energy to do tasks, so fewer tasks get done
- depression especially disrupts the memory of what's been positive and what's been accomplished...
- consider what it is you want help with most
- well-established risk factors
- mood disorders in the family
- loss of loved one
- chronically disatisfying job or relationship
- chronic medical disorder
- suffering or witnessing abuse or violence
- having had depression before
- tendency to brood or ruminate
- recurrent sense of helplessness and hopelessness
- being female
- living in poverty
- single most important area to focus on in protecting you, your spouse, and your children is promoting healthy and open relationships within the family and among extended family, friends, and the larger community
- childhood depression often goes undiagnosed because the symptoms mimic other common symptoms - being withdrawn or sleepy, having stomachaches, or being irritable. That's why it is key for parents and caregivers to ask directly about being depressed, about feeling sad, and even about having thoughts of suicide.
- treatment - ct, cbt, medication, interpersonal therapy, other therapy styles
- resilience in children with depressed parents
- realistic about the issue, and also realized they were not to blame
- aware of and could articulate strategies to offset the effects of the illness on them
- they believed their actions made a difference, and they took action based on their understanding
- the effects of positive experiences accumulate over time, gradually helping children develop deep inner strengths.
- risk factors for depression in children
- depression in one or both parents
- alcoholism or anxiety in household
- other difficulties or developmental delays in early childhood
- combine warmth and support with effective limits - help establish resilience
- three things to help protect children
- help them to develop and maintain relationships
- be positively engaged in activities outside home
- help them reflect on and understand what they've undergone in the family
- change comes both from broad understanding and from continuing to take small specific steps
- draw on all available resources to get through depression
- as is true in developing resilience, a central quality in being able to deal effectively with depression is optimism, or confidence that one's actions do make a difference
- take action quickly in a crisis
- review actions and strategies that work and use those again
- fitting the ongoing struggle with depression into the context of other vital shared beliefs
- part of healing for many families was no longer seeing depression as the central part of their lives, but as just one of the many things they had to deal with
- often, trying to talk simply introduces the idea that it is okay to talk, even though actual back-and-forth interchanges do not take place
- each time you need help, you may have to rediscover how to get it
- above all, dealing with depression means finding and connecting with many resources at different times - community, religious faith, caregivers, friends, and family.
- ...mental health care and physical health care are inseparable
- the health of the child is inseparable from the health of the parent. care must be available for both.
- who would not forgo those few dollars for a guarantee that all of our children, all of our grandchildren, would never be without health care?
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