For parents who have depression, the suffering is compounded by the fear that they have damaged their children. From his pioneering studies of depression in families, William Beardslee, M.D., psychiatrist-in-chief of Boston Children's Hospital, concludes that parental silence about depression is far more destructive. In his book, Out of the Darkened Room (Little, Brown), Dr. Beardslee issues an impassioned plea for opening up the discussion of depression in affected families.
Depression is in part genetic. How can parents protect children?
In my experience, every parent with depression is afraid they've irrevocably damaged their kids—but none have.
Why do they think that?
How they take care of the children is the dominant fact of mental existence for parents. Depression attacks a person's sense of self and sense of competence; it makes them feel that their capacity to do well for others is deeply impaired.
Parents think they've irrevocably damaged their children partly because they feel badly about themselves, partly because the good things they do they can't see, and partly because they fear they have passed along the disorder.
But there are always many things that can be done to help children. There's every reason to build strength and resilience. And, as with any other illness, if a child begins to manifest signs of difficulty, the time to get help is early on.
What characterizes resilience?
We found that the kids who were resilient had strong relationships. They had strong capacities to get work done, to accomplish developmental tasks, whether learning at school or participating in extracurricular activities. And they had an inner dimension of understanding.
Why are kids' relationships so important?
Depression is in part a disorder of relationships; the depressed withdraw; their relationships are impaired. Depression also breaks connectedness with the larger traditions of which we are a part—family continuity, culture, religion. Part of the antidote is strengthening relationships.
In general, good relationships are engines for healthy development. And relationships are particularly at risk when a parent has a relationship disorder. Kids told us, "the time with my mother or my father was difficult but I could talk to my sibling or my best friend. I could go over to a friend's house and talk to her mother."
How can depressed parents help their kids' relationships with others?
They can make sure that the patterns of everyday living that are conducive to relationships are preserved—getting children to school on time, with the right lunch and the right homework. Preserving after-school activities, whether it's sports at the school or elsewhere, or Hebrew school.
If a circle of friendships has been disrupted because of depression, they can knit it back together, by getting that kid into activities or over to somebody's house, or having somebody over.
A parent can also say, "I value your relationships, I'm going to do the best to support them; if I can't do everything, I'll do something." Kids respond best to praise and positive support, which gets very much impaired when a parent is depressed. Making a conscious effort to ask who the child connected with, or saying "this relationship is good," helps a lot.
What else have you found?
Children need to be told the depression is not their responsibility, and freed from the sense they have done something wrong. Children feel guilty because they got angry or weren't the perfect child or because they couldn't cure their parent.
A child is going to be very worried about an ill parent and needs some reassurance that the parent is going to be all right, or that everything that can be done is being done, that grownups are taking care of it. And children need to be given permission to go back into the world outside of home.
How do parents create the understanding you find so important?
By having a conversation with the children, to talk about the depression, make plans, celebrate the positives, and put the adversity into context.
The mother and father together need to say, "we're going to help you through this, dad's lost his job, it's not your fault, and part of dealing with that is having some days when it's tough to get started or even when he's irritable or crying."
Parents need to tell their children that depression is a biologic illness with active treatments and a course of recovery, so the child gets the sense that something constructive is being done. They need to put depression into context by affirming that other elements of family life will continue—they'll still eat together or take a vacation together. It gives tremendous reassurance to the kids.
Does talking about this help the parent as well as the child?
Absolutely. The single most important thing parents do is to take care of the kids. By focusing on the positive futures of their children parents can find new energy to get things done. That's where they start on the road to recovery. A parent not attending to that continues to feel awful.
And without such conversations, children feel hopeless. Yet we found that very often families would experience events that were absolutely unignorable, like one of the parents being hospitalized, but it hadn't even been discussed between the spouses. We felt we needed to break that silence.
When in the course of illness is it best to hold a family meeting?
Often two to three months after an acute episode, when a parent is recovering and has some energy but the events of the illness are recent enough for people to remember. During acute episodes parents need to rest and gather energy. A simple explanation suffices: "Mom (or dad) has a major illness and is recovering."
Parents are always afraid the child will ask why they have this illness and they can't answer. But the child is most concerned with what's being done and what will protect daily routines.
What if a husband and wife disagree on the need for a meeting?
We found that husbands would often say to their wives, "go ahead and do what you want, I don't want to be involved." But children need to see both parents together communicating well. Much of what goes on in a depression can be misconstrued by children as leading to divorce—the fighting, the crying. It's healing for children to see parents doing this together.