When Sally first came to treatment several years ago, she was a 35-year-old lawyer who, by all appearances, was an accomplished, successful woman.
She gave her father credit as a role model for her professional success. But she was angry with her mother, whom she described as “weak” or “lazy.” Her mother, I learned, had spent a good deal of time in her own room, feeling unable to prepare meals and socializing very little. Sally’s father carried the family.
Sally reluctantly agreed to bring her parents in. I soon saw her mother wasn’t weak or lazy. She was clinically depressed.
Once she came to grips with her mother’s diagnosis, Sally said: “I thought that was just Mom – a weak and fragile person. I never thought she might have an illness causing this.”
In fact, most depression is unrecognized and unacknowledged. Twenty percent of Americans will experience clinical depression sometime in their lives. That figure does not include the additional millions of people who experience various other forms of depression, such as dysthymia – a low-grade chronic depression. And the numbers have been climbing. Worldwide, depression is the fourth most common cause of impairment, and many expect it to become the single most debilitating illness over the next 20 years.
Yet despite advances in treatment, the vast majority of those with this illness never get it. Sally’s family is typical: Many with depression tend to hide or deny it, feeling that it is a sign of weakness.
Depression can take many forms. A patient named Elliot told me his father was constantly irritable, angry and judgmental. After I evaluated his 75-year-old father and suggested that he might have a treatable depression, his wife, who had been living with his anger for 50 years, wept with relief.
Although the father refused psychotherapy, he did agree to medication. Six months later, Elliot said: “Well, he is not Dr. Dolittle, but he is much more relaxed than I ever remember. I can have a reasonable conversation with him and I even saw him smile!” Depression can take other forms as well, with symptoms from lifelong cynicism to hopelessness, social withdrawal or chronic fatigue.
But listing the symptoms – sad mood, sleep, appetite and sexual disturbances, increased risk of suicide – doesn’t begin to address the suffering. I know. After a serious automobile accident, I suffered a clinical depression for three years. Living with quadriplegia, although quite difficult, is not nearly as difficult as living with depression. It is like an invisible, 1,000-pound weight you carry around every day. It affects judgment, making it difficult to see your own worth. Most people with depression look forward to the end of the day when they can go to bed and get respite. Yet sleep can be elusive, and the depressive thoughts and emotions of the day get worse. Many feel as though they don’t deserve to be loved or even to live. So although people with this illness may have friends and family, they still feel alone and misunderstood. That is how I felt, anyway.
Like most illness, depression affects more than one person. Witness Sally’s and Elliot’s experiences over years and years.
Over the summer, William Beardsley was a guest on my Voices in the Family radio show. He is professor of psychiatry at Harvard and the author of Out of the Darkened Room. He researches the impact of parental depression on kids. After studying 275 families, he found that some children were greatly affected and some were quite resilient.
He found that the most severe impact on children was in families where depression was not talked about. He said those children tended to be sad or confused and that they were at increased risk for becoming depressed themselves. “Because depressed people have low self-esteem, they tend to feel guilty and blame themselves for all of the family problems,” he said. “But when the depression is unspoken, the children also blame themselves – that puts the children at increased risk for their own depression.”
Realizing that openness was a critical factor in childhood resilience, Beardsley’s research team began what they call “Family Conversations.” These took place when children were old enough to understand what depression was – generally around 7 or 8 years old. He said two things were made clear in these meetings: (1) Depression can be treated, and (2) Many children with depressed parents do quite well and demonstrate remarkable resilience.
Beardsley emphasized that when children know what their parents are struggling with, and that they are getting treatment, they are much less likely to feel the effects of the depression. After all, we have known for years that children can sense when there is something wrong. In the absence of real knowledge, they will tend to blame themselves and take on responsibility for helping their parents.
When children learn that a parent has an illness called depression and that he or she is getting treated, they are freer to resume the role of being a child. Just acknowledging a depression and seeking treatment can contribute significantly to protecting children from its harmful effects.
Beardsley also found that the children who demonstrated resilience had three characteristics in common: “They were very committed to relationships, they were very good in activities outside of the home (in school, neighborhood and church), and they understood their parents had an illness. Therefore they were able to say, ‘I am not to blame for this, I am not guilty for it, and it is OK to go on with my own life.’ Those are the three characteristics of resilience that showed through like a beacon.”
Silence in a family can cause terrible injury. Truth rarely does.