Depression Roundtable, Part V: Parenting Children with Depression

Posted by Kathryn Soper | March 28, 2010 | 19 Comments

Welcome to Part IV of Segullah’s UP CLOSE series about depression. Parts I, II, III and IV can be found here, here, here and here. If you haven’t already read the series overview, please do so before proceeding.

In our fifth and final post in this depression roundtable series, we turn the discussion to the challenge of parenting children with depression. Rebekah leads us off with a glimpse into her family’s experience.

Rebekah: I have appreciated this discussion so much. Though I have not participated until now, your experiences and honest recountings have given me a really necessary and invaluable insight into the struggles of some of my most dearly loved ones. So first, let me say thank you.

Now. My own experience. My younger brother, now 23 years old, has suffered with unnamed demons for what seems like forever, probably since he was a young teenager, and was finally diagnosed with bipolar disorder three or four years ago. His symptoms are slightly atypical in that he does not have extreme manic phases like we often associate with bipolar disorder; his mood shifts are more subtle and tend toward the depressed. He has been hospitalized several times after suicide attempts, the most recent being nearly two years ago, if I remember correctly. other symptoms include compulsive shopping, compulsive lying, tobacco, alcohol and pornography addictions all in varying degrees.

(An interesting sidenote on the depressed-because-I-am-addicted vs. addicted-because-I-am-depressed discussion: my parents mentioned my brother’s smoking to my uncle, a family practice doctor, who said he had never known a mental health patient who was not a smoker or did not have another addictive behavior of some kind. Which says to me that self medication is entirely common.)

My brother has received every kind of treatment we can think of, including counseling, electro-convulsive therapy, heavy medication, and lock-down hopsitalization. He is currently participating in a residential treatment program at a hospital in the Boston area with mixed results. when he is feeling stable and good, which is more and more the case these days (a good thing, usually), he responds antagonistically to treatment attempts and therapy, a sort of “I know better and don’t need you to help me” sort of way. As long as he has been sick, he has been trying to convince people that he is well. His desire to be “normal” seems almost overwhelming. which is heartbreaking to me. But I also feel as though the energy he spends pretending he is “well” might be better spent actually engaging in his own treatment and getting “well” (or as well as he can), And it frustrates me that he cannot make that connection.

I can completely identify with the experiences already shared that, when a loved one suffers from depression, one’s own emotional needs take a backseat and stability becomes a necessity. I am the older sibling but it is just my brother and I and my parents have born the lion’s share (all) of his struggles (he has been living with them all this time; my mother quit her job to care for him) so I certainly feel hesitation about further burdening them with whatever issues/worries/struggles I might be experiencing. They, of course, have never made me feel this way but I feel a lot of pressure to be the healthy, responsible, emotionally stable child. I can totally relate to similar experiences that have been shared here.

The effect of my brother’s condition on my relationship with him goes in waves. I often feel that I cannot trust him, and what I perceive as his unwillingness to engage with the resources being offered him sometimes frustrates me to the point of finding it difficult to deal with him. But, I have been moved out of the house and not really around ever since he has been diagnosed, so I am mostly separated from the day-to-day experience, and I can often interact with him on a surface level where it sometimes even becomes easy to forget that he is sick at all. A deeper component where we actually talk about his condition, his thoughts and his experiences is rare and mostly missing.

Lately, my experience in relation to my brother has been this, and I would love to hear some thoughts on this. It seems to me very obvious that my brother requires professional help. And it also seems painfully obvious to me that the methods he has tried to employ to get himself on his feet have been unsuccessful, multiple times. The pattern goes something like this: have an episode; receive intensive treatment; start to feel better; make big plans/promises; end treatment early; take a step such as move out, start school, get a job; everything proceeds as normal for a month or two; crash and burn; repeat. Part of the goal of his current treatment is to break this pattern and explore some alternatives. Take things a little more slowly and build up his coping and life skills so when he is ready to be on his own, he can succeed. But he is insisting that he is ready, that he can do it, and is pushing to get a move on his “big plans.” It is plain as day to me that his “plan” has never worked before and that maybe he should consider the options that are being presented to him. Especially since his treatment is coming at the cost of tens and tens of thousands of dollars to my parents. I can’t even describe the frustration I feel when I think of him just casting it aside and going back to his old habits and patterns, which have gotten him nowhere. and have caused untold panic and heartache for us. Any insight here?

And finally, this question. the other constant struggle for my family, my parents especially, has been walking the line between realism and enabling. What is reasonable to expect him to understand and be able to accomplish? What is fair to hold him accountable for? The line between working with his limitations and catering to those limitations in an unhelpful way is a fine, fine one to walk.

Lydia: I have no answer, just empathy, especially about that fine line between working realistically with someone’s limitations and holding them appropriately accountable.  That’s a constant question for me as my son’s mom.

Abigail: I wish I had some answers, but I am also flummoxed by this one.

Both of my daughters have struggled with anxiety and/or depression issues. I read somewhere that oldest and youngest daughters tend to be more prone to anxiety/OCD issues. I don’t know if this is true, but it is certainly true in my family. My oldest daughter, Emma, has had anxiety and OCD, as well as depression. Looking back now, I realize I should have gotten her treatment sooner–cognitive therapy, at least–but I don’t think I trusted my instincts enough to pursue it, and I also didn’t want to admit her issues were serious enough to warrant intervention, so I think there was some denial there on my part, as well. I also see how my own anxiety-ridden approach to parenting in my early mothering years (not that I’m cured now!) helped foster her anxiety, which I’ve felt my share of guilt over. I’ve wondered how much of her anxiety is due to genetics, since anxiety and depression run in my family, and how much of it is a result of my parenting–I’m sure it’s a combination of genetics and environment. But I feel responsible, regardless, even though I know rationally that it’s much more complex than that.

Anyway, I remember one period of several weeks when Emma couldn’t sleep after watching an episode of Little House on the Prairie in which a school burned down. She said she couldn’t stop thinking about fires. She continued to exhibit some OCD and anxiety through her teenage years, such as worrying that someone would die or have an accident if she didn’t follow certain routines.

Emma is very bright but she also worked very hard in high school, spending hours every night doing homework. I put a lot of emphasis on achieving good grades–too much, I’m afraid, which didn’t help with her perfectionism and OCD issues. She earned a four-year, full-tuition scholarship to college. But while she enjoyed her first year at college, she was also very stressed over her grades and worked so very hard in her classes. It wasn’t enough to get a 3.6 to maintain her scholarship; she decided she had to get a 4.0. I remember the first time she got a B on a paper–she called me, crying, feeling like she’d failed. I was worried.

During her sophomore year, Emma moved off campus with a couple of her freshman roommates. And that was when she started to spiral into depression. She had a small, dark bedroom and hated the lack of light in her apartment. Her apartment building didn’t seem to be very social and, since all of her roommates were rather shy (except for one, who had a boyfriend), they didn’t socialize much. Instead of doing something fun together on weekend nights (as my daughter had done the year before with the girls next door), most of the girls in her apartment did homework. She also continued to stress out about her grades, and it seemed to take her longer and longer to get her homework done because she worried so much about getting every detail right and memorizing everything for every test. Every time she had to write a paper she’d become paralyzed, unable to start, and she’d call me and I’d have to talk her through the brainstorming and writing process all over again.

Needless to say, I knew she was struggling. I knew she needed some kind of help. At around the same time, my youngest daughter, Jane, who was turning ten, started having anxiety issues as well. Out of the blue, it seemed, she started worrying that she’d stop breathing–at first it was worrying that she’d stop breathing while she was sleeping, but then she worried that she’d stop breathing at any moment during the day. That evolved into worrying that there was something physically wrong with her (at one point she was worrying that a vein in her neck would burst and she would die), and she obsessed over it to the point that she couldn’t sleep. I was at my wit’s end–no matter how much I tried to reassure her that nothing was wrong, she still obsessed. And of course, I should know that trying to talk someone out of having irrational thoughts is fruitless. I finally called our pediatrician and got a referral for a child psychologist.

The therapist I was referred to was actually a graduate student working on her PhD and doing her clinical hours in a pediatric psychology practice, where she specialized in treating anxiety and OCD. I liked the way she worked with Jane. In fact, Jane only had to go for about five sessions before she was able to get on top of her anxiety. The therapist also coached me on how to better help Jane with her anxiety, and that was very beneficial and eye-opening, as well. I suspect Jane will have bouts of anxiety as she gets older, but I’m hoping that with intervention, we’ll be able to treat her quickly. The therapist told me that it isn’t unusual for anxiety/OCD issues to manifest themselves at around ten or eleven–when a child is starting to go through puberty–and that the earlier the intervention, the more effective the treatment, and the less likely a child will continue to struggle through their teen years and beyond. I don’t know how accurate this is, but if it’s true, I’m glad I took Jane in for treatment when she was ten, but I also regret not doing the same for Emma. But I realized I could try to do something for Emma now–better late than never–so, during one of Jane’s visits I asked the therapist if she would see Emma, and we set up an appointment.

It took some persuasion to get Emma to go, but she started seeing the therapist weekly, and those visits were quite helpful. I could tell that she seemed more relaxed, better able to cope. The therapist mainly did cognitive therapy and worked on OCD and anxiety. However, several months went by and although Emma seemed to struggle less with OCD issues, she was still very unhappy. Things continued to get worse through Thanksgiving break and Christmas break. I suggested she try medication. In fact, I’d suggested it several times when Emma was in high school, during bouts of more severe anxiety, but only tentatively. I didn’t talk to her about it or insist on it enough. I worried about the stigma she might feel over taking medication; I also worried about starting her on medication and what that might mean long term–how would she ever get off of medication to have a baby, etc? Even though I myself had been helped by taking antidepressants, I suppose I still was in denial where my daughter was concerned.

During that winter semester of her sophomore year, I could tell that Emma was clinically depressed. She came home for dinner every Sunday and vented and cried about everything–school, and how she couldn’t cope, her roommates, her apartment, her life. She didn’t want to go back to her apartment. She was extremely sensitive. She told me that nothing brought her joy, that everything seemed dreary to her, that she could see nothing to look forward to in the future. Of course she was depressed, and I was worried. So, I told her I thought it was time to consider medication. Emma brought it up with her therapist, and her therapist told her that she doesn’t really endorse taking antidepressants for treating anxiety and OCD; she said that medication masks the symptoms of anxiety and OCD, but doesn’t treat the illogical thought patterns behind the disorders, and she thought cognitive therapy was more effective longterm. However, I think she was missing the fact that Emma was clinically depressed.

At that point I was unsure myself about what was the best treatment for Emma, and since her therapist was the “expert,” I dropped the medication issue for a couple of months, But Emma became more despondent, until I finally decided it was time to intervene, and I took her to the doctor, who prescribed an antidepressant. By that time Emma was so miserable that she was relieved to do something and went with me willingly, and after that doctor’s appointment, when she left, medicine in hand, she was so relieved and so grateful that I regretted not intervening much earlier.

Emma continued to see her therapist and took medication, and that seemed to be an effective treatment. She left on a Study Abroad trip a few months later, and was gone for two months. When she came back, she told me she’d still struggled with bouts of depression while she was away, but it hadn’t been nearly as bad as she’d felt before taking medication. She still didn’t seem to be quite out of the hole, so we went back to the doctor and he doubled her dosage and that seems to be doing the trick. This year she has a much better living situation–she moved to a different apartment complex, she likes her roommates, she’s living next door to the same fun girls she lived next door to as a freshman, she’s working part-time and is enjoying her classes, and, while she still works hard and gets good grades, she doesn’t stress over school as much. She actually got her first A- last semester, and she took it in stride–I think she was even a little proud of her slightly-less-than-perfect GPA.

Yet I still wonder about the ramifications of depression for her. I wish I’d been more attuned to her feelings when she was a teenager. I wish I’d gotten her treatment sooner. What’s the saying about hindsight? I would certainly do some things differently, knowing what I do now.

Euodias: I think kids grow up and understand that sometimes parents just don’t know how to best help their children. When I first became depressed, clearly my parents didn’t have a clue (taking me to be exorcised!)  However I have never been angry about it. I don’t blame them,. They were learning too. Chances are your kids won’t dislike you all that much, they will trust you have the best of intentions.

Abigail: My mother has not apologized for very big mistakes she made as a mother; in fact, she often denies that the things we bring up ever happened and that makes you a little crazy, because you start to doubt your own perceptions and feelings. Plus it makes it much more difficult to forgive and move on. So I think in my reaction to that I’ve erred on the side of apologizing too much. My father, when he is feeling morose and sorry for himself, often apologizes, but he wallows in guilt and shame, without saying he’ll make any effort to do things differently–that’s just the way he is (“I’m sorry I’m such a loser father”). That kind of apologizing is unproductive and self-centered. So I think there’s a happy medium–being able to own your mistakes, apologizing and validating your child’s feelings, and resolving to do better, without enabling your children to blame you for everything that has gone wrong and the choices they have made. Then they get stuck in the blaming/victim mode. That’s a balance I’m striving for (hope this made sense).

Euodias: I think you’re right on. While my mom apologizes too much for some things (which I think she does somewhat sincerely), there are things she thinks didn’t even happen. It drives me crazy. But I have siblings who back me up, validating my memory–so that helps.

Deborah: Abigail, thank you for confiding in us, and for being the truly wonderful mother you are. Remember, if the eternal health of God’s children rested on our performance as mortal parents, God’s plan (sending kids to clueless people) is a really stupid one. Seriously. I remind myself of that all the time. I wring my hands over the consequences of my parenting (and make no mistake–there are formidable consequences!) and wonder how this could ever be okay, and then I remember God set it up this way. And I remember my kids already had a perfect childhood in the spirit world, and that they didn’t come here to have another one. Quite the contrary, in fact.

Hannah: Great perspective Deborah. I never really thought about it that way, but it’s so true. Thanks.

Anna: I have a daughter who has been Eyore since she was a very small child. She is extra sensitive, moody, and always walking the line between melancholy temperament and depression. So far I haven’t taken her to be officially diagnosed, although I think I could have. I monitor her, and we talk about managing emotions and coping skills. I’ll be surprised if she doesn’t require treatment at some point in her life.

Esther: My 11-year-old daughter has manifested symptoms of anxiety from about the age of 4. She has seen several child psychologists for brief periods over the years for her anxiety and other OCD-like symptoms. Cognitive therapy seemed to help her through those really rough times, but she has never been formally diagnosed with anything. Lately, I have noticed that she has regular periods of sadness—teary episodes where she just gets entirely overwhelmed by something that to me seems very small and insignificant. She is an extremely sensitive child when it comes to her own emotions or those of others. She has a pleaser personality and wants everyone else to be happy and taken care of. She tries so hard to be brave, but there are so many things that worry her (especially getting sick). I think she keeps a lot of it inside. I try to validate her concerns by listening to her and reassuring her, but I often don’t know what to do to help. I’m wondering if she has depression.

Priscilla: I have a daughter and a son who struggle with depression, both of them grown now. My daughter goes on and off anti-depressants as she feels the need. My son is a stoic and won’t take meds. But they are both tight with Jesus, and I can’t help but think that’s related to the depression. It’s my experience, too, that no matter what else we do to treat our depression, the deepest healing comes directly from Jesus. It occurs to me that my children are like me — close to the Savior, high-functioning, unhappy. It’s hard to know if my legacy serves them well or not.

Euodias: I left my son’s therapy session today feeling some mother angst. But I really try to put it all into perspective. I know when my mother used to call and apologize all the time, it drove me crazy. I felt like I was supposed to be feeling bad or be blaming her for something–as if I should be damaged from her bad mothering, I wasn’t (and she wasn’t a terrible mother). I finally told her to please stop calling to apologize. The truth is I think it is inevitable that we will feel some angst as parents, and question ourselves.

Sometimes I think our parenting matters more than anything in the world, sometimes I take a step back and think in some ways it’s not all that important. I know that sounds terrible. I wish I could explain it better. I think in Moromonism we have the importance of mothering so beat into us, we forget how there are lots of women who don’t mother, and we all are trying to get to the same place. Our kids’ salvation depends on us, and yet it doesn’t. Our kids’ happiness depends on us, but it doesn’t. It’s quite a paradox.

Deborah: Yes, and as influential as parents can be, when all is said and done, each of us are responsible for our own happiness, our own relationship with God that brings salvation.

Abigail: Because I’ve struggled with depression and anxiety myself, you would think that I would be better equipped to help my children who struggle also. Well, yes and no. On the one hand, I’m better able to identify symptoms, empathize, and advocate for them. But I’ve also found that my own anxiety can often get in the way of doing what’s best for them, and being depressed myself makes it harder to address their issues as well. My oldest daughter and I tend to feed off of each other’s anxiety–if she’s anxious, I instantly go into anxious mode myself and just want to fix everything quickly so that neither of us is anxious anymore. But that has been counterproductive. My daughter has pointed out on more than one occasion, “I just want you to listen to me and then reassure me that I’m overreacting.” If I get anxious myself, however, it just confirms her fears. Also, what she really needs is my confidence in her to solve her own problems, not me trying to fix it for her. It really takes professional coaching to overcome this tendency. And depression, since it’s so debilitating, can definitely impede my ability to help my children work through their own issues. You just don’t have the energy or clarity of thinking to be able to do this well when you’re depressed.

Deborah: SO TRUE! Depressed parents can empathize, and that empathy can mean a great deal. But if you’re in the midst of an episode yourself, you’re even less capable of helping your kids. It’s a tremendous challenge to parent children with depression even when you’re at the top of your game. And the struggle is different with each child in this situation–what works with my daughter is not always what works with my son.

Lydia: I can add a little about how depression/anxiety looks different in males.  My son, who’s fifteen now, was always different than other kids, more sensitive, with a few exaggerated fears and extreme shyness (social anxiety).  Even the shyness comes across differently in boys.  A shy girl hides behind her mom, looking adorable, and people take it that way.  A shy boy refuses to look people in the eye or answer their questions, hides behind a straight face that looks almost like a glare.  His behavior can appear hostile instead of adorable.

When my son was eight and we moved away from our cozy, tight-knit student family community in graduate school, it triggered full-blown depression/anxiety.  I didn’t have a label for it at the time.  All I knew was that my son was terribly unhappy and often raged.  The emotional rages are something you can’t really even imagine unless you’ve been there.  Because he’s physically cautious, he never broke anything or hurt anyone.  But he experienced and expressed a level of emotional raging that was just as frightening and shattering as if he had broken stuff.  In fact, after one of his rages, my body would often feel like it had been broken into millions of tiny pieces.  It could be triggered by any small thing, something that would be upsetting but not normally debilitating like a sibling knocking over a little part of a creation he’d built with toys.

That first year at parent-teacher conferences his teacher lovingly looked me right in the eye and asked me if he was happy at home.  Tears sprung up and I said, “No,” so relieved that someone else noticed and cared.

I wish I had known then what I know now about listening someone through horrible, frightening, overwhelming emotions.  But his rages scared me, especially on behalf of his three younger siblings.  Unless you’ve seen a person in that state, you probably can’t imagine why I felt compelled to protect my younger children from an eight-year-old who’s not breaking anything.  But I did.  So, instead of staying with him in his misery, I separated everyone from him, to protect them.

In the middle of these rages, he wouldn’t stay in his own room.  He’d follow me around the house.  Sometimes I’d try to take the other kids away from the house, but he’d usually follow us out to the car.  I remember once locking ourselves in my bedroom and huddling in the far corner behind the bed, where his screaming, wailing, and bashing on the door wouldn’t be as loud.  One of the most humiliating moments of my life (which also illustrates how desperate I felt) was when I locked him outside in winter.  I threw his snow clothes out after him, but, of course, he didn’t put them on.  A neighbor knocked on the door, concerned for my son’s safety.  Much more than the personal embarrassment, though, it makes my heart break now to think of how these separations added to his pain and prolonged the damage.

After a few years, I learned how to listen to even the ugliest and hardest things and I learned to take him away from the house, so that I could stay with him, without exposing the other children to all that emotion.  I would often have to order him into the car, but he would go, and he would be so relieved afterward.

We knew he was reacting to the move–friends who were like brothers to him had scattered across the country and world; it was almost like they had died–but we assumed it would heal over time.  It didn’t.  When he went to his first scout camp four years later, and I felt the difference in our home having him gone, I knew something had to change.  Somewhere around that time, he had also started saying some scary things like it’d be better if he just didn’t exist.  (Obviously, I’d gotten better at listening by then.)  I also realized I didn’t want to wait until he was an angry teenager, bigger than me, to start treatment.  WIthin a few weeks after he got back from scout camp, we had visited the family doctor and started him on Prozac.

At that doctor’s visit, my son–he has social anxiety in addition to the depressive rages– crouched silently, curled up in a ball, in the corner of the exam room.  I answered all the doctor’s questions.  Our family doctor was kind and unflappable, and over the years my son’s gotten to where he sits on the exam table and talks to the doctor himself.  He can also now look other adults in the eye and answer their questions.  In fact, with treatment, he seems like a regular, likable shy kid.

Now, after years of successfully using medication and being received by me even when he’s feeling terrible, I feel like I have a pretty much normal teenager on my hands.  He’s still my most challenging child by far, but it feels like we now live in the realm of normal.  He thinks he knows everything.  He wants to make his own choices and not be bossed around by his parents.  He’s often unkind, insulting, and impatient with his siblings, but he also makes up the coolest, most creative games that they and all the kids in the neighborhood want to play.  He’s work-averse and procrastinates homework until the last minute.  And he’s a genius.  For real.  He reads at a graduate school level.  He remembers everything he’s ever read or learned.  His boundless curiosity compels him to research things constantly.  He excels at everything he tries–writing, inventing new languages, computer programming, math, music, karate, physics.  As long as he turns things in, he gets As.  His school counselor is confident he can get a perfect score on the ACT if he studies.  Funny how often genius and mental illness go together.

The depression/anxiety come out in his responses to everyday hurts or stresses.  To normal  family conflict, he almost always responds by lashing out verbally.  To normal frustrations that aren’t anyone else’s fault, he responds by lashing out verbally.  Being asked to give a talk in church is completely debilitating, as is watching a movie or TV show that triggers old childhood fears.  But, again, I feel like we live in the realm of normal.  Everyone has their things, stuff that drives them crazy, stuff that’s extremely hard for them.  We may live a little on the edge, but I have hope that he’ll be able to serve a mission, go to college, find someone to make a normal, happy-with-many-struggles life with. I know that the mission could re-trigger everything we’ve already been through and worse, but I choose to focus on enjoying how relatively normal he is right now, how wonderful and enjoyable he is most of the time–his intelligence, his interesting conversation, his wit, his bubbly sense of humor, his energetic curiosity.  I know that sounds incongruous with what I described earlier, but what can I say . . . he’s human.  We’re full of incongruities.

Abigail: Lydia, that’s a difficult burden to carry. I so appreciate your sharing this, because I know several mothers who have children with similar struggles, and these women feel so very much alone. People rarely talk about these kinds of challenges, so your willingness to share this is huge.

And that’s the perfect note on which to end this series of posts. Thanks to each and every participant, whether in the Segullah staff discussion or the comment threads. Truly, our willingness to share our experiences is one of the greatest gifts we can give each other.

Related posts:

1. Sam and Sally go to the Bishop
2. UP CLOSE: Depression Roundtable Series Overview
3. Depression Roundtable, Part IV: Family Ties

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