The Effects of Parental Depression / Depression might be Mommy's secret, but for the kids scars remain
Octobers are hard for Allison Miller. As the weather cools and the leaves turn, the 24-year-old North Texas teacher resists the urge to hide away and lose herself in memories of her father and his animated stories told with bright eyes and wild hands. She tries not to think about the day after his 51st birthday, October 7, 2008, the day before she turned 18, three days before her senior homecoming. The day her dad gave her one last hug, sent her a text to say, “I love you” and ended his life by overdosing on a cocktail of prescription pills.
“I spent my birthday planning my dad’s funeral,” Miller remembers. “[That summer] he had told me, ‘You and your mom and brother are what keep me going in life.’ And when he died, I thought, ‘Are we not worth it anymore?’ It was really hard for him to tell me that and then turn around a few months later and have it all mean nothing.”
When he was alive, Octobers were hard for Miller’s father, too. Like clockwork, as fall rolled in each year, so did waves of sadness, isolation and hopelessness, emotions that would inevitably combine and combust into a nervous breakdown (a yearly episode stemming from his manic depression, a disorder exacerbated by heavy medication use for chronic pain related to a back injury).
Miller remembers the pungent, but not altogether unfamiliar, sting of her father’s absence at her high school graduation. In many ways, she says, he had been gone a long time. “Even when he was alive, I went through a lot without him mentally and emotionally present,” she explains. “It’s not that I felt unloved, but I felt like I missed out on that relationship.”
Clinical depression, which includes major depressive disorder (MDD), manic depression and dysthymia, a milder, longer-lasting form of depression, will affect an estimated one in five American parents at some point in their lifetime. While symptoms may be associated with the “head” (dark thoughts, anxiety, etc.), the condition frequently seizes the entire body (think muscle aches, chest tightness, fatigue). According to the National Academy of Sciences, more than 15 million children live in a home with a depressed parent. Research tells us that depression knows no boundaries, crossing socioeconomic and racial lines and affecting both men and women (though women are twice as likely to develop depression).
But what research has only recently begun to explore is the heavy toll parental depression takes on the millions of children caught in its web. A 2009 report by the Institute of Medicine and the National Research Council called the ways in which depression affects parenting and children’s health and psychological functioning “often ignored.”
“I think it’s neglected,” affirms Natalie Hill-Doyle, licensed professional counselor intern at Depression Connection in Fort Worth. With so much emphasis placed on the individual, we sometimes miss the whole picture. “The family is a unit and how they work together is key,” she stresses. “When one person is down, they’re all down.”
Growing up, Miller says she was frequently consumed with feelings of worry, guilt and helplessness — all common emotions in the children of parents with depression, according to experts. As her mother, a college professor, strived to keep the family afloat, her father withdrew more each day, secluding himself in his dim, home office. Miller, the baby of the family, sensed her family coming undone around her, though she had no idea why. “Depression affects everyone around you,” she says, “even when you can’t see it. I never felt like he didn’t care, but I always felt like he was very closed off from us.”
Emotional disengagement is one of the most common symptoms of depression and one of the most harmful to the child of a depressed parent.
Thirty-six-year-old Cheneya Cruze was diagnosed with depression over 15 years ago. Today, she says a regimen of prescription medication helps her manage her symptoms. But on bad days, she avoids interaction at all costs, wanting to do nothing but stay in bed all day. “At those points I could literally pack up everything and just go away,” says the local mom of two, who admits to snapping at the smallest provocation. The changes happen slowly and subtly, but Cruze says she knows her kids take notice.
Tiffany Smith, owner of Tiffany Smith Counseling in Flower Mound, says kids are much more intuitive than most realize. “They’re way smarter than we are!” she asserts, explaining that children can pick up on the minutest change in a parent’s demeanor. “Kids might be worried about Mommy or Daddy,” says Smith. “They’ll feel like they’re not loved or there’s something wrong with them. They don’t understand depression. They know Mommy feels sad, but they don’t know why.”
Evidence is mounting that growing up with a depressed parent can result in a myriad of negative outcomes, including an increased risk for mental health problems, cognitive difficulties and troubled social relationships. While parents fight their own demons, kids often suffer in silence, succumbing to self-blame and feelings of helplessness at not being able to fix Mommy.
In younger children, Smith says these feelings can manifest in tantrums, separation anxiety and bed-wetting. Older kids might become anxious, expressing fears of death or separation. Research by the American Psychological Association found that some children adopt the role of caretaker, taking it upon themselves to care for the parent’s emotional distress and physically caring for younger siblings.
“The child gets in survivor mode and becomes the parent of the parent,” says Catherine Karni, Ph.D., associate professor in the Department of Psychiatry at the University of Texas Southwestern Medical School. “It’s not emotionally healthy. We’ve seen it in kids as young as 5.” But perhaps even more concerning, Karni adds, is the heightened risk these children face of developing depression themselves.
Like father, like daughter
When she was 14, Miller began to lose control of her emotions. She was consumed with rage and began to experiment with self-harm. “It scared me,” she says. “I began to look at [my dad] and think, ‘That’s my future. I’m going to be just like him.’”
One day, the emotions boiled over, igniting a fire that couldn’t be squelched. She was angry with her dad when she went into the garage and locked herself in her parents’ car, ignoring her mother’s pleas to come out. Using the sharpest object she could find, she carved the words “I HATE HIM” into her arm. Three years later, at her father’s funeral, she could still see the scar.
A 2006 study published in the American Journal of Psychiatry followed a group of children with depressed parents and a group of children with parents with no known mental health conditions over the course of 20 years. It found that the group who grew up with a clinically depressed parent fared much poorer than their counterparts and faced triple the rate of anxiety disorders and depression in their 30s. If the parent developed depression early in life, the child was at an even greater risk.
“It’s very much genetically predisposed,” Karni explains. “But that doesn’t mean that every parent that has depression will have a child with depression. Usually, 50 percent of the time we find a family history of depression. Is there a risk factor? Absolutely. Does that mean that your child will absolutely have depression? I don’t think anybody can say that.”
The good news, she adds, is that there are measures parents can take to improve the outlook for their children, starting with getting help for themselves. “There is a risk, but that doesn’t mean that your child will not do well in the future,” she says. “The parent needs to go get help and things can get better.”
Following the incident in the garage, Miller was diagnosed with clinical depression, put on antidepressants and enrolled in therapy. Today, she’s candid about her battle with depression and the pain that still ebbs and flows. But when the darkness begins to creep in, she remembers the haunting look on her mother’s face as she read the first line of the suicide letter her father left on the family computer ... and how she immediately collapsed to the floor. “I know what it was like for everyone around him,” she says. “And I would never want to make anyone feel the way that we felt when he left.”
A deadly condition
There’s no denying that those who suffer from severe depression are ill. It’s a disorder that affects the chemistry of the brain and nervous system; the consequences of not treating it are not only debilitating, but can also be deadly. Suicide claims the lives of nearly 40,000 Americans each year and, according to the Centers for Disease Control and Prevention, over 60 percent of suicides are committed by men and women with untreated depression.
The numbers are staggering, yet of the 19 million suffering from depression in the United States each year, less than half will seek help, according to Mental Health America.
“Sometimes they’ll be resistant to getting treatment if they have depression because they don’t want the label,” Smith says. In many cases, Karni adds, they might not even realize there’s a problem. “Especially if you’re thinking about moms who take care of kids,” she offers. “They get overwhelmed."
For those who are apprehensive about seeking treatment or unable to recognize the symptoms in themselves, it’s paramount for family and friends to step in, express concern and offer to find help in the way of a professional who can suggest the appropriate course or treatment: typically psychotherapy (or “talk therapy”) and/or a combination of FDA-approved antidepressants prescribed by a physician.
“It’s important to be vigilant about the symptoms of depression and help them get help,” Karni insists. “Because if you cannot take care of yourself, you cannot take care of others.”
The family secret
In the final years before his suicide, Miller and her father were waging the same war under the same roof, yet each felt completely and utterly alone. “It was frustrating at times to feel like I didn’t have anyone around that understood,” she says. Attentive and supportive, her mother did everything right according to expert recommendations, but Miller still felt alone in what she calls the “maze of depression.”
Part of the stigma surrounding depression is that it is wrongfully considered a problem that only happens to the criminal or the weak-minded. It’s often a taboo topic among even the most close-knit of families.
Cruze says she didn’t even know there was a family history of depression until she was diagnosed at age 20, and her mother came clean about the depression that nearly all of the women on her side dealt with. “It was just one of those things nobody talked about,” Cruze says. “I didn’t know there was such a huge history in my family because it wasn’t something you admitted to. You just took your medicine and hoped nobody found out.”
Smith urges families to treat clinical depression like any other illness, remembering that it’s a complex medical disorder with biological, psychological and social components — not a temporary bout of the blues. There’s no “snapping out of it.” Plenty of otherwise strong people suffer from this debilitating disorder. It’s one of the most common mental illnesses and requires long-term, professional treatment. “Not talking about it is the worst,” Smith stresses. “If a parent has diabetes, or cancer or some kind of medical condition, the family talks about it. Depression is the same thing.”
When 37-year-old Michelle Sedas was hospitalized for depression two years ago — her third hospitalization due to depression — her husband told their two children she was going to the “spa.” This summer, when comedian Robin Williams hung himself in his California home and suicide became a topic of national discussion, her 10-year-old son began to ask questions. “I told him where I really went and why,” the Lewisville mom reveals. “I explained what suicide was and told my son that I had suicidal thinking. He said, ‘Mom, am I going to get that?’”
When discussing depression with children, Smith encourages parents to use age-appropriate language and not to underestimate the difference a family therapist can make. “The whole family needs to be involved in the process, because it affects the whole family,” she says. “It’s important for Mom to hear how her depression affects the kids and how the kids perceive her. Sometimes parents think, ‘Oh, they don’t know because I don’t cry in front of them.’ [Parents] need to hear, ‘Mommy never plays with me anymore.’”
“You may think you can do this alone,” Hill-Doyle says. “But I recommend therapy no matter what.” However impossible it may seem in the wake of depression, fractured relationships can be healed.
Miller never got the chance to tell her father how his depression affected her. She never got to say, “I know how you feel.” Her father’s daughter, she empathizes with the despondence he felt, saying she walks through each day with the physical and emotional scars of depression.
But through her loss, Miller says she’s found purpose, making it her life’s work to prevent others from experiencing the pain that her father’s suicide caused her. She’s become an anti-suicide advocate, sharing her story with those struggling with suicidal thoughts or reeling from the suicide of a loved one. Her message: It can get better. This isn’t how it has to be. “Getting help is important,” she says, “not just for yourself but for everyone around you.”
Sedas echoes Miller’s sentiments. “You have a responsibility to help yourself,” she says. “It’s not selfish. You’ve been entrusted with the care of a child, and you’re responsible for getting help so that you can be a good parent.”
It can get better.
This isn’t how it has to be.
“It’s not the things we say that make us sick, it’s what we keep inside,” Sedas adds, reciting a favorite quote. “When you’re suffering, don’t keep it to yourself. Your children need you.”