Writer and critic Daphne Merkin has chronicled her struggles with depression in fiction and in essays in the New Yorker and the New York Times Magazine. Her new memoir, This Close to Happy, includes a vivid account of her early years, when symptoms from insomnia to inconsolable cryingled her to be hospitalized at the age of 8. Child Mind Institute President Harold Koplewicz recently sat down with Merkin to ask what advice she might give to parents of children who are depressed — and to the children themselves.
Daphne, you’ve been through a lot and you have great insight. What would you like to say to young people who are struggling with depression?
My strongest message would be that you are not alone. One of the tragic aspects of depression is how isolating it is. You tend to feel cut off. Other people don’t understand. It doesn’t show, like a sprained ankle or measles. In the end, it’s an internal condition. And I think too often it doesn’t get conveyed to people around you, either because you feel it won’t be understood, or you feel a certain amount of shame. But there are other children, and teenagers, suffering from it, and there’s more comprehension of it than you might think.
Given what you know now, what advice would you give to your 8-year-old self?
First, I would tell my 8-year-year old self that what I was feeling had a name. Depression can sometimes feel like something from outside, a monstrous force attacking you. So it would have helped me to know there was such a thing as depression. And it would have helped to know that it wasn’t something to be ashamed of, which I think often goes with it. Children want to be like other children. When you’re depressed you feel different from everyone around you. While everyone is going more or less merrily along with things, you feel like you want to stay home, you want to stay in your room, you want to curl up in bed. But I’d also tell myself that there are treatments for depression, and these treatments actually work. The frightening thing about depression is you feel there’s no way out of it, you don’t see an exit.
Based on your experience, what do you think parents need to know about having a child with depression?
The most important thing is that it is in fact something that can happen in childhood. I think it would help for parents to recognize it as an actual illness. That it doesn’t always present in ways that alert you to it. I don’t think most children and adolescents would announce that they feel depressed. They might disguise it with other symptoms. They could become remote, enormously quiet, enormously pulled back, angry, anxious. If your child is changing their behavior, or even their affect, the feelings they have, it could be depression.
How can parents help depressed children?
I think one way parents can really help children who are depressed is to encourage the expression of feelings that may not be so comfortable to hear, that may make the parents anxious. We like to think that our children are happy, don’t suffer from dark feelings, and I think sometimes we convey a certain expectation that everything is okay. If your child is feeling very dark, and doesn’t know necessarily why, they need help in coming out with it, in not hiding it. That’s one way parents can be really useful: being receptive to the child’s articulation of negative feelings, of hopeless feelings, which can, of course, in any of us, stir up anxiety. It’s helpful to the child to think that they have a clear path to expressing what they’re feeling, even if it’s as unhappy as depression.
What would you say parents should NOT do when a child is depressed?
What parents should not do is probably their most instinctive response: to make light of it. Perhaps they do it out of their own anxiety, or perhaps they haven’t experienced depression, so it’s an alien thing. What doesn’t help is a version of pull-yourself-up-by-your-boot-straps advice like, “Oh, come on, you’re just being lazy, you’re just being obstinate.” Parents, without being alarmist, should take it seriously when it presents. I would hope they know their children well enough to recognize that this is different than recalcitrant behavior or obstinacy.
What would you say to parents who worry that a child’s depression is their fault?
I think I would give them simple advice, which is not to get stuck in guilt machinery: What did I contribute to this? Did I not breastfeed long enough? Or was I too strict about bedtime? The truth of the matter is depression is a complex, multi-factored illness and the blame game isn’t particularly useful. It’s neither all genetic nor caused by a bad environment exclusively. What I mean is that it’s a very complicated illness and it’s better to focus on the child and the depression than anxiously sift through what you might’ve contributed to it.
You were one of six children. How should a child’s depression be explained to siblings?
First, I think it’s important to be honest about it. Not to call it by another name than what it is. To somehow convey the reality of it to the other siblings, so that it doesn’t become something mocked. In my own family, when I was hospitalized at 8, for what turned out to be depression, my mother reported it to my siblings as anemia, as if I was lacking blood or something. My brothers just made fun of the whole thing. Kids are smart and intuitive. If you make up a saga to somehow cover what it really is, I don’t think it will be believed, and will bring relief to no one.
What is the biggest misunderstanding about depression?
The biggest misunderstanding remains what it has always been, that depression is willed, that it’s something you bring on yourself, that you can snap out of it. Or that there’s some way in which depression is an act that you get something out of. But no one wills themselves to be depressed; it’s a real thing. It’s not something you can tough love into going away or even lovingly love into going away. It would be nice if that worked: Let me be more affectionate, and you will be less depressed. But it doesn’t yield to those kinds of ministrations.