Question regarding children with depression
March 18, 2013 11:15 AM Subscribe
Looking for ideas, suggestions and any anecdata on how you've helped a child with depression. Also looking for ideas on how to help a child that is extremely obstinate and refuses to go to school.
A friend of mine's son, lets call him Mark, is 13 yrs old. He is child #3 of four boys. His parents have had their ups and downs in their marriage and its has possibly taken a toll of on Mark. That in addition to a family history of some mental illness/depression may also play a role in this. Mark suffers from depression and has been in therapy for over two years and has also been in in-patent care for a week after a suicide attempt. He is taking medication under a doctor's supervision. Mark has always been a really obstinate and difficult child. As the third of four boys he's been the object of a lot of teasing and taunting. For years he has resisted anything and everything - going places with the family, eating with the family, etc. Lately he refuses to go to school to the point that the school has visited the parents' home a few times to figure out why and what is going on. He seems to not really care about how this takes a toll on his parents and other people, he seems to lack empathy and sympathy. He has only one friend and really doesn't care about social interaction. Even if he isn't interested in learning at school, the opportunity to be social with other kids holds no appeal to him. He is a really bright kid, very athletic and talented - he's very artistic. He spends a ton of time online and listening to his ipod or playing video games. The parents are already trying to limit access to those things. I don't believe he falls on the autism spectrum. His family is fearful Mark is not going to grow out of this and will never be able to live on his own and enter in to full adulthood. One more detail, whether this is relevant or not is that he comes from a family with means and has pretty much been given whatever he wants - and his parents differ on how to punish or set limits with kids. He hasn't had many limits/boundaries set for him. One of the parents has a sibling with a similar background that exhibited similar symptoms later in life (early 20s) and this person has never been able to hold a job and is on disability and can't live alone.
My friend is running out of ideas on how to help Mark. Are there other things that the family could be doing to help him? Do you know of any online resources or books that address this topic? Are there any alternative therapies for children that suffer from depression?
A friend of mine's son, lets call him Mark, is 13 yrs old. He is child #3 of four boys. His parents have had their ups and downs in their marriage and its has possibly taken a toll of on Mark. That in addition to a family history of some mental illness/depression may also play a role in this. Mark suffers from depression and has been in therapy for over two years and has also been in in-patent care for a week after a suicide attempt. He is taking medication under a doctor's supervision. Mark has always been a really obstinate and difficult child. As the third of four boys he's been the object of a lot of teasing and taunting. For years he has resisted anything and everything - going places with the family, eating with the family, etc. Lately he refuses to go to school to the point that the school has visited the parents' home a few times to figure out why and what is going on. He seems to not really care about how this takes a toll on his parents and other people, he seems to lack empathy and sympathy. He has only one friend and really doesn't care about social interaction. Even if he isn't interested in learning at school, the opportunity to be social with other kids holds no appeal to him. He is a really bright kid, very athletic and talented - he's very artistic. He spends a ton of time online and listening to his ipod or playing video games. The parents are already trying to limit access to those things. I don't believe he falls on the autism spectrum. His family is fearful Mark is not going to grow out of this and will never be able to live on his own and enter in to full adulthood. One more detail, whether this is relevant or not is that he comes from a family with means and has pretty much been given whatever he wants - and his parents differ on how to punish or set limits with kids. He hasn't had many limits/boundaries set for him. One of the parents has a sibling with a similar background that exhibited similar symptoms later in life (early 20s) and this person has never been able to hold a job and is on disability and can't live alone.
My friend is running out of ideas on how to help Mark. Are there other things that the family could be doing to help him? Do you know of any online resources or books that address this topic? Are there any alternative therapies for children that suffer from depression?
OK, that aside, to answer-ish your friend's question: they should be (and maybe they are, it's unclear from your post) involved with Mark's therapist and doctors in addressing concerns as they arise. Blunt affect (emotionless, checked-out responses/behaviors) can be a side-effect of medications, or a symptom of the disease itself, the doctors can help them to work out which it is in Mark's case.
If his medication isn't doing anything, it may be the wrong medication. If his therapy isn't doing anything, it may be the wrong therapy. There's really not enough information here for anyone to say. But it sounds as though the parents are exceedingly afraid about his future, when what they really need to be dealing with is how to make his *present* bearable.
posted by like_a_friend at 11:33 AM on March 18, 2013 [9 favorites]
If his medication isn't doing anything, it may be the wrong medication. If his therapy isn't doing anything, it may be the wrong therapy. There's really not enough information here for anyone to say. But it sounds as though the parents are exceedingly afraid about his future, when what they really need to be dealing with is how to make his *present* bearable.
posted by like_a_friend at 11:33 AM on March 18, 2013 [9 favorites]
As soon as I learned how to forge my mother's signature on my sick notes I stopped going to school. Because school was where I was bullied, taunted, shamed, humiliated, abused, etc. So how is his school environment? Does he have social anxiety as well as depression? What about sensory issues? Classrooms were awful for me. In addition, loud noises and social situations can be overwhelming, especially if there are many conversations going on at once. Eating in groups might be awful too, lots of smells and sounds. I don't think he's necessarily lacking empathy or sympathy, he might just be overwhelmed and need some shown to him first.
posted by elsietheeel at 11:33 AM on March 18, 2013 [13 favorites]
posted by elsietheeel at 11:33 AM on March 18, 2013 [13 favorites]
I know you say that Mark is in therapy, but is the rest of the family in therapy? Just curious. I was not exactly Mark, but I definitely had many of these things going on in my life at this age (except for refusing to go to school, school was an escape for me).
The reason that I'm curious about family therapy is that I was oversensitive to all of the emotional chaos, messy marriage issues, etc. going on in my family--I was a cross between a "canary in a coal mine" and "a super magnet" for everything that was happening. Depression? Yes. Artistic/smart? Yes. One friend? Yes. The apparent lack of empathy/sympathy that I exhibited in my family was due to the fact that I just couldn't handle even opening myself up even a tiny bit...one chink in my armor and I was just NOT going to be able to keep it together any longer. It was easier to shut down, b/c I just did not have healthy, strong emotional boundaries to keep the toxic emotional culture of my family at an arm's length.
My problem was not a "jeanmari" problem..it was a dysfunctional family systems problem. But it was easier for everyone to use me as the focal point, b/c I did act out all of the emotional stuff for the rest of the family. Years later, when I moved far, far away and got my own life, I was able to do the hard work of recovering from that and remapping who I was in close relationships. One of the turning points was when my friend turned to me and said, "You are beating yourself up for being such a bad "seed" but what happened in your family when you acted out?" It hit me like a bolt of lightening that when I acted out, my family would stop fighting and join together against me. I was keeping the family together, in a strange, only-in the-mind-of-a-kid-could-this-make-sense way. And when I changed how I acted towards and interacted with my family, even from a distance? OMG, the push back was intense b/c I had a ROLE to play. But I wasn't buying it anymore. They fight amongst themselves now, and I have a cordial to good relationship with them but I'm not in the crossfire anymore.
This long, navel-gazing essay is to illustrate...it may not all be Mark. Mark might exhibit the symptoms of a family systems problem.
posted by jeanmari at 11:34 AM on March 18, 2013 [30 favorites]
The reason that I'm curious about family therapy is that I was oversensitive to all of the emotional chaos, messy marriage issues, etc. going on in my family--I was a cross between a "canary in a coal mine" and "a super magnet" for everything that was happening. Depression? Yes. Artistic/smart? Yes. One friend? Yes. The apparent lack of empathy/sympathy that I exhibited in my family was due to the fact that I just couldn't handle even opening myself up even a tiny bit...one chink in my armor and I was just NOT going to be able to keep it together any longer. It was easier to shut down, b/c I just did not have healthy, strong emotional boundaries to keep the toxic emotional culture of my family at an arm's length.
My problem was not a "jeanmari" problem..it was a dysfunctional family systems problem. But it was easier for everyone to use me as the focal point, b/c I did act out all of the emotional stuff for the rest of the family. Years later, when I moved far, far away and got my own life, I was able to do the hard work of recovering from that and remapping who I was in close relationships. One of the turning points was when my friend turned to me and said, "You are beating yourself up for being such a bad "seed" but what happened in your family when you acted out?" It hit me like a bolt of lightening that when I acted out, my family would stop fighting and join together against me. I was keeping the family together, in a strange, only-in the-mind-of-a-kid-could-this-make-sense way. And when I changed how I acted towards and interacted with my family, even from a distance? OMG, the push back was intense b/c I had a ROLE to play. But I wasn't buying it anymore. They fight amongst themselves now, and I have a cordial to good relationship with them but I'm not in the crossfire anymore.
This long, navel-gazing essay is to illustrate...it may not all be Mark. Mark might exhibit the symptoms of a family systems problem.
posted by jeanmari at 11:34 AM on March 18, 2013 [30 favorites]
Parenting non-standard kids with standard parenting techniques is...often not useful.
Is there any real reason he can't be homeschooled, in a largely self-directed fashion? I would at a minimum get him a copy of The Teenage Liberation Handbook.
Mostly I would seek to find out if non-standard parenting and schooling practices improved his happiness and his interest in getting an education. You mention that he's bright, talented artistic -- he sounds like a good candidate for self-directed schooling (and also possibly a poor fit for standard schools). Freedom + good resources can produce surprisingly good results.
I would not seek to limit the non-self-harming leisure activities of a depressed teen; I don't know why the parents are trying to run interference with the iPod etc. It sounds like there is a lot of anger that he won't, for example, do things with the family, without a lot of introspection as to why that is, or a lot of 'Hey, wait, do we really need to force this? Is it benefitting my child or my relationship with my child to fight these fights?' He is not the only one lacking empathy from the sounds of it.
Are any of the people in his life offering him appropriate empathy and sympathy? You mention 'he's been the object of a lot of teasing and taunting,' describe a family situation where he is apparently mostly bossed about instead of being asked for input, and yet it is a surprise that, with so little useful modelling going on, he seems to lack empathy. He's a teenager but he's still a...he's a kid. He needs love and care and examples of empathetic behaviour. 'I am punishing you to make you good, because I care' is not going to increase his awareness of how to be a good person. On preview: +1 like_a_friend.
SSRIs do not really work as advertised; there aren't magic medical cures for depression. I would encourage the family to work hard to find him a counselor that he really clicks with.
Anyway, I would encourage your friend to look outside the box for solutions to this.
I was also once a bit of a 'Mark'
posted by kmennie at 11:36 AM on March 18, 2013 [13 favorites]
Is there any real reason he can't be homeschooled, in a largely self-directed fashion? I would at a minimum get him a copy of The Teenage Liberation Handbook.
Mostly I would seek to find out if non-standard parenting and schooling practices improved his happiness and his interest in getting an education. You mention that he's bright, talented artistic -- he sounds like a good candidate for self-directed schooling (and also possibly a poor fit for standard schools). Freedom + good resources can produce surprisingly good results.
I would not seek to limit the non-self-harming leisure activities of a depressed teen; I don't know why the parents are trying to run interference with the iPod etc. It sounds like there is a lot of anger that he won't, for example, do things with the family, without a lot of introspection as to why that is, or a lot of 'Hey, wait, do we really need to force this? Is it benefitting my child or my relationship with my child to fight these fights?' He is not the only one lacking empathy from the sounds of it.
Are any of the people in his life offering him appropriate empathy and sympathy? You mention 'he's been the object of a lot of teasing and taunting,' describe a family situation where he is apparently mostly bossed about instead of being asked for input, and yet it is a surprise that, with so little useful modelling going on, he seems to lack empathy. He's a teenager but he's still a...he's a kid. He needs love and care and examples of empathetic behaviour. 'I am punishing you to make you good, because I care' is not going to increase his awareness of how to be a good person. On preview: +1 like_a_friend.
SSRIs do not really work as advertised; there aren't magic medical cures for depression. I would encourage the family to work hard to find him a counselor that he really clicks with.
Anyway, I would encourage your friend to look outside the box for solutions to this.
I was also once a bit of a 'Mark'
posted by kmennie at 11:36 AM on March 18, 2013 [13 favorites]
He seems to not really care about how this takes a toll on his parents and other people, he seems to lack empathy and sympathy...
Depression does that. The inner turmoil really blinds you to others. Add-in the natural teenage urge to disassociate from the parents and, well...
posted by Thorzdad at 11:37 AM on March 18, 2013 [3 favorites]
Depression does that. The inner turmoil really blinds you to others. Add-in the natural teenage urge to disassociate from the parents and, well...
posted by Thorzdad at 11:37 AM on March 18, 2013 [3 favorites]
For one thing, I really hope that Mark's parents aren't thinking of their deeply ill and suffering child as "difficult" and "lacking empathy." I even more deeply hope that, even in the depths of their own suffering at seeing Mark suffer, they aren't communicating to him any of the sense I get from your post that adults in his life think that any of this is his fault and that he's making their lives harder. Yes, this is hard on his family; but he's certainly not doing it on purpose, and everyone who interacts with him needs to banish from their minds and hearts any hint of an idea that he's doing anything wrong. This is a child who is doing everything he can to keep a disease from killing him, and any sense that he is behaving badly or being spoiled or otherwise doing this on purpose could be, literally, fatal.
Mark's parents need to be working with his doctors closely to keep their child safe and healthy. If they don't trust the doctors, or if the doctors are not providing adequate care, they need to find him new doctors. Medication is not enough; he needs to have adults he can trust to talk to, and he needs the full support of everyone in his life.
His parents need to sit his brothers down and explain that any "teasing and taunting" is absolutely forbidden because it causes their brother to suffer deeply. The whole family should go to counseling together to figure out how to make home a safe place for all of the children. If the parents' marriage isn't strong, they should get marriage counseling to figure out how to deal with their own issues without hurting their kids.
Either the school needs to work with his parents to make school emotionally safe for Mark, or Mark's parents need to find some other way for him to get his education. I'll link here to a couple of comments I made in an AskMe thread a while ago about how refusing to attend school or to engage with others is a serious cry for help that parents need to take deadly seriously.
This absolutely can't be about making Mark comply with what adults think is best for him, or about allowing the rest of the family to live comfortably with Mark. This needs to be about saving Mark's life, both in the sense of preventing suicide and in the sense of making it bearable and pleasurable for him to engage with the world. Right now, Mark's parents don't seem to have any idea of what Mark is actually thinking and feeling or what treatments are available to help him deal with what he's going through. They need to engage with the best medical and psychological professionals they can find to help their son, and they (and you, and anyone else interacting with the family) need to absolutely banish any blaming from their minds.
posted by decathecting at 11:45 AM on March 18, 2013 [26 favorites]
Mark's parents need to be working with his doctors closely to keep their child safe and healthy. If they don't trust the doctors, or if the doctors are not providing adequate care, they need to find him new doctors. Medication is not enough; he needs to have adults he can trust to talk to, and he needs the full support of everyone in his life.
His parents need to sit his brothers down and explain that any "teasing and taunting" is absolutely forbidden because it causes their brother to suffer deeply. The whole family should go to counseling together to figure out how to make home a safe place for all of the children. If the parents' marriage isn't strong, they should get marriage counseling to figure out how to deal with their own issues without hurting their kids.
Either the school needs to work with his parents to make school emotionally safe for Mark, or Mark's parents need to find some other way for him to get his education. I'll link here to a couple of comments I made in an AskMe thread a while ago about how refusing to attend school or to engage with others is a serious cry for help that parents need to take deadly seriously.
This absolutely can't be about making Mark comply with what adults think is best for him, or about allowing the rest of the family to live comfortably with Mark. This needs to be about saving Mark's life, both in the sense of preventing suicide and in the sense of making it bearable and pleasurable for him to engage with the world. Right now, Mark's parents don't seem to have any idea of what Mark is actually thinking and feeling or what treatments are available to help him deal with what he's going through. They need to engage with the best medical and psychological professionals they can find to help their son, and they (and you, and anyone else interacting with the family) need to absolutely banish any blaming from their minds.
posted by decathecting at 11:45 AM on March 18, 2013 [26 favorites]
If Mark hasn't undergone comprehensive neuropsychological assessment, that needs to happen. Sometimes you can get that done through the school, but if his parents have good insurance and personal resources, it may be quicker and more effective to do that on their own. They should meet with his prescribing physician (hopefully a psychiatrist and not a general practitioner) and say they want to arrange a neuropsychological assessment so that everyone involved in his care can have the clearest picture possible of what is going on with him and work toward the most effective treatment plan possible.
Family therapy is sometimes more effective that individual therapy at that age when a child has outgrown play therapy but doesn't have the emotional maturity to get much out of traditional individual talk therapy. A family therapist can help his parents come up with a behavior plan that sets realistic, prioritized rules, boundaries, rewards, and consequences.
Finally, the school needs to have an active role in supporting Mark's treatment. If Mark is located in the U.S., the most effective way to create a collaborative relationship with the school is to get a 504 plan or IEP in place (two similar written plans for accommodations for students with disabilities, which include "emotional" disabilities such as depression, anxiety, ADHD, etc.). The parents need to contact the school administration and let them know that they would like to initiate the process of determining whether he qualifies for an IEP.
This last piece is another area where having resources can (perhaps sadly) make a difference in outcomes. There are educational disability advocates, including disability attorneys, who can be a valuable source of support in gathering the information you need and making the compelling arguments to get a child the right supports and services in place in the school environment.
Despite the name, I've found the Conduct Disorders online support form to be one of the most valuable places on the web for information and support for any parent who is dealing with any sort of serious and intractable behavioral problems, whether they ultimately stem from ADHD, depression, anxiety, bipolar, ODD, asperger's/autistic spectrum, or whathaveyou. It's a good place to get ideas about meds, behavior plans, school issues, or just to scream scream scream when you need to.
Best of luck to your friend. No judgment from this end--it is SO SO hard to parent pre-teens and teens with psychiatric issues, but the suicide thing esp.--shit, you know, you've got to keep pushing. I'm glad they are able to talk to you about how much they are struggling with this. They also need to keep talking with all their providers and not settle for stop gap measures.
posted by drlith at 12:08 PM on March 18, 2013
Family therapy is sometimes more effective that individual therapy at that age when a child has outgrown play therapy but doesn't have the emotional maturity to get much out of traditional individual talk therapy. A family therapist can help his parents come up with a behavior plan that sets realistic, prioritized rules, boundaries, rewards, and consequences.
Finally, the school needs to have an active role in supporting Mark's treatment. If Mark is located in the U.S., the most effective way to create a collaborative relationship with the school is to get a 504 plan or IEP in place (two similar written plans for accommodations for students with disabilities, which include "emotional" disabilities such as depression, anxiety, ADHD, etc.). The parents need to contact the school administration and let them know that they would like to initiate the process of determining whether he qualifies for an IEP.
This last piece is another area where having resources can (perhaps sadly) make a difference in outcomes. There are educational disability advocates, including disability attorneys, who can be a valuable source of support in gathering the information you need and making the compelling arguments to get a child the right supports and services in place in the school environment.
Despite the name, I've found the Conduct Disorders online support form to be one of the most valuable places on the web for information and support for any parent who is dealing with any sort of serious and intractable behavioral problems, whether they ultimately stem from ADHD, depression, anxiety, bipolar, ODD, asperger's/autistic spectrum, or whathaveyou. It's a good place to get ideas about meds, behavior plans, school issues, or just to scream scream scream when you need to.
Best of luck to your friend. No judgment from this end--it is SO SO hard to parent pre-teens and teens with psychiatric issues, but the suicide thing esp.--shit, you know, you've got to keep pushing. I'm glad they are able to talk to you about how much they are struggling with this. They also need to keep talking with all their providers and not settle for stop gap measures.
posted by drlith at 12:08 PM on March 18, 2013
Can he attend an alternative school tailored toward students with psychiatric problems? While you don't want to necessarily put him in an environment where he can "learn" bad behaviors from juvenile delinquent/court ordered kids, there are some psych hospitals that run a school program that addresses the mental health of their students as well as schooling. Have them ask the therapist if there are options in their area and explore those types of settings further.
I also agree with looking at this through a family systems/therapy lens. I can see how he would be simply shutting down because something is too difficult for him to deal with (could be school or family related).
posted by MultiFaceted at 12:39 PM on March 18, 2013
I also agree with looking at this through a family systems/therapy lens. I can see how he would be simply shutting down because something is too difficult for him to deal with (could be school or family related).
posted by MultiFaceted at 12:39 PM on March 18, 2013
Seconding drlith.
I was a special ed high school teacher who worked for many years with kids who presented with similar difficulties.
Forget about online resources and books for now. (Imagine it this way...let's say a person has been having what turns out to be intensely painful migraines for years, and instead of going to a doctor, they go online and read books and try every treatment they can find to fix their headaches when they should have just gone to a doctor. Go to a doctor.)
So their first step has to be getting this kid a full neuro-psychological testing battery done so competent mental health professionals can discover and address his issues. It's great that he's in therapy, but from what you've written and from my own experience, therapy isn't really helping this kid.
So everyone needs to find out exactly what's going on with him and then move forward. And I would certainly bet that the family needs therapy as a family to really help him (and themselves).
Next, the school system needs to get involved. Once a kid is in school-refusal mode, you need to convene a meeting, probably get him on an IEP or a 504 to accommodate his needs and ensure that they're fully responsible for getting his academic needs met.
Don't start looking into any stopgap measures until he's been fully tested.
And because you've mentioned a suicide attempt, please tell your friends they need to completely remove all means of self-harm from their house immediately.
Lastly, continue to be a supportive friend. This is a horribly isolating, guilt-ridden place for a parent and you are a very good person to help your friends.
posted by kinetic at 1:00 PM on March 18, 2013 [2 favorites]
I was a special ed high school teacher who worked for many years with kids who presented with similar difficulties.
Forget about online resources and books for now. (Imagine it this way...let's say a person has been having what turns out to be intensely painful migraines for years, and instead of going to a doctor, they go online and read books and try every treatment they can find to fix their headaches when they should have just gone to a doctor. Go to a doctor.)
So their first step has to be getting this kid a full neuro-psychological testing battery done so competent mental health professionals can discover and address his issues. It's great that he's in therapy, but from what you've written and from my own experience, therapy isn't really helping this kid.
So everyone needs to find out exactly what's going on with him and then move forward. And I would certainly bet that the family needs therapy as a family to really help him (and themselves).
Next, the school system needs to get involved. Once a kid is in school-refusal mode, you need to convene a meeting, probably get him on an IEP or a 504 to accommodate his needs and ensure that they're fully responsible for getting his academic needs met.
Don't start looking into any stopgap measures until he's been fully tested.
And because you've mentioned a suicide attempt, please tell your friends they need to completely remove all means of self-harm from their house immediately.
Lastly, continue to be a supportive friend. This is a horribly isolating, guilt-ridden place for a parent and you are a very good person to help your friends.
posted by kinetic at 1:00 PM on March 18, 2013 [2 favorites]
SSRIs do not really work as advertised; there aren't magic medical cures for depression.
This is not something MetaFilter is qualified to say.
Mark's parents need to find him a therapist he clicks with, and a therapy he will stick with. If there's a pediatric hospital in your area, I would highly suggest they get him an appointment with the psychiatric/psychological department there. If there isn't, they should be asking the school what options they might have.
Medication might help him get over the hump or he might end up needing it to function normally for the rest of his life. There is no shame in that, and yes, SSRIs or other medications can literally be life savers.
I strongly suggest getting the rest of the family into therapy as well, especially Mark's brothers. They need to back off the taunting and teasing and find some other way to express themselves as brothers. This isn't boys being boys, this is bordering on bullying a kid who is in an incredibly fragile mental state.
posted by cooker girl at 1:07 PM on March 18, 2013 [4 favorites]
This is not something MetaFilter is qualified to say.
Mark's parents need to find him a therapist he clicks with, and a therapy he will stick with. If there's a pediatric hospital in your area, I would highly suggest they get him an appointment with the psychiatric/psychological department there. If there isn't, they should be asking the school what options they might have.
Medication might help him get over the hump or he might end up needing it to function normally for the rest of his life. There is no shame in that, and yes, SSRIs or other medications can literally be life savers.
I strongly suggest getting the rest of the family into therapy as well, especially Mark's brothers. They need to back off the taunting and teasing and find some other way to express themselves as brothers. This isn't boys being boys, this is bordering on bullying a kid who is in an incredibly fragile mental state.
posted by cooker girl at 1:07 PM on March 18, 2013 [4 favorites]
Mark is not going to school, and they doon't know why not. Also, Mark is clinically depressed.
Those are the two facts to focus on here. I don't care if Mark is empathetic or not; I operate under the assumption that kids who have trouble showing empathy need even more love and attention, because that must be a lonely way to live...
So, how do we help Mark and also get him to go to school?
I notice you don't say much about whether Mark's family is religious, or conservative, but I think that information could be essential to figuring out what's going on with Mark. Could Mark be depressed about something he cannot openly discuss with his parents?
Ask your friends how they would react to any of these possibilities: What if Mark is on drugs? Suppose he was afraid of failing out of school? Could Mark be sexually active? If the suicide attempt be the result of a relationship that ended badly, an unrequited crush, embarrassment over romantic entanglements of some kind--what would they say to Mark? If Mark was gay, and in any of those situations, would they handle it the same way?
It all comes down to this: Can they accept their son for who he is, even if his actions go against their own beliefs, and if so, have they told Mark that?
I'd suggest Mark's parents sit down with Mark and his therapist to have that talk. I think what is most important here is not punishing Mark for not going to school, or taking away the few things he still enjoys(!), but figuring out what events might have triggered the depression in the first place and helping Mark find a road out by providing a loving, supportive base, free of judgment.
Also, sometimes parents keep things from the kids, to "protect" them. It's better, in my experience, to clue everyone in rather than treating depression like The Family Shame We Don't Talk About. All that does is confuse the kids, keep them from helping out, and create more stress for everybody involved. Mark's brothers need to know, if they don't already, how serious this situation is, and that they can help Mark by putting their energy into propping him up, rather than putting him down, until he can get himself back together.
posted by misha at 1:18 PM on March 18, 2013 [1 favorite]
Those are the two facts to focus on here. I don't care if Mark is empathetic or not; I operate under the assumption that kids who have trouble showing empathy need even more love and attention, because that must be a lonely way to live...
So, how do we help Mark and also get him to go to school?
I notice you don't say much about whether Mark's family is religious, or conservative, but I think that information could be essential to figuring out what's going on with Mark. Could Mark be depressed about something he cannot openly discuss with his parents?
Ask your friends how they would react to any of these possibilities: What if Mark is on drugs? Suppose he was afraid of failing out of school? Could Mark be sexually active? If the suicide attempt be the result of a relationship that ended badly, an unrequited crush, embarrassment over romantic entanglements of some kind--what would they say to Mark? If Mark was gay, and in any of those situations, would they handle it the same way?
It all comes down to this: Can they accept their son for who he is, even if his actions go against their own beliefs, and if so, have they told Mark that?
I'd suggest Mark's parents sit down with Mark and his therapist to have that talk. I think what is most important here is not punishing Mark for not going to school, or taking away the few things he still enjoys(!), but figuring out what events might have triggered the depression in the first place and helping Mark find a road out by providing a loving, supportive base, free of judgment.
Also, sometimes parents keep things from the kids, to "protect" them. It's better, in my experience, to clue everyone in rather than treating depression like The Family Shame We Don't Talk About. All that does is confuse the kids, keep them from helping out, and create more stress for everybody involved. Mark's brothers need to know, if they don't already, how serious this situation is, and that they can help Mark by putting their energy into propping him up, rather than putting him down, until he can get himself back together.
posted by misha at 1:18 PM on March 18, 2013 [1 favorite]
He's a child of a volatile sounding marriage whose teased (bullied?), has only one friend, is depressed and suicidal and you're putting the burden of his state of mind and that he doesn't care about how he's affecting the people around him?! If I was classified as obstinate, difficult and was taunted by my siblings, and was then expected to shield them from the suicidal thoughts they'd caused in me, so they don't have to look on the consequences of the absolute misery they've caused their own brother... How is this child even still with us!? My heart breaks. It wouldn't surprise me if he's being bullied in school as well.
And the only thing he enjoys is video games, which his parents are about to take away from him.
This whole family needs therapy. The parents need to stabilise their marriage. The other siblings need to be hauled over the coals for how they're treating their brother. He needs to be protected from his own family, and mum and dad need to stand up for him. If he enjoys drawing, video games and his iPod, for God's sake let him have that at least, it's probably his only refuge in life. Treating his depression is about more than therapy, you need to treat the cause of it which sounds like a lord of the flies family life and quite likely, major social issues at school. This is NOT his fault and blaming him could be the straw that breaks the camel's back.
posted by Jubey at 1:20 PM on March 18, 2013 [15 favorites]
And the only thing he enjoys is video games, which his parents are about to take away from him.
This whole family needs therapy. The parents need to stabilise their marriage. The other siblings need to be hauled over the coals for how they're treating their brother. He needs to be protected from his own family, and mum and dad need to stand up for him. If he enjoys drawing, video games and his iPod, for God's sake let him have that at least, it's probably his only refuge in life. Treating his depression is about more than therapy, you need to treat the cause of it which sounds like a lord of the flies family life and quite likely, major social issues at school. This is NOT his fault and blaming him could be the straw that breaks the camel's back.
posted by Jubey at 1:20 PM on March 18, 2013 [15 favorites]
His parents have had their ups and downs in their marriage and its has possibly taken a toll of on Mark. That in addition to a family history of some mental illness/depression may also play a role in this. Mark suffers from depression and has been in therapy for over two years and has also been in in-patent care for a week after a suicide attempt. He is taking medication under a doctor's supervision.
He sounds like he is in quite a bad place. Are there options to increase his treatment? How often does he go to therapy? Does his therapist think he should go more often? What does his therapist recommend that his family do to help him? Is the family together in family therapy? If not, why not? Are the therapist and the doctor coordinating his care? Is the doctor a psychiatrist who specializes in adolescent depression? If not, why not?
Mark has always been a really obstinate and difficult child. As the third of four boys he's been the object of a lot of teasing and taunting. For years he has resisted anything and everything - going places with the family, eating with the family, etc. Lately he refuses to go to school to the point that the school has visited the parents' home a few times to figure out why and what is going on.
These are symptoms of severe depression. Characterizing someone who is intense pain and who has tried to kill himself as "obstinate" and "difficult" and "resistant" to being normal is incredibly lacking in empathy and unhelpful. What are his parents doing to try to address these specific issues? Are they stopping the teasing and taunting? It seems pretty natural to avoid dinner and going out with family if those people bully you. How have they addressed the problems with school? Is his refusal to go because of bullying, boredom, general depression, asshole teachers? Is home schooling an option? Is another school an option? What does Mark want around schooling? What does his therapist think?
He seems to not really care about how this takes a toll on his parents and other people, he seems to lack empathy and sympathy. He has only one friend and really doesn't care about social interaction. Even if he isn't interested in learning at school, the opportunity to be social with other kids holds no appeal to him.
Of course he doesn't seem to care what toll this takes on other people. He's severely depressed. That's how it works. I hope this is just your language and not the way his parents think about him, but saying he "really doesn't care" about anything is a horrible thing to say - you don't know what he thinks, and the way he seems to feel could be quite different from how he actually feels because he is severely depressed. Judging him for not being nice enough to his parents is an awful thing to do to a child who is intensely suffering. Would you make the same characterization - criticizing him for not wanting to socialize - about a kid who has a life-threatening physical illness? Because that's what he has, a life-threatening illness.
He is a really bright kid, very athletic and talented - he's very artistic. He spends a ton of time online and listening to his ipod or playing video games. The parents are already trying to limit access to those things.
Really? His parents are taking the things in his life that give him the most pleasure and cutting off his access to them? That's awful.
His family is fearful Mark is not going to grow out of this and will never be able to live on his own and enter in to full adulthood. One more detail, whether this is relevant or not is that he comes from a family with means and has pretty much been given whatever he wants - and his parents differ on how to punish or set limits with kids. He hasn't had many limits/boundaries set for him.
If this is an accurate description of his parents' attitudes, if they really think that whether or not he will grow out of it is the main issue, then they need a serious reality check. My worry isn't whether or not he'll be able to live on his own, it's whether or not he'll be able to live at all. The setting of limits/boundaries is not that relevant, his need for treatment for his severe depression is the issue.
My friend is running out of ideas on how to help Mark. Are there other things that the family could be doing to help him? Do you know of any online resources or books that address this topic? Are there any alternative therapies for children that suffer from depression?
I'm really really glad that they're looking for more ideas for how to help. I've made a bunch of suggestions above. Fixing their marriage should be right at the top of the list. Family therapy should be happening weekly. Working with Mark and his therapist and the family therapist and the psychiatrist to figure out a treatment plan should be next. Completely reframing the way they think about the kid to stop blaming him for his depression would make a huge difference.
posted by medusa at 1:51 PM on March 18, 2013 [10 favorites]
He sounds like he is in quite a bad place. Are there options to increase his treatment? How often does he go to therapy? Does his therapist think he should go more often? What does his therapist recommend that his family do to help him? Is the family together in family therapy? If not, why not? Are the therapist and the doctor coordinating his care? Is the doctor a psychiatrist who specializes in adolescent depression? If not, why not?
Mark has always been a really obstinate and difficult child. As the third of four boys he's been the object of a lot of teasing and taunting. For years he has resisted anything and everything - going places with the family, eating with the family, etc. Lately he refuses to go to school to the point that the school has visited the parents' home a few times to figure out why and what is going on.
These are symptoms of severe depression. Characterizing someone who is intense pain and who has tried to kill himself as "obstinate" and "difficult" and "resistant" to being normal is incredibly lacking in empathy and unhelpful. What are his parents doing to try to address these specific issues? Are they stopping the teasing and taunting? It seems pretty natural to avoid dinner and going out with family if those people bully you. How have they addressed the problems with school? Is his refusal to go because of bullying, boredom, general depression, asshole teachers? Is home schooling an option? Is another school an option? What does Mark want around schooling? What does his therapist think?
He seems to not really care about how this takes a toll on his parents and other people, he seems to lack empathy and sympathy. He has only one friend and really doesn't care about social interaction. Even if he isn't interested in learning at school, the opportunity to be social with other kids holds no appeal to him.
Of course he doesn't seem to care what toll this takes on other people. He's severely depressed. That's how it works. I hope this is just your language and not the way his parents think about him, but saying he "really doesn't care" about anything is a horrible thing to say - you don't know what he thinks, and the way he seems to feel could be quite different from how he actually feels because he is severely depressed. Judging him for not being nice enough to his parents is an awful thing to do to a child who is intensely suffering. Would you make the same characterization - criticizing him for not wanting to socialize - about a kid who has a life-threatening physical illness? Because that's what he has, a life-threatening illness.
He is a really bright kid, very athletic and talented - he's very artistic. He spends a ton of time online and listening to his ipod or playing video games. The parents are already trying to limit access to those things.
Really? His parents are taking the things in his life that give him the most pleasure and cutting off his access to them? That's awful.
His family is fearful Mark is not going to grow out of this and will never be able to live on his own and enter in to full adulthood. One more detail, whether this is relevant or not is that he comes from a family with means and has pretty much been given whatever he wants - and his parents differ on how to punish or set limits with kids. He hasn't had many limits/boundaries set for him.
If this is an accurate description of his parents' attitudes, if they really think that whether or not he will grow out of it is the main issue, then they need a serious reality check. My worry isn't whether or not he'll be able to live on his own, it's whether or not he'll be able to live at all. The setting of limits/boundaries is not that relevant, his need for treatment for his severe depression is the issue.
My friend is running out of ideas on how to help Mark. Are there other things that the family could be doing to help him? Do you know of any online resources or books that address this topic? Are there any alternative therapies for children that suffer from depression?
I'm really really glad that they're looking for more ideas for how to help. I've made a bunch of suggestions above. Fixing their marriage should be right at the top of the list. Family therapy should be happening weekly. Working with Mark and his therapist and the family therapist and the psychiatrist to figure out a treatment plan should be next. Completely reframing the way they think about the kid to stop blaming him for his depression would make a huge difference.
posted by medusa at 1:51 PM on March 18, 2013 [10 favorites]
First of all, I would suggest that the whole family needs thorough evaluation from a medical doctor who is qualified in family therapy. Sending him to some feeble form of therapy on his own isn't preventing his siblings from bullying him, it isn't stabilizing his parents' marriage, it isn't keeping him safe from bullying at school, and it isn't ensuring that he can still hang on to the few pleasures he has in life. Those are things that other people have the power to change and he has not.
Also, he probably knows that he is going to grow up and become an utter failure who can't take care of himself. I'm sure it's been thoroughly drilled into his mind, such that he is no longer able to imagine a better future for himself. Since he already knows he is completely powerless, he has no motive to get better as far as the eye can see.
Instead of blaming him for being sad when his siblings bully him, his siblings need to be disciplined and taught to relate to one another like decent compassionate people. Adults often assume that children have no choice but to be cruel to one another, but that's really not true, since even children have a measure of the control over ourselves that all humans have. At the same time, adults also often assume that children who are the targets of cruelty, have total freedom of choice to behave in ways that won't compel others to bully them; that's even less true because a child, like any other human, really only has control over himself, not over others.
Instead of blaming him for interrupting their marital difficulties with his suicide attempts and school refusal, his parents should be in therapy to learn to relate to each other better. For the sake of all their children. There, I said it.
Instead of trying to think of ways of forcing him to go to school, someone with expertise in school refusal needs to figure out what's at school that he's so desperate to avoid. There are quite a few options nowadays for children with school refusal, and since his parents apparently have means, they should be able to exercise quite a variety of options.
Instead of taking away the one escape he has from the misery of his life, the people with actual power to alleviate that misery should find ways of doing so. Once the most important people in his life are no longer a cause of misery to him, he may even be motivated to engage with them.
posted by tel3path at 2:12 PM on March 18, 2013 [7 favorites]
Also, he probably knows that he is going to grow up and become an utter failure who can't take care of himself. I'm sure it's been thoroughly drilled into his mind, such that he is no longer able to imagine a better future for himself. Since he already knows he is completely powerless, he has no motive to get better as far as the eye can see.
Instead of blaming him for being sad when his siblings bully him, his siblings need to be disciplined and taught to relate to one another like decent compassionate people. Adults often assume that children have no choice but to be cruel to one another, but that's really not true, since even children have a measure of the control over ourselves that all humans have. At the same time, adults also often assume that children who are the targets of cruelty, have total freedom of choice to behave in ways that won't compel others to bully them; that's even less true because a child, like any other human, really only has control over himself, not over others.
Instead of blaming him for interrupting their marital difficulties with his suicide attempts and school refusal, his parents should be in therapy to learn to relate to each other better. For the sake of all their children. There, I said it.
Instead of trying to think of ways of forcing him to go to school, someone with expertise in school refusal needs to figure out what's at school that he's so desperate to avoid. There are quite a few options nowadays for children with school refusal, and since his parents apparently have means, they should be able to exercise quite a variety of options.
Instead of taking away the one escape he has from the misery of his life, the people with actual power to alleviate that misery should find ways of doing so. Once the most important people in his life are no longer a cause of misery to him, he may even be motivated to engage with them.
posted by tel3path at 2:12 PM on March 18, 2013 [7 favorites]
Also, focusing on Mark being primarily a depressive personality could be missing the point. It sounds more like he has bad anxiety. When anxiety goes through the roof, prodded by whatever is scaring the shit out of him at school, and stays at a high level for a long time the body can just shut the system down and go into a depressed mode. I thought I was primarily afflicted by depression most of my life, now I know that depression for me is just a symptom of my anxiety run amok.
I don't know what I would have made of the information at the age of 13, but later in life learning about the evolutionary explanation for anxiety really put my issues in perspective and ESPECIALLY helped me take some of the blame for my life's difficulties off of myself and slap it happily on millions of years of evolutionary misfortune that I could in no way be held responsible for. Maybe knowing the reasons he feels the way he feels can make it a little less frightening as it did for me.
Aaron T. Beck's book on anxiety and phobia disorders puts it plainly and effectively enough, I think.
posted by TheRedArmy at 4:08 PM on March 18, 2013 [2 favorites]
I don't know what I would have made of the information at the age of 13, but later in life learning about the evolutionary explanation for anxiety really put my issues in perspective and ESPECIALLY helped me take some of the blame for my life's difficulties off of myself and slap it happily on millions of years of evolutionary misfortune that I could in no way be held responsible for. Maybe knowing the reasons he feels the way he feels can make it a little less frightening as it did for me.
Aaron T. Beck's book on anxiety and phobia disorders puts it plainly and effectively enough, I think.
posted by TheRedArmy at 4:08 PM on March 18, 2013 [2 favorites]
tel3path mentioned "school refusal" - I'd like to reinforce that this is a not just a descriptive phrase for what's happening with Mark, this is a phenomenon that is widely studied. School refusal is not the same as truancy, and it's not just him being obstinate either. It is usually related to anxiety or to being bullied. Interventions for school refusal are not necessarily the same as for other manifestations of depression or anxiety. Can you find a local expert in school refusal to consult?
Is Mark enrolled in public school in the US? Any time you have a student who has issues that are preventing them from succeeding in school - whether they are neurological, behavioral, emotional, physical, whatever - you should seriously consider getting an IEP (Individual Education Plan). The parents and the school district will come up with a plan for assessment and accommodation, with measurable goals. At Mark's age, he should be encouraged to participate in the process. If an alternate placement (different school, independent study, all the way up to residential treatment) is best for Mark, the school district is obligated to provide it. It can be a bureaucratic nightmare, and often it's hard to tell what the best environment will be until you've tried a few things. And schools do not have a lot of resources to spare. But it's worth a shot.
As a parent, it is terrifying to admit that you don't know how to help your child - even more so to look at your family system and realize that it could be actively harmful. It takes a lot out of you, but as the adults in the equation it is your friends' responsibility to get some changes underway. Family therapy, parenting classes or resources, marital counseling, respite care, in-home support, individual therapy not just for Mark, partial hospitalization programs - will any of these help? I don't know, but they are there for your friends to try.
posted by expialidocious at 4:46 PM on March 18, 2013 [1 favorite]
Is Mark enrolled in public school in the US? Any time you have a student who has issues that are preventing them from succeeding in school - whether they are neurological, behavioral, emotional, physical, whatever - you should seriously consider getting an IEP (Individual Education Plan). The parents and the school district will come up with a plan for assessment and accommodation, with measurable goals. At Mark's age, he should be encouraged to participate in the process. If an alternate placement (different school, independent study, all the way up to residential treatment) is best for Mark, the school district is obligated to provide it. It can be a bureaucratic nightmare, and often it's hard to tell what the best environment will be until you've tried a few things. And schools do not have a lot of resources to spare. But it's worth a shot.
As a parent, it is terrifying to admit that you don't know how to help your child - even more so to look at your family system and realize that it could be actively harmful. It takes a lot out of you, but as the adults in the equation it is your friends' responsibility to get some changes underway. Family therapy, parenting classes or resources, marital counseling, respite care, in-home support, individual therapy not just for Mark, partial hospitalization programs - will any of these help? I don't know, but they are there for your friends to try.
posted by expialidocious at 4:46 PM on March 18, 2013 [1 favorite]
anonymous: "Mark has always been a really obstinate and difficult child. As the third of four boys he's been the object of a lot of teasing and taunting. For years he has resisted anything and everything - going places with the family, eating with the family, etc. Lately he refuses to go to school to the point that the school has visited the parents' home a few times to figure out why and what is going on. He seems to not really care about how this takes a toll on his parents and other people, he seems to lack empathy and sympathy. He has only one friend and really doesn't care about social interaction. Even if he isn't interested in learning at school, the opportunity to be social with other kids holds no appeal to him."
As somebody who's been struggling with major depression since I was younger than Mark, I felt angry when I read this. Mark is suicidally depressed. Obstinate? Difficult? He is 13 years old and in such distress that he just tried to kill himself. His parents think it's "difficult" to be around him and it "takes a toll" on them? How freaking "difficult" is it to BE him? How much of a toll is it taking on HIM? He's been so depressed that he's been in therapy for two years now, which has apparently not improved or he wouldn't have tried to kill himself, and his parents are surprised/upset that he doesn't want to socialize with his peers or eat dinner with the family? The family that includes three brothers who have for years made him the object of a lot of teasing and taunting?
Just about everybody in this family needs to be doing a whole hell of a lot of introspection and self-work. Mark's been profoundly depressed for years without, apparently, getting reasonable help for it. What's everybody else's excuse?
posted by Lexica at 6:03 PM on March 18, 2013 [15 favorites]
As somebody who's been struggling with major depression since I was younger than Mark, I felt angry when I read this. Mark is suicidally depressed. Obstinate? Difficult? He is 13 years old and in such distress that he just tried to kill himself. His parents think it's "difficult" to be around him and it "takes a toll" on them? How freaking "difficult" is it to BE him? How much of a toll is it taking on HIM? He's been so depressed that he's been in therapy for two years now, which has apparently not improved or he wouldn't have tried to kill himself, and his parents are surprised/upset that he doesn't want to socialize with his peers or eat dinner with the family? The family that includes three brothers who have for years made him the object of a lot of teasing and taunting?
Just about everybody in this family needs to be doing a whole hell of a lot of introspection and self-work. Mark's been profoundly depressed for years without, apparently, getting reasonable help for it. What's everybody else's excuse?
posted by Lexica at 6:03 PM on March 18, 2013 [15 favorites]
My god, that poor boy.
The truth is, OP, you don't really know what's going on in that house. You don't live there. If this boy is suicidal at the age of 13 I would think it's more than your typical sibling teasing we're talking about, and more than just the "ups and downs" of a marriage. He could be being abused by a parent or by his brothers. You don't know. And honestly, it's so common in abusive families to make the abuse victim into a "problem child" when they begin displaying behavioral and emotional issues.
The only things you can really do, as a person who is not part of this family, is to (a) suggest therapy for the entire family, and individual therapy for each parent, and (b) decide that you are going to be on this boy's side. Be a champion for him. Tell him you are available if he ever wants to talk. Tell him you're sorry he's suffering from depression and that he's not alone. Tell him that it's not his fault and that he's a good kid. I don't know what kind of relationship you have with him, but if you can hang out with him a bit - perhaps go play basketball or something, since he's athletic - he might open up a bit. It sounds like he needs an adult he can trust and who has his back.
posted by imalaowai at 7:07 PM on March 18, 2013 [4 favorites]
The truth is, OP, you don't really know what's going on in that house. You don't live there. If this boy is suicidal at the age of 13 I would think it's more than your typical sibling teasing we're talking about, and more than just the "ups and downs" of a marriage. He could be being abused by a parent or by his brothers. You don't know. And honestly, it's so common in abusive families to make the abuse victim into a "problem child" when they begin displaying behavioral and emotional issues.
The only things you can really do, as a person who is not part of this family, is to (a) suggest therapy for the entire family, and individual therapy for each parent, and (b) decide that you are going to be on this boy's side. Be a champion for him. Tell him you are available if he ever wants to talk. Tell him you're sorry he's suffering from depression and that he's not alone. Tell him that it's not his fault and that he's a good kid. I don't know what kind of relationship you have with him, but if you can hang out with him a bit - perhaps go play basketball or something, since he's athletic - he might open up a bit. It sounds like he needs an adult he can trust and who has his back.
posted by imalaowai at 7:07 PM on March 18, 2013 [4 favorites]
ALTERNATIVE SCHOOLING. I basically was this kid (not to the point of self-harm, but pretty close), and being pulled out of regular school probably kept me out of an institution. It's not crazy or weird or obstinate to hate middle school. Middle school is soul-crushing, and if he hates it that much he shouldn't be there. It's okay to not be interested in "being social" with a bunch of random kids who might not treat you all that well. He sounds like independent study or art school would be a good fit. I think he'd also benefit from some kind of mentor outside the family.
posted by Nibbly Fang at 9:18 PM on March 18, 2013 [2 favorites]
posted by Nibbly Fang at 9:18 PM on March 18, 2013 [2 favorites]
This thread is closed to new comments.
He seems to not really care about how this takes a toll on his parents and other people, he seems to lack empathy and sympathy
is strictly a true or fair interpretation. My guess would be that he's in too much blinding internal pain to even register at a level of sympathy or empathy. It's like asking someone, "jeez, don't you realize how hard it is for ME to deal with YOUR gaping bleeding head wound?"
posted by like_a_friend at 11:28 AM on March 18, 2013 [44 favorites]