What do a 45-year-old professor, several well-educated parents, a retired psychotherapist, a concerned husband, and a college student all have in common? These are people suffering–or intimately connected to someone suffering–from clinical depression who didn’t know it.

How, in this day and age, with so much information available, is it possible that depression can still go undiagnosed and therefore untreated? Perhaps this is part of the reason why the blog “Depression Part Two” on Hyperbole and a Half  just went viral (besides how extraordinarily creative it is). Here are some reasons why smart people can miss the signs of depression:
1. Depression can creep up on you.
Not all depression is so severe that you can’t stop crying or get out of bed. For many people, the feelings of sadness manifest as a growing disinterest in life’s activities. What used to be fun or interesting seems unimportant or shallow. You don’t feel like going to your friend’s birthday party so you make up an excuse. You feel bored by the books or TV shows that used to appeal to you. You don’t notice how, little by little, you are pulling back from others, spending more time alone, locked in your room.
2. Depression seems to be a logical response to life’s challenges.
Since depression often worsens or can be triggered by loss or stress, you figure that you are responding appropriately to what is indeed a painful time in your life. You may have broken up with a boyfriend, had difficulties at work, done poorly on a school assignment, or moved away from a supportive environment. When you don’t snap out of it, even when your life circumstances appear to get better, you don’t realize that your negative mood state has persisted for months or even years. 
3. Some depression manifests as extraordinary irritability rather than sadness.
One of the most commonly misunderstood or overlooked manifestations of depression is hypersensitivity or irritability. People around you tell you that you are constantly cranky. You seem …

“Nature, we are starting to realize, is every bit as important as nurture. Genetic influences, brain chemistry, and neurological development contribute strongly to who we are as children and what we become as adults.” -Stanley Turecki, M.D.

Sue and Alan Richardson are like so many other distressed parents who reach out to our counseling clinic. They have three kids. Two have been launched successfully, and they have warm relationships and good communication. Sue and Alan are devastated because one of their kids, now 19, is such a problem. Samantha struggled with depression beginning in junior high, rages at them on occasion, tried to make it at college but couldn’t stand the pressure, and has bounced back home again. What went wrong? They parented all three kids similarly but Samantha was always more difficult and highly sensitive.

Stopping the Blame Game

Parents often get blamed or blame themselves for any problem that shows up in their children. We now know that every baby is born with certain innate inherited characteristics or temperament. Temperament is, by definition, the part of a child’s personality that is not caused by good or bad parenting. Built-in traits will affect each child’s style of interacting with people, places and things throughout their lifetime. The research validates what many parents knew intuitively all along. Some babies are easy, and some are more challenging. Because it is almost taboo to say something negative about one child or to compare your kids, many parents don’t get the support that they need when struggling with a more difficult child.

The Nature Vs. Nurture Debate

The debate about just how much of our behavior and personality is genetic vs. environmental, or nature vs. nurture, has raged on for the last hundred years. Twenty or thirty years ago, in an ongoing effort to understand why people behave in certain ways, both good and bad, researchers focused more on the nurture side, examining things like the family environment or types of parenting that were correlated with problems or resiliency in children. In the past ten …

“Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul.”  ~John Muir

In my last blog on the growing numbers of kids being diagnosed with ADHD, I wondered out loud about the potential negative effects in our modern culture of things like: too much time spent indoors, too little sun and exercise, too many electronics, and not enough sleep. Rather than dwell on the causes of our problems, let’s consider what we can do to reduce the impact of stress on the lives of both adults and children. Not from a medical psychiatric perspective, but from the perspective of everyday life.

Ask yourself this question: Do you or your kids suffer from Nature-Deficit Disorder?

This wonderful name was coined by journalist Richard Louv with the publication of Last Child in the Woods. His newest book, The Nature Principle: Human Restoration and the End of Nature-Deficit Disorder, offers a new vision of the future, in which our lives are equally immersed in nature and in technology.

What do we already know about the positive effects of time spent outdoors, immersed in nature?

Rachel and Stephen Kaplan, environmental psychologists from the University of Michigan, are internationally known for their research on the effect of nature on people’s relationships and health.The Kaplans got involved in studying the effects of nature back in the 1970s, and since then have done extensive research on “restorative environments” to understand the psychological benefits of time spent in nature and what types of natural environments stimulate health and reduce stress.

In order to work or study efficiently, we need to maintain focused attention on the task at hand–something that everyone struggles with–most especially those with Attention Deficit Disorder or ADHD. Too much focused attention can lead to mental fatigue and increased stress. One remedy for this fatigue is exposure to nature. The wilder the better, but even a little bit helps. Office workers with a view of nature are happier and healthier at work; kids do better academically; hospital …

I have spent countless hours in deep discussion with both parents and professionals questioning why so many kids are being diagnosed these days with Attention Deficit Disorder (ADD) or Attention Deficit with Hyperactivity (ADHD). Is there some causal contributor in our food or environment? Is it due to changes in parenting practices? School environments? The increase in technology in everyday life? The lobbying power of drug companies? All of the above?

What Are the Facts?

The number of American children leaving doctors’ offices with an attention deficit hyperactivity disorder (ADHD) diagnosis has risen 66% in 10 years, according to a Northwestern study. ”The magnitude and speed of this shift in one decade is likely due to an increased awareness of ADHD,” explains first author Craig Garfield, M.D., perhaps causing more physicians to diagnose the disorder. Researchers also found that psychostimulants have remained the most common medication, prescribed to 87% of children with ADHD in 2010.

No matter what the reason, it is frightening to think about.  Not only are kids being given psychiatric medications at younger ages, more young adults than ever before are now taking ADHD medications, usually powerful and addictive amphetamines like Adderall. In the past four years, IMS Health reported that the number of monthly prescriptions has more than doubled for Americans ages 20 to 39. The use and abuse of stimulants is on the rise.

Far too many kids, once 18 and away from home, decide on their own to get a prescription. Certainly some of these kids have legitimate difficulty keeping up with their studies because of real attention problems. Countless others look up the symptoms on the web and act the part. A 2010 study  by researchers at the University of Kentucky compared two groups of college students– those diagnosed with ADHD and others with faked symptoms–and found they were indistinguishable on the standard tests typically given. Once your kids become adults, there is nothing much that parents can do. But, is there anything you can do NOW to stem the tide? I think so.

What Can Parents …

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“Too many people spend money they earned..to buy things they don’t want..to impress people that they don’t like.”                                    -Will Rogers

Sally and Smitty brought their two kids, Hilary, age 13, and Justin, age 10. The parents were constantly fighting with the kids and each other about money. We talked not only about how this family made decisions about money but also about what Sally and Smitty had learned in each of their families growing up. In Sally’s family, money had been the main instrument that her father had used to control both his wife and the kids. When her dad was pleased, he bought her whatever she wanted, and when he was angry, he was a tightwad. In Smitty’s family, there was never enough money. His parents amassed huge debts, constantly bought things they could not afford, and were even now trying to borrow money from Smitty. When Hilary and Justin made impassioned demands for the latest fashion items or video games, Smitty always said no and Sally wanted to say yes. Sound familiar? Disagreements about money–how hard you should work, how much you should save or spend, and who gets to make the decisions about it–are often the cause of conflict in families. What are some of the important lessons that parents should be teaching their kids about money? What do you wish that you had learned as a child about money that could have saved you a lot of time and trouble?
#1 Start teaching your kids about the connection between work and money when they are little. Money does not grow on trees.
Start by giving your child an allowance when they are as young as six years old. Make it clear what kinds of expenditures the money is for. Some parents link allowance money to household chores. The disadvantage of this strategy is that kids get the message that they should be paid to help out. I think …

Mr. and Mrs. Harrison called to request family therapy after their 13-year old son called Child Protective Services. When a social worker arrived at their home on a quiet suburban street, Mrs. H was horrified and embarrassed. What Billy called abuse was his parents’ seizing of his Xbox after they caught him playing at 1 a.m. on a school night. When he refused to hand it over voluntarily, his father grabbed the machine and threatened to throw it out the window. 

What Ever Happened to My Sweet Child?

Although power struggles between children and parents are a normal and predictable part of social and emotional development, they typically escalate when children start to grow into teenagers. The strength of some teens’ emotional reactions blow their parents away. Just as power surges occasionally knock out your home’s electricity, creating at least temporary havoc, so can these emotional outbursts bring normal life to a sudden halt.

The sudden intensity of power struggles often come as a shock to parents raising their first teenager. Sometimes the first kid glides through adolescence with very little drama but the second-born makes the challenge. Emotions escalate and often cruel words are spoken on both sides. Kids accuse parents of being mean, unfair, crazy, out of touch…parents call their kids selfish, disrespectful, lazy and disobedient. Is there any way to avoid the pain, the guilt, and the worry of this stage of development?

The Unpredictable Effects of Hormones

Unfortunately, the answer is yes and no. Some of the reason that power struggles can escalate to new levels has to do with the biology of adolescence itself. As boys (starting anywhere between 9 and 15) and girls (starting anywhere between 7 and 13) move into and through puberty, they have their own internal surges to contend with–namely the flood of hormones necessary to ensure normal development. Because of hormones, your son or daughter will have stronger emotions than ever before, feeling overly sensitive, highly anxious or becoming easily upset.

Although it can be difficult for everyone involved to deal …

“Everything is a battle and we can’t stand it any more.”  These are the first words spoken by Sylvia, mother of two, and her husband quickly agreed. “We can’t get the kids to school on time, get them to turn off their electronic devices, do their homework, or go to bed without resistance and stalling. Can you help us?”

If this sounds like your house, there is light at the end of the tunnel. And the answer does not have to involve spanking, shouting, nagging, criticizing or coercing. Although power struggles between parents and their children are exceedingly normal–especially in adolescence–they should not be the norm of everyday life. What’s a parent to do and why do we get into power struggles in the first place?

A crucial component in the development of a healthy personality is gaining a sense of autonomy.

Starting around the age of two, children demonstrate their desire for increased independence by discovering the power of the word “NO!” and “mine”. Toddlers have a strong desire to figure things out for themselves, and when they succeed, they gain a sense of self-confidence and self-control. This stage has come to be known as “the terrible twos” because it can take parents by surprise when their sweet baby begins to have a mind of her own. In truth, it would be terrible if this stage didn’t happen.

Power struggles stem from a natural urge in children to have control over their choices.

Too many parents interpret their child’s resistance as defiance or lack of respect for authority. This sounds pretty bad, doesn’t it? In fact, when a parent thinks about resistant behavior in this way, it makes it far more likely that the parent will react to the kid’s non-compliance with an overly intense emotional response such as increased annoyance and anger. When setting limits with kids, the less emotional the better. By asserting himself, your child is building a stronger, more separate self. Kids need to learn to be independent by practicing how to stand …

If you get the Sunday newspaper, you were probably one of the 33 million subscribers who saw yesterday’s Parade Magazine cover story, “The Secrets to a Happy Family,” by the New York Times columnist, best-selling author and dad, Bruce Feiler. Feiler is perhaps best known for his book Walking the Bible, also made into a wonderful PBS series. I respect the man for many reasons–he is a great writer, an intrepid explorer of diverse cultures and religions, and a deeply committed father. But the article, and other information gleaned from interviews with Feiler, left me worried.

Already poised to be a best-selling parenting book on Amazon, since the book hasn’t quite gone to print, I haven’t gotten a copy yet. Nevertheless, as a mental health professional with more than thirty years of experience successfully helping parents and families to be more loving and effective, I was upset by the article featured so prominently in Parade. Quite a publishing coup, but at what cost to parents and families? Here are some thoughts for future readers to consider:

 What credentials make Bruce Feiler an expert on parenting or on characteristics of healthy families?

Quoted in an interview on his Amazon page, Feiler proclaims,”As for parenting books, the biggest problem is they’re out of fresh ideas.” Step aside, mental health professionals. You have nothing new to offer. Besides, the “old” information, confirmed by thousands of researchers, is, well, old. Which must mean invalid, right?

Unfortunately, this just isn’t true. A body of solid research–and books that outline the findings–are there for the picking, and new studies on healthy families are being done constantly. Important findings are available from resources such as the National Institute of Mental Health, the U.S. Dept. of Health and Human Services, the Pew Research Center, The Harvard Family Research Project (and similar projects in universities around the world). In fact, there are so many professional, competent contributors to this field that the amount of information is overwhelming. They/we are not out of fresh ideas.

Surprisingly, Feiler chose to ignore the usual psychologists and family experts, and instead, as stated in his interview, …

“You all know that I have been sustained throughout my life by three saving graces – my family, my friends, and a faith in the power of resilience and hope. These graces have carried me through difficult times and they have brought more joy to the good times than I ever could have imagined.”                                             -Elizabeth Edwards

Life isn’t always easy. It’s not a bed of roses. The journey inevitably includes suffering, for some far more than for others. Most of us have known good people who have not been able to withstand the pain of existence and have succumbed to drugs and alcohol, acts of violence, and even deep despair and suicide.

But, at the same time, there have always been heroes–strong men and women who have overcome hardship and risen to greatness. There are examples of strength and resilience in every walk of life–athletes, artists, politicians, whistle-blowers, game-changers. There are also the unacknowledged heroes among us–people who will never be rich or famous but who were there as role models, facing life with grace and courage.

One important way to teach our kids how to be resilient is by studying and celebrating our heroes. What can they teach us?

1. Reach out to others.

At times of loss and trauma, most people feel alone. Just knowing that others have gone through whatever hardship we are currently facing can provide hope and comfort. This is why support groups are so effective. In 2010, researchers at Brigham Young University and the University of North Carolina at Chapel Hill examined every research paper on the relationship of social relationships and health, involving more than 300,000 men and women. They found that those with poor social connections had on average 50% higher odds of death in the study’s follow-up period (an average of 7.5 years) than people with more social ties.

2. Notice and celebrate the gifts that you are receiving.

A crucial …

“In order to succeed, people need a sense of self-efficacy, to struggle together with resilience to meet the inevitable obstacles and inequities of life.” -Psychologist Albert Bandura

Given that change, with accompanying losses and hardships, is an inevitable part of life, it is crucial to learn how we can increase our capacity to rebound or spring back after painful life events, a capacity called resilience. Although we know that some aspects of resilience are inborn (related to temperament as explained in another blog), others aspects can be learned and practiced. Just as children are vaccinated to avoid physical disease, parents can help by inoculating them for the challenges they will face throughout their lives.

This can be done by teaching kids to have a resilient mindset or a positive lens through which they see themselves and the world. An example of this is teaching young children that mistakes are an inevitable part of learning new skills and are actually helpful rather than something bad to be avoided. An essential building block of resilience is a high level of self-efficacy. Although I have a pet peeve against fancy words when simple ones can do just as well, I think that it is important that parents, teachers, and therapists learn about self-efficacy: what it is, why it is important, and how to build it in ourselves and others.

Self-efficacy is defined as a person’s belief (whether true or not) in his or her ability to succeed or manage in specific situations or tasks. It is what helps nurture effort, perseverance, resilience, serenity, and optimism in the face of adversity. Do you remember the children’s story, The Little Engine That Could? When the little blue train has to pull a load of toys over the mountain, she succeeds only when she tells herself, “I think I can, I think I can, and then delights in her success by saying to herself, “I thought I could, I thought I could!” The little engine is a model of high self-efficacy.

Albert Bandura, …