Author of Can Preschoolers be Depressed? Pamela Paul, speaks to the complexities of diagnosing depression in young children. She says that while there are many reasons for refraining from categorizing developing children, it is useful to know that there are interventions that might help.

Having over fifteen years of experience using EMDR for treating symptoms of mood, spirit and body, I absolutely believe that there are creative approaches to activating the brain’s neuroplasticity during the early years - in such ways that may offset the neural tendencies that direct depression. Paul points out that “the brain literally changes course when you prod it in a given direction,” and it does. May we derive some hope here that as we continue to learn more about the healing powers inherent in the brain, we come to discover new ways to empower children and their families.

Here are some exerpts I found of interest:

• “Depression was originally seen as an adult problem with origins in childhood, rather than something that existed in children. The psychoanalytic view was that children didn’t have the mental capacity for depression; their superegos were not sufficiently developed.”
• “One of the most important mental-health discoveries of the past 10 to 20 years has been that chronic mental illnesses are predominantly illnesses of the young,” says Daniel Pine, chief of the emotion-and-development branch in the Mood and Anxiety Disorders Program of the National Institute of Mental Health. They begin when we are young and affect us, often profoundly, during the childhood years, shaping the adults we become.
• Controversy over whether major depression could occur in teenagers, something we now take as a given, persisted until the 1980s. First adolescents, then grade-school children were considered too psychologically immature to be depressed. Stigma was a major fear. “There was this big worry that once you labeled it, you actually had it,” explains Neal Ryan, a professor of child and adolescent psychiatry at the University of Pittsburgh. By the early 1990s psychiatrists had come to recognize that depression occurs in children of 8, 9 and 10.
• Still, in 1990, when Luby first broached the subject of whether children could be depressed even before they entered school, her colleagues’ reactions ranged from disinterest to hostility. Then in the late ’90s, the study of early childhood entered a kind of vogue among academics and policy makers. This was the era of President Clinton’s White House Conference on Early Childhood Development and Learning, and there was a wave of interest in the importance of what was termed “0 to 3.”
• “We realized, Gee, maybe we better look more carefully at preschool, too,” Pine says. “And that’s where we are today. The issue of diagnosis of depression in preschoolers is being looked at very carefully right now.”
• Diagnosis of any mental disorder at this young age is subject to debate. No one wants to pathologize a typical preschooler’s tantrums, mood swings and torrent of developmental stages. Grandparents are highly suspicious; parents often don’t want to know.
• Some in the field have reservations, too. Classifying preschool depression as a medical disorder carries a risk of disease-mongering. “Given the influence of Big Pharma, we have to be sure that every time a child’s ice cream falls off the cone and he cries, we don’t label him depressed,” cautions Rahil Briggs, an infant-toddler psychologist at Children’s Hospital at Montefiore in New York.”

To read the entire article on NYTimes, click here.

http://www.huffingtonpost.com/jane-shure/reflections-on-the-doctor_b_680001.html It’s complicated.

The relationship between a therapist and patient — it’s really complicated, as is the journey to healing our childhood wounds. Last week, in the New York Times Magazine, Daphne Merkin self-disclosed of her life in therapy, opening us to a much needed public dialogue.What helps one person deal with their inner life may not be effective for another person. We do not conform to cookie cutter categories — we’re diverse. Such is the case when one considers the best way to approach psychotherapy. There isn’t only one way to do it and there isn’t necessarily a “best” way. Certainly, the field has evolved significantly over the second half of the last century, providing ample evidence that there are many ways to achieve deep levels of change and increase satisfaction in the life one lives.

Merkin’s article reminds me of how the psychoanalytic approach to healing “neurosis” and other “maladies” of the psyche can be limiting and risk leaving patients more vulnerable to having the self disregarded, even rejected. Steeped in the belief of therapist neutrality and the need for relational distance, the traditional model doesn’t hold up for most of us living in the twenty-first century.

Far beyond the issue of “who has the time or money required for several days of analytic treatment,” is the recognition that people change within the context of feeling connected to a real person and when they have experiences that challenge their belief systems. I was disheartened to read that the author was never told about her therapist’s cancer, thereby never able to say goodbye or get any sense of “closure,” and disturbed to know that she was never given permission to leave therapy. These actions are certainly not unique to those practicing in the analytic tradition, but they are more common in the hierarchical structure of the analyst-patient relationship.

I remember years ago having lunch with a good friend who revealed how strange and off-putting he found his former therapist’s unwillingness to share anything about herself, such as where she was going on vacation. I was struck by the irony of how the distance maintained by the therapist created a sense of alienation rather than one of connection, and wondered why that type of therapeutic approach continued to be promoted in psychotherapy training at the time. For me, it was one of many moments in my professional development when I paused to take in the feedback from a person in the patient position, feedback that has often been discrepant from the feedback given by those of us in the so-called “expert” position. We’ve come a long way since those days close to 20 years ago, but reading Merkin’s article, I’m saddened to say, reminds me of how much further we have to go.

I believe it’s authenticity that heals us. When we can be ourselves, supportive of our strengths, and accepting of our shortcomings, we grow in self-confidence, engage in more healthy relationships, and overall, feel better about ourselves. As a therapist, I’ve had to seek coming to know my own authentic self, questioning the rules and wisdom passed down from one generation to another.

It continues to be time for all of us to reevaluate traditional models of psychotherapy, and continue to update our understanding of what promotes emotional healing, resilience and interdependency in relationships. We all need to do so — therapist, patient, parent and anyone else interested in promoting a sense of greater well-being in children and adults.

http://www.huffingtonpost.com/jane-shure/american-liberty-gratitud_b_612157.html

I remember that time in my life when I was just starting to develop a political consciousness. It was 1975. I was living in Europe for a college semester abroad. Meeting up with people from all walks of the world inspired me to broaden my understanding of how national powerbrokers influence public opinion.

Recently I traveled to Argentina, a country that experienced horrific war acts against its people during the years of 1976-1983. The  30,000 who perished are known as the “Desaparecidos” - in English it’s the “disappeared”- named that way because rather than coming under open gunfire, the Argentine military junta abducted people while going about their daily routines, leaving their families and loved ones never to see them again or know of their fate.

Astounding for me to think about how those years in Argentina contrast with what was going on in my life here in the US. Those were the years when I graduated college, went to Grad school, and initiated my career as a psychotherapist. Those days were filled with discovery about sexism and racism, learning about empowerment of self and others, and finding my way as a feminist and wife.

My final day in Buenos Aires, I shared café with fellow psychologists. Relying on their English language skills, they answered all my questions, clarified my confusion and set the historical records straight. Then one of them looked me deeply in the eyes and said “In 1975 I was twenty-one and was arrested at a demonstration.” Coming of age in the 60s and 70s, I knew from demonstrations.

I listened on as he told me “I was imprisoned for four years.” Shock overwhelmed me - he was committed for the crime of peaceful protest. There I was sitting face to face with someone who embodied the cruelty and senselessness of a military junta - of people who get off on using their supreme power to strip away other’s basic rights and dignity.

I was aghast and without even thinking about it I was also immediately filled with gratitude - gratitude for how fortunate I’ve been; how lucky I’ve been to have the luxury of taking so much for granted. All I could focus on was  how much I treasure feeling safe enough to have an open conversation without fear of being turned in and punished, having access to universities and other think tanks that remain active despite shifting political tides, and being fortunate that our economic system didn’t bottom out anywhere close to where Argentina’s did in 2001 (when the pesos went from being worth the equivalent of a dollar to a quarter,  just overnight).

I am blessed to live with the protections our system affords. It’s so easy to criticize people and parties and, believe me, I do it as much as the next person does. But in these days, upon returning home, I continue to be mindful of how precious freedom is and how important it is to appreciate it when you have it. I am more appreciative than ever before.