MENTAL H EALTH SERIES, PART 2
RESPONDING TO FOSTER CHILDREN'S DEPRESSION
RESPONDING TO FOSTER CHILDREN’S DEPRESSION
This is the second in the Mental Health Series, a series of blogs corresponding to six foster parent training classes that I am facilitating at San Bernardino Valley College on Tuesday and Friday mornings from 9 a. m. to Noon, starting September 28 and concluding on October 15, 2010. If you live nearby and want to attend the classes, email me.
What Does Mental Health Look Like? was the topic of the first class.
Today we are going to explore ways to RESPOND to foster children’s depression. We could spend a lot of time going into the neurobiological intricacies of depression in general, but we will not here. But you can check out this hub. http://hubpages.com/hub/The-Neurobiology-Of-Depression
And we could even have a big time discussion about the difference between "being depressed" and clinical depression. Sometimes that discussion can get nutty in that, depression is depression. Whatever label you want to put on the child’s mood, it will not make a difference in terms of your RELATIONSHIP with the foster child and how you RESPOND to that child’s depression.
It’s not like you can say to Billy or Natasha, "Hey, look here. I know you do not have clinical depression, so just suck it up!" Or, "Well, let’s just see what the psychiatrist says about your mood. I don’t want you thinking that just because you’re depressed you can slack off on school and chores and that people are going to feel sorry for you. Life it tough. You better get that before life gets any tougher."
I am sure none of you say those things, but I am willing to bet that we all want to say those things when we are just plain drained emotionally from trying to take care of very wounded children. And especially if we are also depressed or if we were depressed as a child growing up for lots of good reasons, but no one ever gave us any slack.
GRIEF AND GRIEVING
Whatever else you want to believe about your foster children, there is one undeniable fact. They have lost, lost, lost, and lost some more. It is almost shameful to count the number of times that some foster children have been moved from foster home to foster home, not even considering their initial removal from HOME and perhaps being bounced around to relatives before being placed in foster care. And how many foster children have experienced one and sometimes several failed adoptions? If you recognize that for each loss in our life, our body demands that we go through grieving, then many of our foster children will be grieving for a very very long time. One of the stages of grief is DEPRESSION.
Now notice I said, our body demands we go through grieving. Elizabeth Kubler Ross tells us that grief is not as much a psychological process as it is a physiological process. And that seems to ring true when you think of all that your body goes through when you are grieving. It is not anywhere in your "head" but definitely in your body.
SYMPTOMS OF DEPRESSION
I think many of the symptoms of depression are obvious, One important symptom that is not obvious is aggression. Children who are depressed are often aggressive and acting out. We usually don’t think of a depressed person having that much energy!
We also want to recognize that just plain old sadness is a symptom Loss of interest in favorite activities, preoccupation with death and suicide, and a sense of hopelessness are all symptoms. Hopelessness is a big ticket item. For example, you would not think of gang members being depressed, but their extreme lack of hope is a dead give away that they are depressed and very very depressed. A kid who wants to flop on his or her bed all the time is a depressed kid. The kid who wears a jacket in the dead of summer is a depressed kid. A kid who hoards food and hides it under the mattress may be a depressed kid, hopeless that life will ever change, sure that he will always be short-changed and there will never be enough. A kid who lies is telling you that it is depressing that no one really wants to know the truth of his story. The teen who smokes pot is telling you that pot makes all the depressing things in his or her life go away for awhile. Obviously children and teens who cut on themselves are telling you that they are trying to cut out the pain, the depression, the intense sadness, the emptiness, the lack of emotional connection to either themselves or anyone else.
So if you are, for whatever reason, getting caught up in the symptoms of depression, lest you judge a child or teen depressed when they are not, what can I say? Well, I could say, just give it up!. When you lose, one time or twenty times, you lose, and life will require that you go through depression. It is not something to be rescued from. On the contrary, as in the movie, Never Ending Story, we want to be prepared to walk with the depressed child through the swamp of sadness. From this perspective, antidepressants some times dis-serve those needing to experience depression because they mask the depression and in a sense do not allow us to do the necessary emotional "work" associated with depression.
NEUROBIOLOGY OF DEPRESSION
Now I know a few paragraphs above, I said we were not going to talk about this! And there is a very informative blog there to read, and those attending class will receive a copy of that blog. But let me tell you a little bit!
There is an on-going neurochemical and neuroelectric conversation between our thinking brain and our emotional brain. This "conversation" serves to regulate our experience of life. It keeps us balanced. The actual dialogue also includes the brain stem or the survival brain. This balancing act is often called homeostasis.
There are several important neurological feedback loops between our thinking brain and emotional brain. One of those is a feedback loop between our hippocampus (memory) which is located in our emotional brain and our prefrontal lobe (decision making, consciousness, impulse control) which is located in our thinking brain. So when I have an intense emotional experience and the conversation between the thinking brain and the emotional brain continues, then the emotional experience is processed into our memory and we do not get stuck in the emotional experience or overwhelmed by the emotional experience.
If the emotional experience is over the top, so to speak, then what happens is the chemistry necessary for the hippocampus to process the emotional experience into memory is neutralized, so the emotional experience stays with us, unfortunately only in its emotional form and is "stored" in the amygdala to which we have no conscious access. So we have this overlay of emotion and there is initially no way for the thinking brain and emotional brain to have a conversation about it. We are stuck there. That is what happens with depression.
And if Elizabeth Kubler Ross is correct, then our brain is telling our body, "you just need to sit with this for awhile. It’s too big just to walk away from. Can’t drag it, can’t toss it, can’t get rid of it. Sit with it and at some point, your brain will recycle and you will be able to do something with this experience other than be in it. But for the time being, you’re here."
Now the other thing that is happening is while the emotional experience is being recorded in the amygdala, the amygdala is also creating a mental model of the experience. The brain will use this mental model to generalize the experience to other similar events in our life. The good news is we will be able to recognize when an experience is in fact depressing. That is important because many of us sluff off depressive experiences as not depressing. "I can handle it," we tell ourselves. No, you can’t. It is too big to handle. You gotta sit with it! The bad news about the amygdala making a mental model of the experience is, if we do not at some point integrate the experience into our memory, then what we are left with is a mental model that all life is depressing. Another important reason to walk along side our foster children when they are depressed so we can walk them to a place where they can know that life is SOMETIMES depressing, but NOT all the time, and Life is more generally speaking wonder-filled.
I had a first hand experience of this "phenomenon" this morning when I went to help a friend. For some reason the friend was really really angry with me and their life in general and directed all of that anger toward me. I did a pretty good job at the moment of not taking it in, but when I finished helping, I just sat in my car, STUNNED, like someone had kicked me in the stomach. I suddenly did not want to live anymore. I was not suicidal. I just did not want to live. I wanted to go home and crawl under the covers and sleep. Fortunately I have more than one friend, so I called another friend and talked! I metaphorically "crawled under the covers and slept" by having a conversation with that friend. As much as I wanted to sluff off the experience and tell myself that I was okay, I could barely move. I was not okay. I drove the car at about ten miles an hour for blocks. My body was telling me, "this is too shocking to just to toss away. You have to just sit with it." At one point, I cried and I continued to cry off and on throughout the morning. After several hours of sitting with it and talking it over with my friend, I have found a way to make some sense of it, even to take ownership of my part of it. It is possible now to move this experience into my memory where it will become a PART of my day’s experience, but it will not consume me. And it is probably not over, obviously. I will still need to sit with my friend and see what healing we can bring to our relationship. So I may continue to get depressed about this situation off and on for some time to come, but I am CONSCIOUS now of how this works. I am not a victim to my depression.
HOW DO YOU KNOW A CHILD IS DEPRESSED?
Well, this may be a tad redundant in that we already talked about symptoms. But, I want you to become experts at reading non verbal language. The way the person holds their body, their head, the way they walk, sit, talk, hold themselves tall or bent over, the little cracks in their voice as they talk, the hesitations, the attempts to fight back the tears, the tears, the attempts to bait other people into a fight, the sleeping on the bed when everyone else is playing and having fun, isolation, not being involved in activities that ordinarily they cannot get enough of, these are all symptoms that require more than just your knowledge of depression. These indicators require sharp observation on your part.
I also want you to become an expert at reading other people’s faces. The face is always telling us A LOT. A good book for this is Parenting From The Inside Out by Daniel Siegle and Mary Hartzell.
SO, WHAT TO SAY? To begin with, I want you to start addressing the obvious. You do not have to be Mr. or Mrs. Freud to talk about the obvious.
"So, I understand that this is your (third...sixteenth) foster home.... That cannot be a good experience to get bounced around from foster home to foster home."
If you say this to a child, they will either not respond, or perhaps brag about why they get bounced around or take the blame for it. If the child does not respond, you say, ""This is difficult to talk about, uh." If they brag, you can say, "Wow, you’re a pretty courageous kid." If they take the blame, you absolutely must say, "I’m not so sure about that."
"You know the social worker told me that .......your parents are in jail, your mom/dad died of....someone hurt you sexually....your were hurt pretty bad.....you have a very difficult time getting along with other kids,,,,,adults......you hurt yourself a lot....you are always trying to run away....like to have sex with......have a pretty mean temper.....lie through your teeth.....steal everything in sight.....Is any of that true? You know I’ve learned that I cannot believe everything they tell me about the foster kids who come here."
You do NOT make that last comment to try to pretend that they do not have the problems they do, but simply to allow them to tell their side of the story and to have a sense that you want to HEAR their side. Doesn’t matter how off base or inaccurate their side of the story is. What is important is for you to hear it and LISTEN!
Throughout each day, notice the child, notice what is going on. Notice how social they are or how isolated theyare. Notice how talkative and how untalkative. Notice how much they are sleeping. Notice tears that are just "dying" to get out. Notice how uptight or anxious. Whenever you are with the child, consider initiating a conversation about the obvious or what everyone knows already. Going some place in the car can be a good place to for these conversations. If there are several foster kids in the car, it can be pretty interesting to have a group discussion and then they all begin to realize how much they have in common.
"Wow, you look sad today. You know what? It makes sense to me that you are sad. Sometimes I try to imagine what you have been going through and you know it makes me sad just thinking about it. So I can imagine what it must be like for you because you actually lived it.....You know, I have noticed that you have been really losing your temper a lot and fighting with the other kids. You know sometimes when we are depressed and down in the dumps, that’s how we let other people know that we are depressed. Are you depressed?......You know it is not easy to go through all that you have gone through.....I bet sometimes you blame yourself for all that happened.....What I want you to know is that you are not to blame for your parents’ behavior and it is okay to feel all down in the dumps. In fact, you will probably feel down in the dumps for awhile, maybe even a long while, but you and I can talk about it, and just talking about it, I guarantee will make you feel a whole lot better. In fact sometimes, we could go to MacDonalds or Starbucks and talk about it. Talking about sad stuff but having a delicious coffee drink at the same time.....You know I am so glad you came to our home and I think we can be here for you, to heal this awful stuff that has gone on for you.....to support you growing up and some day actually being on your own.....I think there are a lot of wonderful things that are going to happen for you while you are here."
LET’S SAY YOU ARE TAKING CARE OF INFANTS OR TODDLERS. Well you can have the same conversations, but your vocabulary will change. The important thing in those conversations is that you will do the talking. The infant or toddler will talk back non verbally, and they will HEAR EVERYTHING in YOUR non verbal language, in the tone of your voice, and so on.
"I am so glad you are here, little one.....You look so sad sometimes, but I am here to take care of you and to smile at you and you can smile back.....I am going to take good care of you.....Your tummy is going to feel full,not too full, but full enough so that you will feel very very loved while you are here....I am going to keep you safe, little one....I will not let anyone hurt you ever again....I’m going to rock you, tickle your back....."
If a child or teen is non responsive or sort of a smart mouth, you can still skillfully engage.
"I really get it that you do not want to talk to me about what you have gone through. I’m not sure, if I were you, that I would want to talk about it either, especially to someone I don’t know. But I am going to keep bringing it up, so you will know that I feel comfortable, and who knows maybe some day you will want to talk. So I am here when that day comes."
"I am so impressed with how well you drive adults crazy. You are really good at it. Hey, but come on. Do yourself a favor. Tell me what’s going on inside there. What hurts so bad?"
It doesn’t hurt to do a little explaining to them about depression.
"You know anytime we lose anything, we lose our favorite toy or we loose our keys or our piggy bank money, any time we lose anything, we are going to feel really bad about it. That is just how it is. And I know you have lost a lot, and I just want you to know, that even if you don’t feel bad right now, it can creep up on you at any time, and it will. So just know I am here, and I can handle it with you."
But don’t say you can handle it unless you really mean it!
When kids start talking about their depression, DO NOT give advice. DO NOT tell them it will get better with time. DO NOT problem solve it. JUST LISTEN and refelct back that what they are expeiencing is real, typical of depression, and necessary.
And if you have problem doing this, that is telling you that you are not taking good care of your own depression. Being depressed is bad enough without someone screaming at you all the time to get over it.
THANKS FOR READING AND COMMENTING AND IF YOU ARE IN CLASS TODAY, THANKS FOR YOUR ATTENDANCE AND PARTICIPATION.