Some of our thought patterns are shaped by our upbringing. “As a child, I was never praised by my parents,” confided Sarah. “I cannot ever remember receiving a compliment until after I was married. Consequently, I sought approval from others. I have this terrible fear of people’s disapproval.”

Sarah’s intense need of approval is a common element with many who become seriously depressed. Research has revealed that such persons tend to build their self-esteem on the love and approval received from others, rather than on their own achievements. They may estimate their own worth by the extent that they are likable or significant to someone else. “Loss of such support,” reports one team of researchers, “will lead to a fall in self-esteem and this contributes significantly to the onset of depression.”

Perfectionism

An exaggerated concern about gaining the approval of others often expresses itself in an unusual way. Sarah explains: “I strove to do everything just right so that I could get the approval that I didn’t get as a child.

[Box on page 8, 9]

Childhood Depression: “I Wish I Weren’t Alive”

An interview with Dr. Donald McKnew of the National Institute of Mental Health, who has researched this subject for 20 years.

Awake!: How prevalent do you consider this problem to be?

McKnew: A recent New Zealand study of a thousand children found that by the age of nine, some 10 percent of the children had already experienced a depressive episode. And we get the impression that 10 to 15 percent of schoolchildren have mood disorders. A smaller number suffer from severe depression.

Awake!: How can you tell if children are severely depressed?

McKnew: One of the key symptoms is that they find no pleasure in anything. They don’t want to go out and play or be with their friends. They’re not interested in the family. You see loss of concentration; they can’t keep their mind even on television programs, much less their homework. You see a feeling of worthlessness, a personal sense of guilt. They’ll go around saying they think they’re no good or nobody likes them. Either they can’t sleep or they oversleep; they lose their appetite or they overeat. Plus you hear suicidal ideas such as, “I wish I weren’t alive.” If you see a conglomeration of these symptoms, and it’s lasted for a week or two, then you’re talking about a seriously depressed child.

Awake!: What are the key triggers of childhood depression?

McKnew: When you get down to the specific factors in any given child’s life, the major thing is probably a loss. While this usually means a parental loss, it could include friends, close relatives, or even a pet. Second to losses I would put depreciation and rejection. We see an awful lot of children who are maligned and made to feel they’re small or insignificant by their parents. At times a child is made a scapegoat. He is blamed for anything that goes wrong in the family whether he is at fault or not. Hence, he feels unworthy. Another factor is a mood disorder in a parent.

Awake!: The book Why Isn’t Johnny Crying?, which you coauthored, states that some children who are depressed engage in drug and alcohol abuse or even delinquent behavior. Why is this?

McKnew: We believe they’re trying to hide the depression, even from themselves. Their way of dealing with it often is to stay busy with other things, like stealing cars, taking dope, or drinking. These are ways of disguising how badly they feel. In fact, trying to hide their depression is one of the clearest ways that children differ from adults.

Awake!: How can you tell when it is depression and not a child just misbehaving?

McKnew: By talking with these children, getting them to open up, you will often find the depression. And if the depression is properly treated, their behavior improves. Though something else was showing up on the surface, the depression was still there underneath all the time.

Awake!: How can you get a depressed child to open up?

McKnew: First of all, choose a quiet time and place. Then ask specific questions like, ‘Is something bothering you?’ ‘Have you been feeling sad or blue?’ ‘Are you upset?’ If there has been a loss, you could ask, depending on the circumstances, ‘Do you miss Grandma as much as I do?’ Give the child a chance to ventilate his feelings.

Awake!: What would you tell severely depressed children to do?

McKnew: Tell their parents about it. This business of detection is a serious one because generally only the children know they’re depressed. Parents and teachers usually don’t see it. I have seen adolescents who have gone to their parents and said, “I am depressed, I need help,” and they’ve gotten it.

Awake!: How can a parent help a depressed child?

McKnew: If the depression seems to be debilitating, then it’s not something to be handled at home, any more than is pneumonia. A debilitating depression must be taken to a professional because there may be a need for medication. We use medication in well over half of our cases, even with children down to five years of age. We also try to readjust the child’s thinking. And by these means the depression is eminently treatable.

Awake!: If it’s not a debilitating illness, what can a parent do?

McKnew: Take an honest look at yourself and your family. Has there been some serious loss that needs to be talked about and dealt with? When losses occur, don’t belittle a child’s sadness. Allow him the freedom to work through his grief. Give a depressed child special amounts of attention, praise, and emotional support. Spend extra time with him alone. Your warm involvement is the best form of treatment.