Depression

Depression

INTRODUCTION

INTRODUCTION

Seventeen-year-old Melissa had been dating Brian for eight months when he broke up with her- over the phone. The following Monday Melissa sat where she and Brian had eaten lunch together since last September. Her friends sat with her. “I say you’re better off without him,” Amy said. “Yeah,” agreed Crystal. “You guys fought all the time anyway.” “I hear Joy and Nathan just broke up,” offered Julie with an excited smile. “You’ve always had a crush on him, haven’t you?”

Melissa didn’t answer. She lifted her tray and left her friends without a word. They don’t understand, she thought. They’ve all had lots of boyfriends. But Brian was her first real boyfriend, and she had entertained fantasies about marrying him ever since they started dating. When they first started going out, Melissa had made up her mind to be everything Brian wanted. She’d lost a little eight and begun dressing with him in mind. She tried so hard to please him; if he showed the slightest pleasure in s

omething she did or said, she would work to do more of the same. When their relationship became more physically intimate, she determined to give Brian anything, everything; they began having sex after six months as a couple. When Brian broke up with her, Melissa couldn’t believe it. She cried and begged him not to leave her. She told him she’d change; she’d do anything he wanted. But he refused. Her first reaction was anger. After all I’ve done to make him happy, she thought. Then her anger turn inward. I did everything I know how to do, and it still wasn’t enough. I must be totally worthless. I’ll never have a man love me. I don’t deserve to have a man love me. Over the next few weeks, Melissa started spending more time alone in her room. She seldom went out with her friends, preferring instead to stay home, listen to music, and stare at the bedroom walls. She found it difficult to eat, and after a few weeks of having trouble getting to sleep, she began to miss school frequently, and her grades plummeted. When her parents confronted her about her conduct, she shrugged, “ I don’t care” was her only response.

“I don’t understand,” her mother told the pastor of their church. “she seems like she’s totally different girl she was.”

THE PROBLEM OF DEPRESSION

Simply stated, it is a feeling of sadness. Defenitions of depression may vary from one culture to another. All of us may experience depression at one point in time and this is just a normal reaction to a particular event such as death of a loved one or losing a job. It becomes abnormal when it is excessive, profound and prolonged, and already affects our daily functions. Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates reffered to depression as melancholia, which literally means black bile. In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Fruid linked the development of depression to guilt and conflict. John Cheever, the author and a modern suffere of depressive disorder, wrote of conflict an experiences with his parents as influencing his development of depression.

Once thought to be singularly adult problem, depression is a regular state for many teens- and preteens. “Researchers and clinicians now concede that depression frequently occurs in children (Evan, Reinhart & Succop, 1980; French & Berbin, 1979 ) and adolescents (Friedrich, Reams, & Jacobs, 1982; Seigel & Griffin, 1984; Teri, 1982a,1982b).” While it is difficult to measure how many teens suffer depression, “the findings suggest that a substantial proportion of young people are suffering from strong feelings of unhappiness and despair.” One source states, “Nearly 5 percent of all teens are identified as clinically depressed every year.” It is a complex and dangerous condition that often seems to defy description and definition. This is partly because people use the term depression to refer to different things: a general sadness, “the blues,” humiliation following failure, or a period of stress and emotional volatility. Even mental health professionals have struggled for years to devise a clear definition. Depression defines n many ways, such as in:

Webster’s Tenth Collegiate Dictionary defines depression as “a state of feeling sad” but adds a second definition: “ a psychoneurotic or psychotic disorder marked specially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal tendencies.” Wikipedia Dictionary defines depression as “a state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings and physical-being.”

Gregory Richards state that depression, is the most common emotional illness of our day. It is a later response that comes as a result of accepting harsh reality. It is more than “the blues”. It is an emotionally handiccapping condition that renders life meaningless. It is like a deep, dark pit from which there is no escape. It is a mood disorder which feelings of sadness, loss, anger, or frustration interfere with everyday life for an extended period of

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depres sions Psychiatrist John White, in his book The Masks of Melancholy, shares some helpful

Depressive (affective clarification of the forms depression takes in the following chart. Second illness) ary

depres sions

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From The Mask Melancholy by John White.

Depressive illness is two kinds: Primary depressions or Secondary Depressions. Secondary depressions occur in the course of some other illness and condition, such as alcoholism. Primary depressions, White says, “ are mood disorders which may are not associated with any other form of mental or physical illness.” Primary Depressions can also be categorized in two ways: bipolar and unipolar depressions. Bipolar depression, encompassses a group of mood disorders that were formerly called manis-depressive illness or manic depression. These conditions show a particular pattern of inheritance. Not nearly as common as the other types of depressive dosorders, bipolar disorders involve cycles of mood that include at least one episode of mania or hypomania and may include episodes of depression as well. Bipolar disorders are often chronic and recurring. Sometimes, the mood switches are dramatic and rapid, but

most often they are gradual. Unipolar depression, by contrast, a mood disorder characterized by a depressed mood, a lack of interest in activities normally enjoyed, changes in weight and sleep, fatigue, feelings of worthlessness and guilt, difficulty in concentrating and thoughts of death and suicide. It is also a plunge into emotional darkness relieve(if at all) only by restoration to normal moods. “To merit the description of depressive illness,” White says, “all of these conditions must last at least a month, and usually last much longer [sometimes years].”

Adolescent depression, as opposed to that experienced and displayed by adults, can be even more difficult to categorize and identify. Dr. Ross Campbell writes: Teenage depression is difficult to identify because its symptoms are different from the classical symptoms of adult depression. For example, a teenage in mild depression acts and talks normally. There are no outward signs of depression. Mild teenage depression is manifested in fantasies, in daydreams, or in dream during sleep. Mild depression is detectable only by somehow knowing the child’s thought pattern and thought content. Few professionals even can pick up depression in this state.

In moderate depression, also, the teenager acts and talks normally. However, in moderate depression, the content of the teenager’s speech is affected, dwelling primarily on depressing subjects such as death, morbid problems, and crises. Since many adults today seem to dwell on pessimistic trains of thought, the teenager’s depression may go unnoticed… In the vast majority of cases, only in severe depression does the teenager actually appear depressed… there is an exception to this, however. Teenage depression is difficult to identify because teens are good at “masking” it; that is, they can cover it by appearing OK even when they are absolutely miserable. This is often called smiling depression. This is a front which teenagers employ unconsciously … primarily when other people are around. When depressed teenagers are alone, they let down or relax the mask somewhat. This is helpful to parents. If we are able to see our teenagers at times when they believe no one is looking at them, we may be able to identify depression.

Adolescent depression can also be hard to recognize because it can be often mistaken for or accompanied by other things, such as premenstrual syndrome (PMS) in girls.

Premenstrual Syndrome (PMS) refers to a varied group of physical and psychological symptoms, including abdominal bloating, breast tenderness, headache, fatigue, irritability, anxiety, and depression that occurs 2 to 7 days before the onset of menstruation and cease shortly after menses begins. In addition to becoming more irritable, teens might lose interest in activities they formerly enjoyed, experience a change in their weight, and start abusing substances. They may also take more risks, show less concern for their safety, and they are more likely to complete suicide than their younger counterparts when depressed. Generally a condition in adolescents, acne increases the risks of depression in teens.

MYTHS ABOUT DEPRESSION A.

Depression as well as other psychiatric disorders remain trivial. Over the years, a wealth of information through evidenced based medicine has been gathered to define, diagnose, and treat depression and other psychiatric disorders. A lot of researhes have been done over the past decades especially on the biological component/etiology of depression to distinguish this illness as a distinct entity.

B.

Depression will go away on its own and needs no treatment. Untreated depression last from 6 to 13 months with some episodes lasting more than two years. This carries a significant amount of morbidity to patient, relatives and society in general. As the course of the disorder progresses, patients tend to have more frequent episodes that last longer and are more resistant to treatment. On the other hand, most patient undergoing treatment have episodes lasting less than 3 months.

C.

Depression is a result of a character weakness. Aside from the cause of depression being unknown, no single personality trait or type uniquely predisposes a person to depression. All induviduals of whatever personality type can and do become depressed under appropriate circumstances.

D.

Depression is caused by “bad spirits.” The etiology of major depression revolve around several areas such as biological, genetic, and psychosocial factors. Of these, the biological factors specifically those involving altered neurochemistry is the most consistent. No study has proven or even shown associations of “bad spirits” witchcraft with depression.

The following are the myths about depression and its treatment : •

It is a weakness rather than an illness.

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If the sufferer just tries hard enough, it will go away.

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If you ignore depression in yourself or a loved one, it will go away.

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High intelligent or highly accomplished people do not depressed.

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People with developmental disabilities do not get depressed.

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People with depression are “crazy.”

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Depression does not really exist.

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Children, teens, the elderly, or men do not get depressed.

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There are ethnic groups for whom depression does not occur.

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Depression cannot look like (present as) irritability.

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People who tell someone thay are thinking about committing suicide are only trying to get attention and would never do it, especially of they have talked about it before.

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People with depression cannot have mental or medical condition at the same time.

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Psychiatric medications are never necesarry to treat depression.

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Medication is the only effective treatment for depression.

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Children and teens should never be given antidepressant medication.

THE CAUSES OF DEPRESSION Some types of depression run in families, indicating that a biological vulnerability to depression can be inherited. This seems to be the case, especially with bipolar disorder. Families in which members of each generation develop bipolar disorder have been studied. The investigators found that those with the illness have a somewhat different genetic makeup than those who do not become ill. However, the reverse is not true. That is, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will develop the illness. Apparently, additional factors, possibly a stressful environment, are involved in its onset and protective factors are involved in its prevention.

Major depression also seems to occur in generation after generation in some

families, although not as strongly as in bipolar I or II. Indeed, major depression can also occur in people who have no amily history depression. An external event often seems to initiate an episode of depression. Thus, a serious loss, chronic illness, difficult relationship, financial problem, or any unwelcome change in life patterns can trigger a depressive a depressive episode. Very often, a combination of genetics, psychological, and environmental factors is involved in the onset of a depressive disorder. Stressors that contribute to the developmentof depression sometimes affect some groups more than others. For example, minority groups who more often feel impacted by discrimination are disproportionately represented. Socioeconomicallydesadvantaged groups have higher rates of depression compared to their advantaged counterparts. Immigrants to the United States may be more vulnerable to developing depression, particularly when isolated by language.

“Since teenagers are in transition between childhood and adulthood,” writes Dr. G. Keith Olson, “ it is not surprising that… many adolescents’ depression relates to developmental struggles. … Some depression in adolescence is quite normal, probably more normal during this developmental stage than at any other (except perhaps old age).”

I’ve read that depression is an excuse not to grow up, not to be responsible for your own happiness, that it is self-pity. Still, depression can be extremely complex, ant the causes may be numerous and varied. Biological factors, ambivalence, parental rejection, abuse, negative thinking, life stress, anger, and guilt are among the causes that may prompt teens.

BIOLOGICAL FACTORS Family history, or genetics, is one of the strongest of the potential causes of depression. In fact, recent research indicates that if one of your parents has had depression, your own risk of depression almost double. Donald P. Hall, MD, the author of Breaking Through Depression says, “the risk of depression is 20 percent for women and 10 percent for men, and the risk is doubled if one of your parents suffered from depression.” Depressions sometimes run in families. Researchers believe that it is possible to inherit a tendency to get depression. This seems to be especially true for bipolar disorder. Studies of families with several generations of bipolar disorder (BPD) found that those who develop the disorder have differences in their genes from most that don’t

develop BPD.

Major depression also run in families, but it can also develop in people who have no family history of depression. Either way major depressive disorder is often associated with changes in brain structures or brain functions. Collins writes, Depression often has a physical basis. At the simplest level, we know that lack of sleep, insufficient exercise, the side effects of drugs, physical illnesses, or improper diet can all create depression. Thousands of women experience depression as part of a monthly premenstrual syndrome (PMS) and some are victimized by postpartum depression following childbirth. Other physical influences, like neurochemical malfunctioning, brain tumors, or glandular disorders, are more complicated creators of depression. There is evidence that that depression runs in families and may have a genetic basis. This is difficult to demonstrate conclusively; research reports are sometimes contradictory. Other research has linked depression to brain chemistry that often can

be altered by antidepressive drugs.

AMBIVALENCE Ambivalence is a state of having simultaneous, conflicting feelings toward a person or thing, coexistence of two opposing drives, desires, feelings, or emotions toward the same person, object, or goal. Stated another way, ambivalence is the experience of having thoughts and emotions of both positive and negative valence toward someone or something. A common example of ambivalence is the feeling of both love and hate for a person. The term also refers to situations where “mixed feelings” of a more general sort are

experienced, or where a person experiences uncertainty or indecisiveness concerning something. The expressions “cold feet” and “sitting on the fence” are often used to describe the feeling of ambivalence. Ambivalence is experienced as psychologically unpleasant when the positive and negative aspects of a subject are both present in a person’s mind at the same time. This state can lead to avoidance or procrastination, or to deliberate attempts to resolve the ambivalence. When the decision to be made, people experience less discomfort even when feeling ambivalent.

Tim LaHaye writes: Some psychiatrists, like Dr. Ostow, consider ambivalence “the most common precipitative cause of depression.” He defines ambivalence as “ the sense of being trapped, that is, being unable to remedy an intolerable situation.” Collins refers to this as “learned helplessness,” and says, “ When we learn that our actions are futile no matter how hard we try, that there is nothing we can do to relieve suffering, reach a goal or bring change, then depression is a common response.

It comes when we feel helpless and give up trying.”

PARENTAL REJECTION Researchers Joan Robertson and Ronald Simons reported that, according to a study they conducted, “Perceived parental rejection was significantly associated with both depression and low self-esteem, with low self-esteem showing a strong relationship with depression.” Their finding agreed with earlier studies (Brown and Harris , 1978; Brown et al., 1986) that found that young people who experience depression. Young people who were raised in a family environment of excessive parental criticism, belitting, shamming- or of neglect and inattention- are likely to struggle with the adolescent task of reevaluating themselves and their place in the world. A number of studies suggest that family background is a crucial factor in a young person’s vulnerability to depression. James J. Ponzetti Jr. writes : Depressed students recall poorer relationships with their parents and childhood friends. They also remember less family togetherness (Paloutzian & Ellison,1982). Mahon

(1982) and Hecht and Baum (1984) noted significant corellations between depression and disrupted patterns of attachment suggesting that the lack of bonding early in life may contribute to the experience of depression. Let me tell you a story : Mark and Debbie were both professing Christians. They met through the church youth group. Both were sixteen years old when they began dating. They were both sophomores in high school, both had been raised in the same town, and both were good students (though Debbie usually earned better grades than Mark). They had so much in common. But not everything. Mark was the star basketball player of his high school team and was named to the alldistrict team. When he won the trophy as the most valuable player for the district champinoships, he smile hugely and strode to the center court to accept the trophy with a swagger that communicated his sense that he thought he deserved the award- and more. He didn’t scan the faces in the crowd to find his parents because he knew they wouldn’t be there. They never were. Debbie didn’t understand. She played on the field hockey team, and her parents never missed a game. They seldom missed a practice, in fact. They seemed to take an intense interest in

everything she did. It wasn’t just Mark’s sport events that his parents missed, though. His dad was a bussinessman who treaveled a lot, and his mom was an obstetrician; they were highly respected in the community. But most mornings, Mark left for school without seeing his parents and usually scrounged in the kitchen to make his own dinner. Mark sometimes commented to his youth pastor that he could probably die and his parents wouldn’t discover the body until it began to stink up in the house.

Neglecting is also considered as parental rejection. Neglect can appear in many forms and at different levels of severity. Most authorities consider neglect to be inattention to the basic needs of a child or young person (that is shelter, food, clothing, medical attention, school attendance, etc.)

The most severe form of neglect, of course, is when a child is physically harmed or dies from lack nutrition, supervision, or medical attention. But some youth suffer a type of neglect that is not so readily recognized, not so easily documented. Many pastors and youth pastors consider disinterest and uninvolvement on the part of

the parents a major problem for young people. Seventy percent of the national youth leaders surveyed rated the problem of inattentive parents as “very important,” and 30 percent of those leaders rated the situation of inattentive parents of teens as a “crisis”. A young person whose parents seem unconcerned inattentive is likely to experience hurt, frustration, anger, (sometimes resulting in bitterness or rage), as wells as feelings of insecurity and loneliness. A teen that is hurting because of parental indifference or inattentiveness is likely to be in desperate need of an adult who will show interest and offer support; such care and concern will never replace the attention the youth desires from Mom and Dad, but it can certainly help, particularly if the adult responds to the youth’s need. I just want to testify my own experience about this matter: I’m an only child. My Dad passed away when I was still 4 years old. My mom became busy working just to fulfill the obligation of my Dad to me as the provider. She doesn’t have any time to attend some school activities which involve parents such as foundation day, family day, etc. She can’t even help me to do my assignments. But inspite of that, I can say that she never failed to give me what want materially. So, to make the story short,

my mom became inattentive to me. Until suct time, that it comes to the point that I’m seeking a mother’s love and care which she can’t give me. Every time I try to show my sweetness to my mom, like any other children does to their parents, she always refuses. She’s telling me she’s tired. So, what I did is, I seek attention and love to those people who surround me. To my teachers, friends, and to those old people. But all of these are only nothing but just temporary. They kept telling me they love me but they don’t show me through their actions. They all leaved me. They left me hanging without even noticing it. Then it came that I give up. My mind was set that no one could loved me. I am the only one who could love and accept me for who I am. I bacame desperate that even I thought of suiciding. In my desperate time, God sent me a very special woman. She came in the darkest part of my life. At first, I’m really annoyed at her, she does nothing but to give me a sermon, until wihout even noticing,that those annoyances disappear and turn into love. I can’t explain what she did that soften my heart. All I know is that she made me feel that I’m precious and other people can loved me for who I am. She maturely

understand me when I am on my immaturity mode, every time I’m sad, she always give me her time by listening to my burdens and consoling me. Just as what the usually mother does. She fulfilled my longingness for a mother’s care, which my mom can’t give me. Sometimes she attend my school activities which involve parents, which my mom never done before. She even made an effort to brought me to a doctor to consult for my health condition, which my mom had never did. She even support me financially. Though she’s not my real mom, she made me feel as if, I was hers. And that very special woman I’m telling you about is my beloved Nanay Aleli and I owe her a lot.

ABUSE K. Brent Morrow and Gwendolyn T. Sorell are among those researchers who have traced a connection between depression and abuse – particularly physical and sexual abuse. They concluded that “severity of abuse was the single most powerful predictor of selfesteem, depression and negative behavior in incest victims.” There is two type of abuse, sexual abuse and nonsexual abuse.

Sexual abuse is commonly defined as “any form of sexual contact or conversation in which [a] child is sexually exploited for the purpose of bringing sexual gratification to the exploiter.” It is a term that covers a broad range of actions and activities, from exposure to actual intercourse , such as: •

An adult showing a child his or her genitals

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An adult asking a child to undress to be looked and fondled.

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An adult touching a child’s genitals.

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An adult having a child touch his or her genitals.

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Oral-genital contact.

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Forced masturbation

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Penetration of the anus or vagina with fingers of another object.

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Anal penetration

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Intercourse

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Use of children for the production of pornographic materials.

I heard a case about a girl who was sexually abused : It began when Mona was six years old. A nineteen-year-old uncle who lived close by,

who was like a big brother to her, would often take Mona with him when he went places, for rides in his car, to friend’s houses, and to an occasional movie in town.

Then one day, when they arrived at Mona’s house to find her parents gone, her uncle suggested they go out to the barn to play. He offered to show her a secret and exposed himself to her, charging her to keep their “little secret”. From that time on, things develop gradually. He bagan to fondle her and kiss her, and eventually he induced her to fondle him. Mona knew something wasn’t right about the things her uncle was doing, but he promised to never hurt her. He never became violent, and Mona kept their secret, but his abuse did have an effect. Over the next several years, Mona began to dread contact with her uncle and even began to hate him.She even tried once to tell her mother what was going on, but her efforts only resulted in confussion. She didn’t know if her mother disbelieved her, misunderstood her, or blamed her for what was happening. Mona’s family moved away from that uncle when she was nine, but their move didn’t end her problems. She bagan having nightmares and started to withdraw into an emotional shell. By the time she entered her teens, she had few friends at school or at church, and she

wrestled with severe depression at times. When she was fifteen, she bega to date –slowly at first- and soon had become sexually involved with several boys at school. Her newfound “popularity” was unrewarding however. “I felt like I could never be loved,” she said. “Atleast not the way I wanted. It wasn’t like I was giving myself away in exchange for love; I didn’t feel like I had anything left to give away.”

Sexual abuse does not always involved physical harm or even physical contact. “Within a family, there can be incidents that I would label [abuse] even though they don’t involve actual contact,” says Emily Page, a mental health counselor in Massachusetts. “For example, if a father… undress and masturbates in the front of [his daughter], he’s creating psychic and emotional pressure in the girl.” Two landmark studies, conducted by David Finkelhor (1978) and Diana Russell (1983) reported the incidence of sexual abuse of children and youth. Finkelhor’s study of 530 women found that 14 percent reported intarfamilial sexual abuse (by a family member) before the age of eighteen, and 19 percent reported extrafamilial abuse (abuse by a non-family member). Russell’s study of 930 randomly selected women in San Francisco revealed that 16 percent had experienced

intrafamilial abuse and 31 percent had been victims of extrafamilial abuse. Such statistics reflect unimaginable tragedy, tragedy that is often exacerbated by the fact that sexual abuse of children may be “the most muted crime,” as illustrated in the following account: Jill, my sister’s daughter, is fourteen. Her stepfather has been [molesting her] and going into her bedroom at night for the past six months. I know she’s telling the truth because she did the same thing to me when I lived with them. Jill couldn’t stand it and finally told her teacher. The teacher told the school psychologist, who said that either the child was lying and very sick or the family was in great trouble. The father could go to jail. When confronted, the stepfather said Jill had lied. Jill’s mother believed her husband. Wringing her hands, she pleaded with her daughter to “confess.” Otherwise who would support them and her younger brothers? Jill tried to stick to her story, but with persistent pressure and increased guilt at depriving the family support, she finally “confessed” that she lied. She was denied a request to live with me and placed under psychiatric care.

Such experiences can be extremely damaging to a child or young person and may impose effects that are far-reaching and long-lasting. Nonsexual Abuse is a kind of abuse that doesn’t involve sexual intercourse such as : physical abuse, emotional abuse, verbal abuse, A case of child abuse or neglect is reported every ten seconds in the United States. Many more go unreported. The number of child-abuse reports reached 2.99 million in 1993, forty-five reports for every thousand children. Over one million cases were verified. An estimated 1,299 children died as the result of neglect or abuse in 1993, and 43 percent of those deaths occurred in families that had previously been reported to child protection agencies. Taking children and youth out of the home isn’t always the answer, however; a study by Trudy Festinger, head of the Department of Research at New York University’s School of Social Work, revealed that 28 percent of children who are placed in foster care suffer some form of abuse while in the system. And the ACLU’s Children’s Project estimates that a child in the care of the state is ten times more likely to be abused than those in the care of their parents.

Abuse may take many forms. Author Angela R. Carl defines child abuse as: … specific acts of commission or omission by parents or other adults… that lead to non-accidental harm or threatened harm to a child’s physical, mental, or emotional developmental state. Physical Abuse includes all acts that create injury or substantial and unnecessary risks of injury. Violent shaking or slapping, shoving, kicking and punching are all forms of physical abuse. Tying a young person up or locking him or her in a closet are abusive behaviors. Burning a child with a lighted cigarette or match is also abuse. Not all physical contact or corporal punishment is abusive, but any act that leave bruises, cuts, scars, or welts are certainly abusive, as are physical acts designed to cause harm or humiliation. Not all abuse is physical however. Emotional Abuse is defined by Carl as: … a pattern of blaming , belittling, verbally attacking, or rejecting a child, or demanding that a child assume responsibilities that he is incapable of handling.

Emotional Abuse is generally more difficult to identify and to prove, but it is nonetheless abuse and no less harmful because it is less recognizable. It includes words or attitudes intended to provoke, disgrace, or shame a child or young person. It includes verbal abuse such as screaming, insulting, or name-calling. It includes slamming doors and throwing things. It can even include jokes or things said in jest. “Most parents are guilty of some emotionally abusive behaviors at one time or another,” says Carl, “and a certain amount of emotional abuse s accepted by society. For some parents, though, emotional maltreatment of their children becomes a pattern of life as opposed to an occasional frustrated outburst followed by an apology and expression of love.” Neglect I another form of abuse, considered by experts to be the most common single form of abuse. Nearly half (47 percent) of verified abuse cases are cases of neglect, and 40 percent of deaths due to abuse are due to neglect. (Fifty-five percent are due to physical abuse, 5 percent to both.) Neglect is the failure of a parent or other caretaker to make adequate provision for a child’s needs and well-being. Carl defines neglect as failure to provide:

…even a bare minimum degree of care in providing food, clothing, shelter, medical care, education, and supervision. All children skip meals, wear soiled or torn clothing, go to school with runny noses, and experience accidents that might have been prevented by parents from time to time. But neglect involves a chronic inattention to the basic needs of a child. Parents who leave young children unattended are guilty of neglect. Parents who do not ensure their children’s attendance at school or who allow severe illness to go untreated are guilty of neglect. Parents who knowingly allow their children to be placed in danger- with an abusive family member, for example- are guilty of neglect. Parents who ignore their children, failing to express interest and love, are guilty of neglect. Whatever form of abuse may take, it must be treated seriously and responded to sensitivity.

LIFE STRESS The word `stress` is defined by the Oxford Dictionary as "a state of affair involving demand on physical or

mental energy". A condition or circumstance (not always adverse), which can disturb the normal physiological and psychological functioning of an individual. In medical parlance `stress` is defined as a perturbation of the body’s homeostasis. This demand on mind-body occurs when it tries to cope with incessant changes in life. A `stress` condition seems `relative` in nature. Extreme stress conditions, psychologists say, are detrimental to human health but in moderation stress’s normal and, in many cases, proves useful. Stress, nonetheless, is synonymous with negative conditions. Today, with the rapid diversification of human activity, we come face to face with numerous causes of stress and the symptoms of anxiety

and

depression.

Numerous researchers and authors cite stress as a pivotal factor in depression. “When a person encounters stressful events in life that feel over-powering or threatening, one possible reaction is depression,” writes Olson. Such events in the life of a teen may include the rupture of an intense relationship with a peer; family discord; parental separation, divorce, or death of a parent; unwanted pregnancy or

abortion; and any event which lowers the teenager’s self-esteem such as expulsion from school, failure to make a team , academic failure, or not being invited to popular social events.”

ANGER A young person who has not learned or devised ways of effectively handling and expressing anger is more likely to struggle with depressive illness. Doctor Minirth and Meier write: Over and over in the literature on the subject, depression is described as anger turned inward. In the vast majority of cases, anger is very apparent in the facial expressions, in the voice, and in the gestures of the depressed individuals. They are often intensely angry, but usually they do not recognize their anger. A young person may be angry at a friend or loved one who has died, or at an abusive parent, or at his or her own helplessness. If he or she has been taught (by his

parents, church, teachers, etc.) that anger is always bad, the youth may repress anger rather than resolving it. “Anger is a very commonly experienced and displayed emotion during adolescence,” writes Dr. G. Keith Olson. “Sometimes its occurrence is understandable and predictable; at other times it comes as a surprise and shock to everyone, including the angry individuals themselves.” While extreme mood swings and emotional instability are a natural part of the teen years, temper outbursts and aggressive behavior can be signs that a young person’s anger has reached unhealthy proportions and is not being handled appropriately. Psychology Gary Collins writes: [Anger] occurs in varying degrees of intensity- from mild annoyance to violent rage … It may be hidden and held inward or expressed openly. It can be a short duration, coming and going quickly, or it may persist for decades in the form of aggression, unforgiveness or revenge … Anger, openly expressed, deliberately hidden from others, or unconsciously expressed , is at the basis of a host of psychology, physical, and

spiritual problems. Dr. Les Carter outlines three general Repression is a form of denial. If a person denies that he is angry, then he feels no obligation to deal with his anger. The problem is solved (temporarily). Naturally this is a dangerous method of handling anger. Repression may have its short-term rewards, but in the long run repressed anger is usually especially powerful and bitter. By repressing it, a person is pushing anger from the conscious to the subconscious. There it can fester and worsen without that person’s knowledge… [Expression is another way people handle anger.] Anger is not always expressed verbally. It can be expressed through behavior. Well over half of all communication is done through nonverbal means. Nonverbal expressions of anger can include a stern look, a slam of a door, ignoring someone, crying, or giving a cold glare. Released anger refers to anger that is dismissed, or let go. It is not confused with repressed anger. Repressed anger is simply pushed into subconscious mind. But when anger is released, the person has made a conscious decision that anger is no longer needed and it is therefore dropped. People can gain the ability to release anger only

after they first gain some mastery of the art of expressing anger. The problem many teens and preteens face is that they to repress their anger (particularly if their parents or churches have taught them that anger is always bad) or they have never learned how to express it in appropriate ways. And, of course, very few young people (or adults) have learned how to release anger when is warranted. As a result, bitterness , rage, and anger build up until they explode in brawling, slander, or other forms of malice.

GUILT A story of Andrew : Andrew was seven when, one winter morning, he left the house to catch the school bus … without his coat. His mother called after him, but Andrew could see the school bus coming up the road and didn’t want to miss it. He turned and watch frm the bus stop as his father raced toward him with Andrew’s coat in his hand. Moment later, Andrew’s dad crossed an icy patch on the sidewalk; his feet flew out from underneat him, and he hit the ground hard, his head making a loud cracking noise as it hit the sidewalk.

His dad’s injuries from the fall were severe, and he was rushed to the hospital where, due to complications arising from his fall, he died eleven days later. After his father’s accident, Andrew, a formerly bright and cheerful kid, became dull and morose. At ten, he was nearly killed when he stepped into the path of a car on the street in front of his house. At thirteen, he began suffering from extended bouts of severe depression. At fifteen he tried to take his life. Andrew’s mother had grieved for years over her husband’s death and even no longer over the change she had witnessed in her son. She knew her teenage son was suffering deeply, but she couldn’t understand why. It came as a total shock to her when she discovered, after attending a counselling with her son, that he had been consumed with guilt for most of his life because he blamed himself for his father’s death.

It was not difficult to understand why guilt can lead to depression. When a person feels that he or she has failed or has done something wrong, guilt arises

and along with it comes self-condemnation, hopelessness and other symptoms of depression. Guilt and depression so often occur together that it is difficult to determine which comes first. Perhaps in most cases guilt comes before depression but at times depression will cause people to feel guilty (because they seem unable to “snap out” of the despair). In either case a vicious cycle is set in motion… Guilt feelings often contribute to suicidal tendencies as well. Like what Andrew feels toward the death of his father. Olson writes: Suicide is often the individual’s own attempt to take control of punishment of sins or other misdeed of which he or she feels guilty. When no punishment has been received frrom society, friends or family, the induviduals chooses to be the victim of his or her own self-punishment. Too often suicide becomes the ultimate punishment. “Guilt is an inescapable fact of human existence,” writes Dr. Keith G. Olson

in his book Counseling Teenagers. It is also an inescapable fact of adolescence. Psychologist Jane marks says, “Children… tend to believe that they are responsible for the events around them.” That tendency sometimes continues into adolescence. If a friend gets hurt in their presence, they’re apt to fell some degree of guilt about it. If they pass a homeless man on the street, they may even feel guilt over his condition. Add to this acute- often unreasonable- sense of culpability the reasonable guilt that results from wrong acts they do commit, and the result is a potent spiritual and emotional mixture. Olson describes guilt as: … a very painful, disruptive fact that plays a significant part in many of our psychological, emotional and physical disorders. Christian psychiatrist Quentin Hyder described the complex emotion of guilt in this way: “it s partly the unpleasant knowledge that something wrong has been done. It is partly fear of punishment. It is shame, regret or remorse. It is resentment and hostility toward the authority figure against whom the wrong

has been done. It is a feeling of low self-worth or inferiority. It leads to alienation, not only from others, but also from oneself, because of the discrepancy between what one really is and what one would like to be. This leads to loneliness and isolation. Guilt therefore, is partly depression and partly anxiety. Olson goes on to point out that Christians often have greater difficulty coping with guilt than non-Christians do, particularly those christians who are more legalistic in their theology and practice. And Bruce Narramore states : It is amazing how consistently the church has taught that guilt feelings experienced by God’s children come from God. I believe the reason the church has equated guilt feelings with the voice of God is due to its failure to distinguish between three different types of guilt and God’s method of dealing with Christians and non-Christians. A brief look at these distinctions will help

clarify the problem. The first, civil or legal guilt, signifies the violation of human law. It is a condition or state rather than a feeling or emotion. We can be guilty of breaking the speed limit, for example, even though we may not feel guilty. Theological guilt, on the other hand, refers to the violation of divine law. The bible indicates that each of us is theologically guilty; we have all “sinned and fall short of the glory of God”(Romans 3:23). But theological guilt is not a feeling or emotion. It is a condition or state of being in which we are less perfect than God intends us to be, but it is not necessarily accompanied by the emotional aspect of guilt. In a biblical sense, we are all in continual state of theological guilt. …But this doesn’t mean that we feel guilty. Psychological guilt is the punitive, painful, emotional experience that we commonly call guilt. In contrast to the legal and emotional types of guilt, psychological guilt is an emotinal feeling. Obviously, psychological guilt is the type of guilt that afflicts many teens

and preteens, sometimes to an intense degree. Psychological guilt, while it may accompany legal or theological guilt, is highly subjective. Dr. Gary Collins points out that this subjective guilt may be strong or weak, appropriate or inappropriate. It may be befecial, prompting us “to change our behavior or seek forgiveness from God and others. But guilt feelings can also be destructive, inhibitory influences which make life miserable.”

THE EFFECTS OF DEPRESSION The effects of depression can read like a catalog of physical and psychological afflictions. Among the effects are physical and emotional effects, shortened attention span and/or daydreaming, masked reactions, withdrawal, suicidal behavior, and depressive tendencies in adulthood.

PHYSICAL EFFECTS

Minirt and Meier catalog some of the physical ramifications of depression : Clinical depression includes the physical symptoms …. These biochemical changes have various physical results : The body movements of the depressed individual usually decrease. The quality of his sleep is affected …. Initially, rather than sleeping too litle, he may sleep too much. His appetite is also often affected. He either eats too much or too little (usually too little). Thus, he may have either significant weight loss or weight gain. He may suffer from diarrhea, but more frequently from constipation. In women, the menstrual cycle may stop entirely for months, or it may be irregular. There is often a loss of sexual interest. The depressed individual may suffer from tension headaches or complain of tightness in his head. Along with slow body movements, he may have a stooped posture and seem to be in stupor. He may have gastrointestinal disturbances. He may have a slow matabolic rate. He may suffer from a dry mouth. A rapid geartbeat and heart palpatations are

fairly common. These physiological changes scare most individuals into hypochondriasis (an overconcern with physical illnesses).

EMOTIONAL EFFECTS While teens may not exhibit the classic signs of adult depression, as mentioned above, they may evidence some emotional effects of depression, such as those described by Minirt and Meier : One major symptom of depression is a sad affect (or moodiness). And individual suffering from depression has a sad facial expression. He looks depressed. He either cries often [“ the weeps”] or feels like it.

His eyes are cast down and sad. The corners of his mouth droop. His forehead is wrinkled. He looks tired, discouraged, and dejected. His features are strained. As the depression progresses, he gradually loses interest in his personal appearance.

DAYDREAMING Campbell suggests: In mild teenage depression, the first symptom generally seen is shortened of attention span. … [The teen’s] mind drifts from what he wants to focus on and he becomes increasingly distractable. He finds himself daydreaming more and more. This shortening of attention span usually becomes obvious when the teens attempt to do his homework. He finds it harder and harder to keep his mind on it.

And it seems that the harder he tries, the less he accomplishes. Of course, this leads to frustration, as the teenager then bleames himself for being “stupid” or “dumb”. You may escape from painful reality or frustration by creating a make-believe situation fantasy that is morepleasurable than the real situation.

MASKED REACTIONS Researchers Marion Ehrenberg, David Cox, and Ramon Koopman point out that adolescents do not typically express their depression directly but rather through the use of “masks,” or “depressive equivalents.” Collins lists the following “masked reactions.” •

Aggressive actions and angry temper outburst

•

Impulsive behavior, including gambling, drinking, violence,

destructiveness or impulsive sex •

Accident proness

•

Compulsive work

•

Sexual problems

Other masked reactions might include deliquency, school phobias, and poor grades.

WITHDRAWAL Campbell writes: In this miserable state the teenager may withdraw from peers. And to make matters worse, he doesn’t simply avoid his pers, but may disengage himself from them with such hostility, belligerence, and unpleasantness that he alienates them. As a result, the teenager becomes very lonely. And since he has so

thoroughly antagonized his good friends, he finds himself associating with rather unwholesome peers who may use drug and/or are frequently in trouble.

“Perhaps this is the easiest butleast effecive way to deal with depression,” writes Collins, who adds that withdrawal can take several forms: •

Leaving the room, taking a vacation, or otherwise removing oneself physically from the situation that arouses depression.

•

Avoiding the problem by plunging into work or other activities, by

•

thinking about othe things, or by escaping into a world of television or novels;

• •

Hiding the problem by drinking or taking drugs- behavior which also could be used to “get back” a the person who makes you depressed; and

•

Denying, consciously or unconsciously, that depression even exists.

SUICIDAL BEHAVIOR Many studies have linked adolescent depression to suicidal behavior (including

Carlson and Cantwell, 1982; Crumley, 1979; Pfeffer,Zuckeman, Plutchik, and Mizruchi, 1984; Simons and Murphy, 1985). Collins write : Not all depressed people attempt suicide but many do, often in a sincere attempt to kill themselves and escape life. For others, suicide attempts are unconscious cry for help, an opportunity for revenge, or a manipulative gesture designed to influence some person who close emotionally…. While some people carefully plan their self-destructive act, others drive recklessly, drink excesive, or find other ways to flirt with death. I had read an article in a Christian magazine , and the story is this : Fourteen-year-old Lori had been baptized just months before at Blue Spring Community Church, a one-room country church a few miles away from her home. The ceremony was attended by about sixty people, nearly half of them members of Lori’s family. Lori dropped out of church not long afterward, however. The pastor and his

wife visited her several times, but they failed to persuade Lori to return to the small

church. The entire church was concerned for her, but no one suspected the real reason for her absence. Lori was pregnant.

About a month before she expected to deliver, Lori tidied her room, emptied her school locker, and wrote a note to her mother:

“You kept asking me if I was OK and I kept telling you I was, but I wasn’t OK. I’m sorry, Mom. I’ve got too many problems. I am taking the easy way out.”

Lori left that day before her mother arrived home from work. She walked to the railroad tracks near her house, knelt between the rails, and folded her hands over her little round belly as Amtrak 168 barelled down upon her. The train engineer, a man who had a fourteen-year-old daughter of his own,

later said that when he saw Lori, it was too late to stop the train. He watched her cross herself before she died.

One out of seven teenager with recurrent depression commits suicide. Seventy percent of patients who commit suicide have depression and would have consulted or attempted to consult a physician or counselor within 6 weeks of their attempt.

“A clinically depressed youth may become suicidal,” writes author Marion Duckworth, and the expert agree. She cites her own experience: I remember writing my own diary when I was a teenager and angry at my mother,” She’d be sorry if I was dead.” But for a seriously depressed youth, the thought of suicide is ongoing and if help is not forthcoming he may become convinced it’s the only way out.

Suicide is the second leading cause of death among teenagers. Youth specialist and lecturer Jerry Johnston writes, According to the National Institute of Mental Health, eighteen teenagers per day kill themselves in the United States. Every eight minutes another teenager takes the suicidal plunge. What a nightmare it is to realize over a hundred of teenagers per week kill themselves in the world. In a year’s time, the total comes to a staggering sixty-five hundred lives lost … Reliable sources now say that over a thousand teenagers try unseccefully to kill themselves every day! Almost one teen per minute tries to commit suicide.

Dr. David Elkind reports : A recent survey of 1,986 teens in Who’s Who Among American High School Students found that 30 percent of these young people had considered suicide, 4 percent [had] attempted it, and 60 percent said they knew a peer who

had attempted suicide or had killed himself.

The statistics do not tell nearly the whole story, however. Many suicides are not even counted in the above statistics due to several factors. Dr. Keith Olson points out: There are more successful suicides each year that are counted as other forms of death because of lack of knowledge of the victim’s intent or motivation. A significant percentage of one-car accidents are actual suicide…. Some people who are medically ill die only because they stop taking their medication. And others “flirt with death” by their invlvement in high-risk occupations and sports (e.g., sky diving …) and life-endangering habits (e.g., smoking, heavy drinking and drug abuse). And finally, Marvin E. Wolfgang has studied a form of suicide that is maily peculiar to adolescents and young adults. “Victim precipitatal homicide” occurs wen one person provokes or set up another person to kill him or her.

More importantly, perhaps, statistics alone do not convey tha tragedy of teen suicide, nor its epidemic proportions. The human tragedy of promising lives lost in a moment, of parents, siblings, and friends enduring unspeakable grief and sorrow, of families and communities torn apart, cannot be measured. David Elkind points out that it is often difficult to identify teens who are contemplating suicide partly because “teenagers in particular are often reluctant to reveal the problems they are experiencing or their inner thoughts. Unfortunately many teens also conceal their inner pains and fears so that their parents and closest friends have no idea that they are suffering and considering suicide.

“Nonetheless,” Elkind says, “while many young people often give no implications of an impending suicide attempt, others do.” Some of the signs that may alert a parent, teacher, youth leader, pastor or friend to a possible suicide

attempt include: •

Previous suicide attempt

•

Threats of suicide

•

Talking about death

•

Preparation for death (cleaning out locker, giving away possessions, etc.)

•

Depression

•

Sudden change in behavior (acting out, violent behavior, etc.)

•

Moodiness

•

Withdrawal

•

Somatic complaints (sleeplessness, sleeping all the time)

•

Fatigue

•

Increase risk-taking

•

Drafting suicide note While it is not always possible to recognize the signs of suicidal tendencies

or to prevent a teen from complaining or committing suicide, a familiarity with the causes and precipitating factors of adolescent suicide can make a crucial difference.

THE RESPONSE TO THE PROBLEM OF DEPRESSION

Depressive disorders make those afflicted feel exhausted, worthless, helpless and hopeless. Such negative thought and feelings make some people feel like giving up. It is important to realize that these negative views are part of depression and typically do not accurately reflect the actual situation. It should remembered that negative thinking fades as treatment begins to take effect. In the meantime, the following are helpful tips for coping depression. •

Eat healthy foods. Many may find that folate food supplements help improve

•

their mood.

•

Make time to get enough rest to phsically promote improvement in your mood.

•

Express your feelings, either to friends, in a journal, or using art to help release some negative feelings.

•

Do not set difficult goals for yourself or take oa a great deal of responsibility.

•

Break large tasks into small ones, seet some priorities, and do what you can when you can.

•

Do not expect too much from yourself too soon as this will only increase feeling failure.

•

Try to be with other people, which is usually better than being alone.

•

Participate in activities that may make you feel better.

•

You might try exercising mildly, going to a movie or a ball game, or partcipating in religious or social activities.

•

Don’t rush to overdo it. Don’t get upset if your mood is not greatly improved right away. Feeling better takes time.

•

Do not make major life decisions, such as changing jobs or getting married or divorced without consulting others who knows well. These people often can have a more objective view of your situation. In any case, it is advisable to postpone important decisions until your depression has lifted.

•

Do not expect to ‘snap out’ of your depression. People rarely do. Help yourself

•

as much as you can, and do not blame yourself for not being up to par.

•

Remember, do not accept your negative thinking. It is part of the depression and will disappear as your depression responds to treatment.

•

Plan how you would get help for yourself in an emergency, like calling friends, family, your physical or mental-health professional or a local emergency room if you were to develop thoughts of harming yourself or someone else.

•

Limit your access to things that could be used to hurt yourself or others (for example, do not keep excess medication of any kind, firearms, or other weapons in the home).

WHAT IN GENERAL SHOULD DEPRESSED teen DO in addition to treatment? It is first important to learn what the circumstances are that brought the condition and know what to expect particularly during the initial period of treatment. Teens need to remember that they should not blame theirselves for their illness as they did not ask themselves ro suffer from it. Teens should at best give themselves a

reprieve from nrgative thinking for now. They should take their medications as prescribed, get plenty of rest, stay physically active, eat regularly, and keep socially involved. Having something to do takes your mind off the negative thoughts and channel your energies to more productive endeavors. Also, exercise helps the release of endhorphins which makes us feel a sense of well being. This may be difficult for unmotivated teens so that is when the madication can help.

WHAT IN GENERAL SHOULD A DEPRESSED TEEN

NOT DO? A depressed teenager should not drink alcohol. Alcohol causes similar changes in brain chemistry as occurs during depressive episode. Many teenagers with major depression attempt to self medicate with alcohol to either help themselves sleep or to ‘calm their nerves’. While it may initially help them fall asleep, it’s sedative effect wears off quickly causing early morning awakening. More drugs are metabolized in the liver and taking alcohol may likewise hinder or hasten the metabolism of these drugs. For the same reason, illicit drugs and other sedative or stimulating agents are not to be taken. A depressed teenager should not make any major life decisions

likewise especially if depression is moderate severe.

HOW CAN SOMEONE HELP A PERSON WHO IS DEPRESSED? Family and friends can help! Since depression can make the affected person feel exhausted and helpless, he or she will want probably need help from others. However, people who have never had a depressive disorder may not fully understand it’s effects. Although, unintentional, friends and loved ones may unknowingly say and do things that may be hurtful to the depressed person. It may help to share the information in this article with those you most care about so they can better understand and help you. The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This help may involve encouraging the indivudual to stay with treatment until symptoms begin to go away (usually several weeks) or to seek different treatment if no improvement occurs. On

occasion, it may require making anappointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication for several months after symptoms have improved. Always report a worsening depression to the teenager’physician or theraphist. The second most important way to help is to offer emotional support. This support involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feeling experessed, but point out realities and offer hope. Do not ignore remarks about suicide. Always report them to the depressed person’s theraphist. Invite the depressed person for walks, outings, and to the movies and other activities. Be gently insistent of your invitation is refused. Encourage participation in activities that once gave pleasure, such as hobbies, sports, religious or cultural activities. However, do not push the depressed person to undertake too much too soon. The depressed person needs company and diversion, but too many demands can increase feelings of failure. Do not accuse the depressed person of faking illness or of laziness. Do not

expect him or her “ to snap out of it”. Eventually, with treatment most depressed peole do get better. Keep that in mind. Moreover, keep reassuring the depressed person that, with time and help, he or she will feel better.

WHERE CAN ONE SEEK HELP FOR DEPRESSION? A complete physical and psychological diagnostic evaluation by professionals will help the depressed person decide the type of treatment that might be best for him or her. However, if the situation is urgent because a suicide seems possible, taking the teen to the emergency room is appropriate course of action. The patient might not realize how much help he or she needs. In fact, he or she might feel undeserving of help because of the negativity and helplessness that is a part of depressive illness. Listed below are the types and places that will make a referral or provide diagnistic and treatment services. 

Family doctors



Mental-health specialists, such as pssychiatrists, psychologists, social workers, pastoral or mental-health counselors.



Health-maintenance organizations



Community mental-health centers



Hospital psychiatry departments and outpatient clinics



Community support gropus, often hospital-afflicted



University or medical-school-afflicted programs



State hospital outpatient clinics



Family service/social agencies



Private clinics and facilities



Employee assistance programs



Local medical and/or psychiatric societies

HOW CAN I HELP MYSELF NOT FEEL DEPRESSED? A testimony of a teenager who experienced depression : Some days I feel fine, some days I feel like absolutely crap. I don’t know if I’m imagining how I feel, or whaever, but most days I can convince myself that even if

I’m imagining it, that kind screwed up imagination itself probably means I should see someone. But I can’t/won’t/ don’t want to. I just barely ever talk about how I’m feeling, or negative stuff that happens ( it took me about a month to let my close friends and family know that I’d broken up with my long-term boyfriend). I have normal coversations about how crap last night’s tv was and so on, even stuff like the cute guy I hooked up with, but nothing really deep. And I know I could if I really wanted to, but I really really don’t want to. When I was 4th year, I told a techer I was very close to about being depressed, and then it went to my parents and I spent a few months enduring sessions with an absolute idiot of psychologists. Probably not helping me now. Things I do at the moment to help myself: •

Plan for specific future goals. Like a week’s holiday later this year, and work toward it (look up my destination, put money away)

•

Exercise. I’ve played sport my whole life. I normally exercise three or four times a week. It’s good, but I feel worst at night, and can’t really just head out for a jog at 3 a.m.

•

Being conscious of good things. I’ve started noticing the awesome scenery around me, like going to one of the prettiest campuses in the country. I try and list positive things I’ve got, like travel opportunities and so on.

My original question was how could I make myself see a therapist, but on writing I think that I won’t until I really want to. So, what can I do for myself to help me feel better? And, spontaneous extra question, how do I bring stuff like this with friends, without being an attention seeking drama queen? If you don’t want to talk about how you feelto a theraphist, but you are willing to confront thses feelings, maybe you can try online theraphy. I have no experience, but I can imagine it’s a lot easier to type about how you feel with a theraphist than to actually talk about it. I think theraphy’s not a bad choice, if you can convice yourself to do it. Yoga might help and you can do it at night. It sounds like you are not in the habit of having confidants. When not try opening up to your friends little at a time? Start with smaller confessions/admissions and work up to bigger ones. Like, instead of “I always feel ike

crap and think I need psychiatric help,” say, “I can’t believe I sleep all weekend/couldn’t sleep. I think all this crap at work/school is really starting to wear me down.” Alternatively, you could just flippantly ask, “have any of you tried theraphy? I swear, xx is driving me so crazy I’m starting to have dreams about it.” See how it flies. I bet some of your friendshave had theraphy and that alone might make it more palatable.