In our society, we seem to have forgotten that depression is not the opposite of happiness. Children must be allowed to be sad and experience unhappiness. They need the support of adults around them to help them cope, by providing them with coping strategies to take into adult life.
All children will experience loss and a grief reaction how they manage will depend on the adults and structures around them. If those adults and structures have provided a secure containing environment, then the building blocks for adult life are put in place, so sadness and unhappiness are normal, albeit painful, aspects of growing up.
Unfortunately many children and young people are subject to insecure, uncontained, sometimes abusive experiences. Children, unlike adults, are often powerless to make any changes in their lives. Research tells us that even many early abusive experiences affect the brain and its development. In these circumstances, children may well become depressed or develop symptoms of anxiety, or may self-harm.
As professionals, we sometimes need to step in and enforce change, perhaps through the courts. Sometimes we may offer family therapy, where a child is positioned in complex family dynamics, or we may support a school to help them manage self-harming behaviour. We need to take time to understand what is happening in a child’s life and not simply react to their symptoms, which in some cases means the use of anti-depressants.
Sadness is a fact of life, and we mustn’t allow it to be medicalised. Western culture does seem to see children as problematic and young people as troublesome, rather than troubled. We have much to learn from other cultures, whose beliefs and practices challenge western values. We must reflect on our own practice in order to provide a holistic service to the children and young people who are referred to us.
Val Brooks is service lead, child and adolescent mental health services, Nottinghamshire Healthcare NHS Trust