"Preschool depression" sound like a term created just to piss off psychiatry skeptics — but clinicians argue that it's real. And descriptions of the condition are some of the saddest things you'll ever read.
Writing in the Times Magazine, Pamela Paul records this interaction between a depressed preschooler and his mom, during a form of therapy where the therapist induces guilt so that parent and child can work through it (in this case, the therapist gave the kid a cup that was made to break when he picked it up):
The boy nodded tearfully. "I feel like I'm going to go into the trash can," he said.
"Who would put you in the trash can?" his mother asked.
"You would," he replied in an accusatory voice.
"I would never do that," she said. "I love you. Accidents happen." The boy seemed to recover, and they chatted about her earrings, which he flicked playfully with a forefinger. Then his face drooped again.
"Are you mad at me?" he asked, and then added, almost angrily, "I never want to do this activity again."
"You're not a bad boy," she consoled him. [...]
"I am a bad boy," the boy said, ducking under the table. "I don't think you love me now." He started to moan from the floor, whimpering: "I'm so sad. I'm so sad."
Another kid, offered a trip to Disney World, said, "Mickey lies. Dreams don't come true." Reading these stories made me kind of depressed, and they also convinced me that even the youngest children can have problems that go beyond mere transitory sadness. But what can we do about them? Doctors aren't sure — many are worried about overmedicating and labeling kids, and preschoolers are especially difficult to diagnose. Explains Paul, "Preschoolers not only lack the linguistic sophistication to describe the experience, but they're also still learning what emotions are." How do you help kids so young they barely know what a feeling is?
One possible answer: involve the parents, but don't blame them. While a parent's depression can influence a child's mental health, psychologist Joan Luby says, "I've seen many depressed kids with nurturing, caring parents." And while we often tend to blame parents for problems that show up in kids — especially this early — parents can actually be part of the solution. Says Luby,
Psychotherapy for depressed preschoolers should always involve the caregiver. Not because the caregiver is necessarily bad or doing anything wrong, but because the caregiver is an essential part of the child's psychological apparatus. The child is not an independent entity at this age.
Amid all the sadness of this story, there's a grain of hope, which is that maybe recognizing illnesses like depression in preschoolers can head off more serious problems in adulthood. Writes Paul, "recent successes in treating autism have also shown that in many cases, the earlier the detection and intervention of a disorder, the greater chance for significant results. One principal argument for diagnosing depression early is that even with a genetic predisposition, depression isn't cemented into the psyche; the very fluidity of preschoolers' mental states seems to make them more treatable." Preschool depression may not be a new mental illness du jour — perhaps, some speculate, today's depressed adults were depressed as toddlers too, but society wasn't yet equipped to notice. Now that we are, maybe we can help kids before depression is "cemented into the psyche" — and perhaps have a shot at really stopping an illness that so often proves devilishly difficult to treat.
Can Preschoolers Be Depressed? [NYT Magazine]