Out of the Darkened Room: When a Parent Is Depressed: Protecting the Children and Strengthening the Family

One of the foremost concerns for many depressed patients is the effect their illness may have on their family. Severe depression may create deficits in a patient’s ability to provide structure and interact lovingly with their children; parents may also worry that the disorder will be passed on genetically. Out of the Darkened Room: When a Parent Is Depressed: Protecting the Children and Strengthening the Family is a useful book that addresses this important topic with creativity, understanding, and compassion. Dr. Beardslee calls on two decades of research and years of clinical wisdom to create a guidebook for prevention in families facing affective disorders. This book brings practical, step-by-step advice to life with detailed stories of longitudinally followed families, as well as glimpses into the author’s personal family history. Rather than focusing on pathology, it empowers families to work against long-term effects on their children. The key recommendation, family communication, is described in detail, and the text approaches this core preventive strategy with respect for what a daunting task it represents. The first half of Out of the Darkened Room outlines six steps toward family dialogue about depression. The entire process is first illustrated through the story of one of Dr. Beardslee’s first families, one in which a couple and their three children dealt with depression complicated by recurrent suicidality and a history of sexual abuse. In the subsequent chapters, the book breaks down the particulars of each step. “Sharing a history together,” the first step in Beardslee’s proposed method, represents the initial dialogue of parents who have dealt with depression. At this stage, frank discussion with children is yet to come. Rather, spouses or single parents begin to make sense of their experience of depression and how it fits into their family story. This chapter encourages us to think of affective disorders as family diseases, illnesses that disrupt the continuity of the shared narrative. Whether producing irritability, low activity levels, poor concentration, or other symptoms, these disorders affect every individual member of the family unit. Here the author describes various signs of depression, encouraging potentially affected readers to work toward overcoming denial that could prevent possible diagnosis and treatment. The next two chapters present basic information about depression, including the underlying biology, and risk factors and protective factors that contend to determine who becomes afflicted. The author then briefly outlines criteria for diagnosis and evidence-supported treatments such as cognitive-behavioral psychotherapy, interpersonal psychotherapy, and medications. Information is provided about dysthymic disorder, mania, childhood depression, and suicide, as well as comorbidities such as substance abuse, posttraumatic stress disorder, and eating disorders. The book then turns to the subject of resilience, which Beardslee defines as “the emergence over time of unexpected strengths and competencies in those at risk” (p. 65). After years of seeing families in crisis, Beardslee states, his interest turned to preventive care. For him, preventing pathology in the children of depressed parents meant discovering how and why some did well in the face of great adversity and then promoting these qualities in others. In their research, Beardslee’s team selected several children who displayed great resilience and looked at what qualities they shared. These youths had a sense that their parents or other caregivers loved them, and despite natural wishes to cure the ill parent, they realized they were separate people who could not effect this change. They showed capacities for empathy and self-awareness, and believed in the potential for their actions to make a difference. In chapter 6, “Enhancing Strengths and Reducing Risks: The Vital Balance Across Time,” the author further characterizes resilient children as having deep interpersonal relationships with parents or other mentors, a lack of self-blaming, and productiveness outside the home. Parents are urged to assist their children with these tasks. The mechanics of the essential intervention, a family meeting where all caretakers and children capable of sitting through it are present, are outlined in chapter 7. Objectives of the meeting include reassuring children that parents will ultimately be all right and that the family will not be overwhelmed, stressing that no one is to blame for the illness, pointing out the strengths of the family system, and explaining what treatment will be undertaken. Discussion should involve events and conditions that the children have witnessed or are likely aware of but that may not have been acknowledged. Children should be made comfortable to talk openly about their fears and concerns. In the next several sections, the author encourages continued dialogue within the family. He points out that as youngsters grow and mature, their questions about depression will change. They will need new and more sophisticated answers. Above all they will need to know that the family structure will not break down and that their parent will be all right; with this security, they can work on the developmental