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Book Forum: Child and Adolescent Psychiatry   |    
Out of the Darkened Room: When a Parent Is Depressed: Protecting the Children and Strengthening the Family
Am J Psychiatry 2003;160:806-807. doi:10.1176/appi.ajp.160.4.806
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New York, N.Y.

By William R. Beardslee, M.D. Boston, Little, Brown and Co., 2002, 286 pp., $25.95 (paper).

Dr. Beardslee is Psychiatrist-in-Chief at Boston’s Children’s Hospital; his brief and thoughtful text was written to help families cope with depression among their members. The 13 chapters read easily, and I found the epilogue with notes and references extraordinarily helpful. On finishing the book I immediately recommended it to several families. Dr. Beardslee’s collaboration with staff and families from different social strata over a period of more than 20 years enabled him to choose examples from a heterogeneous practice. He acknowledges at the outset his special dedication to the stricken after the loss of his eldest sister in her mid-20s. Families start off with him by sharing their history together as he assesses each member’s resilience and knowledge as well as uniqueness.

Dr. Beardslee’s review of the biological basis and cause of depression is brief and clearly states that biology is NOT destiny. He puts known risk factors in perspective early in the text. Brevity is also evident in his approach to diagnostic entities and the panoply of therapies—medications take up fewer than three pages. There are plenty of texts on pharmacotherapy for depression.

Dr. Beardslee’s emphasis is unequivocally on family dynamics and individual growth. His case studies are families who survive hospitalizations and suicides. His artistry is apparent throughout; however, he keeps himself in the background, so it is difficult to understand his particular style of action and use of language. His ability and availability are key to the sense of security he generates for his needy patients at times of crisis. For more than two decades, his Boston group (which includes psychologists and social workers) has studied almost 300 youngsters from about 150 families through different hazards and family healing interventions. His clinical results delineating resilient and vulnerable adolescents have already been published the American Journal of Child and Adolescent Psychiatry,American Journal of Psychiatry,Biological Psychiatry,Psychoanalytic Study of the Child,American Journal of Orthopsychiatry, etc.

This book emphasizes particular familial struggles in spare pithy terms, sometimes Biblical in the vignette approach. Dr. Beardslee notes the influence of his father’s text, A House for Hope(1). Frank and Fern cope with grandfather’s death. Clair and Len develop strength to cope with Len’s illness. Jerry and Glenda learn to deal with Glenda’s bipolar illness. Young Jesse learns to deal with his mother’s suicide with the special help of his school and community. "In trying to help Jesse deal with his emotions, his class visited his mother’s grave and he talked about her." How is that for community involvement? Another child, Charlie, survives his parents’ acrimonious divorce with a transient addiction to computer games, journal writing, medications, therapy, meditation, and rigorous exercise. Rebecca, 14, learns to deal with her mother’s self-mutilation.

Toward the end of his presentation Dr. Beardslee presents a plan to change the system. He says that, at the time of his writing, "we are privileged to live in a time of great plenty.… Thus it is possible to achieve the goal of health for all children and all of their caregivers without an undue burden or without cutting other essential services." In facing the future, Dr. Beardslee follows Benjamin Spock (outdated and not one of my favorites). He quotes Dr. Spock as saying, "Relax. You are doing better than you think you are." This encouragement "applies even more to families wrestling with depression."

This cheery optimism may be good for a book for families whom you want to encourage. Obviously the economy has changed since this exegesis. My experience with families with bipolar disorder for the past 30 years is less sanguine. I too have seen an individual who lost both parents to suicide, and he has done remarkably well. But there are many failures and a lack of resources. Colleges throughout the United States report increasing suicidality and abuse of alcohol. The lofty Princeton alumni magazine, with many of the best and brightest undergraduates, published a lead article this fall reporting alarming and depressing survey data about hopelessness, suicidal thoughts, and suicidal impulses (2). McLean Hospital follow-up data for its out-of-state referrals (personal communication) demonstrate the need for community follow-up.

Dr. Beardslee has some important points to make, which we should all heed promptly. The nurturant community and family are both vital, and medication is adjunctive, not primary, especially for adolescents.

Beardslee WA: A House for Hope. Louisville, Ky, Presbyterian Publishing Corp, 1999
Greenwood KF: When college life overwhelms: on campuses, growing concern about mental health. Princeton Alumni Weekly, Dec 4, 2002


Beardslee WA: A House for Hope. Louisville, Ky, Presbyterian Publishing Corp, 1999
Greenwood KF: When college life overwhelms: on campuses, growing concern about mental health. Princeton Alumni Weekly, Dec 4, 2002

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