Depression is considered as a disease, which affects the mind of an individual and result in abnormal behavior of the individual to themselves and to others. Depression occurs when there is an excessive sadness experienced by the individual and the individual where not able to overcome the strong emotions. Depression has been overlooked and under diagnosed for several years by the psychiatrics and medical professionals. Especially in adolescent age, which is considered as time of emotional turmoil, mood swings, and increased sensitivity, depression seems to be under diagnosed.
Many physicians considered depression as an adult disorder and only recent studies proved that 7-14% of children under the age of 15 also experience episodes of manic depression. Later after 1980 only, mood disorder in children was included in the psychiatric illness (Brown, 1996). Brown states that depression in children and adolescents has always been understated as children hardly express their anxieties. He also states that in a survey conducted among 120,000 teenagers, three to four thousand children’s suffer from mood disorder and among them 10-11 children’s commit suicide. Generally, mood disorder is often accompanied by other psychological disorders like eating disorder (Lasko et al, 1996), suicide (Blackman, 1995, Brown, 1996, Lasko et al, 1996, Oster & Montogomery, 1996), anxiety (Oster and Montogomery, 1996), hyperactivity (Blackman, 1955), substance abuse (Blackman, 1995, Brown, 1996, Lasko et al, 1996, Oster & Montogomery, 1996) which prevents the presence of mood disorder. ” “According to Blackman, 1995 adolescent death is increasing tremendously than the death rates of cardiovascular disease and cancer in youths of age group 15 to 19 years.
He states that as the reasons for depression are not shown obvious by the sufferer, it is very difficult to identify the person with depression. ” However, in past 25 years though the incidence of suicide has decreased in genera, the suicide rate among the adolescent seems to be subject of concern. On the other hand, in spite of the increased suicide rate among adolescents, depression seems to be under diagnosed and leads to severe problems in school, work and personal adjustment, which often prolong, into adulthood. As suicide rate among adolescent is increasing the early diagnosis of the symptom would help in preventing the disorder. However, as symptoms of mood disorder take different forms in children, diagnosis should not only left with the physician or psychiatrics, even parents and teachers and others who interacts with the children should be involved in the process. Moreover, depression among youth is generally unidentified as teenagers usually express boredom and irritability when they are highly depressed. Hence to access such behavior it is becomes highly difficult,” says Oster and Montgomery, 1996.
CLINICAL DEPRESSION However, depression when considered clinically it is defined as a serious medical illness that negatively affects the self-felling, thinking process and the behavior of an individual. The normal functioning is disturbed when the individual is depressed. Often these individuals tend to loose interest in their regular activities, which once they enjoyed and always feel sad and hopeless for extended period. Clinical depression affects the individual’s life as whole. It changes the general habits of the person, and it deprives the individual ability to work, think and communicate with people.
SYMPTOMS OF CLINICAL DEPRESSION The symptoms of clinical depression comprise considerable changes in mood and related behaviors such as withdrawal, unhappiness, decreased energy and suicidal thoughts. According to Brown, 1996 depression is expressed as “an elaboration of duration and intensity of normal mood changes. ” However, sever warning signs of mood disorder among adolescent include unusual change in eating and sleeping habit and complete loss of interest in regular activities. (Blackman, 1995, Oster and Montgomery, 1996), constant irritability and violent behavior, disruptive behavior. (Brown, 1996).
For most of the teen population, the problem arises due to low self-esteem, which arises from increased stress on peer popularity. However, this is not the only cause poor family relationship, less financial security from family, decreased family support and continuous denial by the parents and the society. (Lasko et al, 1996). At many instances, the children get disturbed when the parents are struggling over marital problems, career problems, or physical illness, this affects the children’s behavior in total, they get isolated form the family and develop higher risk for suicide, says Brown, 1996.
In addition, Brown, 1996 suggest that the best way to diagnose such children and adolescent who are at the risk of suicidal attempt is by screening the vulnerable group by the risk factors such as increased alcohol abuse, severe mood problems and verbal signs of suicidal attempts, within in the last three months prior to the attempt to the suicide. VARIOUS CLINICAL DEPRESSIONS Mourning and Manic Disorder According to Melanie Klein, the loss of any existing external object brings about a feeling with the mourner as a lost of internal good object as well.
The pain of the loss of the external object troubles the internal self very badly. “Every time when the pain of loss arises the people tend to receive an unsecured feeling. ” (Kelin, 1983b, p. 77). Hence, when a child is growing awareness about the loss of loved one especially mother causes ‘deepest source of painful conflicts’. (Kelin, 1940). As the child grows, it starts facing many real losses. Initially, the child tends to miss the weaning especially during the depressive period. Slowly the child starts developing other defenses as it grows.
The child tries to overcome the loss by perceiving itself as an omnipotent object. In later stages, the ego of the child denies the importance of its good things and tries to control both good and bad ones resulting in hyperactivity of mania. By doing so the child has a feeling of victory over the good ones and this sense of achievement prevents the child from mourning and slowly the inner world of the child get destroyed without giving any clue to the outer world. (Joan Riviere, 1936). The child when reaches the adulthood the mania inside increases and the adult start perceiving the feeling of persecution.
When this stage continues for a longer period, the inner world of the adult collapses and worsens. (Sigmund Freud). Kelin calls this condition as a state of mental illness, which goes unrecognised and common among the patient with manic disorder. Mourning process will have extreme mood shifts between mania, a state of heightened feeling and depression, a state of despair. The person affected with this disorder usually releases their stress by crying, which act as a relaxation technique to them and by sharing their grief with their loved ones usually their parents. (Kelin, 1937).
However, when the adult is incapable of mourning would start denying love to both internal and external object hence resulting in disgust towards everything he/she faces. Schizophrenic Condition “This type of condition is associated with libidinal and aggressive impulses are split along with love and guilt. ” (Klein, 1946). The person with this problem are split into good or bad based on the impulses they carry such as if the person carries love and related feelings they tend to be good and if the person carries aggressiveness or hatred feelings they are subjected to be bad.
These good and bad object are developed form the experiences faced by the child from the external world. (Elizabeth Bott Spillus). According to Klein, 1946, “if a child is offended by the internal object and if it is bad, then the child tend to free itself from it, by projective identification. ” Kelin also states that, “when the pressure of anxiety or guilt overwhelms during the depressive period the ego of the child tries to run away to violent activities. When this turns to the extreme, the child becomes psychotically ill. However, “when the child is below the extreme level the ego of the child is weakened and impoverished and the belligerent components such as power, strength, vigor, knowledge and many other most wanted traits are lost. ” (Donald Winnicott). Thus, the loved person would be in trouble as all the bad parts of the child are imposed on the loved person. However, in case of the child holds good qualities then it becomes over dependent with the loved ones.
Moreover, when the child is left behind without proper attention it results in separation of child from the family because the parting felling arises due to anxiety-provoking and aggressive impulse due to unattended feelings of the child. “Schizoid patients are difficult to be treated than the manic-depressive ones because of ‘their withdrawn, unemotional attitude, the narcissistic elements in their object-relations and a kind of detached hostility which pervades the whole relation to the analyst create a very difficult type of resistance’. ” (Kelin, 1946, p. 18).
Jealousy and Idealization According to John Steiner, “envy act as a major destructive drive among the depressive patients. It is been in the patient from their birth. ” Jealousy arises at the time of weaning. The breast of the mother either satisfies the child or dissatisfies the child. According to Klein, 1957, “the good breast, the first good object, divide off from the bad breast, may seem to hold all good things itself and thus be a source of intolerable envy for the infant. Thus, the more the good breast is used the more intensely the envy is experienced. ”
The more the envy is present in the child the child tends to spoil the good objects until the envy diminishes. Later the child would no longer left behind with good object. In addition jealous, destroy the enjoyment of the child as whole and makes appreciation an impossible character in the child. Klein emphasises on role of gratitude among these children’s for healthy development. He states that it helps the child to develop the ability to love people and maintain goodness in them. Apart from this, the feeling of gratitude also provides a sense of wealth and kindness among the envied children.
However, clinically treating envy patient is a challenging process as therapeutic situation boost the patients envy. For example, the health profession who is treating the patient may act as a cause of envy, because of his therapeutic skill or wisdom. TREATMENT FOR DEPRESSION Treatment for the disorder is generally provided in two avenues, they are “psychotherapy and medication”, says Blackman, 1995. Psychotherapy is provided to cases with mild disorder, whereas medication and psychotherapy is provided when there is a severe problem of depression persists among the patients.
However, a severe case when not treated with proper medication would result in fatal problems. According to Brown, 1996, the children with severe mood disorder has to be diagnosed earlier and treated promptly to reduce the risk of multiple episodes of depression throughout their life span. For past several years, depression among children and adolescent have largely been disregarded by many health professionals and general public, but now the importance of early diagnosis and treatment has well realised and the treatment and diagnostic procedures also exist.
However, many teenagers can successfully overcome the stress with the help of the parents, psychiatrists, teachers and friends. (Blackman, 1995). Hence, family and friends can be of great help to depressed patients by emotionally understanding the patient condition and be supportive to them to overcome the negative impacts of depression. Self- realisation would be the first treatment to the depressed patient. Apart from this proper treatment along with self-education to the depressed patient can help them overcome the diseases and maintain a balanced and positive lifestyle.