Jane was nearly 40 years old when she came to see me for poor self-esteem. Despite her achievements, she never felt good about herself and was unable to sustain a relationship with a man.
She attributed much of her difficulty to her father, whom she described as angry and judgmental. "It seemed everything I did was never quite good enough for him," she said.
Naturally, she internalized these criticisms and spent much of her life feeling flawed.
After a few months, she agreed to invite her father in for a session. When he came in with Jane's mother, he did seem angry and short-tempered. He said for most of his life he had had "a short fuse" and didn't take much joy in anything.
After further exploration, I suggested that he was depressed and had been most of his life. I explained that his irritability, along with his pessimism and negative worldview, were classic symptoms of depression.
Unfortunately, he disagreed with me and refused to get a second opinion.
Nevertheless, our session had a powerful impact on Jane. Rather than viewing him as an ogre with negative intentions, she was able to see him as someone with an illness. And we could explore the real possibility that her poor self-esteem might be a symptom of depression.
The greatest harm Jane experienced was growing up in a family with untreated depression.
About 20 percent of Americans will develop a clinical depression over their lifetime, according to the National Institute of Mental Health. The incidence is growing, and first episodes are occurring at younger ages. And despite improvements in medication and psychotherapy, depression often recurs. That's because each episode raises the odds of having another one.
We know a great deal about depression. We know that it can take the classic form of hopelessness, irritability, and changes in sleep, appetite or libido, and that it can be linked to anxiety, drug use and other illnesses.
We also know that good care can produce substantial improvement in nearly 80 percent of cases, even though fewer than half of people with depression receive treatment.
But we still know very little about the effect of depression on family members. And since 20 percent of us will be depressed, that means the majority of us will be touched at some point by depression.
The condition is the root cause for many divorces. The withdrawn husband who doesn't get involved with his children may be depressed. And so may be a wife who seems unhappy with everything in the family. And we know that when a parent is depressed, children are at greater risk for depression.
So what can be done? Depression can be treated with psychotherapy and medication. And this can be supplemented with exercise, meditation or yoga, and social interaction.
Family members can help make the situation worse with criticism or nagging. But with compassion, they can also give the impetus to get their loved one into treatment.
A colleague once said that depression begins from the outside in. Friends and family can often see depression in a loved one before they feel it themselves.
Depression should be discussed openly to diminish shame and secretiveness. Older children should also know about the genetic risks involved with depression and that early treatment means better prognosis.
Depression is most destructive when it is unacknowledged and untreated.
Jane's father never changed his behavior, but his criticism stopped having an effect on her. She took a course of medication, continued her therapy, and did some volunteering at a children's organization. Within a year, Jane was feeling more hopeful about herself and less angry at her father.
Inside Out: Getting Help for Depression
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