Children are becoming more and more depressed, and the doctors who can help them are far from enough. In recent years, the Children’s Psychiatry Department of Peking University Sixth Hospital (hereinafter referred to as PKU Sixth Hospital) has often been overcrowded, and some patients can only be admitted to the adult department.
One worrying data is the analysis of the national survey data of over 30,000 adolescents in the “2022 Adolescent Mental Health Status Survey Report.” The results show that among the adolescents surveyed, 14.8% are at various levels of risk of depression, with 4.0% belonging to the severe depression risk group.
What is happening to the children? “Some children are jumping off buildings, and parents still cannot understand what is happening to their children.” Dr. Lin Hong from PKU Sixth Hospital’s Children’s Psychiatry Department has seen too many such regrets.
Since 2009, Lin Hong has been treating children with depression using “family therapy.” “When a child is ill, it is very likely that the whole family is ill. It’s not just about treating the child.”
But she does not attribute the blame solely to the parents. She sees these parents also struggling, confused, and even fearful in their pain. They also do not know what is happening, what to do, and even “their childhood has not been properly taken care of.”
Many parents do not want to, “If the child doesn’t come, what’s the use of us coming.” They feel embarrassed to step into that door, do not accept that the child has a mental disorder, and certainly do not accept it themselves, with a deep sense of shame.
Their purpose for seeking medical help is very clear – how to get the child back to school quickly.
Many people do not know that if a child can no longer go to school, their social function is impaired. In fact, by the time a child reaches this point, they have usually been through a very difficult and painful process.
“I have seen too many anxious parents in Beijing. Those who come to us for treatment mostly have good conditions. Especially those parents who have achieved social status through their own efforts are prone to default thinking that their children can only be better than themselves, “Look at my conditions back then, her conditions are much better now.”
But when we communicate with parents, over ninety percent will say, “We have no expectations for our children.”
In fact, their expectations are already unconscious. A father said, “I don’t expect him to get into Tsinghua or Peking University anymore, but he should at least go to college. It shows that he is unable to accept that his child may take a break. Another mother said, “I told my daughter not to care about exam results. But this time, she didn’t even pass the English that she usually excels in.”
Parents feel innocent and think it’s the child’s fault, not theirs. In truth, the parents’ expectations have long been internalized by the children. What is internalization? How others see me has become how I see myself.
Many high-achieving children often have perfectionism and obsessive behavior. When they were young, their parents had very high demands, even rewriting a word incorrectly. As their study tasks became more demanding, they would stay up late writing, then feel tired during the day and unable to focus in class. If a child is too anxious in pursuit of perfection, their emotions will be greatly drained, affecting their ability to focus on studying, thus creating a vicious cycle.
So, it is often the top students who are more prone to depression. The psychological disorders of low-achieving students are more likely to manifest in destructive behaviors.
There are parents who cannot understand, saying, “My child used to be the top of the class, why does he suddenly not want to go to school?” This child had been excessively pushed by the parents, exhausting all his efforts to achieve the top spot. Now he cannot accept that he can no longer be the best. What to do? By not going to school anymore, he can forever maintain his top position. This kind of forced nurturing, waiting for the real ability to catch up, becomes difficult for him to accept.
This child could not go to school for a long time and locked himself at home. Even after more than a decade, his mother still cannot understand, “He was the most outstanding child of mine, why is he like this now?”
With more and more children coming for treatment due to depression, there are behaviors like obsessive-compulsive, regression, self-harm, suicide, and others.
Parents are confused and anxious. I tell them, “Discovering a problem in your child early is not a bad thing. It is not just a matter of life and death within one or two years of a child being ill. If this problem is not resolved, it could last a lifetime. When adults come for treatment with adult psychiatry, half of them can trace their illness back to their adolescent years.”
“You have a friend, don’t you?” I specialize in systemic family therapy, viewing the child’s situation from a biological, school, family, and broader social system. We typically begin with a family tree chart, including parents, grandparents, aunts, uncles, and even helpers like teachers, classmates, or pets related to the child. As the systemic pressures increase, the most fragile social group within, namely the children, becomes most vulnerable. Since the pandemic, children’s psychological issues have sharply increased, and despite our overtime efforts, we still lack the manpower, directly caused by the increasing stress in the overall system due to issues in different aspects.
With children being at home all the time during the pandemic, teacher-student relationships and friendships have become complicated. For children, peer relationships are crucial, but if they can’t meet in person, maintaining those relationships becomes challenging.
Children suddenly feel “particularly lonely, oppressed, sad, and a bit scared” during this time, and many highly educated parents are finding it difficult to perceive their children’s emotional needs.
I met a girl who used to be very close to her grandmother, but during the pandemic when the grandmother couldn’t return from out of town, the communication between the mother and daughter seemed normal on the surface but was actually in two different worlds.
The daughter is more concerned about fairness, does not like small groups, yet craves to be part of the larger friend groups. Once, feeling upset, she told her mother that she didn’t have any friends at school. Her mother said, “Don’t you have one?” The daughter then self-blames, “Am I being too ambitious?”
Coincidentally, the girl’s academics also started to decline. Her mother said, “I haven’t pressured you, have I?” The child, feeling guilty, thinks, “Look at how understanding my parents are, and how much effort they put into me. I feel really sorry for them.”
The mother held several family meetings which she thought were efficacious in disciplining her daughter, but she didn’t understand why the child became more distressed after each session, feeling burdened with daily sorrow, even finding it hard to breathe at times.
In the daughter’s eyes, her mother holding meetings felt more like a court trial. Since then, she started having nightmares every day and would cry intensely once or twice a week, not even understanding what she was crying about.
This girl blossomed with intuition. During therapy, she said, “When I was unwell, I found this society really annoying. Why does that swan have such a long neck? I feel like going over there and slapping it a few times. What is this bird calling for? It’s annoying. I used to find the elderly women singing in the park unimpressive. Now I see them expressing their emotions, searching for joy in life.”
Emerging from the darkness, the girl matured gradually. She also uplifted me. At this point, we can still place trust in the power of life itself.
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In family therapy for more than ten years, I find it most challenging to work with parents resistant to seeking psychological help. They cannot accept that their children have mental disorders and cannot accept it themselves. We conduct group therapy for children in hospitals, and many children say, “My mom is sicker than me; my dad is sicker than me, but they don’t take meds, don’t get hospitalized…”
Children understand parents the best because the facade is hardest to maintain at home. When parents have conflicts, they often come to complain to the children separately.
I am particularly concerned about five or six-year-old children who often hesitate to leave the consultation room, sometimes circling around, unwilling to go. At this young age, they lack the ability to think, and when they face parents who are unwilling to confront family issues, it becomes even more challenging to treat them.
For older children, if parents are unwilling to face the problems, we shift our focus to the children and help them explore paths to problem-solving and personal growth.
During divorces, some parents involve children in their conflicts, even using them as tools. We need to help children detach. For instance, a third-grader suddenly lost eyesight. The ophthalmologists found no physical issues, and recommended child psychiatry.
Through interviews, it came to light that the parents were going through a divorce. One day, during a fight, the mother injured her waist. She said they could divorce, but the husband would have to support her for the rest of her life. She asked her son to testify, claiming that the father had pushed her leading to her injury. The boy, caught in the conflict, couldn’t bear it and suddenly lost his eyesight, making him unable to testify in court.
Children exhibit high levels of wisdom at times. During treatment, I asked the boy, “Your parents are not getting along and are heading towards a divorce. What do we do since we can’t change that?” The boy replied, “Let it be; I think we should just mind our own business.” As he accepted this reality, he let go.
Yet another crucial issue is that our culture commonly perceives 18-year-olds as adults. However, the prefrontal cortex of the brain is not fully developed until the age of 25. This region is associated with impulse control, decision-making, and judgment. Society should not make these children bear adult problems prematurely.
We’ve observed that in many families, children are prematurely placed in adult roles.
In,”there was a father who came for an appointment saying his son is in Grade 11 and rebellious, thinking that his son has a problem. We had the child do a family constellation (a therapeutic tool, where the patient places a bunch of small wooden figures on a plate to assess the patient’s relationship with the environment). On the figure, he was far from the father but very close to classmates and teachers. The father got very angry. I had to ask the father to leave and talked to the boy alone.
The child told me that his mother had been driven out by the father. His stepmother and the younger brother, who was born to his stepmother, were also mistreated. He felt being grown up; he should solve this problem himself.
In systematic family therapy, when parents have the consciousness of growing together with their children, they can effectively improve family relationships and solve problems. We analyze problems together, avoiding further escalation of conflicts, parents do not need to blame themselves, nor do they have to blame the child.
There was a child who climbed onto the window sill more than once. The mother wanted the child to learn to manage emotions. She said, “I know he isn’t just joking with me. Whenever the mother mentioned, the child, annoyed, said, ‘I’ve never joked around. I sit there only because I am in unbearable pain.’
“Can you please not wait until I sit on the window ledge every time for you to stop?” The child’s emotional management is also crucial. When adults only manage their emotions through cold violence, children suppress their emotions, expressing them through self-harm or self-attack.
A Children replicate adult patterns of behavior due to genetic inheritance and the style of upbringing, we are more likely to become like our parents.
In one typical East Asian family, the mother was very capable and hardworking, but had a strong need for control, resorting to cold violence when unable to control things.
Fortunately, these parents have a growth mindset. When their child faced problems, the couple began setting aside their differences and facing them together. Later, I suggested the wife to step back a bit, and the father to step forward a bit. Initially, the father seemed powerless, but he discovered that he fulfilled more family roles than he thought. At the same time, the mother also felt less stressed.
The daughter said, “I got sick, not only did it give me a lot of power but also to my father.”
The child’s problem became an opportunity for the entire family to grow. Critical is that the couple is willing to confront and resolve their issues. It has been three years since this case. At the beginning, the child was unable to go to school, then resumed and is now applying to universities in the US.
Repair:
I often say that we cannot only blame the parents. This is a structural and cultural issue in society. The pressures children feel also originate from changes in societal structures. With the declining birth rate, children’s stress has also increased.
I saw a depressed child draw his family tree diagram. On both sides of the family, he is the only descendant, and until the end, the grandfather supervised the child, being overly indulgent and spoiling him. Before passing away, the grandfather said to the father, “I only have one grandson; you must raise him well. He didn’t say this every day, but the pressure on this child was immense.”
In every aspect, we are not yet ready with appropriate responses, including our schools, education system, mental health services, public scientific cognition, and other aspects. For instance, like Hu Xinyu, who talked to his parents and said he didn’t want to go to school. At this point, parents don’t really understand what is happening with their child either.
Parents were also not read by their parents, and nobody taught parents to read their children, we now expect the parents to understand, the request is too high.
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“Teenage depression is a global issue. Children are like small saplings. If they have good genetic potential and are well nurtured, they will grow well, but if the biological aspects are problematic, no amount of nurturing can help if they face storms. This is the law of life.”
Symbiotic with difficult growth is innate resilience. I’ve met some kids with growth insight.
There was once a girl who was severely depressed, sensitive with good expressive abilities, dreaming of being “choked and forced to go to school by a demon.” There were also issues at home, where the mother complained that her husband was irresponsible, overly compliant to his mother, never admitted mistakes, and they had been separated for a long time, leading to significant conflicts.
After a year of treatment, with no major changes from the parents, always comparing her to other children, she continued to self-encourage, “I just need to compare myself.”
She tried to do things she enjoys, like making strawberry pudding. Out of interest, she read many psychology books. After resuming school, when classmates were losing interest in exams, she could provide guidance, and her classmates praised her, “What she says is profound.” This showed that she could play the “therapist” for herself and even help others. It was time for our therapy to end.
I documented the transformation of this girl: “When I got sick, I found this society really bothersome. Look at the swan with that long neck, what’s that for?! I really want to go over and give it a slap. What’s that bird calling for? It’s annoying. Originally, when I saw the elderly women singing in the park, I felt unimpressed. Now, I see that they express their emotions, seeking joy in life.”
Having emerged from the dark, the girl matured gradually. She also inspired me. At this point, we can still have faith in the power of life itself.
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