Daniel 

This website is dedicated to our son, Daniel, pictured below.  The plaque shown below is on a bench outside the middle school in Arlington, Va., which Dan was attending.        

Daniel Kidney, in who's honor this site is dedicatedLesson:  Teach Yourself, Then Trust Your Instincts                                 

            Daniel’s smile lit up the room.  His laughter was infectious.  His  sense of humor ranged from silly to clever, soundly grounded in Middle School male sensibilities.  At 12, his body was changing.  The baby fat was gone. Dan got taller every week.  He was in that fortunate position that many of us never attained in which the girls were more interested in him than he was prepared to be interested in them – or, at least, to admit.  He wore the symbols of his age -- baggy pants and a backward baseball cap -- and he left his shoes wherever he felt like taking them off.  He had many friends.  He had the opportunities to do whatever he wished with his life as the son of upper middle class parents who burst with pride over their boy. Dan was growing up to be a bright, handsome young man in a family that loved him dearly.  Life should have been his oyster.

            The only area where Dan had visible difficulties was in school work.  Although most kids, especially boys, have problems paying attention in class and doing homework, Dan’s problems attracted the attention of his teachers, starting in fifth grade.  Prior to that time, before homework became so important and when after school activities were those chosen by his parents, Dan was a good student.  He always tested in the “very superior” range of the many tests administered to him by schools and counselors.  But his grades spiraled downward.  TV was cut out on school nights.  We attempted to monitor his homework carefully.  We read many books on how to get children to do their homework, most of which demanded unrealistic and, in the extreme, unwanted control over a child’s daily life.  These regimens could not be imposed successfully on Dan, who, along with his older sister, always was “strong-willed” when it came to discipline.  He became more argumentative and hid information sent home from school about homework and his performance.  Household friction increased, with no visible benefits.

            We knew Dan was under-performing.  Teachers always identified Dan as bright and able but, after fourth grade, distracted and sometimes withdrawn.

            On a teacher’s recommendation, we took Dan to a psychologist who specialized in “motivational counseling.”  We told him about Dan’s habits, but also said that we sensed a “sad spot” in Dan that sometimes appeared, then. after a day or two, went away.  The psychologist tested Dan and concluded that he had no learning disabilities or depression. Rather, he reported that Dan had poor coping skills and needed to find ways to motivate himself to succeed.  All Dan supposedly needed was some counseling, the psychologist said.  He suggested we ease up on pressure about homework.  This conclusion pleased us, of course.  Nightly peace could return to the household.

            A year of counseling later, Dan’s performance still was declining.  At a fall conference with Dan’s sixth grade teachers, we were told Dan continued to be inattentive, tired and often withdrawn.  One teacher told us that “Dan seems very depressed.”  Yet, he continued to be very social, count many friends, enjoy roller blading, sleepovers and basketball.  He started playing lacrosse.

            On a friend’s recommendation, we consulted another psychologist.  We told her about the “sad spot,” and, as we had told the motivational counselor, that Dan’s family had a history of depression and alcohol abuse.  She tested Dan and concluded he had attention deficit disorder.  She also concluded that he demonstrated oppositional behavior disorder, at least with his parents, and continued to cope poorly with his emotions, which he usually kept inside himself except when angry.  The psychologist concluded that while Dan was not depressed, he seemed to have “withdrawn from life” and should be carefully monitored for depression.  Although this psychologist could not counsel Dan on a regular basis, due to her own schedule, she recommended that Dan be counseled by a colleague in her practice group.  She also recommended we read books about ADHD and that Dan be tested for possible special mainstream treatment at school.

            She also suggested Dan be sent to a neurological surgeon specializing in children for prescription of Adderall, a cousin to Ritalin.  Her report did not mention the family history of depression and alcohol abuse.

            We did all these things.  The school found only very moderate learning problems and put Dan in one elective class for kids with homework problems.  We tried to use the tricks described in the ADHD books to help in schoolwork, such as breaking homework into short bites.  Dan began taking Adderall.  He saw the recommended psychologist weekly.  We kept in mind that Dan needed to be monitored for depression, but relied on meetings with Dan’s psychologist to assess the situation professionally.

            Dan did not seem concerned about the testing and counseling.  He was indifferent to changing counselors, but was happy that meeting with the new counselor was scheduled to avoid conflict with his weekends.

            Dan began taking Adderall in April.  In May, we saw dramatic results.  Dan was able to focus more in school and play.  He seemed less withdrawn and easier to engage.  He always had a good vocabulary.  Now, he used it more.  His grades improved to the point that he received recognition for improved performance in the last marking period of the year.  Although he, like his sister, was still quite argumentative with us, and he still had the occasional “sad spot,” we thought Dan’s problem had been identified and addressed.

            On the recommendation of the neurologist, we stopped the Adderall for the summer.

            Within a couple of weeks, Dan’s mood changed totally.  Other than day camp, Dan spent most of the summer indoors, watching TV, videos or playing on the computer.  He rejected all invitations from his parents to attend baseball games, play miniature golf, or do other summer activities.  Most disconcertedly, play invitations from friends dropped off, and Dan often rejected the few he received.  Part of the drop-off presumably was due to summer vacations, but Dan refused to call even those friends we knew to be home to plan any activities.

            We met with Dan’s psychologist in early August, at our request (every meeting we had with this psychologist in the 10 months he “counseled” Dan was at our request).  We told him our concerns that Dan seemed withdrawn, in high contrast to the spring.  We reminded the counselor that his colleague had warned that Dan should be monitored for depression.  The psychologist suggested we were only worrying over normal adolescent rejection of parents.  We decided to resume Adderall, which was to be done anyway, in anticipation of the start of school in September.

            The Adderall did not cause an improvement as it had in the spring.  On our own vacation at the end of August, at a beautiful lakeside cabin with a swimming dock, canoe and kayak, Dan retreated to the one bedroom that had a TV and VCR.  He was a virtual hermit after two or three days of the two-week vacation.  When a parent came to watch TV with him, he turned the TV off.  He never came to the living room, where there was another TV and VCR, to watch programs with his family.  We concluded then that Dan was depressed, not merely showing adolescent independence, but thought perhaps the start of school, returning to his friends, would ease the problem.  In any event, we already had reported Dan’s withdrawal over the summer to the psychologist, who had not been concerned.  He was the professional.

            Dan did seem to enjoy returning to school for a couple of weeks, but then, despite the Adderall, many of the same issues of school performance which had nearly disappeared the previous spring returned.  Only this time, Dan seemed more concerned and worried about his performance than he had in the past, and seemed mystified when he received marks on papers and tests that were low.  By this time, we were quite concerned about Dan’s mental health and did not press him very hard on his performance.  He also got into a couple of minor scrapes at school – the result of play, not true misbehavior – which resulted in some disciplinary actions.  We thought the school was unnecessarily harsh, but Dan, who never was a  troublemaker, seemed embarrassed by the discipline.

            In mid-October, we again, at our request, visited Dan’s psychologist.  This time we were much more forceful than in the past, telling him flatly that, in our view, Dan was depressed, that the Adderall was not working, and that Dan seemed withdrawn from his family and friends more than ever.  The psychologist did not give any weight to our concerns, saying dismissively and rhetorically:  “Well, what do you want, more drugs?”  We later found that the psychologist did not even record our warnings about depression in his “progress notes.”

            Friday, October 27 started as a normal day, with both kids going to school.  According to later reports, there was nothing especially unusual about Dan’s school day.  He arranged with his English teacher to take a makeup test on Monday.  He got permission from his Dad to leave after-school care a little early to prepare for a Halloween party that evening.  The night before, he had worked on his “costume.”  He was going as a “punk,” though he didn’t look the least bit punkish, but for a hand drawn symbol of anarchy on a t-shirt.

            Dan’s dad got home from work in time to see Dan off.  From the back seat of the car of a friend’s father who was driving them to the party, Dan said, “Dad, I love you.”  His dad said, “Dan, I love you, too.  Have a good time.”  Those were the last words they ever exchanged.

            Dan called from the party later that evening to ask if he could go on a sleep-over at a friend’s house. His mother told him he could not.  Dan knew we disapproved of too many sleep-overs because the boys usually stayed up until early in the morning and Dan usually took until Tuesday to recover his energy and a better temper.  We had turned down sleep-over invitations before without any ill-effect.

            Dan was driven home by a friend’s father.  He came by our bedroom and glared at us.  We waved at him, then Dan went into his room.  We, to our eternal regret, decided not to bother him, because experience told us he would shout angrily at us to go away rather than accept any comfort from us.

            An hour later, we found Dan hanging on a belt strung from his chin-up bar in the door frame between his bedroom and the bathroom he shared with his sister.  He was dead.

            Dan never talked about suicide.  None of his friends  recalled any such conversation.  Initially, we felt that Dan acted on impulse and anger in a fashion which could not be anticipated.  We were, we now believe, very wrong.

            Several months after Dan died, we reminded ourselves that our observations and instincts had told us Dan was depressed. We somehow found the strength to research depression and, especially, the relationship of depression to suicide.  We read many books and scanned the internet for materials.  The materials actually are fairly accessible.  The symptoms of depression, according to DSM-IV, the bible of the psychiatric profession, are comprehensible to a layperson.  We, however, had not engaged previously in any such systematic study.  Our knowledge of depression before Dan died was based on impressions derived from our culture -- movies, newspaper articles and the like -- and not at all organized.  We relied on the professionals to know the symptoms and to take them seriously.

            What we learned was very troubling.  Dan had many of the symptoms of depression in his last year of life, especially in the last four or five months.  Our instincts were correct that Dan was depressed, but we could have read the signs  much earlier had we known what to look for and pressed the professionals for proper treatment, including medications.  As it was, we were ignorant when Dan was alive and did not know that reliance on the professionals treating Dan was misplaced. 

            We believe that had the psychologist referred us to a psychiatrist, even when we consulted him 11 days before Dan died, there is a good chance Dan would be alive today because antidepressants would have taken the “edge” off his compulsion and anger, even before the medicines were fully effective.  Certainly, had Dan been put on such medications when he was first tested and found to have “withdrawn from life,” Dan would be alive today.  However, we later learned that the last psychologist never did anything of consequence to “monitor” Dan for depression.  He arrogantly dismissed our warnings and did no organized cataloging of symptoms to make a depression assessment.  He was so unfamiliar with his colleague’s report that even after Dan died and we met, he did not recognize that his colleague's written report 10 months earlier had called Dan “withdrawn from life.”  Significantly, he never maintained any written treatment plan or, over 10 months, prepared any written analysis of Dan's condition or the progress of any treatment.  The sum written total of Dan's file, other than the original psychologist's testing materials, was the equivalent of five type-written pages with cryptic notes a couple of sentences long describing Dan's mood and activities at weekly analysis sessions.  Nowhere was there any attempt to apply the DSM or any other methodology to Daniel's condition or "treatment."  Indeed, it was not clear any treatment was involved.  Our reliance on this psychologist to treat Dan, and to provide us thoughtful conclusions resulting from rigorous professional analysis, was horribly misplaced.

            This experience has led us to create this website, so that other parents and adult friends of children can moreThe Peace Bench at Dan's middle school easily learn what we have learned and so that they can make informed judgments about their loved ones and about the judgments of health care professionals.  Learn now.  Use the resources page.  Seek out advice of professionals, of course, but also trust your own instinct once you have learned the basics of depression.  Be willing to question the professionals.

            Depression does not always cause suicide, of course, but it is responsible for most suicides. There are no options after death, so suicide can never be ruled out as a possibility with a depressed child or adult because the stakes are so high.  Depression always causes unhappiness and heartbreak, both for the patient and for his or her loved ones and friends.  Sometimes depression is situational, understandable as a reaction to a crisis.  Dan’s family knows that kind of depression personally.  But chronic depression is different.  It has no evident “cause” in life events.  It often is a result of genetics, and is, therefore, a disease whose cause and approach are deeply hidden.  Depression often is misdiagnosed as something else in children, often ADHD.

             We reject the contention, already offered us, that creation and maintenance of this website means something “good” came from Dan’s death.  Even if the site is successful, and even if it helps in some small measure to save another life, we will never consider it worth the loss of our son.  We mourn his lost life (he had another 70 years to live), the loss of a brother and the loss of a son.  No mere website can replace our Daniel.

           Our outcome was tragic.  It need not be so for you.  If this site helps others to have better outcomes, it will still be worthwhile. 

Epilogue

            Twenty-eight months after Dan died, the Virginia Psychology Board held a hearing to address our complaint that Dan's analyst did not meet minimum professional standards when he failed to monitor Dan for depression, take seriously our warnings that Dan was becoming seriously depressed, or even give thoughtful analysis to Dan's condition.  We also complained that it violated professional standards for the psychologist to fail to disclose to us, Dan's parents, that he kept minimal records, did not prepare written treatment plans or written periodic analyses of Dan's condition and treatment, and claimed to maintain such information in his head for, as he said at the hearing, 30 child patients.   Although the analyst's lawyer tried to make it sound as if we had alleged the analyst was directly responsible for Dan's suicide, we never made that allegation.  But we do believe that with appropriately professional treatment and attention, including referral to a psychiatrist for possible drug treatment for depression, Dan might well not have killed himself.  We sought no money or damages; we wanted the analyst removed from the profession or, at least, strictly supervised.

            The hearing was conducted by a subcommittee of two board members.  One was a psychologist and the other had a Ph.D. in education.  The analyst asserted he never considered Dan depressed and could not recall any warnings from his parents about depression.  Of course, none were reflected in his cryptic notes.  In addition to our own testimony, we had notes prepared by Dan's mother during our first meeting with the analyst after his colleague had tested Dan and determined he needed monitoring for depression and seemed "withdrawn from the world."  Her note reflected that even then, soon after Dan started his weekly sessions with the analyst, he described Dan as "screaming depression."

            During the hearing the chairman of the two-person subcommittee commented about the analyst's lack of written records:  "Well, you know what the malpractice lawyers say:  If you didn't write it down, it didn't happen."  This was met with laughter from everyone in the room except Dan's family.

            At the conclusion of the one-day hearing, after less than an hour of consideration behind closed doors, the subcommittee announced its decision:  The analyst would be reprimanded for poor record keeping and required to undergo record-keeping training.  There was not even the suggestion that the analyst had failed to treat, despite lack of any evidence but his own say-so that he had done so, and there was no consideration of the failure to disclose the material fact to Dan's parents that the analyst supposedly kept all plans and analyses in his head for his 30 patients.  The jocular response to the comment about malpractice lawyers turned the observation on its head.  The malpractice comment means that if the treatment is not recorded, the practitioner cannot claim to have rendered it.  In Virginia, this is converted to mean that if the practitioner doesn't write anything down, he can later claim to have done anything, and the "regulatory" authority (captive, as in most states, by the profession it regulates) will not be skeptical.  You can read the subcommittee order by clicking here.  It was not appealed by the analyst and later became final.  We, the parents, had no right to appeal.  [We wrote a commentary about the importance of written records and the resistance of the psychology profession to professional recordkeeping standards.  Click here for the essay.)

 

            This is not a website about grief and loss.  There are many other websites and resources dedicated to those subjects.  But the author recently came across a passage in a novel by Philip Roth which neatly encapsulates what I believe is the world view of most parents who lose a child, especially, but surely not only, when the child is very young and the cause seems so unfathomable.  This is the passage:

            He had learned the worst lesson that life can teach -- that it makes no sense.  And when that happens the happiness is never spontaneous again.  It is artificial and, even then, bought at the price of an obstinate estrangement from oneself and one's history . . . . Stoically he suppresses his horror.  He learns to live behind a mask.  A lifetime experiment in endurance.  A performance over a ruin.

American Pastoral, by Philip Roth, p. 81.  (1997).  Vintage Ed. (1998).

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            The purpose of this site is to share useful information and personal stories.  We ask others who read this to submit their stories -- those with successful outcomes, those that are sad and those "still in progress.".  We ask that you report in some detail – though not necessarily as detailed as this report – what you saw or see in your child and what happened or is happening.  We hope others will recognize their own child in some of these reports and perhaps feel compelled to learn about depression and then to trust their reason and instincts and, when necessary, to challenge the professionals.  Submit your own story, useful resources and news events to the Website Administrator for posting at webmaster@depressedchild.org. 

                                                                                                                                               

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