Childhood Depression and Overprotective Parenting

This brief, quick post will start my posts on how a child’s environment can affect childhood depression.  A child’s environment; especially the relationship, attachment and experiences a child has with their parent or primary caregiver can affect how a child sees themselves, other people and the world.

Many parents try but they can’t protect their children from life.  Life happens and an overprotective environment can cause more stress than it prevents.  Overprotective parents love and nurture their children but those parents may let their own fear take over.

Children need guidance to help them learn how to deal with stress, to grow and mature but if that guidance makes them feel like they can’t do anything on their own or help them have a certain level of independence then that guidance can contribute to issues like depression and anxiety.

Some parents have a hard time letting go.  They don’t feel comfortable letting their children explore the world or make mistakes but that’s a problem because children learn from their experiences outside the home and they learn from their failures and mistakes. 

Some overprotective parents are so afraid their child will suffer if they fail or make mistakes that they won’t let the child try anything new.  If a child isn’t allowed to play sports or to go to activities where they can learn social skills, the child can become socially awkward. They also won’t get to experience what it’s like to be on a team, what it’s like to loose and how to deal with loss but most of all they won’t learn how to deal with the stress that new experiences can bring.

Parents don’t want to see kids struggle but it’s not healthy for parents to shelter and do things for their children.  Parents need to let children learn how to handle some situations on their own.  If a parent always shelters and helps a child, the child learns to always look for help instead of trying to figure things out for themselves. 

Overprotective parents can make a child feel afraid of the world and inadequate, like their parents don’t trust them and maybe they shouldn’t trust themselves, like they’re not able to do a good enough job on their own and that they’ll always need help and like they can’t do anything without their parents.  An overprotected child is often left with low self-esteem and no self-confidence. 

We all gain confidence and self-esteem by overcoming challenges on our own.  Without those challenges a child has no opportunity to learn, mature and grow.  The child may become afraid of new things, afraid of failure, afraid he can’t succeed without help and afraid to experience life.  A life of fear is not much of a life.  It can be hard for an overprotected child to learn how to deal with their fear and emotions. 

Low self-esteem, no self-confidence and fear can contribute to depression and anxiety.  Not every child with overprotective parents will have problems but many do.  Overprotective parenting may be one factor of many that can lead to depression but understanding a child’s environment and experiences can help therapist understand the child and her issues better. 

Many overprotected children internalize their pain.  They turn everything inward onto themselves.  They may be more likely to hide their pain and that’s important for a therapist to know but overprotective parenting isn’t the only type of parenting that can cause issues.  I’ll talk about overly lenient and permissive parenting next time.                                            

Childhood Depression and the Amygdala

This will be the last post on the brain for now.  I’ve written about several parts of the brain that affect depression or are affected by depression.  Now I’d like to talk about the amygdala.  I’m writing in very basic terms so don’t be scared away by the subject.

The amygdala has been called the center of emotions.  It has also been called the fear center.  One of the jobs of the amygdala is to form and retain emotional memories and memories related to emotional events.  Another job of the amygdala is to detect threats and control our fear response that gets us ready for fight or flight.  Fight or flight is the fear response.  When we feel in danger, do we run or do we fight?    

Our muscles tighten our blood pressure increases, our stomachs feel like they get tied into knots, our respiration increases, we sweat more and we may get chill bumps on our skins.  This is the fear response but these are also symptoms of a panic attack. 

In threatening situations, we need this fear response to protect ourselves but for some children, they feel threatened in relatively normal situations like when they talk to someone new or when they’re in a crowd of people or when they are away from the people and places that make them feel safe.   

Research has shown that the brains of depressed and anxious children are very similar to the brains of depressed and anxious adults.  Their amygdala can become overly active when seeing, feeling and experiencing negative emotions and under active when seeing, feeling and experiencing positive emotions.

When depressed children experience negative emotions, their overactive amygdala may cause them to feel those emotions too strongly and too deeply.  When they experience positive emotions, their underactive amygdala may cause them to feel those emotions less acutely than the average person. 

Other research has shown that children with larger than normal amygdala can be more anxious and may be at a greater risk of developing an anxiety disorder or depression when they grow up.  Not all children with larger than normal amygdala have or will have problems but many do or will.  Other studies have shown children with depression may have smaller than normal amygdala. 

A larger than normal amygdala is seen in childhood anxiety but a smaller than normal amygdala is seen in childhood depression.  It’s kind of confusing.  I’ve always had trouble with both.  I think it’s more about the amount of activity in the amygdala; too much activity can cause the amygdala to be hypersensitive and the child to feel negative emotions stronger, less activity can make it less sensitive making it more difficult to feel positive emotions 

Research has shown that stress, poverty, trauma and other negative events in childhood can affect the development of the amygdala causing it to be over active sometimes and under active at other times.  

When the amygdala processes information it sends a signal to the hypothalamus causing the hypothalamus to release CRH hormones.  The HPA axis is activated and cortisol is released.  Too much activity in the amygdala causes too much activity in the HPA axis causing too much cortisol, which can kill some neurons and can keep new neurons from forming in certain areas of the brain.    

I’ve said it before, the brains of depressed and anxious children are different.  These differences can cause children to feel emotional pain more intensely.  These children are not just being difficult.  They truly hurt and need the sympathy and empathy that anyone with an illness deserves.

I realize all this brain stuff can be complicated but I hope I’ve helped some people understand childhood depression a little better.  Thanks so much.  My next posts will be about how parenting types can affect childhood depression.               

Childhood Depression and the Brain: Hippocampus and Prefrontal Cortex

This is a continuation of my posts about the biology of childhood depression.  I’m writing about the brain in very easy to understand language.  I’ve written about neurotransmitters, the HPA axis and cortisol in my previous posts.  Now I’d like to talk about the hippocampus then the prefrontal cortex.  They’re not as complicated as they sound.  I’m giving very basic descriptions that most anyone can understand.

The hippocampus is a part of the brain that helps form new memories of experiences and events in our lives like what happened, where it happened and when it happened but also memories about how the experiences and events made us feel and how those emotions affected us.

I wrote about cortisol a.k.a. the stress hormone in an earlier post.  Traumatic, depressive or stressful experiences and events are processed through the hippocampus then sent to the HPA axis and cortisol is released.  If too much cortisol is released over time, the cortisol can kill off neurons in the hippocampus and stop the hippocampus from making new neurons. 

I wrote about neurons and neurotransmitters in a previous post.  When neurons are killed and new neurons can’t be made the hippocampus can become smaller.  Studies have shown the hippocampus can be reduced as much as 20% in some depressed individuals. 

A smaller hippocampus can make it more difficult for a child or anyone to process and deal with trauma and traumatic or depressive events and memories.  This can cause more stress which would increase cortisol levels even more and that can cause the hippocampus to become smaller.  It seems like a vicious cycle. 

A smaller hippocampus can also make it more difficult for children, adolescents and adults to think, reason, understand and remember.  This could explain some of the cognitive issues depressed people can have.  On a more positive note; daily exercise, therapy, and anti-depressants can reverse some of the damage to the hippocampus by helping the hippocampus make new neurons.  So there is hope. 

Now I’d like to talk about the part of the brain called the prefrontal cortex.  The prefrontal cortex helps us process, interpret and regulate how we feel.  It helps us see relationships between events.  It helps us interpret events and make predictions about the future consequences of our actions.  It also helps to regulate stress by inhibiting the HPA axis and reducing cortisol levels. 

When the prefrontal cortex is working the way it is supposed too it can help regulate negative emotions but when it’s not working right it may make the HPA axis hyperactive and too much cortisol may be released. 

Too much cortisol over a period of time can reduce activity in the prefrontal cortex.  This reduction in activity can affect our ability to process and regulate our emotions. 

The prefrontal cortex is divided into two halves.  The left side helps establish positive feelings and may inhibit negative emotions.  The right half establishes negative memories.  The left half seems to be more affected by cortisol, reducing activity in the prefrontal cortex and possibly reducing our ability to feel positive emotions and inhibit negative emotions. 

One part of the prefrontal cortex called the ventromedial prefrontal cortex is the key center for processing and regulating emotions.  Studies have shown that the ventromedial prefrontal cortex is thinner in children who began suffering from depression during their pre-school years.  This may show that the prefrontal cortex could be implicated in depression early in a child’s brain development.  It helps parents know and understand that depressed children aren’t lazy or mean or difficult.  They have an actual biologically based disorder. 

Depression and anxiety are based in the brain like many psychiatric disorders but with therapy, exercise and sometimes medication children can overcome their pain and live a relatively normal life.   

In my next post I will talk about the part of the brain called the amygdala.           

Childhood Depression Has Many Faces

Childhood depression is finally emerging from the shadows.  More research is being done now than at any other time.  People are realizing that children can hurt and suffer too.  Many children are benefitting from therapy everyday but other children are still suffering.

You may ask, what does childhood depression look like or how can you tell a child is depressed.  Childhood depression can look different with each child because each child is different.  You may see depression in some children but not in others because some children can become very good at hiding their pain.  You may not be able to tell a child is depressed just by looking at them.  A child’s pain can come out in many different ways.

Anyone who has worked in community mental health or a psychiatric hospital will notice that many children receiving therapy have behavioral problems.  Their depression can come out as anger, aggression, irritability, yelling, talking back, throwing things, being mean or hurting others.  I’ve said it before, these children often get help right away. 

The prognosis of depressed children with behavioral problems can depend on how involved their parents are, family stressors and even socio-economic status.  Children who live below the poverty line may have a harder time because of the stress of poverty. 

Therapists in community mental health have started going to schools to provide therapy for children who can’t get to sessions any other way.  I have worked with both children and adolescents at their schools.  Children with behavior problems are identified quickly but that’s one of the problems.  Everyone focuses so much on children with behavior problems that they overlook the children who are good.

The pain of good children is often hidden because they are good.  They do well in school.  They make good grades and they never get into trouble.  They often sit with their heads down, doing everything thing they are supposed to.  If they show negative emotions, they are often ignored or even punished.  They learn that showing negative emotions is bad.  The often learn that crying or being sad is frowned upon so they hide their pain.  They learn to smile when they’re not happy and to hold their tears till they are alone. 

Good children tend to be more sensitive and they feel emotions more deeply but they may not know how to deal with or cope with their sensitivity and deep emotions so they turn their pain inwards, toward themselves; blaming and internalizing all the sadness, fear, guilt, anger and shame. 

Sometimes adults may get a glimpse of the pain a good child feels.  The child may look sad, lonely or tearful but a child who hides their pain can come up with an excuse.  It can be very hard identifying good children who suffer from depression.  Sometimes they are not identified till it’s almost too late.  That’s why it’s a good idea to have a child assessed for depression once a year. 

Children get a physical exam once a year so why not a psychological exam once a year?  A yearly assessment can identify children who need help.  Once a counselor or therapist breaks through the façade of a good, depressed child their emotions can flow like a raging flood.  The feeling a child gets when someone finally sees their pain is hard to describe.  Just knowing someone sees their pain is enough to give a child hope. 

Again I’ll ask, what does childhood depression look like.  The truest answer is that it depends on the child and some depressed children are hard to identify but a yearly assessment can help.  Thanks so much for reading.

A Brief Post on Affluenza

I’ll get back to the brains of depressed children in my next post but I’d like to address this so called Affluenza.  I’ll talk more about parenting styles in future posts but for now I’d like to talk about this thing that shouldn’t really exist, at least it's not in the DSM but Oppositional Defiant Disorder is in the DSM.    

Poor parenting and emotional problems exist at every socio-economic level.  It doesn’t matter how rich or poor someone is; bad, selfish or neglectful parenting can result in behavior problems, emotional issues like anger and depression or dysthymia, and poor choices and bad decisions by children or adolescents.  Some of the symptoms can be related to depression.  The parents of these kids do not teach their kids about right and wrong or about consequences.  Many children in community mental health have similar attitudes and issues as the affluenza teen but they are usually poor or middle class. 

Bad, selfish parenting, neglect and a lack of attention and emotionally close relationships can cause many issues in children and teens.  These kids often lose their temper very easily.  They can have many conflicts with parents, other adults and peers.  They tend to argue.  They often refuse to do what they are supposed to, what they are asked to do and refuse to follow rules.  They can purposely annoy people and try to irritate people in order to make them angry or uncomfortable.  Often these kids feel a lot of anger, resentment and even bitterness themselves.  They may want others to feel as bad as they do.  They also get some strange pleasure from irritating and annoying people.

These kids often blame others for all their problems, mistakes and misbehaviors.  They rarely, if ever, take responsibility for their own actions and choices.  They tend to be very touchy and easily annoyed themselves.  They get frustrated very easily.  They can be spiteful and vindictive.  They may have very low self-esteem and be insecure or they may have an overinflated self-esteem possibly over-compensating for insecurities.

These kids can be stubborn and refuse to follow directions.  They refuse to cooperate, compromise or negotiate with anyone.  They can be verbally aggressive and abusive.  They are often very moody, being fine one minute then angry and yelling the next.   

This pattern of behavior can be seen in very young children, even in pre-school.  A young child with a difficult temperament, who is highly reactive and who is hard to soothe may be more likely to develop these issues.  As the child gets older their issues can get progressively worse.  Older kids and teens with these issues are more likely to drink alcohol and use drugs, causing a whole set of other problems and issues. 

These issues aren’t just caused by being rich.  Poor parenting; a lack of close, loving relationships and difficult life experiences can cause any child or adolescent to have behavioral and emotional problems, can cause anyone to have poor social skills, a lack of empathy and selfishness and can cause anyone to make poor choices and bad decisions.  It’s not just a rich people problem.  It is a poor people problem, middle class people problem and it has become a society problem because when these kids grow up, they can cause problems for other people and society as a whole.  Next time I’ll get back to writing about the brain of depressed children.          

Childhood Depression and the Brain: HPA axis and Cortisol

The brains of depressed children are different than the brains of non-depressed children.  Depression and anxiety can strain a young, gentle and weary mind but it can also strain a sturdy, rock solid mind.  Depression doesn’t discriminate.   

In my last post I talked about neurotransmitters.  In this post I will write about the HPA axis and cortisol.  I’m trying to write about the brain in a way that most people can understand so I don’t want you to be scared away by some of the complicated names.

Depression and anxiety are about feeling negative emotions too deeply.  These emotions include sadness, despair, hopelessness and fear.  Stress can bring out these negative emotions and these negative emotions can cause stress.

When a person feels stress something called the HPA axis is activated.  It’s not really about what it’s called but what it does.  The H stands for the hypothalamus which is a region in the brain.  Stress causes the hypothalamus to release CRH hormones which stand for corticotrophin-releasing hormone. Again it’s not about their names but what they do. 

This CRH hormone sends a message to the pituitary gland which is also in the brain.  The pituitary gland is the P in HPA axis.  It releases ACTH which stands for adrenocorticotropic hormone.  It sounds complicated but it’s not.  Just know that ACTH is released into the blood stream. 

The A in HPA axis stands for the adrenal glands which are situated right above the kidneys.  When the adrenal glands detect ACTH in the blood they secrete something called cortisol.

Cortisol has been called the stress hormone.  It is released during the fight or flight response through the HPA axis.  Some people naturally secrete more cortisol than others but excessive, chronic stress can cause too much cortisol to be released and over a period of time the cortisol can kill neurons and can inhibit new neurons from forming in certain parts of the brain.  That means fewer neurotransmitters are released. 

I wrote about neurons and neurotransmitters in my previous post.  I’ll write more about the different parts of the brain cortisol can affect in my next few posts but I want to get back to the HPA axis.

In normal brains the HPA axis is a negative feedback loop which just means that when cortisol is released it is supposed to suppress the hypothalamus from releasing CRH hormones.  This is supposed to bring cortisol levels back to normal but in depressed and anxious children this negative feedback loop doesn’t work the way it is supposed too. 

Depressed and anxious children who are under chronic stress from things like trauma, poverty or emotional issues, to name a few, have been shown to have a more hyperactive HPA axis causing higher levels of cortisol. 

Cortisol interacts with neurotransmitters like serotonin, norepinephrine and dopamine.  It also interacts with their neurons and receptors.  Remember from my previous post receptors are the locks and neurotransmitters are the keys.  If cortisol kills off some of the neurons and receptors, then the neurotransmitters can’t do their job which is to help us feel better.  This can cause depression and anxiety. 

Chronic stress and hyperactivity of the HPA axis leading to too much cortisol can cause structural changes in some parts of the brain.  It can be hard to tell if these changes in the brain are genetic or if they are caused by the high cortisol levels. 

In my next post I’ll write about the parts of the brain called the hippocampus and prefrontal cortex.  I hope my posts have helped people understand childhood depression and anxiety a little better.  I welcome comments.  I just ask that you be respectful.  Thanks so much.     

Childhood Depression and the Brain: Neurotransmitters

I’d like to talk about how the brains of children who suffer from depression are different.  First I’ll talk about neurons and neurotransmitters.  It may sound complicated but it’s not.  I’m going to be as basic as I can be because I understand most people haven’t taken a neuroscience class.         

The brain is full of neurons.  They are nerve cells that communicate with each other using something called neurotransmitters.  Neurotransmitters are the chemical messages sent to all the different parts of the brain.  They help the brain function and affect how we feel.  The neurotransmitters associated the most with mood, emotions and depression are serotonin, norepinephrine and dopamine.    

An electrical surge is sent to a neuron and that surge tells the neuron to release neurotransmitters.  Neurons are very close to each other in the brain but they do not touch.  There is a gap between neurons.  This gap is called the synapse. 

When a neurotransmitter like serotonin is released into the synapse.  It swims across the synapse and binds with the receptor sites on the next neuron.  The receptor sites are like locked doors and each door has keyholes.  Neurotransmitters are the keys. 

Certain keys only fit certain locks.  The seratonin keys only fit the seratonin locks.  The seratonin keys tell the neurons they bind with to release an electrical surge to tell other neurons to release neurotransmitters and it keeps doing this throughout the brain with seratonin and all the other neurotransmitters.  Once the seratonin keys swim across the synapse, they fit into the seratonin locks, then the neuron that released the seratonin sucks up any extra remaining seratonin left in the synapse. 

The theory is, in depressed people the seratonin keys don’t swim fast enough to reach the locks or receptor sites in the next neuron.  The seratonin keys don’t have enough time to reach the seratonin locks before they get sucked back up into the neuron that released them.  What antidepressants called SSRIs do is stop the re-uptake or the sucking-up action of the seratonin left in the synapse.

Since the sucking-up action or re-uptake is stopped, the serotonin keys have enough time to swim across the synapse and reach and bind to the seratonin locks on the next neuron.  This helps the person feel less depressed and more normal.  This is a very simplistic explanation but I’m going to be talking about neurotransmitters in my next few posts as I write about different parts of the brain that affect depression or are affected by depression.

I also wanted to briefly discuss something called the MTHFR genetic mutation.  Most every woman has heard of folic acid also known as folate.  It’s vitamin B12.  The brain needs vitamin B12 in order to make serotonin, norepinephrine and dopamine but B12 isn’t able to cross something called the blood brain barrier.  The brain is protected by this barrier.  It keeps out bad chemicals that can hurt the brain but it can also keep out good chemicals that the brain needs. 

In order for B12 also known as folate to cross the blood brain barrier the body has to transform it into methyl folate.  In normal people the methyl folate crosses the blood brain barrier and the brain uses it to help produce neurotransmitters but some people like me have the MTHFR genetic mutation.  The mutation causes the body to have a hard time transforming folate into methyl folate.  Therefor the brain has a harder time producing neurotransmitters. 

A person who has this mutation can suffer from depression because the brain doesn’t have enough methyl folate to make a normal amount of neurotransmitters.  A prescription medical food called L-methyl folate can help people with this genetic mutation produce a more normal amount of neurotransmitters and it can help some people who suffer from depression.  It has actually helped me a lot.  Thanks for your time.                   

Childhood Depression and Living with a Mentally Ill Parent

This post is about what it’s like for a child who lives with a mentally ill parent and how that stress can affect childhood depression.  Again I’ll use myself as an example. 

The stress and strain of living with a mentally ill parent is often too much for a child to handle especially if the child is the mentally ill parent’s main support and care taker.  The child may have to take on many adult responsibilities.  A child may have to help a parent shop, make decisions, pay bills, bathe, make sure they are taking their meds and help the parent tell the doctors how they are doing and what problems the parent is having. 

When a parent has to lean on their child so much it can cause a child to be angry and resentful toward their parent especially if the parent is unable to behave like a normal adult.  That anger and resentment often leads to more guilt and more shame.  Guilt and shame are often pervasive in childhood depression.  My mom’s mental illness caused my own childhood depression to increase exponentially.   

A child who has to take care of a mentally ill parent may also have more issues with separation anxiety.  A child may be afraid to leave their parent home alone, always wondering, “What is she doing? Is she OK? Is she trying to cook by herself? I hope she doesn’t cause a fire? Would she know what to do if something bad happens?”  These thoughts can run through a child’s mind constantly.  I was always afraid of what might happen to my mom if I wasn’t with her.  Her mental illness caused a terrible strain on me.          

I remember being glad when my mom came home from a psych hospital but I had no idea how her personality had changed.  She became childish and frustrating.  It was like our roles had reversed.  Mom became selfish at times.  She could be unreasonable.  I sometimes had to tell her, no she could not do something or she could not have something she didn’t need and we couldn’t afford.  At times my mom was like a spoiled child, wanting her way.  It was like she didn’t know how an adult was supposed to act.

I didn’t know how to deal with it all.  I kept all my pain inside.  I was so angry, frustrated, and embarrassed by mom’s behavior.  I missed the way things had been before she got sick, when she was a normal mom.  I was so ashamed of myself.  My anger, frustration and pain were wearing me down.  I couldn’t sleep.  I couldn’t eat and I cried every night.  At times it was unbearable. 

Life is very lonely and difficult for a child who has to take care of a mentally ill parent.  I loved my mom with all my heart but it was such a struggle trying to take care of her.  Many children have felt the same kind of inner struggle that I did, that combination of love and anger and resentment is overwhelming for a child. 

If you know a child who has a mentally ill parent, do what you can to get the child some help.  It’s a good idea for anyone who lives with a mentally ill person to have therapy themselves so they can learn how to deal with the stress in their lives but children need the help of a therapist even more so.  Children need someone to help them cope with all of their confusing, conflicting emotions and to help them come to terms with and accept a parent’s mental illness.  Acceptance helps us look past the anger and see the love.       

Childhood Depression and a Mentally Ill Parent part 2

This post is a continuation of my posts about how having a mentally ill parent can affect a child.  Again I’ll use myself as an example.  This post is about how a child feels when they see their parent act irrationally and erratic for the first time, when a child actually sees their parent’s mental illness.   

It’s very scary for a child the first time they see a parent act irrational, unsound, even crazy; saying things that don’t make sense, not knowing where they are or not remembering who people are.  It’s like the child is seeing a shell of the person they thought they knew.  Sometimes that shell seems empty, like no one’s there but sometimes the shell is full of thoughts that aren’t real, that don’t make any sense.  A child can become afraid of a parent who is unstable.  That fear can be very confusing for a child.       

The first time I saw my mom’s mental illness, she was in a psych hospital.  She looked up at me.  Her eyes were big and glassy.  She stared right through me.  I wasn’t sure if she was even seeing me.  I wanted to cry and run away.  I wanted to hide my eyes and my heart from what I was seeing; from what was happening; from the pain of losing the person I loved most.

   

My mom didn’t know who I was.  It was very hard to see her like that.  I didn’t understand.  I didn’t know what was happening.  I didn’t know what to think.  I wanted things to be back to normal.  I wanted mom home.  I wanted her to know who I was.  I was so afraid; afraid of her, afraid she’d never get better, afraid she’d never be “normal” again, afraid of losing the most important person in my life. 

I had a very hard time accepting everything.  I felt lost, angry, confused and lonely.  I loved mom but was embarrassed she was in a psychiatric hospital.  I was afraid the kids at school would find out.  I felt so guilty and ashamed that I was embarrassed of her.  I was angry at her for being sick and for being weak.  The stigma of mental illness affects children.  Society said my mom was weak, that I was weak and I believed them. 

I was confused because I didn’t know what was wrong with mom or why she was sick.  I felt lonely because I had no one to talk too.  I was trying to be strong and brave.  I was holding all my emotions inside, pushing them down deeper and deeper, trying to hide them from the world and myself but that was a huge mistake. 

Children don’t understand that holding all their emotions inside only makes their pain worse.  They don’t have the coping skills to deal with such a huge change in their parent or such a huge change in their life.  When a parent is mentally ill, a child needs someone they can talk to, confide in; someone to tell them they aren’t alone and that it’s OK to be afraid sometimes, it’s OK to be angry that someone they love is sick, that it’s normal for a child to be embarrassed by a parent who is acting irrational and out of their head.  A child also needs someone who can explain to them that mental illness is not their fault and that it’s not their parent’s fault but that it’s a physical illness that affects the mind and not a weakness of character.

It’s very difficult for a child to see a mentally ill parent for the first time but living with them when they get home is also very stressful.  I’ll talk about that next time.