Transforming Childhood Depression
Caleb, a 12-year-old boy, sat slouched and sullen on my office couch. Arms crossed and avoiding eye , he seemed less than enthusiastic about being interviewed. I tried a few jokes, but failed to elicit even the slightest smile. Eventually, in a flat tone, he began to answer my open-ended questions with one or two-word replies. His responses came slowly and begrudgingly. And whenever I asked him, even indirectly, to tell me about what he was feeling, he would put up a wall and irritably give his default response, “I don’t know!”
Before our appointment, Caleb’s mother, Julia, and I had spoken by phone. Julia explained that Caleb had lost his dad to cancer almost a year and a half ago. Though reluctant to express his grief verbally, shortly after his dad’s death Caleb heart-wrenchingly said to Julia, “throw rocks at me until I die, then you can bury me.
Although Julia encouraged Caleb and his siblings to verbally express their feelings about their dad’s death, Caleb remained taciturn. “‘I don’t know’ is his usual answer for ‘what do you think?’ or ‘how do you feel?’” his mom said.
“While I don’t want to downplay the significance of a ten-year-old boy losing his dad, I was concerned about Caleb long before that,” she lamented. “I just don’t know what to do for him anymore! Even before his father died, both his father and I thought he was grouchy and overly serious. We have a video of Caleb at two and a half years old, and he looks so unhappy!”
Childhood Depression: A conventional perspective
According to the National Institute of Mental Health, major depression affects 3–5% of children and adolescents, and episodes last on average 7–9 months. Although the diagnostic criteria for children are essentially the same as that for adults, symptoms vary with developmental age. A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or fear that a parent may die. They may lose interest in activities that used to please them and be quick to criticize themselves and others. Also, they may feel unloved and pessimistic or even hopeless about the future. Pre-pubertal children may have a depressed appearance, somatic complaints (general aches and pains, stomachaches, headaches, etc.), separation anxiety, phobias, and hallucinations. Also, depressed children may appear irritable rather than depressed. Severely depressed children are believed to be at increased risk for early adult depressive disorders.
Prior to 1996, the medications of choice for children with major depression were tricyclic antidepressants. However, 13 trials in children failed to demonstrate their efficacy, and they showed a higher risk of toxicity than selective serotonin reuptake inhibitors (SSRIs). Prozac® (Fluoxetine) is the only FDA-approved SSRI for the treatment of depression in children 8 to 17 years old, although many other SSRIs are used “off-label” for children. Nonetheless, the FDA extensively reviewed the cases of 2,200 depressed children and found that children taking SSRIs experienced suicidal thinking and/or attempts at twice the rate of those taking placebo or sugar pills. As a result, the FDA requires a “black box” label warning to clearly indicate this risk—the most serious type of warning in prescription drug labeling. Even so, SSRI prescriptions for children and teens have risen dramatically in the past several years.
Psychosocial interventions such as cognitive-behavioral therapy (CBT) have been shown to be effective for childhood depression and are often used alongside drug therapy. Compared to a placebo group, those who received CBT had lower rates of depression, less self-reported depression, improvements in cognition, and increased activity levels.
Julia described her son as “a moody, sullen, frowning boy who mutters under his breath and makes ‘I hate you’ faces. He avoids having to interact or talk with us, and is especially perturbed if I ask him to do something like put his dirty clothes in the hamper, take out the garbage, or put on a clean shirt for the day.”
Over the last few months, Caleb had lost interest in foods he had previously liked, and although the family planned fun things to do on Friday nights, he remained unmotivated and disinterested in participating.
Caleb struggled with peer relationships and preferred reading a book alone to playing with a friend. His mother had wondered at times if he had Asperger Syndrome. His eye , if present, was fleeting, and he shared similar traits with his cousin who had been diagnosed with the condition. Although advanced academically, Caleb’s social skills and emotional understanding lagged behind his peers’. When he did get together with a friend, the play date sometimes didn’t last long. Julia explained, “Caleb is very quick verbally, and can be sarcastic. He twists words around.
“Caleb likes things predictable. He uses charts to check off completed work for school. He loves to read and has an amazing ability to retain information. He has a very sharp mind,” Julia told me.
“The ‘real’ Caleb loves to laugh, crack jokes and enjoy life! I love to see the twinkle in his eye when something tickles his funny bone, but lately he has been negative and moody,” she said. “He won’t play board games or cards. Occasionally he’ll play make-believe games with his younger brother and sister, but only if he is calling the shots.”
Even when sick, Caleb disdained affection and consolation. If his mom offered a hug, he would stiffen and pull away: “He doesn’t warm up to me even when he isn’t feeling well.”
Shortly after his dad’s death, Caleb developed a severe sore throat.
A picky eater, Caleb avoided meat, mushrooms, and mayo. He liked slightly spicy foods and enjoyed salt. He preferred ice water.
Taciturn and reluctant to talk about himself through most of the interview, Caleb answered most of my open-ended inquiries with a resounding ‘No!’ Even though he had recently celebrated a birthday, he was unable to convey any positive association with the event. He said he dreamed, but “none of them stand out.” He simply shrugged his shoulders when I asked about his father’s death, and when I asked him directly if he was feeling sad, he said, “no.”
However, Caleb did briefly brighten when telling me about his favorite character in the Chronicles of Narnia, Reepicheep: “Reepicheep is a talking mouse who started off one foot tall and grew to three feet. He went to the end of the world and was unafraid of what might happen. He was very brave.” I asked Caleb to tell me some other examples of bravery, but he again sank into himself and responded, “I don’t know.”
Resiliency: The alchemy of transformation
As a practitioner working with children who struggle with psychological and behavioral issues, I am very interested in understanding what most helps children survive difficult, even traumatic, childhoods. Beyond surviving, I’m even more interested in what helps children to become confident, autonomous, and successful adults. In other words, how do children not just endure but transform suffering? What makes them resilient and gives them the ability to thrive after having encountered some great difficulty or adversity? And later in life, why do some adults who experienced difficult childhoods transform their suffering into new meanings, creativity, and compassion while others respond by falling apart, protecting themselves, and eventually becoming bitter, enraged, and mistrustful?
Many of the prominent theorists in psychology, from Sigmund Freud to Erik Erikson, argued that a difficult childhood often leads to minimal creativity, great suffering, and subsequent problems well into adulthood. But a dissident voice in the field, Carl Jung, spoke of the alchemy of transformation—moving through early childhood difficulty into greater integration, health, success, and happiness. Jung used the ancient alchemical metaphor of transmuting lead into gold to symbolize this transformation.
Jung himself likened homeopathy to an alchemical practice. Jung touted alchemy as symbolically representing the process of individuation—the process by which an individual’s various experiences, including difficult or traumatic ones, become integrated resulting in a well-functioning and healthy whole person.
Sound familiar? Homeopathy shares this desired outcome of a fully integrated, healthy, and whole person. When individualizing treatment and taking into account the totality of symptoms, a homeopath prescribes the best-suited remedy with the intention of bringing the patient into an integrated state of dynamic balance. As Hahnemann said, “The totality of symptoms is the outwardly reflected image of the inner wesen of the disease, that is, the suffering of the life force.”1 In other words, the totality of symptoms is a constellation of indications expressing what is out of balance, and not dynamically integrated, within the individual. The vital force, or wesen, expresses this imbalance through symptomatology, and the homeopath prescribes on this constellation.
Interestingly, Jung, like Hahnemann, also believed that our psyche/vital force is self-regulating by nature, and unconscious expressions such as dreams, fantasies, and synchronistic events enter our consciousness with a purpose—to lead us into balance. Likewise, our body, in its wisdom is continually moving toward balance and adaptation. Hahnemann writes that “the spirit-like force that enlivens the material organism as dynamis, governs without restriction and keeps all parts of the organism in admirable, harmonious vital operation…”2 In other words, our vital force is continually moving us towards a state of dynamic wholeness, harmony, and balance.
With the intention of assisting Caleb in moving toward a fully individuated state of dynamic balance that included an integrated experience of his father’s death, I began my analysis of his case.
Salt of the Earth
Caleb’s flat affect concerned me—his body language and taciturn demeanor suggested a deep despondency and a diagnosis of major depression. His disinterest in tasty foods or participating in normally fun activities is consistent with anhedonia—a sign of depression where someone loses interest in or stops enjoying pleasurable activities. He demonstrated difficulty maintaining social interaction with his peers, with play dates often ending prematurely.
Clearly, Caleb didn’t respond well to consolation or compassionate inquiry into his feeling state. He would cross his arms and demonstrate an aversion to consolation or sympathy. Even when sick, Caleb disdained comfort and care. When perturbed, Caleb resorted to sarcasm and thinly veiled anger as a defense to avoid revealing his inner feelings.
On a physical level, Caleb seemed fairly healthy. On average, he contracted two or three colds each winter.
Occasionally, a remedy is so clear at the end of a “case-receiving” that I prescribe on the spot. And in Caleb’s case, this is what happened. Caleb’s presentation seemed a textbook expression of a remedy commonly prescribed for depression, Natrum muriaticum.
Consider Edward Whitmont’s description of Natrum muriaticum:
“The personality who needs Natrum muriaticum as a remedy is described as taciturn, gloomy, joyless and indifferent to pleasure; suffering under the consequences of grief and disappointment; heavy with hidden grief yet unable to weep; desirous of sympathy yet averse to and aggravated by consolation. Averse to company, offending others, discontented and easily provoked.” 3
Natrum muriaticum is a mineral, and in general, people needing mineral remedies tend to be organized and independent; structure and routine are important to them. As Julia had mentioned, Caleb preferred predictability and routine. To date, I’d never met a child his age who used charts to check off completed homework for school!
Food preferences and aversions can be very useful in confirming a remedy selection. Caleb’s preference for salty foods is a well-established Natrum muriatricum symptom. Additionally, people needing Natrum muriaticum tend to like spicy foods and be averse and/or aggravated by eating meat.
I also briefly considered Aurum metallicum and a couple other Aurum salts; in particular, Aurum muriaticum and Aurum muriaticum natronatum. Although Aurum metallicum is a tried and proven remedy for depression and melancholia, the degree of Caleb’s sadness didn’t seem as bleak or destructively violent as what I’d expect from someone needing an Aurum remedy (which has the indication of “better when thinking of suicide—feeling of freedom and cheerfulness contemplating death”). I also have come to expect more guilt and a pronounced sensory sensitivity in people needing Aurum.
A Rapid Response
Given Caleb’s clear remedy picture, I prescribed Natrum muriaticum, LM4, to be administered once per day. (If I had been less confident in the prescription, I would have started with a lower potency remedy, such as an LM1, to diminish the potential for an aggravation of his symptoms.)
Julia ed me a week later with a very encouraging email: “I had no idea what to expect with Caleb. I saw things with more clarity after our time with you… and Caleb is depressed. But after his second dose of the remedy, I noticed a difference. I didn’t know such a thing was even possible with homeopathy—until now!”
Six weeks: smiling & spontaneous
The first thing I noticed about Caleb at our six-week follow-up appointment was that he was smiling, and he had more inflection in his voice. Less emotionally closed, he was spontaneously answering my questions. In general, his emotional state seemed lighter, and Caleb confirmed this impression by telling me he had been feeling happier since starting the remedy. Even more encouragingly, he enthusiastically told me about what fun he had had over Thanksgiving with friends and family!
Julia added that Caleb seemed more open to receiving her affection and more energetic. Excitedly, she exclaimed, “He drew me a little note the other day. I hadn’t done anything in particular, but on the note he had drawn a heart surrounded by twenty smiling faces!”
Twelve Weeks: an expanded emotional repertoire
Twelve weeks after our initial consultation, we had another follow-up. Though in general Caleb continued to engage life with more laughter and joy, Julia said that he had been expressing more frustration recently. Specifically, he was becoming angry with his siblings over chores, and that led to crying outbursts.
I took Caleb’s anger, frustration, and tears as a positive sign. As the old psychoanalytic saying goes, “depression is anger turned inwards.” Because Caleb was expressing a wider range of emotion, including anger and tears, I felt it signaled that he was allowing more feeling to surface rather than internalizing it. I decided to increase the potency of his remedy to an LM5.
Eighteen Weeks: increased creativity
I saw Caleb again six weeks later, and much to my surprise, he brought in some artwork to show me, on his own initiative! I took this as a very good sign that Caleb felt better about himself. Julia confirmed that he was “doing great!” His mood continued to be brighter, and he was co-existing more harmoniously with his siblings.
Eight Months: playful pranks & good health
About eight months into homeopathic treatment, Caleb had a yearly physical, and his primary care physician commented, “This (past) winter was the healthiest ever for him!”
Julia reported that during a recent family reunion, Caleb’s aunt became “choked up” when she watched him interacting and smiling rather than “burying his nose in a book.”
Julia also told me that Caleb had lost a lingering baby tooth. In jest, he and his brother had played a prank on their mother by staging a mock fight in which a theatrical slow-motion punch sent Caleb’s tooth flying across the floor! I took this example of playfulness as another good sign that Caleb’s mood continued to improve. Julia added that Caleb was more willing to help out with his younger siblings, was less antsy, and continued to demonstrate affection toward her: “Unsolicited, he spontaneously washed my car for me!”
Ten Months: a different kid
Ten months into homeopathic treatment, Julia stated, “He is such a different kid than when we first came to you. He has so much more self-confidence now. I feel like he was given his childhood back! He tipped over some books at the store and instead of getting down on himself, he chuckled about it and simply picked them up.”
Two Years Later
As I write, it has been two years since I first started treating Caleb, and he is still doing well with Natrum muriaticum. We have climbed the LM scale gradually over that time, and he is now taking Natrum muriaticum LM8, daily. With each subsequent visit, Caleb seems more animated and excited about sharing stories from his life with me. Fully engaged in living, he keeps busy with the Boy Scouts, swimming, being in nature, his studies, and reading. He excitedly told me recently about “geocashing” with a compass and map.
Julia tells me that his writing has made leaps and bounds, and that though his penmanship remains a problem, “his articulation on paper is as good as his spoken word!” Caleb now tells me, “I prefer reading poetry to reading newspaper articles.”
Transformation and Integration
To witness a boy like Caleb, initially so closed, sullen, and sad, become fully engaged with life and creativity is the most wonderful gift a homeopath can receive! Amazingly, the Natrum muriaticum helped not just his more recent grief over the loss of his father but his overall tendency toward sadness since he was a toddler. Both his mother and I have witnessed homeopathy help Caleb move into a state of dynamic balance. Fortunately, homeopathy also helped Caleb steer away from the serious potential pitfalls of conventional drug treatment for depression (e.g., suicidality). Though these conventional medicines have their place, my preference is to start with less invasive and more curative interventions such as homeopathy first. Natrum muriaticum helped Caleb integrate and transform his loss into creativity, joy, and meaning.
1 The Organon, paragraph 7.
2 The Organon, paragraph 9.
3 Edward Whitmont, Psyche and Substance: Essays on Homeopathy in the Light of Jungian Psychology, pp.87–88.
(Reprinted with permission from Homeopathy Today