Mrs. Gardner's case was discussed in Chapter 3. To recap the essentials, this woman in her forties with a very long history of headaches also developed clinical depression. She was very slow to react to antidepressants. In the meantime, her entire family, consisting of husband and two children, John, aged 17, and Ann, aged 12, came apart at the seams. Ann became a great source of concern to both parents. John was old enough to fend for himself and there was no evidence that he had any particular difficulties. He maintained his closeness with his mother and tried to be as helpful as he could around the house. Even in the depth of her depression, Mrs. Gardner continued to show appreciation for John's fortitude and loyalty.
Ann's story was vastly different. The more her mother's condition deteriorated, the more rebellious Ann became. This also coincided with her father openly expressing his frustration about Mrs. Gardner's condition. It is worth recalling that during the worst phase of Mrs. Gardner's depression, she remained very aloof and spent a great deal of her time in her bedroom, giving specific instructions that she was not to be disturbed. Ann, who had been at the center of this family's attention, found herself isolated, angry, and sad. All this found expression in her behavior. Her defiance was very pronounced. She categorically refused to do anything her mother asked. She was only marginally more compliant with her father. On several occasions, she failed to attend school. Finally, the school authorities contacted her parents. Ann refused to explain herself and declared that they could lock her up for all she cared. She defied her curfew and stayed out late, and on one occasion did not return home until well into the early hours of morning. Finally, she stole from her next door neighbor and made sure that she was caught. She wanted to be sure that everyone knew about her "badness." Through all of this Mr. Gardner remained relatively calm, explaining his daughter's behavior as typical teenage acting out. Mrs. Gardner, despite her medical state, was far more sensitive to Ann's predicament, and it was she who ultimately took action to help Ann.
Thus the two children in this family reacted very differently. As for John, it might be surmised that he grew up with a mother who was periodically unwell. He was also older and had an independent life away from his family. However, he did not flee from his family and in fact was very helpful. While he was upset about his mother's illness, he remained engaged and did his best. He showed no evidence of any undue psychological or emotional distress. Ann, on the other hand, reacted massively to her mother's depression. The literature is unambiguous about the negative fallout of maternal depression on children. Ann lost her main source of support and succor. This happened at a time when she was just entering her adolescence, a fact that cannot be overlooked. Mr. Gardner was convinced that Ann's behavior could be almost wholly explained by her life stage. Perhaps some of it could be. More important, however, is the observation that several risk factors could account more fully for Ann's predicament:
1. Mother's withdrawal from Ann's life and the collapse of Ann's assumptive world
2. Father's preoccupation with his work
3. Loss of parental love and guidance for Ann
4. Ann's emerging adolescence and a need for some autonomy
5. Dissipation of family rules and roles resulting in family chaos
6. Uncertainty over her mother's recovery
7. Ann finding herself alone without the certainty of family life and love and affection that she had taken for granted in her 12 years
It might be recalled that as Mrs. Gardner health improved and she began to assume her rightful place in the family, so did Ann's behavior. Ann also benefited from counseling. A final point about this case is that Mrs. Gardner was the glue that held the family together. Her leadership enabled everyone in this family to follow their pursuits in the secure knowledge that all was being taken care of. With the onset of her mood disorder, the system figuratively became a ship without a rudder, and the most vulnerable person in the system was young Ann, who also became the major casualty of the system's failure. This is an important observation as will be seen in some of our subsequent cases. When one parent can even partially fill the vacuum created by illness in the other parent, the children become less susceptible to distress and disorder. Unfortunately, Mr. Gardner, for his own reasons, was unable to fill the gap.
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