The Childhood Depression: Narrative in Familiar Settings OPINION

Home , Interdiscourse, Parrhesia

International International Archives of Medicine 2016 Medical Society Section: Psychiatry & Mental Health Vol. 9 No. 31 http://imedicalsociety.org ISSN: 1755-7682 doi: 10.3823/1902

Ana Luisa Barbosa Belarmino1, Vládia Maria Frota Prado Azevedo1, Dara Almeida Maurício de Alencar1, Nádia Nara Rolim Lima2, Uilna Natércia Soares Feitosa2, Thercia Lucena Grangeiro2, Ruan Neto Pereira Alves3, Regina Petrola Bastos Rocha4,Maria Eliana Pierre Martins1,2, Modesto Leite Rolim Neto1

1 Faculty of Medicine,Federal University of Cariri – UFCA, Barbalha, Ceará, Abstract Brazil. 2 Postgraduate Program in Health The most mental disorders, including depression, involve the children Sciences, FMABC, Santo André, São Paulo, Brazil. in a way of great influence in their development processes. Similarly, 3 Leao Sampaio Faculty, Course of say the researchers, it is imperative to explore the role of prenatal Psychology, Juazeiro do Norte, Ceará, exposure and develop interventions to reduce the long-term negative Brazil. 4 Regional University of Cariri – URCA, impact of low socioeconomic status state in childhood on cognitive Crato, Ceará, Brazil. ability. On this way, parental practices and communication strategies with the child and the adolescent in the understanding of child de- Contact information: pression happen thought the analysis of involvement narratives of disease, affective practices, empathic and linked in describing the itine- Modesto Leite Rolim Neto. raries of psychic pain and suffering. It is also important to know that Address: 4 Federal University of Cariri – there are “prohibited words” in the family and that these words said UFCA. Faculty of Medicine. and prohibited by relatives appears to make the encounter with the brands and the representations that make up the child depression in  [email protected] search of another character, as a way to associate the words the other access codes, and with this to situate pain and psychic sufferings in the return bedding of voices interpretation, especially in the recognition of what transforms life in mental disease possibilities. Because of that, the discourse have been pointed as one of the steps in the treatment of this disease. In the talk it is important to understand the relationship that requires understanding the child, through contact with the dynamics that seek to explain it by words spoken and prohibited in

the face of life reality. In this way, in terms of depression, the word Keywords heard with ethics and commitment, combined with the medication Childhood Depression; Mental and its monitoring can be a powerful icon in the treatment of disease. Health; Mental Disorders.

According to data from the World Health Organization (WHO), it is estimated worldwide that about 20% of children and adolescents have some mental health problem, situation which can bring negati-

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ve consequences in the short and long term in the The intersectoral work becomes essential to in- developmental trajectories of individuals [1, 11]. clusion and building of referrals for a network of In Brazil, some researches have confirmed a high care and protection, while preserving the role of the prevalence of mental disorders in children and ado- family, in particular. The family, thus, appears as a lescents [2, 3, 4, 5, 6], pointing out that from 12.7% factor of psychological health promotion, especially to 23.3% of the total number of children and ado- considering the importance of quality relationships lescents in the country suffer from some type of linked to coexistence styles with the situation. The- mental disorder, [7, 8, 9, 10, 11] indexes close to se styles are the emotional context of parent-child those given by the World Health Organization. relationships, in which the more specific parenting Mental health problems in children and adoles- practices are implemented, especially in relation to cents tend to be caused by several factors: genetic care and supervision of children. [13, 14, 15] problems, brain disorders, such as epilepsy, violen- In a recent study titled “Grand Challenges in Glo- ce, loss of significant people, chronic adversities bal Mental Health” [14], the children are the group and acute stressful events, problems in the deve- who need the most special attention for preven- lopment, adoption, sheltering, besides, the cultural tion and care. The most mental disorders, including and social aspects that impact significantly the child depression, involve the children in a way of great development. [12] influence in their development processes. Similarly, The lack of awareness about the problem and say the researchers, it is imperative to explore the services offering is evident, although advances are role of prenatal exposure and develop interventions occurring since the implementation of the psychiatric to reduce the long-term negative impact of low so- reform which aimed to overcome violence asylum in cioeconomic status state in childhood on cognitive favor of changing models of care and management ability. in mental health practices. In the 90´s, it started to The initiatives on assistance for children and get in to practice in the country the first federal ru- adolescents who suffer from serious mental di- les regulating the deployment of daily care services, sorder are few and located. The technical and based on the experiences of the first Nucleus or political misinformation to be broken, recognizes Centers of Psychosocial Attention (NAPS/CAPS) and the suffering caused to family member, promo- day-hospitals, the first inspecting and classification te intersectional and individualize the service for rules of the psychiatric hospitals. [13, 14] children and teens, which was before based on Initially, the actions of mental health for children assistance for adults or disabled, it represents the and adolescents in Brazil have been focused on challenge before the new ways to deal with the customer service with serious psychic suffering, in mental health care, especially when it comes to particular the cases of autism and psychosis. Then, professional practices. [15, 16, 17] the concern with several other situations began to Thus, it is imperative to recognize the importance impose as in the case for children and adolescents of family and family context as psychic suffering and care involved in situation of risk and social vulnera- pain expression scenario in the childhood – parti- bility as trafficking, prostitution, alcohol, drug abu- cularly of depression, and as primordial space for se, and violence. Nowadays, the symptoms that recognition, identification of emotional needs, and lead the parents and tutors ask for mental health the development of intervention actions with atten- treatment varies from the situations identified to tion to social exclusion and discrimination. school difficulties, aggressive behaviors, self-harm, Despite this, not all families have the structural, among others. [13, 14, 16, 17] economic and emotional conditions to conduct

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successfully the aspects of living with the disease, build meanings. Related to this, the family narratives although it is considered that these, in some way, as a way to find meanings and manage negotia- work out the experience, deal with their suffering tions at home and when seeking help at the Cen- and their expectations, and they can make a living ter (CAPSi), they find in their itineraries contextual with the disease, seeking support in their network, clues that come from its element of conflict with in some belief system, and in clinical treatments. the experience of the disease. In other words, the [18] conflict creates a tension that organizes the facts On this way, parental practices and communica- of history. [23] tion strategies with the child and the adolescent Taking it to the nest level, no one tells nothing in the understanding of child depression happen without listen to before – and without be in this or thought the analysis of involvement narratives of that place, without be itself or anything different disease, affective practices, empathic and linked in from itself. [24] About that Foucault [25] emphasi- describing the itineraries of psychic pain and su- zes that the speaking event has psychological reality ffering, as well as from established relations in a of participants and is culturally recognized and re- sense building in the living with the child and/or cognizable; in its identification, must be considered depressive adolescent, particularly, in the anxiety the event goals, the spatio-temporal organization, communication which the routine makes it emerge the participants with distinction of their social roles, in the impact of care. [19, 20] the organization of shifts, the standards by which In this context, it is observed that the elaboration the participants perform and interpret the speak in of a meaning to understanding and living with the interaction. disease is a process which highlights the phenome- Usually, the said things says much more than non of illness as a narrative construction and cons- they want. [26] In some ways, the say presupposes titutes an explanatory model, a conceptual system a possible construction for what want to translate that founds the relationship mediator between the and for which an answer is sought, through the disease, the child, and the family reality. [21] approaches with the word, allowing, in the thing Thus, the understanding of the child depression said, a desire to share within the stories, on the narrative, gives us an interpretation about what encounter and reencounter with a knowledge that family members are saying and doing in a given can contribute to the enunciation of events and time, considering the language spaces, registering contingencies, which advertises itself as possibility them in a way that reflects an existence condition of discourse. The prohibited words, by its time, post of the disease, socially and culturally constructed on the variation of communicative discourse update through the meanings outlined to itself and to the forms, to enable the confrontation of the stories other, from the enunciative character of disease. within the suffering. [22] Thus, the words said by family members bring It is able to demonstrate that family narratives themselves more enunciates as they try to show, as place the depressive reality, as part of the commu- interactive activities also carry a multitude of prohi- nicative intent, making it possible to understand bited expectations, hidden on the discourse, as this the symbolic system built socially and culturally in breaks out as a series of reflections and specifics on coexistence with their carriers. Because of this, the the recognition of producers of meanings through interlocutors that permeate the narrative about the translation of his narrative. The disease, therefore, is reality of the disease, related to history production based on human historicity, in its temporality, con- belonging to that reality, reflect the meanings and sisting of a perspective network. [27]

The depressive child, therefore, points out in a reading of things which put in risk the own dynamic family discursive context a symbolic production on of childhood depression. On this direction, we can the understanding of life stories, considering as re- infer through the reflections of Jamison, [35] who levant its identification to disease and sick aspects. says that the things we don´t know kill us. In this Thus, the family discourse gets an enunciation sta- sense, the gap between what is known and what tus [28], taking as presupposition describe, express is done can be lethal. or represent the experiences of the illness of the Recognize these experiences in a Psychosocial At- depressive child. [29] tention Center for Children and Adolescents (CAPSi) The process of interpretation of a narrative requi- allows us to understand the links between the di- res great concentration and a deep dive into what fferent messages produced and broadcast in child- is being said. In the light of this scenario, it is ne- hood depressive context, especially by putting on cessary to capture not only what is said, but also the scene the meanings of disease reporting, in the the reference that the person uses. This reference information description quality built in the interacti- is the seizure of the life of the world, that is, the ve process by family members. assumptions that the person uses to define and de- In the occasion in which we were asked to inves- limit its experience. Assumptions are premises most tigate the contents of child and teens depression in of the time, are not said, but are lived and showed a countryside city of Northeast, we are faced with through the actions, guiding, also, the analyses that a reality made up of kids of both sexes, from urban the individual does of its own experience. [30] and rural areas, whose families would open spaces A lot of times, experiences of talking demonstrate to think about the concept of order and disorder, the dramatis personae of the evangelist agent of life as well as the relationship between them, to (re) story and opens the spaces closed or blocked by the take the personal and cultural meanings in the coldness of the words. At that time, the communi- context of the own language of pain and psychic cative event conveys the suffering, the voices, and suffering, when their children were called depres- the psychic pain that continuously interpret them- sives. Advancing a little more in these spaces, we selves. So it is possible to use these mechanisms will find these codenames which are called pas- [30, 31, 32], overall by contextualizing the childhood sword [36] submitted by the family as "the disease depressive phenomenon. of the nerves". No message can be interpreted without reference This password pointed out an interest in unders- to a super ordinated message, within which com- tanding its condition of transcription, especially in munication is intended. [33] Based on this principle, contexts of discourses, their directions and de- we point out that the historicity and narrativity sys- monstrations on what to dismember the psycho- tem have an interactive interface. From this point of social impact. Understanding password as a code view, the story is a narrative basis discourse, becau- established for each character, we mention the se it is based on the plot that is stroked and even importance of resume as something to be deci- determined by the time and space that updates the phered in order to make familiar what crosses the communicative practices. In these terms, all histori- strange, marking and mobilizing peculiar ways of cal understanding includes a narrative design. [34] translating the tragic. Thus, we see the need to question the disease, It is interesting to note, however, that the word the movements used to understand its interactivity, said and prohibited by relatives appears to make such as communicative practices hard by the family the encounter with the brands and the representa- members, especially when they are not noticed on tions that make up the child depression in search of

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another character, as a way to associate the words and social are the ways through which we cure. the other access codes, and with this to situate pain [37] A code name stipulated to the children as “the and psychic sufferings in the return bedding of voices mentally ill” establishes a rapprochement between interpretation, especially in the recognition of what password and narrative, being that the first family transforms life in mental disease possibilities. The gap emerges from understanding what the other key feature of the family is the call to understand says, While the second is the description of this gap cognitive adjustment difficulties, which encourages below the form of the word semantics and prohibi- the search for treatment. These appeals, depicting ted, (re) told by family. This discursive viability is ex- the anguish of "the pain of be", are stereotyped pressed in the content of Foucault’s work, through by the narratives, by the continuing description of words said and prohibited, especially because the facts, acts, and happening, by the way as the family new is not in what is said but in what is happening (re) tell the story of the child's life, in questioning around it. [33] from its past/past, past/present, present/present, Considering the passwords used to highlight the and tiny idea of future deliberations with the other. meaning, the places of present annoys, as testimo- Is the fear of contagion by another that today all nies of the routine, we feel the need to understand fear, and this fear stirs up the rescue of the most what demarcates the complaint and what it is made intimate and emotional tone of the languages in to map as pathology. Frequently doctors focus on understanding the disease, in other words, the wel- disturbance, separating it from the patient's life, in come by listening is something that still hangs in which the disorder is built, focus on pathology ris- the field of ideology, and thought, thus, listening is king realize the real meaning of the problem. [38] not just to simple mechanical act of listening, but In the talk it is important to understand the re- extensively, to interpret and offer a contrast to the lationship that requires understanding the child, speaker. through contact with the dynamics that seek to Due to the complexity of the issue, we have been explain it by words spoken and prohibited in the strengthening the theoretical bases of the research face of life reality. Thus arises the "will to truth” in a in the process of reconstitution of the codenames, Foucault’s terminology that by its turn, considers as witnessed by the family, through the discourse out- if the word itself could only have authority through lined to their children as "the mentally ill". Highlight a discourse of truth. [33] password changes here in the act of linking words Family life/Fusion is built into the entanglement to disease and disease carrier. Once again, the ways between what the disease does to imagine and of ownership that outlines the relationship of fami- what the context allows thinking about it, through liar with the depressive child and with the other(s). a non-objective, technic, and rational perspective, This implied that the forms of representation to the but under a detailed look of the disease, as a so- access codes to the disease followed the trajectory cial semantics. However, the poetics of social life is of refractoriness to treatment, with all the elements borrowed by the anthropologist Nei Clara de Lima linked to the domain of the language between the from the State of Goias, by relating the oral narra- gaps left by the domains of knowledge that inter- tives as basic source of obtaining the "rhetoric of cross the treatment process – the search for the Enchantment", which consists in the analysis of the cure, the return to life, and the need for clarifica- word through the cultural context in which it is in- tion on the risk and protective factors. The disease serted. In this sense, in narratives can be observed always remains a social phenomenon, because it is and heard people producing explanations of the the intellectual armor through which we interpret, world that they belong. [39]

The interpretation should pay attention to the In this eager (re) invention proposed by the family particularity, moving between the universal and the to seek legitimate pain and suffering that inhabit particular, the individual and the social. [37] This in then, words are born, are silenced, challenged, Poetics of social life is denoting the rhetoric of en- manipulated, unknown, threatened, discovered chantment, which is, the gesture and oral form as and/or echoed on the possibility of questioning family members read the world around them. the new knowledge that want to risk of think com- Enter in this sense, translating the words, whi- plexly, that wants to open their arms to hug. This le manifestations of natural places to each family is a possible dream, and we should not change and child, what is the order and disorder, comes the invisible limits on insurmountable barriers to to characterize the "trunk words" [40], in order to make it true. [43] contextualize the spaces of misfortunes – pain and In this way, we print to the disease a new esta- suffering in their dualities and oppositions, descrip- blishment of translation of their carriers, through tion and psychic life magazines, often caught up in the value of its own time, which challenges the secret places. Because of this, it is created, a mo- uncertainties and put them in places of order and vement among characters at the moment of reso- disorder, as a way of connecting complex networks nate passwords and to present a meaning to what between sapiens and demens, experienced by the restores its experience with the disease. family discourse. Sapiens, is the living being, animal, The pain is always marked with the unpredicta- primate, hominids, and rational systematic dimen- ble and improvisational seal. The words resonate in sion. Demens is the uncertain, unstable, unregula- the head, and they try to throw a bridge between ted, hybrid, and immoderate dimension. [44] reality known as before the loss and that unknown The wounded storyteller [45] – is able to squander today, words that try to turn the diffuse pain of the the pain of sick child by his expression, opportunity body in a concentrated pain of the soul. [41] in which loses the Northern life, in pain and psy- On this direction, the narrative is a polysemic chic suffering. This place, in the context of research, term. However, in general, it can be defined as the allows us to realize, in the scripture of the voices organization of events in time, working out or not that interpret the child depression, a finding that in the causal relationships between such events, time is like a wheel that spins and spins and never usually associated with some sort of change. [29] stop [46]. And, as such, producing mysterious forms It is also necessary to consider that the family of coexistence [39] which confirm themselves in the members narrative, insist on the idea of truth, ba- measure of words employed in the position of passed on what the childhood depressive phenome- swords (re)reading the lived context, [46] demarca- non brings as sequel and what turns on a diary ting experiential scars of psychic pain and suffering. contact with the disease. The real desire of the The speech is very important as to the family as family is to understand the complexity risks which to the child or adolescent to express the feeling is expressed in its own discourse, when time, spa- inside in the mental ill. Many understandings and ce, and social and mental relate, because the ex- discourses are reserved in the “I” inside each one of cessive desire for receptive postures get confused us, in order to delimit the understanding of things in with the desire of be free of pain and psychic the world, these discourse which reach their climax suffering, that in desperate and exacerbated are when released, spoken, externalized, dialogued and expressed through deterioration and mistrust by understood, to, anyway, effectively, generate the family members. We all move with difficulty within personal and social satisfaction of the communi- our limitations. [42] cator.

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However, what is so dangerous in putting peo- desire of the construction of meaning, which is the ple to talk? What is the danger of the discourses apex of the translation of the real will of the family to multiply indefinitely? Where is the danger? [33] member. For the family, the truth is expressed by At the moment when such anxiety is expressed, their explanatory perspective of disease that makes Foucault wants to explain the concern of the ins- them to reflect, continually, about their history of titution in establishing the set of discourse. Note life in a spatio-temporal with the child. that the author draws questions as to know why Thus, considering the peculiar aspects related people can't talk about what they want, where they to this pathology, the binomial child depression- want, how they want and the number of times they discourse is effectively in the body of the family want to. The answer must be found in the historical narrative, which, by its time, is laden with spoken evolution of the discourse over the years, theme and prohibited words, able to provide consistent approached by the author with authority, to try to support in the treatment of disease. In this way, it explain that humanity, through the institution, exer- is easy to see that the narrative is the detailed re- cises the discourse and makes it limited to a bundle porting of what happens before, during and in the of standards, in order to hide and suspend their development of depression. latent truth. Therefore, to listen to the family narratives on In this perspective, it is necessary to understand the route of complaints and symptoms, involves the meaning of discourse as being a limited number a series of theoretical and practical paths that of statements to which we can define a set of exis- flow to the most diverse and different means of tence conditions, general domain of all those listed. seeking to understand words, voices, images, re- That is, a separate group of statements are interwo- quests, pains and psychic suffering, In addition to ven, unraveling regulated practices, to account for the perspective of what is recognized as disease. In a certain number of statements. [26] this context, gradually, the child depression gains Being child depression a human condition that the status of human translation, in the movement is characterized by an existential interference, the of its history and of the family discourse. Is what discourse while practice and enunciative use, brings Foucault similarly considers as a nameless voice on itself the rhetoric reference from the same enuncia- hold. [33] tion, as understanding facilitator mechanism of the Thus, each social act has a meaning and it is disease, not only as pathology but also as a problem composed on the form of its discursive sequences of social nature due to affect a large number of which articulate linguistic and extra-linguistic ele- children at present. The discourse, in this perspec- ments. [47] The act of saying, by itself, notably, does tive, it is always an event that neither the language not configure the discursive practice. It is empha- nor the sense can drain it entirely. Is a function sized, however, that these words bring inside, and that crosses a field of possible units and structures this is noticeable through the gestures, intonations, making them appear with concrete content in time enunciation, anyway, the rhetoric. The said is com- and space. [26] plemented with the unsaid. The narrating/hear is In this way, the discourse is a practice that trans- the tradition that unites in the same discourse plan cends the simple say the word, since this same word the physical and the metaphysical world, the histo- is imbued with constructions that are translated rical and the mythical world. [39] from historical, social, and interpersonal practices. In this line, the childhood depression is an event In the field of childhood depression, this discourse is that erupts in a time and space, when the family too alive with ideas, facts, events and, above all, the would recognize themselves because the meanings

there look obvious, natural [48], translated as a ma- a set that can be commanded the dispersion of trix of meaning. [26] This matrix, by its time, can the subject and its discontinuity in relation to itself. only be perceived in the translation from the bonds It is an area of exteriority in which is developed a of power and knowledge, from the discourse. In this network of distinct places. [26] way, the narrative is taken from understanding of In this way, the field of discursive order agrees the enunciative function of the family members, in with the same understanding of Lima [439], oppor- the recognizing of the plot of power and knowled- tunity in which is highlighted the poetics of social ge which are manifests because of depression. life attached to oral narratives, as a subsidiary source Although, even in the morbidity of their words, of our enquiries about childhood depressive pheno- family members exude the enchantment of their menon. This understanding brings the information discourse. This enchantment does not necessarily sought in Foucault´s work in what interspersed the mean beauty and harmony, but, above all, an ex- discourse said and unsaid. From this point of view in pression of a truth of life, narration of episodes, reveal historical events and people-to-people links, facts and feelings that highlight on said and un- the discourse is seen as enunciative practice – action said, speaker and spoken. Thus, the rhetoric, the of interdiscourse, complementarity and the struggle allegory, the utterance in which the family member of the different fields of power/know. [48] There is is character appear on its own told plot, as itself no enunciate which do not assume other; There is could be seen in what is expressed, in superhuman no one that does not have around itself, a field of effort to understand child depression by means of coexistence. [26] words. In addition, to speak about childhood depression For this reason, to describe a formulation as ut- under the gaze of family narrative is, beyond a sha- terance is not to analyze the relationship between dow of a doubt, redeem the discourse said and the family and what it said (or it wanted to say, or unsaid in the rhetoric of enchantment for, in the it said without wanting to), but in determining what end, to filter the peculiar aspects of the disease, is the position which can and must occupy the de- presented by the word of family members, who, by pressive child to be its subject. [26] This assert only saying, unsaying, smiling or crying, provide us with comes to commune with our understanding, in the the translation of their life histories in the spheres of sense that the family member speaker, by saying its time and space. That time summarizes in a distant enunciation, reflects its subject position, because in past and ideally passed without the disease, that is childhood depression concept, this reflect exercise considered a happy time, such as, by a wrapped gift is inherent in family condition. The family member of pain and psychic sufferings, overpowering the wants to know the reason of the disease and why soul, in which the relation power/know, referred by its children feel pain. Then, when he says, tell or Foucault, summarize into nothing, though a nega- discourse, translates stories lived and question past tive feeling by the want of truth. On this meaning, moments face to present moments for not see fu- still emerge, a future that does not exist or go deep ture expectations. Clearly, for the family members, by morbidity and by melancholy of noting the child the enunciation is the stereotype of their function “pass in the life” amid a disharmonious gift, rooted in life story told, in which it appears as active and/ of personal bad weather. The depression is that ex- or passive subject. perience of disappearance and that fascination for The discourse, consequently conceived, is not the a death state – maybe a dead – that would be also manifestation majestically developed of a subject the only capacity of keeping alive and inanimate. who thinks that knows what says: it is the contrary, [49]

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It emerge, in this mixture, the real voices that ce of objects becomes, differently, on the opposite interpret when the words of family members, said of usual and normal concepts, since the pathology and unsaid in their enchantment narratives, denote is severely reduced, the wisdom to tell the story and a subjective character of their condition of subject to tell itself. The meaning of whom we are, depends speaker/listener. Thus, the family member is the on the stories we tell ourselves in particular, and of main actor of the scene, it is the character of its the narrative constructions in which each one of us own life history, said under the look of depression is, at the same time, the author, the narrator and and unsaid after its social and psychic effects in main character. [51] the living among others. It seems to emerge to us From the perspective of discursive process, the the theory of polyphony, a theory of dialogue in word of the family member constitutes a determi- which it is understood that there are many voices ning factor to make possible the complexity of di- speaking the same discourse, because sometimes sease stabilization, specifically when the interpreter either the recipient is present there, or because offers his "listening", in an attempt to hear the said that discourse if referred to many others. This dou- and realize the embedded in its word of massa- ble crossing would be, in this case, the discursive cre, suffering and pain. The unsaid, in additions the polyphony. [48] transitional period between the said and the say, The relationship between this polyphony and which should be considered as a basic source of what is referred to them, enlarge field of narratives the mechanisms used in so-called "healing" of the through the meaning of words used by family mem- patient. bers, who, by saying, confide their concerns and This painful experience is the crucial moment of describe, vehemently, the pain of the soul which the disease. On this glimpse, listening is its exhaust corrodes and disarms them. valve and also the opportunity of telling its life story The narrative, therefore, is composed on the to disclose its desires and allow the interpreter to tension of two forces. One is the changing, is the see the ways of pathology stagnation. We believe inexorable course of events, the endless narrative of that the pain must be changed, but not forgotten; the life (the story), in which each moment presents contrary, not obliterated. [52] itself for the first and last time. Is the chaos that the The word said and unsaid, although, it is the way second force attempts to organize; it seeks to give capable of provoke the reaction to conflicts and to it the sense, to insert an order this order is reflec- the manifestation of experiences of depressive child, ted by repeating (or likeness) of events: the present such as to suggest expressions in the interpretation moment is not original, but repeats or announces of problems caused by depression. past and future moments. [50] Consequently, the “listening” get into scene In this way, it is easy and complex to realize that with the facilitator element essential to the family the discourse comprises a synesthetic environment and to the treatment of their children, in addition, of induced elements of psychic pathology, lived it will be translated into words, which effectively by the child, which in its family structure and in bothers in the functioning of the environment in its social interaction. There is, however, a sensible which they live. The symptoms of the disease are changing in the signifier and in the signified of the reflected in everyday life, and particularly, enable read things, found in the characterization and con- the interpreter the opportunity to loosen the textualization of depressive child behavior. moorings of what causes the trouble. So further, In the process of reading and (re) reading, inhe- Foucault's discourse reveals a tendency inherent rent in the condition of family members, the essen- in the human being that is to search, incessantly,

a beginning, to get a guide to the discourse, in To understand a little about this pain, it is needed order to deposit the information said and unsaid, allocate the childhood depression in the perspecti- to disclose its longing. The invitation of Foucault ve of narrative, what allows us to delimit a place is that, through research of discourse; we see our of present and authentic events from the particular story and our past, accepting think otherwise the view of their speakers, especially while the place is now is so evident to us. [48] established by the proximal systems with the fa- Therefore, the fear of not have the listening to its mily. In this measure, the happening can be seen as use transform the family, on the sense of bringing what essentially gives a testimony of multiple fails it negative feelings by the longing of truth. on this of adaptation, preserving the possibilities of vulne- connection, the same longing, when accomplished, rability of psychosocial interaction open, and thus, heard, comprehended and reposted, it causes odd indicating other happenings. [56] sensations in the family life, on a way that rescue When it is about a happening that connect other hanging and unimaginable asleep feelings. happenings, the childhood depression gets the rout The family member longing true reflects itself in of the abandonment state, which, although is cha- a desire of being heard, comprehended and “hea- racterized by the passive waiting – disposition of led”, or, unless, to listen and feel that it is possible appeal – for the other, defines, at the same time, a a solution for its infinite and uncountable problems. defensive posture, of protection of a primitive spa- From that moment, listened to, without retaining ce. [57] It comes characterize its inscription of the its discourse, the family member starts a voluntary real, as a way to signalize a progressive habitation process of reaction to the pathology; it is what Fou- of something that needs the identification and in- cault, in an analog mode, calls rupture of the dis- terpretation, in front of the strange that come back, cursive structure. It is the opportunity in which the and repeat, but the same time appears as different. family member face finds the viability of translating [58] the disease, what is relevant indeed in the process We understand that the family narrative would of clinical, psychic and social rehab, because it is make an opening of potential benefits of a preco- seen that the depression reduces the child personal cious intervention in what can print access to the and interpersonal ways in the family relationship. time of the disease, to the sick, such as the commu- Thus, the discourse is a complex relationship, and nication that could be established, considering that, this relationship defines its own rules of existence in each child, the depression crystallize itself around exercise of enunciation of the enunciators [53], be- a particular group of circumstances. [52] cause it seeks to describe what is effectively said, The narratives through the words that circulate from the point of view of its material existence. them, reveal circumstances that take place in the in- The narrative, although, loses much of lived, there terior of lived, allowing the description of experien- is a waste of living that the listening can help to ces which reinforce the ways of coexistence of those rescue it. [54] In the child depressive phenomenon, that share the same mysteries, through the signifi- the “listening”, by the translator, can work as a res- cant damage on developing and global operation cue of implicit elements, hidden inside of depressive of children. [34] It is what is shared with some that child who need to be polished to make possible its serve it of “cement”, which reinforce the feeling of possibility of “healing”. It is the crucial role develo- belonging and favor the new relationship with the ped by the listening: listen to the “pain of being” environment. [59] It is interesting to note, however, [29], which is the top of depression, and which can- that through the narrative the family members re- not be said, but perceived by the word. member what happened, they put the experience

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in a sequence, they found new explanations to that expressed at the time of the story told, life circum- and play with the network of happenings which stances and realities listened in reporting conflicts build an individual and social life. [60] and life events. The child´s family member asks time. Thus, the narrative represents, in the investigation And we can even ask ourselves about the brutaliza- of childhood depression, a way of capturing the tion suffers in its life, to the point that they feel with senses, delimiting particular perspectives of what more clarity the internal perception of time. [49] The provoke, and establish a trace to the own experien- attention required to realize the narrative time is an ces about the lived, associated to the processes of important factor in permanent interaction with the pain and psychic suffering. It is not a simple matter time of informant. To let the narrative acts is permit of putting everything out. Before that, what worries new temporal horizons, new potentiality. Narrating, is to know in which affective circumstances the in- the family discovers that each action evokes other, dividual needs of putting everything out, exactly, always renewed. The smallest of actions carried out what is the thing that must be put out. [61] in the other actions. [49] The actual registration, to remount words, places Childhood depression reaches, through the na- the narrative in settings that provide a cover over rrative, the (re) visiting of each family territory, from the extent of that lives, allowing it to understand commands established of things that causes hel- the longings and movements involved in depressive plessness, allowing a (re) sizing of the situation ex- States, through the way of happenings, of the sce- perienced, thought of what is done between the narios and the actions involved in seeking passage crucial points towards the construction of the own to be interpreted by its strangeness. It is interes- history of suffering. The narrative report situations ting, in that direction, realize that the despair of the which are understood as fragments, compact mo- soul finds refuge in the creation, in the permanent ments of life, and strongly symbolic and essential search for sense. [55] intense happenings. [62] Pain and displeasure allow, through the narra- To tolerate the trajectory of the scenes, connec- tive, the enrichment and the progressive primitive ting them to the moment of narration, to trace the territory housing with the incorporation of thinking. reality an add its original background are exercises However, the opening on the pain becomes possi- continually done by the family members, who re- ble if there is the belief, if the object gives hope. [71] capitulate episodes experienced because of feelings by the rescue of events, old and new answers are disorder caused by the demonstration and the no- emanating, old and new senses are produced, old mination of their own feelings. However, this same and new interpretations are pronounced. In fact, opening spreads on the evil and malicious way, be- a network of significance is established between cause the depression had to rescue all of this, and parts of the stories that are told and confronted the narrative has to translate. with the real circumstances of everyday life. This Initially, the childhood depression shares a set of would make understanding the interpretation and responses which indicate a reality in need of re- depression process, in what the word admits bet- generation, especially in what does the spaces of ween life, death and the search for treatments, whi- need for answers, return to family appeal, assuming le constant rebirths. [62] a position before the wait time for a cure, such On the sick body is the stigma of happenings; as from the filled place by the complaint on the They also lace and suddenly expresses the insur- development of its intimacy with the disease. That mountable conflict. [63] This desire to gain greater time when the truth is searched, the answer, by (re) knowledge about how to identify the disease is connecting the lived story, it highlights facts and

happenings, with the target of rescue the existence, In fact, it is the time that will unchain a kind of allegory, onomatopoeia, dialects. They are expres- restlessness on the search of knowing and getting sed in their word, and in their discourse. something not desired, but that reflects itself by It’s necessary to avoid that the desperation from strangeness and by persistence of the possibility our mortal condition provokes outbreaks of feeling of producing a significant improvement in the ex- immortality. It is healthier for us to project spaces change between the I and the other. To receive the of escape further than conceptual, theoretical, and doubts, the uncertainties, the orders and disorders methodological walls, which close the vision of lar- on the course of pain and psychic suffering, their ger, full, dangerous, creative; unstable, uncertain, speakers, in the sense of to present real intention provocative, and shameless horizons. This is the life: which are being developed in the circumstances of it lazes so uncertain by the biochemical dynamics the disease and its treatment, continuous doubts of matter, it insists on the instability of movement, are narrated about the existence of psyche, reflec- even though when it walks inexorably towards the ted on the repeated recitations on behalf of con- inertia, the harmony, and the balance. [43] temporaneity. [57] Thus, the desired response should be sought In this same direction, it is necessary to mark the through the truth on daily routine, in the expe- importance of the complaint as indispensable ele- riences, in the existential story. To treat depression ment in the translation of the crossing of what it with subsidy in narratives is precisely this: to seek wants to know before what is lived. It is created in an answer in the words, in the discourse, in the this way, a kind of common language, established perspectives of each family member, to eventually between to carry a persistent, opaque, intense, and be able to treat it in a more palpable way, according long-lasting complaint of a depressive nature su- to the context of those informants. The imaginary ffering, [36] and the place occupied by the speak feeds the man and makes him Act. It is a collective, in what transmits while demands. This provokes a social and historical phenomenon. [64] particular relationship in the seizure of spaces, in This same answer, however, depends on a liste- the territorialization of real emergency, in order to ning closely committed to interpretation and with encourage recognition of the place of a time trans- the desired comfort by the depressive, because its cription when it could be possible to prevent/react imaginary, pain, and desperation are in need of to its misfortunes. welcome, which can be made possible by listening. That question opens the possibility to mark the Having a depressive child, however, from this point narrative of childhood depression in clash of for- of view, is a request to be heard. In this context, ces, in the constant rewiring of voices, coming the time comes into play as a facilitator, because, from both inside and outside the family, increasing through its continuity, transmit stability when (re) the time of the disease in conjunction with the tell the story. treatment received. This is the articulation of words The need to be recognized in its identity encou- and because their movement that knowledge are rages families to count its story in a way that the (re) in an attempt to interpret the circumstances person feels the desire to embrace it. We could call which remove the significance to what is familiar, this narration and the fantasy that inspires "origi- real and continually lived, in the establishment of nal novel". This identity falls apart in the transfer what implies in desperation, abandonment, routi- relation, it accepts a new introjection and in an ne, strangeness, absence and death feeling. All this acceptance of doubt about itself, it amplify its own contributes to create a context, an ecology of ideas space. [65] that energize topics, questions and metaphors,

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opening spaces for the appearance of passwords tion, invested by the desire of healing. It is in this in order to cause what is seek to recognize. [66, scenario that fits our understanding context and 67, 68, 69, 70] meaning of depression, to the type of treatment An aspect to be highlighted refers to the possi- to depressed children, bringing the medical team bility of finding the sense emphasized by the pas- to the (re)configuration of legitimation to listening sword in the course of childhood depression, as a the other. carrier of complex networks of representations, on It is a fundamental problem to the human society, the displacement of what is revealed while truth. involving a practical and theoretical challenge, be- The important thing to be identified by its pas- cause it is necessary not only to find solution, but sword is the movement in the voices as practical to explain what happened, how it get started and knowledge that would facilitate the creation of what is its story, provoking, in this way, a search of access codes to the pain and psychic suffering. senses that, to be recognized, must be interpreted. The pain is closely related to learning about the [62] environment and its risks and on the body and its The Defense offered by depressing phenomenon limitations. [71] The strategy would be a scenario to the family members is the word, which is ma- of action that can be changed because of infor- naged according to the degree of intensity of pain mation, events, and unforeseen in the course of and/or psychic suffering that affect them. And this the action. [72] is how, of course, the disease can be treated, ame- Captured by passwords, the family members seek liorated in their effects, crafted in their symptoms, to translate the depression as “the disease of the and can be decreased internal and external in their nerves” – a mark constituted by the intensity of conflicts, from the dissatisfaction of the conviviality suffering and by the possibilities exchanged with with disease. its treatment. The passwords would open the way The childhood depression, however, must be for a therapeutic strategy, which constant would translated as disease that establishes in the family, be the assumption of clinical conditions, underlying capable of being psychic and bodily affected by ex- the suffering of child, of which it would be with, cess of violence experienced inside and outside of requiring greater elucidation. [36] it. [49] Recognize it as a means of access to rea- The childhood depression, therefore, starts to lity, through the gestures, tones of voice, words, acquire various steps to the interpretation about feelings, revealed memories in the psychic life, re- the routine of the disease, rearranging it in own mount speaks and time of what needs listening. discourse of the reality experienced, represented as When the focus is the human psychic life, it cannot disease of the nerves, of fear, of soul, of death, of save time for listening. The depression enables, by the heart, of bad things. The discourse responds the speaking directing it to the other, which unfold to a half listening virtually, or in other words, the the internal times of life. Those times and that speak understanding of interpretation as the sense. [56] In were frozen by the depression, that preserved them this way, we would be entering in the local context, alive, but inanimate. [49] moving between the universe and the particular, It is precisely the emphasis on listening that it is the individual and social, without forgetting the necessary to introduce in the treatment of child- words and senses that the animate them. [37] hood depressive phenomenon, which is considered This assumes, however, a particular relations- here as a problem not only of the depressive child, hip with the balance of the speaker by the other but of its family. The order to listen is the total from senses that arise through the process of medica- the subject to the other: It puts in first place the

contact almost physical of them (by the speaking however, the day when the truth moved from the and by the listening), it creates transference: ‘listen ritualized act of enunciation, effective and fair, to to me’ which means ‘touch me, and know that I its own enunciation: for its meaning, for its form, exist.’ [73] for its object, for its relation to the preference. [33] Because of that, the emphasis of the narrative And this enunciation is, exactly, the expression as substratum in the treatment of childhood de- of its own subjective disorganization. The adver- pression, especially by lead, in its interior, guiding se situations are highlighted by saying the will to elements of this phenomenon manifested in each truth. In the family members’ view, this will of truth family. It is stamped that to be depressive is a per- becomes the desire of determine if the depressive manent condition of life, but to be depressive offers condition is authentic or not. of transitoriness. The definition of establishing the What is called depression today – if we exclude being depressive emanates from the discourse, the melancholic psychosis – it is eminently the status which describes the pain of to be and that, finally, of the soul that hides the subject more than revels the depression says. it; a kind of ethic retreat that stops the subject – Thus, as we are observing, the power of the by comprehensible reasons, sure – of assuming the word in relation to the several faces of depression consequences, better saying, of the existence of un- is really intense. In this way, the discourse could conscious, whose irruption could summarize itself be considered a real kind art, practiced to relieve with the following discovery: “I do not want what the pain. I desire”. [36] Foucault [74], in his last course at Collège de Thought the (re)telling the lived, revealing the France, from February to March 1984, under the secrets of Pandora's box, they meet moments in title “Lé courage de la verité” (The Courage of which the discourses come out, in words that if truth), after study Platão´s work about Socrates’ they wish to leave flow are opened, where what is death, it was demonstrated how the practice of hidden in the chance establish voices and words, truth telling (parrhesia) and the “the care of the hopping that one of them “speak speak” [56], self” can conduce us to our own truth. And, in from what remain of them, that is the reminiscent this sense he claimed to Dreyfus and Rabinow [75]: truth. “What strikes me is the fact that in our society, In this sense, the family members have an ana- art has become something which is related only to gram of their depressive children; a creature that objects and not to individuals, or to life”. The life of doesn’t know anymore with whom it must live and every individual could not be a work of art?” And share its daily routine. [76] I would not like to be it is here that it will translate the truth beyond the forced to enter in that uncertain order of discourse; limits of discourse to operate in the field of rheto- I would not like to see with him what is peremptory ric, of allegories, of dialects, and of enchantment. and decisive; I would like to have him close to me Clearly, the record of these facts, by their limited as a calm, deep, and indefinitely open transparency, and sometimes unavailable nature, translates a di- and that the others could answer my expectation, versified thinking in the form of analyzing the will and that the truths, one at a time, rise themselves; to truth, sought by the family members, especia- It could be necessary only take me, in it and for it, lly by inquietude and by anxiety of a truth that as a happy rudderless boat. [33] comfort them. In that perspective, the will to truth by the fa- The biggest truth was not in what the discour- milies hang in the field of their narrative, in order se was or in what the discourse said: it has come, to measure values, questioning ideas, abolish ideals

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and, above all, look for comfort. Those narratives the feeling of guilt. The depression brings in some show themselves modern, in order to translate an family members as consequence a level of confu- extensive cultural text [77], enabling an understan- sion and devastation that, in its largest part, it stays ding of lived context as social mechanics to the beyond any description. [35] social semantics. [78] According to Foucault´s coun- The Family members constantly warn the lis- tersignature, there is the possibility of this discour- tener or interpreter of the internal dissatisfaction se flee from a right order, determined to take on, that alert their children. After tireless alerts, they effectively, the end of the intended truth. are to be taken as fact; those voices perceived only When the universal path is not for happiness, by it and then establish a consolidated ideation the access to it is entirely singular. The uniqueness of disease of the nerves. However, the narratives of this path requires us to consider that the con- foment themselves by a discourse rooted in the ditions of its possibility are unequal, or unevenly words of indecision, doubt, insecurity, powers and distributed. There is no way preformed neither in perils, pessimism and, above all, by the uncontro- the microcosm, nor in the macrocosm to prepare llable desire of escaping from the pain of being the subject to get it. [36] that bother them. In the field of childhood depression treatment, To listen to, committed, the potential of family the narrative fulfills its facilitator role, by expressing members narratives is to lessen the risk of the exe- the will to truth of the family members. Thus all its cution of the pain and the psychic suffering, es- rhetoric gives a valuable subsidy on diagnosis and pecially when it is still in the stage of saying and treatment of disease, notably by bear with specific unsaying. To interpret and listen to the rhetoric of traits in the act of exposing dangerous thoughts enchantment of the family is one of the effective orally [52], and then filter their real desire that is ste- means to treat and prevent the disease. In this case, reotyped in its truth: “cure”, welcome, inner peace, the listening must be unreservedly committed, be- happiness, serenity and joy. These predicates appear cause it transcends the family boundaries, passing to pass us the tangible meanings, from the words to need support and unconditional zeal of the cli- spoken by the depression, on hold. So there would nical apparatus. be no start; and instead to be the one where the We believe that the words are strong; they can discourse comes out, it would be before the chance crush what we fear when the fear seems more te- of its course, a small gap, the point of its possible rrible than the positive side of life. We turn, with disappearance. [33] increasing attention to the love. The love is another To think of a black time passed is a terrible evil. way to advance. They need to act together: when Depression can easily be the consequence so in the alone, the pills are a weak poison, the love a blind excess of which was cheerful as in the excess of knife, an insight, a rope that crack under the excess which was horrible. The worst of the depression lies of effort. With them together, if you are lucky, you in a present moment that cannot escape the past can save the climbing tree. [52] that idealizes or regrets. [52] In terms of depression, the word heard with In this sense, the childhood depression is a way ethics and commitment, combined with the medi- to interrupt especially the innocence: the mental su- cation and its monitoring can be a powerful icon in ffering that conduces it, it get used to be prolon- the treatment of disease. ged, intense, intimate and indivisible, by letting the Through the psychoanalysis, the childhood de- family members, friends and colleague to handle pression is configured as a moment when the child with a kind of loss almost unfathomable, such as “it is out of mind” and, because of that, it can

attack itself. It is the lowering of the ego self-defen- that are in use that describe thoroughly to designate se capacity, which allows the irruption of disease. what is commonly called "depression" or "depres- With the gradual loss of libido, the anxiety assumes sive diseases". [83] the personality preventing the ego acts and, with It is worth noting, however, that diagnose child that, the child presents specific content of sadness, depression is not the same task that diagnose any low self-esteem, loneliness and need to call people's disease, because of its peculiar character of pain attention that surround It. [79] and/or psychic suffering that changes the specifi- In the same way that, for psychoanalysis, child city of representation of the disease [84], as well depression in lato sensu occurs in a long and lasting as the mechanisms of translation to clinical and moment of fragility of self-defense mechanisms of therapeutic logic. It is necessary to stamp, again, psyche, the body becomes an instrument easy to that the listening must be sensitive and committed. depreciation, and so it is handled as revenge itself. We live a scattering of vanishing lines and streams Being depressed is a State that spends a lot of fra- of deterritorialization effects and speed favor the gility. This fragility is expressed on the vulnerability production of subjective mutations open to expe- of thought, in desperation, in pain. rience – of the space, of the time, of the body, of The pain and psychic suffering generated by the the other – and others opened to a tight identifiable childhood depression depend on each family to set subjectivity. [36] limits to their tortures outlined in living with the We are at a time conducive to suffer, because disease. Fortunately, the boundaries that most fa- of the profusion of therapies, medicines etc. [75] In milies establish for themselves are high. Nietzsche addition, and perhaps as a result of the deterrito- once said that the idea of limits imposed by the rialization flows that pervade society today in all its man maintains it most of the time in the darkest dimensions, is a "great" time for that suffering find part of the night. difficulties to be subject and, from there, treated. Freud, in a letter addressed to Abraham, claims Now, it is referred to a particularity of vital operating that "depression is the persistence of unconscious and delegate to expert. [36] investment in the object-representation". [80] There In terms of treatment, the medication is the ele- are evidences that the problems connected to fa- ment commonly used by most professionals in the mily structure and support are related to childhood field, notably by having a secure and fast stabiliza- psychiatric disorders, specifically to mood disorders. tion effect of depression. Pharmacological manipu- [81] it is important to highlight that the approach lation predominates in the treatment of the causes of childhood depression, it is necessary to consider and in the prophylaxis of the act. However, there is the direct clinical observation, by complementing no need to separate the use of medication and the continually the data analysis of clinical evolution, psychotherapy. They must act together to achieve including the signs and symptoms, bringing to the the end sought. families a contact with diagnosis related to conduc- Antidepressant drugs, which act more specifica- tion, management, and treatment, involving not lly on individual neurotransmitters, not only change only the physical well-being, but also the emotional the clinical practice radically by its popularity and and social. [82] dissemination, but also provided additional evidence As a rule, the diagnosis occurs from the presence for the role of neurotransmitters in the origins or the of certain symptoms that manifest themselves in perpetuation of child depression. Classified as selec- a certain length, frequency, and intensity of time tive serotonin uptake inhibitors, they act mainly by which the world recognized psychiatric manuals blocking the removal of serotonin in the synapses.

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