A question-and-answer column with Dr. Martha Erickson of the University of Minnesota
Question: Several times lately our 4-year-old has gotten all worked up at night, claiming there's a monster under his bed. He says he's afraid to be alone in his room. Is this cause for concern? How can we help him get over these fears?
Answer: What you describe is not at all unusual. For many reasons, young children get frightened when they're alone, especially at night and in the dark. They often imagine all sorts of scary creatures in the closet or under the bed. Very young children can't separate reality from fantasy, and when they can't see what's around them, their vivid imaginations go to work. The frightening images that surround our children on television and film may also feed into these fears.
These images are not all fantasy. Actual news stories of children being abused or kidnapped can erode the security of children of all ages. It is also common for ordinary stress and anxiety to bubble up at night. When children can't name what's making them uneasy, it may come out as fear of imagined creatures.
Such fears become cause for serious concern only when they go on long enough or are so intense that they interfere significantly with the child's sleep or ability to play and learn during the day. In that case, it would be wise to consider whether he has experienced something traumatic and seek professional counseling if needed.
For now, here are a few tips on how to help your son master these fears so you all can rest easily:
"¢ Take your son's fears seriously, without overreacting. It is important not to dismiss or ridicule his fears. Hear his feelings and reflect them back to him with words: "I can see you're really scared."
"¢ Reassure him that you are there to make sure he is safe. Offer comfort as needed, and demonstrate to him that there's nothing frightening in his room. This may mean turning on the light in his closet or looking under the bed to show him that everything is fine.
"¢ Over time, help him master his fears by reading or making up stories about little boys and their monsters (Maurice Sendak's "Where the Wild Things Are" was a favorite at our house). Or join him in an imaginative play and act out monster stories. For example, he could pretend to be the monster and you could be the child who tells the monster to either start being nice or go someplace else. Or your son could be the parent reassuring his stuffed animal or doll that he will keep them safe.
"¢ Finally, see through your child's eyes by remembering your own childhood. What used to frighten you? And what did you find comforting at those times? As with so many aspects of parenting, our own childhood memories often yield the best information on how to care for our children.
Question: My 14-year-old niece recently tried to commit suicide and is now hospitalized in a psychiatric unit. She overdosed on prescription medications; a friend found her just in time. My wife and I are going to visit her soon, but I'm really unsure about what to say to her. Should we mention the suicide attempt or just try to be cheerful and talk about other things? We're terribly frightened about all of this and want to do the right thing. What do you suggest?
Answer: It's natural that you feel uneasy about talking to your niece after such a disturbing event, and I understand how tempting it is to avoid the topic of her suicide attempt. But in the long run, you and other family members will be better able to give her the support she needs if you meet the situation head-on. This first visit will be important in setting the tone for how you encourage her on her path to health and well-being.
I suggest that you start by telling your niece how relieved and thankful you are that her friend found her in time, and how glad you are that she is in a safe place where she can get the professional help she needs. Don't be afraid to show emotion as you let her know how frightening the suicide attempt was for you. And, most important, tell her how much you care about her and want her to be well.
It's also important that you give your niece a chance to talk freely about what she's been experiencing. It's probably most helpful to simply tell her that you're glad to listen if she wants to talk about it--leaving the door open, but not pushing her to say more than is comfortable. Take your cues from her; if she prefers to talk about other things, follow her lead.
One benefit of an open, supportive conversation with your niece is that you can help reduce the shame she may feel about "hitting bottom." You can give her a clear message that if she begins to become depressed in the future, it's OK to talk about it and seek help before she sinks so low. She needs to understand that depression is nothing to be embarrassed about, and that it can usually be treated successfully with therapy, medication and the active support of friends and family.
If it seems appropriate, you also might talk with your niece about other people you've known who have recovered from depression. When young people get to the point of wanting to commit suicide, they see no future, no way out of the dark hole they're in. And they typically feel like they are the only person in the world who has ever felt this way. An important step toward recovery is discovering that many other young people have experienced serious depression but have come through it--with good professional help--regaining their strength and zest for life.
The most common cause of suicide is untreated depression. And depression, by definition, leaves people feeling isolated, hopeless and powerless. Family members cannot be responsible for preventing a loved one from making suicide attempts. But, in partnership with mental health professionals, they can play an important role in helping a young person feel more connected, hopeful and able to cope with the stresses and challenges of adolescence. Beyond the general suggestions I've made here, I encourage you and other members of your family to seek advice from your niece's therapists about how you can be most supportive of her, in the context of whatever unique circumstances and issues underlie her emotional difficulties.