depression, some thoughts
The smile is the only affirmation of one’s comfortable co-existence in this world, and when that twists, and the eyes glisten to see the world dull and gloomy, when the vision of the mind too turns out of focus, and when time seems to extend itself, the description, the definition and the diagnosis is depression.
In everyone’s life there will be many moments that may be described as blue. This is not the radiant vibrant happily freckled bright sky blue, but a murky dull and suffocating gloom. This is commonly and in psychiatric parlance known as depression.
If one were to consider sadness as an emotion and a reaction to external stimuli, depression can be construed as a state of mind, but in actuality it is an illness. It can affect anyone, anytime. It not only hurts and numbs, it makes perspectives bitter too.
It strikes silently and silences. Depressive illness manifests in two ways, a major depressive illness or a minor depressive episode.
In the minor variant, Bitterness is an acquired distaste, something we have learnt to dislike, but sadness is an engulfing disability over which we do not have control. Over the years one may learn to identify troublesome situations and prevent getting hurt, but this is possible only with external situations involving conscious likes and dislikes. In the major form of the illness, depression strikes from inside. There are no obvious contributing causes outside. The neurochemistry of the individual gets disturbed and the illness manifests with signs and symptoms, needing therapeutic intervention.
Whether a person is suffering from major or minor depression the main presentation appears similar. There is a sad mood inside and a forlorn look outside. In minor depression a concerned, rational and objective friend would suffice to tide over the mood, but in major depression medication and therefore professional help is absolutely essential.
Minor depression is also known as reactive or secondary. It is a reaction to (or secondary to) an event that disrupts the emotional equilibrium of the individual. This generally follows sequentially an expectation, a disappointment, a shocked disbelief, shame of failure, fear of incompetence, uncertainty of future and inability to function in order to cope with the distress.
Expectations are imposed and inculcated as an everyday routine right from childhood. You have to be good to get a chocolate, and if you are wrong you miss something. Deep inside is ingrained a notion that if you are good you win and lose only if you are bad. Therefore when we have done everything well, behaved well, and done what is generally known as right and been good by our own definitions, we have to win. If circumstances decide that we have lost, we are shocked, hurt and bewildered. A cheating husband does not get that disturbed when his wife has an extramarital relationship, though he may show his resentment. A student who has not studied never gets depressed when he fails in an examination. It is only when we feel that we have been right and the world is being `unfair’ that depression sets in. Of course, there are many times when we feel we have put in our best, while in actuality it is inadequate to accomplish. Only in those situations when we feel we should have passed and when we have failed, we get depressed. Minor or secondary depression is always our reaction to our perceived failure or betrayal. In inexplicable situations, the betrayer becomes GOD, since there are no other humans to blame. If we cannot blame God and attribute the misery to the mysterious hand of fate, but have to only blame ourselves, we sulk more and sadness is more profound. It does not mean that an atheist would get more depressed in a tight situation; in fact, a rational mind recovers faster as it sees reality more quickly.
The main problem that one encounters when one gets depressed is that one’s ability is reduced and therefore coping and recovering take a longer time. Depression is sadness. Sadness is an emotional reaction to a situation. When the situation and the reaction are disproportionate, it becomes a disorder. Maria Sharapova may miss a simple volley and this situation can irritate, frustrate, sadden or shock her. But she would recover in the next game. We too have met many losses and many failures which we could have prevented had we been at our best performing level. If we shrug or even bang our fist and move on it will not end up as depression. if losing one volley is going to incapacitate talent in such magnitude as to lose a match, it is depression. If it is for a few hours or even a couple of days, sadness need not be called depression. The problem should persist and make present moments painful and future expectancies bleak for it to be termed as a depressive disorder.
Grief following bereavement is not depression since it is an emotionally appropriate and proportional reaction to the permanent loss of a person in one’s life. Prolonged grief however is pathological. Loss of loved one, not necessarily owing to death, is as severe as bereavement, if the love was intense, passionate and honest. Even is such instances, one is expected to be sad, dull, dejected and even angry for some time, not for long. How long one feels low after the loss of a significant individual in one’s life depends not only on the significance of the relationship but also on one’s dependence on the relationship. Dependence is the ultimate expectation and every expectation is pregnant with a disappointment.
It is not often easy for everyone to identify someone who is depressed. Though it may start following a traumatizing event suddenly, the incapacity of melancholy sets in gradually. Though the intensity of depression can be assessed only by a trained professional, it has to be identified by close family members or friends in order to provide timely help for quicker recovery. Time, as the old adage truly remarks, does heal but we do not have to let time ‘take its own time’ to heal with the advent of modern mental health science. Early identification of the disorder is therefore essential for prompt and proper help.
Depressed persons generally exhibit the following symptoms and signs. Sleep is affected. Some may have difficulty in falling asleep while some may awake earlier or intermittently, in rare cases there may even be excessive sleep. Sleep is significant since it shows what the mind wants to do- be alert for further dangers or shut down to escape from reality. Appetite may be altered; some do not want to eat while a few may eat more. Concentration falters, and as a consequence performance levels drop. There may be disregard for personal grooming, loss of interest in previously interested activities. Amotivation to do anything purposeful and fight the mood will be also present. The mood will be described as sad, gloomy, and dull and the emotional responses become lackadaisical. The smile becomes a rarity and the eyes reflect the inner quake. Tears may not be public but they will be ready to flow at the slightest opportunity. Ruminations about suicide too occur in some individuals. Though most of the persons who get depressed may become dull and withdrawn a few may show agitation and restlessness too. In all cases, the content of speech rather than the form of behavior will indicate the depressive disorder.
The mind however is well equipped to handle any trauma. It has its own defense mechanisms. It is for the professional to suggest which areas need to be strengthened in order to overcome the difficulty faster. In this matter however many people come forth with impractical suggestions. If an athlete fails in a meet, you cannot ask him to learn music to overcome the sadness, instead a new workout in a new gym might help. Suggestions to overcome depression are often the result of media hype on meditaion and alternate methods of `treatment’. Yoga will help as much as aerobics. Meditation will help and so will listening to good music. If you care to help an individual who is depressed, be supportive, don’t argue even if he talks nonsense, but never allow him to talk out of tune with reality. If you cannot make him stop talking irrationally, change the topic or silence him by your silence.
Initially medication may be required even in minor depression to help to sleep. But this again has to be under professional guidance and supervision.
Depression can be endured effectively with the right support. Not all can turn their sadness into a Tajmahal; making the rest of life comfortable and successful is by itself a monument to the wound that has caused the depression.
********this is just the first part and we will continue in the next on other forms of depression, defense mechanisms and treatment options*********
written in 2005