Posted tagged ‘mental health’

maladies of the mind..

October 9, 2015

“The lover, lunatic and the poet are all of imagination compact”, remarked the Bard, perhaps signalling that all of them have intense emotional experiences, which we all do have. The term lunatic, inappropriate in all times is invalid now, and mental illness is the description that has replaced it. Mental illness is not just about emotions and their intensity or lack of it, it is an umbrella under which many maladies are contained. Even for this googling generation, almost all mental illnesses are conveniently or comfortably labelled as depression. Depression is just one of the many mental illnesses that affect humans.

Depression though a very commonly used, and rather misused term ( as many use it to call from degenerative brain pathology, technically called Dementia to simple difficulties in social functioning, as in personality disorders), is not just one type. We have all experienced losses and failures and felt low, sad and even at times despondent because of those events. This is called secondary depression. It is a reaction to an unpleasant event in life. Generally this would pass off in time and we would get back to our social and functional adequacy.  And then, there is another one called Major or Primary Depression.

Major Depression is not event related. It can strike anyone anytime, as it is a disorder of neurochemical transmission. Though there are some factors like hypothyroidism, diabetes, certain medications, and some genetic factors that can predispose one to a Major Depressive Disorder, it is essentially a biochemical disturbance that can only be treated with medication. In the currently raging fad that makes people shrug at the very mention of a prescription, MDD is a ripe field for quacks and fakes to swindle people and waste their time in getting early and proper treatment. On this, we shall see later.

What happens when MDD strikes? The person loses sleep to begin with, and gradually loses interest in all that he was involved passionately earlier. It mars his concentration, reduces his functional competency, makes him see the world dark, pushes him into a self- withdrawal, refuses him to take care of himself, and this ‘darkness visible’, can at times push him into a suicidal rumination and attempt. Depression can be considered as a serious emergency because of its potential life-taking possibility.

MDD apart, mood dysregulation can also manifest as a BI-POLAR disorder in which a person alternatively exhibits severe depressive sadness and switches imperceptibly into a ‘manic’ phase that is marked by incongruent elation and disturbing exuberance. This shifting mood makes not just the person unpredictable but also his relationships vulnerable. This again is a major mental illness and can be treated only with medication.

Mood apart, thought is what makes a man function- personally and socially. A severe form of thought disorder in which even perceptions get disarrayed is called SCHIZOPHRENIA. This is a very severe mental illness and it affects all social classes, both sexes, beyond religious and national boundaries in the age group 15 to 45. Unless detected and treated early, schizophrenia can devastate an individual’s life. This again is a neurochemical dysfunction coupled perhaps with a genetic transmission. This is one mental illness that is most researched and even now is the focus of scientific psychiatric investigation. Medication alone can handle this malady.

Schizophrenia is characterised by again loss of sleep and withdrawal in the beginning. But as time passes the individual loses focus in almost everything and is seen going further into himself. Though the affected alone can hear voices talking to him, threatening him and commenting on him, the outsider can still identify this symptom of ‘voices’. The patient would start muttering to self, not like what we all do when stressed or rehearsing for a stressful event, but muttering and alternatively appearing to listen as though he is in a conversation with a non-existent being. Besides hearing voices and responding to them orally or at time by acting out the ‘received ‘commands, schizophrenia is also characterised by delusions. These false beliefs are not induced as in the religious charlatans ‘money making mockery of the public. These delusions are baseless convictions in which even an innocent child can appear as a sinister evil conspiring and planning to harm the patient. These paranoid delusions are very common in schizophrenia. Again, it has to be reiterated that only medication can help these suffering individuals, because of the increasing popularity of  the stylish fad  wondering whether counselling alone would not suffice as therapy. You cannot counsel a schizophrenic patient, because he does not have insight- the reasoning of reality that makes him accept that he is sick. His hallucinatory voices and delusional convictions are unshaken in any conversation that tries logical reasoning. Unless the neurochemical balance is corrected, he will not listen, and therefore not understand.

Another important and common psychiatric illness is Obsessive Compulsive Disorder. Unlike in schizophrenia here the affected person is aware of his problems but absolutely incapable of doing anything to come out of it. OCD is again not a rare illness. It can be seen even in literary descriptions, like the Lady Macbeth lamenting on the inadequacy of all the perfumes of Arabia to wash her stain. OCD is characterised by repetitive actions done consciously but without voluntary control. Unless a specific number of times an act is done the individual becomes stressed and distressed very much. There are tow types of OCD symptoms one is repetitive cleaning and the other repetitive checking. A variant of these two would be repetitive acts that may be guffawed away as quirks or habits. We check because we are scared, we clean because something is dirty. Fear and shame are the underlying emotional disturbances in OCD. Regarding OCD, certainly medication is the first line of treatment. But since the individual can listen to sense and comply with therapeutic instructions, some behavioural modification techniques when taught alongside the prescription would help in recovery.

Now to come to minor mental illnesses, one can see the entire human emotional and social spectrum. From simple anxiety which we all experience and conveniently describe as non-existent butterflies in the stomach, to severe panic in which we cannot get into a lift or even close the toilet door when we have to use the restroom, there are a wide range of problems. Most of them are self-remitting, that is short lived and event related. Some like Phobia persist and do not go away even with total insight and high level intellectual capability.

Dependency on drugs or people can also be a psychiatric problem to be addressed. Addiction is another area of mental illness. Besides these, mental retardation, dementia, personality disorders, relationship  problems, learning difficulties and many more come under the group called psychiatric illnesses. Even the problem encountered by many doctors who are frustrated explaining to their patient that there is no physical problems, but find them coming again and again- the problem of what was once called hypochondriasis is a psychiatric illness. A once popular word, another misnomer that is still in usage- ‘hysteria ‘is also a mental illness.

Hysteria was named thus as the Greeks believed that the uterus of the woman was moving all over her inside and making her do bizarre things. This is now described under two types. One is conversion’- where one converts a psychological problem into a physical one. A common example would be having a headache when one is angry and unwilling to go to bed with partner. The other is ‘dissociation’- where the individual dis- associates from reality to escape stress or seek attention. This is commonly manifested in our country as ‘possession’- by a God or an Evil spirit, according to their cultural milieu. Here the individual though initially behaves involuntarily, at some time enjoys the attention he or she gets and goes on to exhibit the behaviour as and when time permits and need arises.

This is a very, very brief outline of mental illnesses. This may not help you to understand them all. But to identify any mental illness look out for- 1) sleep disturbance, 2)lack of focus in work, conversation and self-care 3) unusual and inappropriate speech or behaviour even if it is only for a brief period, 4) emotional imbalance of inappropriately extreme sadness or elation, 5) a gradual decline in occupational, social and interpersonal spheres of life. If you notice these take the individual to a doctor. Don’t Google and conclude, don’t get swayed by the promises of quacks, don’t ask the opinion of every non-medical person ranging from your auto-rickshaw driver to your jobless neighbour. Mental illness is treatable and in many cases curable. Help them to get their life back.

This was written for ‘THE WEEK’ mental health special issue October 10, 2015 (http://specials.manoramaonline.com/THEWEEK/2015/Mental-Health/experts/various-mind-disorders-symptoms-therapies/index.html)

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jealousy

September 25, 2008

“I wish I were jealous- of myself,” remarked a poet, apparently aghast at his felt incompetence. He may have been depressed at the time, feeling that his vocabulary bank was drying up or he may have been simply suffering from an inferiority complex comparing and thereafter feeling incompetent to rub shoulders with Homer or Goethe. He could just have begun his trip on jealousy.

Jealousy is not the exclusive domain of poets and artists. All of us have experienced jealousy. Though it is not principally categorized as an emotion, jealousy is a feeling that evokes strong emotions. Every human being has been jealous. Winged birds and their flights beyond visual boundaries evoked jealousy, and the zealous human invented the air-plane. The jealous do sometimes channelize their energy into creativity; but, more often than not, the jealous get crushed under the weight of their own desires.

Jealousy snarls at the mind only when there is a comparison; a comparison that is clouded by a wish; a wish that reminds one of one’s own inadequacy or another’s supremacy. There have been innumerable words written on the difference between jealousy and envy. Though being envious is considered a destructive mind set, jealousy has its word origin in a positive feeling – zeal and the desire to emulate. In the Shakespearean tragedy was Othello jealous and was Iago envious? Who was destructive? Is destruction only external? If envy is the fire that is lit to burn down another’s palace, jealousy is a flame that can gut down one’s own hut.

Though, from time immemorial, moralistic ethical teachings have advised humans to avoid jealousy, it has survived and even thrived. In modern times, jealousy is actually promoted. Every advertisement sells an idea that makes you zealous to ‘earn’ that commodity. Earnings- whether economical, social or emotional, always stir feelings of jealousy. You generally want something because you `know’ that someone else can afford that. The zealous are just the masked jealous. To emulate is a yearning, not for self-fulfillment, but for a social sanction. Jealousy is usually not about having, but about not having. To have or not to have is, not a need based decision. It is the product of desire. To kill desires and live in peace is the simplistic teaching of every messiah known and unknown  in this world. If happiness is the basic pursuit of humanity, then the peaceful smile and the graceful simplicity of the portrayed Buddha and Jesus should have evoked tremendous jealousy. Jealousy always spurs one to imitate the object of jealousy and achieve whatever is considered as the other’s achievement. Yet no one has jealously or zealously tried to emulate  Buddha or Jesus, except perhaps for some self-proclaimed God-men or Godly-men who of course have a different agenda to follow.

It is obvious that we all are jealous only of those whom we can easily emulate. A CEO of a MNC can only become jealous of the CEO of another MNC. He normally would not be jealous of the President of India or the USA. Jealousy is therefore based on assessment of opportunities. A columnist would become jealous of a Nobel laureate in literature only if he believes that he has the same potential to create similar works. An author generally is never jealous about an artist. A dancer does not feel jealous about a musician.  There are however, some people who just cannot take it when others win – deservingly or otherwise. These people cannot bear when some one else is in the centre of the spotlight. This is a different game altogether. This is envy- most frequently misused as a synonym for jealousy. Envy is actually an irrelevant, inappropriate and non-productive feeling. In envy I would even hate the plume of a peacock.

Just as how envy is about hatred, jealousy is actually about love! It is love of and for oneself. In a psychosocial perspective, our self is a broad enough term to include our primary family. It is in this societal context that this form of jealousy makes a loving parent become jealous of another’s child and other parents who have won more. When the coveted object is not a social applause but a personal psychosexual gratification, one feels jealousy when the object of love is actually in love with someone else. The primary concept of the mind in these cases is that one deserves much more than one gets, and one deserves so much because of the intense and immaculate self-love. This self-love is not narcissism which by its self consummated nature creates a monument of pride in one’s own mindscape. Narcissism and pride are inseparable while jealousy is essentially about one’s inability to achieve. Narcissism is about having in abundance while jealousy is always about insufficiency. Narcissistic self-love would look down on others while the jealous self-love would keep looking up at others.

Yearning and itching to reach the pedestal that another has reached creates various forms of unrest in the mind. There is sadness that one has not reached the line, and then comes a paranoia that there is a cosmic conspiracy preventing one’s deserved success. The blame game begins. Gods and stars are blamed for not formulating the right design called luck, society and family are blamed for not giving the right breaks. The whole world is blamed for not being capable of understanding and accepting true greatness. The mind sulks. The sulking mind falters. Everything is perceived with disbelief. There is lack of faith in others leading to doubts about self-worth. There is anger. There is bitterness. Simpler things become harder to do. Failures begin. Infinite circles of pain, paranoia, anger and sadness begin. Then and thus, jealousy becomes envy.

Emotions are the mind’s reactions to external events. Emotions though intense are not permanent. We all become angry or sad at times, but the same intensity of the feeling does not last for days and months. In the case of envy and jealousy it is different. Though envy and jealousy are also emotive responses to external events, they cast a deeper impression in the mind. They cloud the mind and colour the perspectives. Everything is viewed through the green-eyed glass of jealousy. Nothing is the same anymore. The affectionate competitor becomes the nasty winner and relationships become superficial societal obligatory chores. Once jealousy sets in, the mind begins to doubt. Even the sneer hides a fear. Contempt becomes a camouflage for failure’s self-inflicted wound. This state of mind can alter the route of life and lead to a downhill blind alley. It is in the best interest of oneself that one needs to encounter and handle feelings of jealousy and envy.

A  psycho-philosophical understanding of emotions declares that there are just three types of feelings – the pleasant, the unpleasant and the neutral ones. Jealousy of course is unpleasant- not only during its acute experience but also in its tragic aftermath. There is only one way to deal with these unpleasant emotions. One has to identify, understand and accept the pangs, causes and confusions of jealousy. The technique is simple. Just start watching the advertisements on the media. It is actually the moral right of every advertiser to entice more than educate, therefore just watch non-judgementally. Products are offered. Advantages are described. Even social reputations are challenged. But just watch. A product is offered for sale. To buy or not should be based on whether one needs it or not. Now examine the need to buy or have. Is it to enhance one’s own pleasurable moments of life or just to display in a corner without even noticing the dust gathered on it? But there are times when we can fall in love with an artifact and empty our purse to possess it. Even this will not create future unpleasantness, except perhaps when the credit card statement does not tally with your bank balance. Uneasiness and unpleasantness begin only when you want to buy or have something simply (and only) because someone else has it. It becomes more unpleasant when you realize that you cannot afford it. So the best way to overcome jealousy would be to become capable enough to afford whatever you want. Capability enhancement is the key. When you are immersed in a full-time activity like enhancing your skills, economy or relationships, there will be not be any time to be jealous.

Just learn to begin to be jealous of yourself.

written 2006

depression , some more

September 22, 2008

There are some who say that Buddha, and for that matter Jesus too was depressed. Perhaps they did display sadness in words and deeds, but that sadness was an emanation of empathy, which made posterity confer them with divinity, and not the yearning for sympathy that is characteristic of a depressive disorder.

Melancholia, one of the early descriptive terms for depression, dates to ancient Greece. All cultures, all over the world have recorded from early times, in epics and poetry, descriptions that would, in modern scientific and medical thinking, be called clinical depression. For centuries many have postulated on the cause of depressive illness, and based on their background and the scientific data available in that period, attributed it to body humors, bile, and in some cultural contexts a curse.

Symptoms are the manifestations of a dysfunction in any mechanism, and when the mind becomes dysfunctional with a depressive disorder the following symptoms are commonly seen- low mood or sadness nearly every day almost the whole day, loss of energy, lack of faith in one’s self- worth, sleep and appetite disturbances, neglect of self- care, inability to enjoy or indulge in previously pleasurable activities. If these symptoms persist and cause deterioration in social / occupational functioning, then the illness requires immediate intervention. In severe depression, suicidal ruminations are common and critical.

Depression, though often considered a reaction to unpleasant events, as an illness is quite common, and rather complex. Various factors contribute to a depressive illness. Genetic, neurobiological and environmental factors are the ones most commonly considered as causes of depressive illness. If you are depressed it does not mean your child is going to get depressed, similarly the chromosomes of your parents are not making you depressed. Genetic possibilities have been debated in psychiatric research but not conclusively proven. However if depression runs in the family, then one can be expected to breakdown more quickly and easily than other people in the face of stress. Unpleasant environment or events can trigger a sad mood which may be a forerunner of the illness spectrum.

Diabetes, hypothyroidism and many endocrine disorders can instigate depression in people. HIV, tuberculosis and some more systemic infections can cause depression. Some drugs used to treat other illnesses can cause depression.

Women in particular have a tendency to get major depressive disorders. Hormonal imbalance and endocrine dysregulation can cause depression.  Preceding or following menstruation some women experience and exhibit mood changes. This is not to be confused with major depressive disorder, in which the mood worsens as days pass. Immediately after child-birth, some women experience a depressive-psychotic breakdown, and this is called post-partum disorder.

When we talk of a major depressive disorder, we should keep in mind that this is an illness, caused not by anyone or anything outside. Neurotransmitters, chemical substances necessary to process functioning in the nervous system are considered as the most important cause of this illness. Therefore medical management is essential.

Medical management of depression involves prescribed medication, and in some rare cases even electric shock therapy is considered appropriate. When the thought process is numbed by the depressive illness, the affected individual cannot be counseled. The neurochemical balance must be restored. This is where the popular `Prozac’ comes into play. There have been anti-depressant drugs much before fluoxetine (the real name for prozac) came into vogue. There are many more newer antidepressants that have been discovered and available in the market.

Antidepressant medicine is intended to regulate neuro-chemicals like serotonin and norepinephrine and the actions of dopamine. There are many types of antidepressants and the choice of the drug for the individual is always based on the clinical assessment of the consulting psychiatrist.

Of course, as with all medicines (including the commonly consumed paracetomol) there are side- effects for each of these anti-depressants. The most common side-effects of antidepressants are constipation, blurring of vision, dryness of mouth, nausea, and in a few cases drowsiness. Depending on the severity of the illness and the side- effect the drug needs to be continued or changed.

It is a myth that medications used in psychiatry are for sleep, and they will be addictive. Many are also under the wrong notion that an individual has to take medicines life-long. These false ideas propel people to take recourse to alternative therapies. Reiki, Pranic healing, Aroma therapy and the whole range of non-pharmacological treatments are widely advertised and therefore acclaimed. They may to a small extent contribute to recovery in secondary depression (which would have subsided anyway over a period of time). In the case of major depressive disorder, only medication will help. Maybe after the initial phase, when the symptoms are controllable and tolerable, these techniques will help the individual to believe in recovery. It needs to be emphasized again and again that major depression being a medical illness needs medical treatment.

Besides the commonly encountered frustrated sadness after a failure, depression comes in many forms. Major depressive disorder is the severe form that needs immediate treatment as it contains a volatile suicidal risk. Sometimes mood swings from the sad end to the excited, both extremes stretching all norms of behavioral expectations. This condition is called manic depressive psychosis. In some cases there is a condition called atypical depression, where the individual would be more agitated and touchy, trying to do things he actually cannot, becoming irritable and losing concentration easily. This condition requires a correct clinical diagnosis for proper treatment.

There are people who always look low, down, unable to laugh and enjoy life, but who are capable of functioning in their occupational role well. They are called depressive personalities, and no treatment is going to bring a ready smile on their face. This is something the individual has learnt from early days. His motto and theory of life would be “I can only lose, so why should I smile, after all being happy does not last long”.counseling does not help these people since their ideas and notions are deep rooted in their psyche.

When someone is down with depression in your intimate circle, keep a watch without making it appear intrusive. Depression invites suicidal thoughts. Give them company, but do not patronize. You cannot make them see sense till the acute phase is over, so do not try to talk them out of it. All you can do in the beginning is to wait for the medication to start working and in a couple of weeks the individual will be ready to listen and understand reality and logic.and then, talk, talk more and talk sincerely.

Some other conditions mimic depression. There are many who apparently seek philosophical and mystic meanings in life, not doing anything constructive or productive. For some this is a mask for their laziness or incompetence. Some like to play the sick role as it generates sympathy and accrues attention. A close and careful observation of the life-style, work pattern and past record will help in distinguishing these pseudo-depressives.

Depression, gloom, fatalistic thinking, pessimism, disregard for personal grooming or comfort, and long periods of inaction are all seen in some artists. Depression does not create an artist. Only the artist, like any other individual can get depressed. It is also a myth that depression spurs creativity since many poets write wonderfully about the state of sadness. Creativity can always find an apt expression whether the mood is sad, happy or angry. It just so happens that happiness is a song while sadness is a poem. Literature abounds with descriptions of depression. William Styrron’s ‘Darkness Visible’ is a beautifully written account of a major depressive disorder. Any artist can create a wonderful work on depression, but not in depression. One has to be out of depression to become functional and creative. The good news is that though depression is debilitating, it is definitely treatable quickly and effectively with the newer drug formulations.

written 2005, part two of the previous post

depression, some thoughts

September 18, 2008

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