Wednesday, May 4, 2011

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.

Read more : depression, some thoughts

Dr.R.K.Rudhran, psychiatrist. chennai,tamilnadu,india.


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