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In the previous column I wrote about normality and abnormality and forwarded the notion that regardless of one's ideology there are people whose behavior or mood is not normal. Who even cares what is normal and what is not? From a physician's point of view, this distinction is very important as we have treatments that can relieve the psychological torture associated with some untreated mental illnesses.
Treatments for mental illness rarely cure a patient (neither do most non-surgical treatments for non-infection based illnesses). Rather, they reduce the symptoms to a tolerable level. This is of no small consequence. By just reducing the symptom intensity, patients' and their families' lives can be greatly enhanced. Indeed, one of the great advances in the treatment of the medically ill (notice I use medically ill interchangeably with mentally ill) after the discovery of antibiotics has been the discovery of antidepressants.
What makes depression an illness and treatable? Let's go back to the normality discussion. Traumatic or disturbing events usually cause feelings of sadness. These feelings can run the gamut from mild to extreme. For example, extremely traumatic events can cause intense or overwhelming sadness (self evident so far). For those without depression, the sad feelings are usually mild and short lived. What happens when the sad feelings don't go away? I guess you can try the old remedy of trying to pull yourself up by your boot straps. But what if that fails? Well, now you're in the realm of clinical depression, which can be broken down into major, minor and even a potentially new category, sub-syndromal or very small depressions.
Bereavement is a natural place to begin in separating normal sadness from abnormal sadness (depression) . We all experience bereavement over and over throughout our lives. I think that bereavement should be added to that list of inescapable events, the others being, birth, death and taxes. Bereavement is the state of grief that a person experiences with the death of a loved one or with a major loss, e.g., relationship, job, etc. Depression is a state where the predominant emotion one experiences is sadness and is often accompanied by vegetative signs. How do both of these states where sadness is found differ?
In depression there is often not a precipitating event or, if there is one, it is generally not of an extreme nature (this is especially true in people with severe recurrent depression). In bereavement there is a death or serious loss. Depression tends to foster unremitting thoughts of sadness, guilt, and lack of a desire to live. The sadness of bereavement usually comes in waves only when we think about our loss. Depression often produces a state in which persons are unable to effectively perform their job or participate in their family. Depressions tend to be long lasting, e.g., from months to years.
Bereavement on the other hand, does not interfere with one's life; it may alter it but doesn't stop it. Finally bereavement is time limited. This doesn't imply that thought about the loss will not sadden, but rather that we are able to pick up our lives and move forward without impairment.
Just as you can be a little sad, you can also be a little depressed. Big depressions have been recognized since recorded time. Recent research is showing that people can have minor depressions that last for years. One way to think about mood is that it lies along a spectrum. For depression the spectrum can range from small to profound.
A person with minor depression is sad more than half of the time, with the sadness being accompanied by one or two vegetative signs. In major depression one is depressed more days than not and the depression is also accompanied by vegetative signs. Vegetative signs include poor sleep, low energy, poor concentration, poor appetite, and being agitated or slowed down. Other signs are loss of interest (this can range from loss of interest in sex, to not enjoying usual hobbies), guilty ruminative thoughts and recurrent thoughts that life is not worth living.
The form of depression a person has will determine what therapy is offered. Just as in treating hypertension, where blood pressure can range from normal to very high and the treatment offered is dependent on the level of pressure, so is it with depression.
Next column, treatments for depression.
© 1996 Peter Melgaard Thompson
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