Depression i a: A brief overview of the normality of ‘rise and fall’; ‘ebb and flow’.

Time and again in the composition of these blogs, I have been at pains to lay due and proper emphasis on the familiar and stimulating phenomenon of “individual differences”: this state of uniqueness is our birth right and so I intend at the very beginning of this blog, albeit briefly, to ‘spell out’ what is meant by it and why I consider it’s relevance to be so crucial. We humans, from the moment of conception and onward, share several common endowments and inputs to our growth and developments, which have made/makes us who we are; e.g. inherited genetic potential: an internal chemistry forming and fashioning brain and body, a physical and emotional environment, a common heritage and personal history; and all are regularly resourced by the continual flow of learning and experience. Yet, because we differ from individual to individual – sometimes in small and subtle, at others in major ways – we each can rightly ‘boast’ this genuine and priceless uniqueness.

Now why should I begin this written discussion on human depression for your interest, in such a manner? Well, it is simply because our attempt to describe and understand depression is best served when viewed from a “holistic” (from the Greek, “holos” meaning “whole”) viewpoint and perspective. In one person, depressed mood (which as we shall come to appreciate in future blogs on this subject, is but one of several symptoms required to justify a differential diagnosis of depression may be a perfectly healthy reaction to change or stress and little, if anything, more than that. In another, it can be a precursor to depression in “state” form, demanding gentle and careful monitoring, sensitive and insightful understanding and – at any rate in the broadest sense of the term – treatment.

Most of us will presumably be familiar with that sense of ‘flatness’, which commonly follows in the wake of an output of intense and concentrated energy, or excitement. A patient came to my clinic one Monday in mid-July and in response to my opening inquiry, replied that she was feeling “rather flat and down today”. She continued, “I’m a great tennis fan and I haven’t missed a moment of TV coverage of the Wimbledon fortnight. But well, as you know, it ended yesterday and there is just the bare screen and memories to provide comfort. Everything has been packed away and the players and crowds have departed for another whole year”.

On another occasion, I visited the home of an elderly patient who was being wonderfully cared for by her only daughter who, so she once told me, took a morning job as a secretary to earn some money; but also, “to get a break from mother”. When I called, she had just returned home from driving her mother’s two sisters (and obviously, her aunts) to the airport. They had been across from Canada, for a fortnight’s holiday, she informed me as she closed the front door and we made our way to her very comfortably appointed sitting room. Once there, she slumped into an easy chair. “I’ve enjoyed the change” and – pausing to add,”Most of the time at any rate” – she continued, “The company was quite good and sometimes, they were actually good fun to have around”. Then, after a short pause, she added, “But do you know, I’m all in,…exhausted”. Following a further pause, she added, “and truth to tell, I’m actually feeling quite down”. Or then again have you – or a member of your family, or a friend perhaps – ever uttered words to the effect, “Once these wretched exams are over, I am going to go out and ‘paint the town red’”? And I bet you haven’t and didn’t. Why? Well it was most probably because at the end of it all, you were ‘flat’, emotionally and physically drained, exhausted.

From the above examples, we clearly witness that complex network of interacting impulses and influences, which underpins every human response, in action. Nature has evolved within us a remarkable and hugely effective compensatory system, which as and when required, can elevate mood and arouse or ‘damp down’ feelings. It can alert or inspire us to action or alternatively, enforce rest in pursuit of recovery. In my next blog, I hope to continue from where I an leaving off today; moving on toward an attempted clinical definition of human depression.

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