Depression ii a: coping with life’s ‘deeper ‘troughs’.

Hopefully, my most recent contributions in this form will have afforded you with at least a glimpse into the variability of human responses, mood-wise that is. Consequently it is clear that depression is always likely to be a highly complex human condition. Indeed – and although in the final paragraph of last week’s blog I have provided what most experts in the field would agree is a fairly adequate working definition – in practice, the term depression is used in a host of different ways. From antiquity to the modern era, writers and commentators on the subject (known in earlier days as “melancholia”) have, more often than not, failed to achieve a consensus. Indeed, there still remain important aspects – both of terminology and substance – which ‘fuel’ discussion and debate, as witnessed in published papers on depression appearing in learned and scientific journals in there hundreds, year on year.

Not surprisingly therefore, depression generates great interest and concern, especially among those caught up, in one way or another, with the management of serious/life-threatening illnesses; (but by no means, not only so). In the first place – and not surprisingly – any individual in any community or society, whose ‘run-of-the-mill’ interests and activities have been suddenly and unexpectedly interrupted, threatened and in some cases, devastated by such illness is, to say the least, likely to be more vulnerable to it. Second – and as witnessed in the foregoing blog – that vulnerability is likely to be influenced and moderated by individual differences, i.e. will depend upon the range and norm, in this sense, on their unique ‘dial’.

A third point of great relevance and importance is a key aetiological (causal) factor, which distinguishes different types of depression, as follows. “Psychogenic” (sometimes referred to as “reactive”) depression, is an internal reaction to an external event(s) and circumstances, i.e. past and present experiences: loss of one’s job or of a valued relationship /friendship, perhaps even by death. “Biogenic” (sometimes referred to as “clinical” or “major”) depression is similarly an internal response; but this time brought about by chemical changes taking place within the brain as a direct outcome of treatment side effects. Such unanticipated and “unprepared for” episodes can ensue from some intense physical and/or psychological impact, capable of inducing sudden change, inflicting intense psychological trauma. In other instances, it can be drug-induced, e.g. an unavoidable, sometimes potentially toxic side effect of, for instance, certain forms of cancer chemotherapy.

In point of fact, we really should, of course, make the point before going any further that every single human response – is biogenically induced, in that there is an essential biochemistry underlying and underpinning it. However, as we are using the terms “psychogenic” and “biogenic” here, we are referring in very precise terms to initial causation, i.e. what ‘triggers’ it in the first place, if you see what I mean. This latter point is more readily made and understood by means of an example from real life.

Stephen was a patient of mine whose life suffered adverse change in a most sudden and traumatic manner, over a span of less than six months. The unfortunate and unhappy sequence of events began with the tragic loss by sudden illness of their little daughter Gillian, aged three years. Stephen’s wife Marjorie was in the advanced stages of her second pregnancy when this terrible tragedy occurred. Within a few weeks of Gillian’s death, Marjorie was delivered of a baby boy Ben and just six weeks later, he, i.e. Stephen, received a diagnosis of Hodgkin’s disease (malignant disease of lymphatic tissues). Fortunately, Stephen’s illness was diagnosed at about the earliest stage that such a malignancy is detectable and following necessary tests etc. he was placed on treatment almost within days. Happily – and in terms of his response to treatment – things went well for Stephen on the ‘illness front’ and he made excellent progress through to good health once again.

Some 18 months on and now back to working fulltime in what Marjorie one-day described to me as their “drastically changed normality”, Stephen began to run into difficulties once more. This time however, it seemed to be in no way directly related to his recent cancer illness. According to Stephen’s own report the first sign of this deterioration was an increasing inability to sleep at night. This not unnaturally led to feelings of chronic tiredness and bouts of utter daytime exhaustion. Consequently, his enthusiasm for his job as a civil engineer began to suffer. Indeed – and for the very first time that he or anyone else around him could remember – attention to important and sometimes essential detail began to suffer badly.

Not surprisingly, Stephen’s self-confidence also suffered a decided downturn. Making decisions became increasingly difficult and his ability to concentrate was – well let me use his own words, “Next to non-existent”. As for Marjorie, she had continued unceasingly to support and encourage him in every conceivable way. However, it was now becoming plainly apparent to her and others beside, that her normally caring and attentive husband was becoming progressively more impatient, irritable and seemingly lacking in his customary understanding and insight. Over the time of his illness, I had come to know Stephen very well and as things appeared now to be deteriorating almost by the day, I made time for him as and whenever. One ‘regular attender’ in the daily round of feeling that troubled him (and Marjorie also of course) was that of guilt concerning a growing disinclination to spend time with Ben. What happened next will provide the subject matter of my next blog to you on this topic.

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