Depression: Some final thoughts.

I have decided to write this postscript, because as is often the way with afterthoughts, they emerge from a ‘thicket’ of focus and concentration on a given topic (in this case, depression) and are often at least worthy of articulation and further comment. I hope you may agree.

How many times over the years have I carried out domiciliary or home visits, only to find on arrival that the patient had become so much the focus of attention, that everything needing to be done (as well as much that needn’t) is being duly and dutifully carried out by others? Some years ago I knew a male patient who unfortunately had contracted bladder cancer. A consultant oncologist, whose opinion was that his patient was now “losing ground” had referred Alistair to me. Also – and based on his wife’s report – her husband was becoming “increasingly moody, depressed and dependent” as day followed day. As it happened, I had once known Alistair ‘in another life’, if you see what I mean, several years earlier. In those days he had been an extremely pro-active Trades Union official (although that was not the capacity or context in which I had known him). In everything that I had learned of him in those days, Alistair had appeared to possess drive, tenacity and at times, a rather innovative approach to life, both within the home (especially in DIY) and in his occupational and leisure life.

Following his referral to me by his consultant, Alistair attended my clinic on a few occasions; but I knew that I was missing something and after he had failed to keep at least a couple of appointments, decided the time had come to pay a home visit. At the precise moment of my arrival, Dorothy, his wife was ‘whirling’ a hoover around the living room carpet. “Come into the sitting-room”, Alistair invited. “We’ll get more peace in there”. There then followed a sequence of events, which quite fascinated me and were indeed, very revealing.To begin with, it soon became clear that Alistair was waiting for the first pause in hoovering to occur and when it did, promptly opened the door, calling through to his wife, “Dorothy, could you put the kettle on pet for a cup of tea?” As events transpired it was evident that this not only meant “put the kettle on”, but also, ‘make the tea, let it brew, put the pot, cups and saucers (not forgetting my patient’s favourite brandy snap biscuits) onto a tray; bring it all through to the sitting room on a trolley, pour it out and give me the cup of tea and a biscuit (and presumably, hopefully, one for the visitor) in our hands. Within minutes, a laden tea trolley duly arrived, just as the doorbell rang, which Dorothy hurried off to answer. For a moment I was tempted to intervene and pour the tea myself. However – and if honesty is to prevail – I really wanted to see what happened next. So I remained firmly in my comfortable armchair, from where I had a ‘box seat’ view of proceedings.

At length Dorothy – who in between time, had not only answered the door and responded to the telephone (although I should add that there was a receiver in the sitting room well within Alistair’s reach) – smilingly ‘busied’ into the room, wiping her hands on her ‘pinnie’. Before she could so much as even comment on the untouched tea trolley (if that was what she intended) Alistair greeted her with, “Ah, there you are. The doctor’s dying of thirst here. We were beginning to think that you had decided to leave me”.

Perhaps I have said enough in the above account, to at least introduce an important concept, known as, “learned helplessness” and I shall write more on this topic in my next week’s blog.

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