27/06/2020
A BRIEF STORY OF ‘DEPRESSION'
By a psychiatrist
Depression has truly come to be very common. This is the experience of most professionals and the general population too has become aware of this ‘new’ menace.
But before we talk about its increased prevalence, I wish to talk something good and encouraging about this ‘disease’.
It needs to be stressed that ‘Depression’ is not ‘insanity’ or ‘Madness’ as these words are understood and used by the common man. Most people suffering from any psychic malfunction are haunted by a fear of going mad and it should allay their fears to know that ‘Depression’ is poles away from madness. On the other hand, IT IS A PROBLEM THAT AFFLICTS THE WELL-READ AND THE INTELLECTUALLY ADVANCED PEOPLE mostly. I tell my patients that development of depression in them is a tribute to their intellectual achievement and capability. Many great men, notably Shakespeare have suffered from it. Read Mirza Ghalib’s, ‘pahle aati thee haale-dil par hassi, ab kisi baat par nahein aati; mot ka ek din mukarar hai, neend kiyon raat bar nahein aati’.(earlier I kept laughing at the state of my desire-filled heart but now I can’t laugh at any-thing (smiling and laughing have given me up)……alas, why ‘has my restful sweet slumber vanished from my eyes’? Bertrand Russell the great philosopher suffered from it, he says. And so on. Many famous actors, top Govt., and private functionaries remain under treatment for it. President Nixon had it. It’s no slur but a qualification to suffer from depression.
This little information goes a long way in relieving a patient’s fear lest he be going mad. It fills him with some pride and self-confidence which he is lacking the most then. This small assurance and this little praise often returns the colour on his face and helps straighten up his bowed head and enclosed shoulders. His chest fills up and the tone of his speech at once changes. “I am not insane, on the contrary I am considered intelligent and balanced by a specialist doctor”, he realizes.
The fact stands that depression is not a disease for fools. A fool is ever happy and he also never ages. That’s an old saying. IT IS A "MOOD DISORDER" AND NOT DISEASE OF "INTELLECT" and this is important to note.
Clinical depression represents just an exaggerated form of our occasional moods of sadness or of feeling low and lethargic. Ordinarily most people at some time or the other feel ‘Unwell’ or ‘off-mood and lazy for short periods and then are well again; their usual active selves. Such short episodes go unnoticed. But if the same ‘unwellness’ becomes prolonged or becomes somewhat intense it is called depression and the person having it is taken to a doctor. It is just a matter of degree of ‘lowness’ and it’s duration that separates normal sadness from treatment-worthy depression. And we repeat that it is only a mood disorder, having no work with one’s intellectual functions. It is fully treatable and leaves one’s intellectual functions untouched and unaffected.
While we say this, we must also accept that Depression per-se is not even a disease but a temporary deviation of some personality traits. It is a disorder which one carries in one’s ‘Swabhav’—temperament or blood. Truly it is a temperamental disorder; a combination of a sensitive temperament and a mind that is capable of thinking deeper than usual.
It is felt to be on the increase because of increased and wider spread education of the population making them able to feel an abstract affliction. In earlier times, depression though perhaps as common was not felt or perceived at the higher psychic levels by an illiterate patient and instead he would report only the bodily aches, pains and discomforts that averagely accompany the psychic feelings of sadness, insufficiency distaste for life processes etc. To locate such ethereal upsets, one needs an ability to form concepts while as locating a bodily disorder is far easier. This is called Somatisation. Another thing which a patient should note about this disorder is that if it is not treated or is treated wrongly, it gets well by itself also, with time. It is a self-limiting problem. But who can afford that time these days and also the lag that wastage of a few months can cause in one’s life in these competitive times. Hence, the importance of proper diagnosis and quick treatment now.
An example (copied from my book ‘Pleasures of life) will help explain our points: Parents of an 18 year old, 1st year B.Sc student observe some serious changes in his life routine. Ordinarily he was very studious and meticulous about his books and studies, now he has practically given up his books. They lie open and scattered on his bed but he keeps lying down with eyes closed by their side, often for hours. They had never seen him wasting his time like that. He doesn’t leave his room and has given up meeting his friends, whose company he was earlier very fond of. Hardly telephones anyone; never asks for food or other eatables as in past and when offered, eats a portion to return the rest saying he has no need for these. When pestered by parents as to what was wrong simply replies ‘I don’t know and sheds tears. This boy was honest not to blame any of his body parts for his problem because he could find no fault in any part. At the same time he had not yet acquired the ability to form concepts about vague undefined feelings originating within him and so could not verbalise his problems in concrete terms. We will say he was unable to conceive and understand these new happenings in himself. He had earlier experienced happiness in life as a child but never thought of it as something external to himself and never needed to pay special attention to that feeling. In place now he finds a new and a very different so far unknown feeling to have replaced his earlier world of happiness. He finds it totally foreign to himself and yet cannot put its various elements in place to say that he is perhaps feeling sad. It’s a new concept that he had to form. And concept formation assumes first a perception of happenings and then putting and relating these fragments to each other so to form a meaningful whole which can be communicated in concrete terms. The boy instead could feel having got trapped in a dark tunnel with no visible lights of exit on any side. It can be a desperate situation and he can conclude that his entire life could be equally dismal. He is filled with fear. And su***de appears a logical solution. In contrast to this psychic type of depression projecting ones feelings and ideas onto a body part is far easier and when that happens we call it Somatised (soma= body) depression. Perceiving and locating a discomfort in one’s abdomen or some pain in one’s back or joints or head-aches is far easier, not needing any special skills. And that is what is easily done by an illiterate housewife etc. And such were the patients that predominated earlier. And even now they report first in medical or even surgical OPDs. The untrained doctors treat them with vitamins and pain killers for months. So we may as well, for the sake of simplicity and understanding classify ‘Depression’ in to just two groups, viz., Conceptual or Psychic depression and Somatised or Masked depression.
In earlier times it was the somatised depression that was common in an illiterate population. Now it is the Conceptual form that is getting more common because of higher educational and general-knowledge spread especially in the cities. This, my hypothesis needs scientific verification, however. Another reason often forgotten during evaluation of many serious diseases is the unprecedented rise in the country’s population as a whole and of its cities in particular. Our Asians breed like pigs and rabbits and so the proportionate increase in cases too. Earlier the villager patients got themselves treated by godmen till the disease vanished by itself. In any case both types of the malady respond to modern treatment equally well and quickly; please note.
It is interesting to talk about the cause of depression and its treatment and perhaps more interesting to talk about its prevention but that will be in my next.
Before we close, I would like to suggest to the reader to try imagining whether he can at will perceive ‘Sorrow’ or ‘sadness’ in his own self. Can a person feel its taste? Perhaps it is difficult, like for a person with a full stomach to imagine and appreciate hunger pangs especially in others. Pains of real depression can, however, be excruciating, felt deep somewhere and the person finds himself helpless and trapped. It can be a disgusting experience and many sufferers are convinced that they can never come out of it. I say this because a person who has never felt that real pinch of sorrow ;it’s sharp cutting edge, may perhaps never know and experience real joy as well and he equally will never try to search for it in life. He may even laugh when told about it. You are wrong if you think millions can make you happy and joyful. That is a universal delusion, a mirage. Money can purchase everything but not joy. And to repeat a fact, you can never feel and more importantly value pleasure if you have never felt a pang of real sorrow in your heart. It is a person’s real good fortune and true greatness if he can empathise with others and share their suffering. Conversely a man who has all his life lived in affluence can never appreciate the suffering of those in ‘want’; he can never appreciate how and where it hurts. That insensitiveness of man is the background plot for an unending human tragedy.
Dr. C.L.Ganjoo md.
Author of ‘Pleasures of life’
(Book published by Amazon USA)
Email: drclganjoo@gmail.com
Mobile: +91 9891427495
