THE BLACK DOG OF DEPRESSION-
“A man has many skins in himself, covering the depths of his heart. Man knows so many things and yet he does not know himself. Go into your own ground and learn to know yourself there”- Meister Eckhart.
I have often sat with clients and heard them say “ I don’t know if I am depressed…what exactly is depression?”
This article is aimed at people who are wondering whether they, or someone close to them is suffering from depression. It will provide basic information relating to diagnosis, causes, psychological treatment modalities and offer some useful resources to explore.
Below is a depression checklist adapted from the DSM IV-TR (The Psychiatric “Bible”). If your symptoms (or someone close to you) are congruent with some/ or many on the checklist, this does not necessarily mean you are clinically depressed. If however you recognise 6 or more symptoms which have lasted for a period of 2 or more weeks, more days than not, it would be advisable for you to visit your healthcare provider.
- Significant loss of energy, fatigue, feeling slowed down
- Feelings of emptiness, persistently feeling low and/or anxious
- Loss of interest in pleasurable activities, including sex
- Disturbances in sleep patterns (insomnia, oversleeping. early morning waking)
- Moderate/significant appetite/ weight changes (gains or losses)
- Recurring thoughts about death/suicide or suicide attempts
- Pessimistic, hopeless feelings
- Feeling worthless, guilty and/or trapped
- Memory lapses, loss of concentration, inability to make decisions.
- Physical symptoms: aches and pains not caused by a recognizable physical cause or disease. (chronic back pain, stomach or headaches)
The many faces of Depression:
Listed below are some (and by no means exhaustive) examples of the many different paths that Depressive illness can follow.
- Dysthymia is a chronic low-grade depression which lasts for 2 or more years.
- Major Depressive Disorder is chronic, recurrent depression. It is characterized by sharp, severe episodes, which are often (but not always) triggered by environmental stressors (e.g. loss of employment). These episodes can also manifest when life is perceived to be going well.
- Single episode depression occurs when a person who has previously been unaffected suddenly develops severe depression.
- Postnatal (postpartum) depression is recognizable in that ‘feeling blue’ lasts longer than 1-2 weeks i.e. it is ongoing.
- Bi-Polar Disorder (previously called Manic-depression) This form of depression is called Bi-polar because the person alternates between one emotional pole (down/depressive) and another (up/manic). The manic episodes can last for weeks or even months, as can the depressive episodes.
Manic Symptoms include:
Decreased need for sleep
High levels of distractibility
Flights of ideas or racing thoughts
Some interesting statistics:
Although accurate South African depression related statistics are difficult to come by, the World Health Organisation claims that depression is one of the fastest growing illnesses on the planet. Depression can affect anyone, from any demographic, it does not discriminate with regards to age (approximately 3% of children and 5-8% of adolescents in the U.S. suffer from Clinical Depression). Those suffering from depression are 30x more likely to commit suicide than the general population. Approximately 2x more women attempt suicide than men. Men however are 4x more likely to die from their attempts due to using more lethal means.
So what actually causes depression?
Depression can come about because of personal loss, financial problems, physical illness and stress. Such events constitute environmental cues
Psychological and Chemical Factors
Powerful psychological forces also influence the course of depression. For example, an individual may have circular, self-defeating thought patterns which leave one feeling exhausted and “stretched”. When depressed, the mind often runs rampant, spewing all manner of toxic (often unsubstantiated) thinking into the thought stream. Imagine a swimming pool without a filter, soon the water becomes brackish and green. The brains neural highways carry this toxic thinking using neurotransmitters as surely as they carry any other feeling and thought in the human experience. Biochemical and psychological forces within the brain have a close relationship and need to be explored in order to re-establish equilibrium.
The origins of depression can also include genetic factors. Genetics, environment and biochemistry are also closely linked and while there clinical evidence of depressive heredity, it does not mean that one will develop depression if a relative has depression. Excessive pressure on genetic loading through biochemical and environmental stressors may activate depression within the individual but the converse is also possible, that with an effective, integrative strategy for managing low mood and stressors one can offset powerful genetic precursors.
The road to healing.
We are no longer in the Dark Ages regarding the treatment of depression. There are a variety of chemical and psychological treatments which have been show to be incredibly effective in the battle against depression. The list below is a brief descriptor of current psychological strategies for dealing with depression.
Cognitive-Behaviour Therapy (CBT)
The goal of CBT is to address the client’s self defeating patterns of thought and how those thoughts translate into negative attitudes and destructive behaviours. Therapy focuses on challenging self-defeating assumptions (cognitions/thoughts) as well as giving exercises designed to modify outward actions (behavioural aspects). CBT is a tool based, short-term intervention which can range anywhere from 6-20 sessions.
Exploratory Therapy (Psychodynamically orientated psychotherapies)
The core goal behind exploratory therapies is to resolve long-standing, sometimes unconscious conflicts and repressed feelings within an individual. An example of this type of work would be a thorough exploration of the complex relationship dynamics that exist between a parent and child (father and son, mother and daughter) and what the individual has internalized, repressed feelings, working models of the world (and how this model affects his/her world). Exploratory therapies are medium/long term interventions.
Mindfulness Based Therapy (MBCT/MBSR)
This type of therapy focuses on the restless nature of the mind and its role in generating depressive thinking. The individual is shown ways of developing the capacity to remain present as opposed to being caught in a ceaseless reactive or aversive cycle. I often tell clients that it shifts one from being an actor moving unconsciously through their script to a curious member of the audience who can observe the nature of their minds without constantly being caught up in the drama.
This brief outline is aimed at providing information and possibly a mere glimmer of hope to those of you in the grip of depressive illness. If you or someone you now is suffering from depression, I urge you or your acquaintance to undertake a journey into therapy. Healing is not only possible, it is probable.
The Invisible People
“You can judge a society by how they treat their weakest members” Gandhi
Since psychiatric care was decentralised last year in South Africa, patients have been moved from hospitals into community day hospitals that don’t have the appropriate resources to deal with mental illnesses. As a result, many of society’s most vulnerable have slipped through the cracks in the system and now walk the streets like invisible people.
You see some walking down the verge of highways, muttering and gesticulating to themselves, others crouch on the pavements outside busy eateries, invisible to the well-heeled patrons. The invisible are not ghosts of souls passed over, they are people who live among us, with beating hearts and blood flowing through their veins, mothers and fathers, sisters and brothers, each with a unique deep story to be told. This is one such story.
Nosipho* is a 36 year old woman who hails from the Eastern Cape. Although she grew up under Apartheid, she was able to attend a local convent school where she thrived under the tutelage of a benevolent English teacher. She was a bright student who enjoyed writing stories in which she fantasized of escape from her small, poor community. In her stories she was a gospel singer who would travel the world and sleep on soft beds with many clean crisp sheets, which would keep her warm and safe. Even at 15 she knew that she wasn’t going to be famous, that she would probably have to drop out of school soon in order to look after her small sister as her grandmother was ailing fast, but the fantasy lingered and soon she began to discover the signs…
At first, the signs were few and far between, a stone turned over in the dust was a clue to be followed, Nosipho heard her name mentioned on the radio whenever she came into her grandmother’s room and seemingly random events began to appear linked. Soon the signs multiplied, one upturned stone lead to another, she would hear her name whispered on the wind and yet when she turned around, no one was there. Her friends began asking her if she was smoking isango (cannabis) because she appeared entangled in a dream-like stupor. A grin became the mask she wore to fend off the constant questioning of her peers, a grin she wore to trap the tears at her grandmothers grave. After the funeral, her mother returned to Cape Town to look for work, leaving Nosipho with her eight-year old sister. It was hard to be a mother when she was still just a child herself.
The days were long and difficult and when she could finally come to rest the cacophony of voices would begin their weaving dance. The voices she heard sounded as if they came from the space outside of her, sometimes they would shout incoherent nonsense right next to her ear, at other times the voices would sound as if they came from far over the barren horizon. One of the voices was recognisable, it was her grandmother who told her that she had been bewitched by an inyanga (medicine-man) and that if Nosipho did not go and find her mother in Cape Town soon, her sister would die. Every day the voices grew in strength and soon Nosipho would not leave the house for fear of being attacked by spirits sent by the inyanga. She would leave the house just before dawn, when the voices were still asleep, to arrange small piles of stones around the home to protect the sisters. Soon she forgot to wash or get food and her worried sister brought shuffling, concerned elders into their cluttered room where they found Nosipho muttering into her tattered shawl. People in the village began to look at her strangely and whispered behind their hands when she passed. One night, after a particularly harrowing day during which she been viciously beaten by other children who had called her cursed, she fled to Cape Town, to find her mother, a night some 20 years ago.
Today Nosipho is still searching for her mother. Miraculously she has managed to eke out a thin existence living on our streets or in caves scattered though the rain soaked mountains of Cape Town. For the past month she has sought shelter behind the blazing red bougainvillea beneath my balcony where she laboriously wraps black plastic bags around her head to fend off the razor sharp voices that continually torment her, even in her sleep. A few months ago, I went with Nosipho to the day hospital to see the Psychiatric Sister in order to get her antipsychotic medication which could radically change Nosipho’s quality of life, but after 3 hours of waiting in line (with no identification documents) I had to return to work and Nosipho fled soon thereafter citing the accusatory stares of others as the reason.
A 2007 study by the Medical Research Council revealed that 1 in 6 South Africans struggle with a mental disorder. Many of us have experienced bouts of mild depression and anxiety in our own lives, but living with severe mental illness requires great courage and the road to recovery is often long and hard. Patients admitted to Valkenberg often come from disadvantaged communities where there are not the resources needed to provide necessary support. Many families and communities are overwhelmed from the strain of caring for the person with a severe mental illness. Thankfully, there are small groups of volunteers who work diligently to offer people like Nosipho some measure of aid.
Organisations such as The Friends of Valkenberg Trust-021 447 2092 and Cape Mental Health- 021 447 9040 are always in need of volunteers and donations of any kind. As South Africans who have overcome so much in our own troubled history should we not open our hearts and find our compassion for those among us who are in such desperate need our aid?Read more