Issues in Mental Health: Dealing with Depressive Disorders
By Albert S. Rossi, Ph.D.
There are a number of sincere religious persons, Orthodox and non-Orthodox alike, who view depression as a self-imposed state which the depressed person should “snap out of,” the sooner the better. Well meaning friends and relatives can exhort the depressed person to “get with it,” hoping such advice will prompt the person to be done with the inactivity and begin living fully. A few reflections, based upon information from the National Institute of Mental Health and clinical case studies, might be in order.
We might first consider what a depressive disorder is and is not. Depression is a mood disorder which affects persons of all ages and classes. It is the most prevalent of the mental illnesses and the most responsive to treatment. Many depressed persons do not get treatment, usually because they or their family expect the blue symptoms to disappear. The National Institute of Mental Health estimates that fully 25% of all American women and 11.5% of all American men will have a depressive episode in their lifetimes.
Perhaps the most important insight concerning depression is that it is an illness and not a weakness.. Research has convincingly demonstrated that depression is a deficit in neurotransmitter substances in central nervous system chemistry. Specifically, the depletion of norepinephrine at the synapses of the brain neurons is clearly responsible for the illness we call depression. The reasons for the depletion of norepinephrine are not fully understood but may well be a combination of genetic, bodily caused (somatogenic) and psychologically caused (pschogenic) sources. In any case, the depressed person suffers from a chemical imbalance in brain chemistry.
Everyone experiences transient feelings of sadness and loneliness associated with unhappy events, failures, or emotional letdowns due to personal loss or other causes such as holidays. These are not depressive disorders. Clinical depression is marked by a change in behavior, which often persists, towards lower functioning (that is, not having the desire to get out, work, shop, and carry on other activities as regularly as before) and withdrawal. Usually changes in sleep patterns, food intake, sex and enjoyable activities accompany clinical depression. These changes can continue for long periods if the person does not receive adequate treatment.
Common complaints of depressed persons are feelings of unworthiness, guilt, helplessness, inability to concentrate, excessive fatigue, slowed thinking, or the reverse, agitated behaviors. The symptoms are rather the same, and, depending upon the person, the clinical condition would be defined as mild, moderate, or severely depressed.
Depression in its ultimate form can include the possibility of suicide. Not all seriously depressed persons commit suicide, nor are all suicides committed by depressed persons. About 15 per cent of all severely depressed persons commit suicide. Old age contributes significantly to this figure. However, in recent years there has been an alarming increase in the rate of teenage suicide. Nearly twice as many women as men attempt suicide. More than three times more men than women actually commit suicide.
As is always highlighted when discussing depression, of all the mental illnesses it is the most responsive to treatment. Therapies come in three different modes, used individually or in combination. These therapies are drug therapy, psychotherapy, and electroconvulsive shock therapy (ECT). The drug therapies have become quite refined and specific, generally managing to stabilize the depression in two to five weeks. The two major categories of drugs for unipolar depression (depression not including manic phases) are tricyclics and MAO inhibitors. What can be said about these drugs is that, generally speaking, they work. The psychotherapy which seems to be the most effective is a cognitive, short-term approach which sets about changing some of the depressed person’s thinking and explanatory system. Electroconvulsive shock therapy (ECT), usually used with a mild anesthetic and muscle relaxant to minimize muscular response, has declined in use in recent years. As drug therapy has become more precise and efficient, ECT has been needed less. However, ECT is the treatment of choice for a person who is severely depressed, at high risk for suicide, and either does not respond to drugs or has a drug intolerance.
Appropriate treatment of virtually all persons, older and younger, can bring some relief from suffering and some renewed vigor.
Depression and Despair
Depression becomes a moral issue in terms of what the depressed person does with it, how the person responds to the chemical imbalance, the illness. Obviously, the depressed person’s freedom and guilt regarding the depression cannot be judged by friends and relatives. This judgment can become a serious temptation for those around the depressed person. Often friends and family members think they know the depressed person very well, feel manipulated and become exasperated. The tendency then is to assume a better-than-thou attitude and moralize, telling the person what to do and accusing him or her of gamesmanship and faulty choices.
On the surface depression appears rather the same as despair. They are not identical. Depression is a personality disorder. Despair is a lack of faith and hope in God. While they may have common symptoms, the distinction between depression and despair must be kept in mind. Not capitulating to a bottomless despair, all the while living a gloomy life style, might be quite courageous for some persons suffering from the chemical imbalance of depression. The last thing they need to hear from apparently self-righteous and sincere Christians is that depressed persons are “bad” or “guilty” for being so gloomy and depressed. We simply cannot judge our sisters or our brothers, regardless of how nonfunctional or apathetic they might appear.
Usually depression includes strong feelings of neurotic, unfounded guilt which this family and friends want to be careful not to increase. Depression feeds off itself and depressed persons can be driven deeper into depression by being made to fee guilty about their state. This becomes tricky because being around a depressed person is not easy. Sometimes it even seems as if the depression is contagious and we must become defensive to protect ourselves from it. Anger and impatience an easily aroused in friends and family members around the depressed person particularly if he or she is accusing and rejecting, as is often the case. However, it must be said plainly that angry responses, impatient responses, and moralizing b”. friends and relatives are counterproductive and, called for what they are, sinful.
How Can We Help?
The depressed person is in pain, often suffering acutely, and desperately needs help understanding and support. This does not mean fostering helplessness or assuming responsibility for the depressed person’s happiness. This does mean understanding) and accepting the illness, and loving the depressed person for the real person he or she really is, illness and all. It is more accurate and energizing to view the” depressed person as needy rather than manipulative or slothful or of bad character.
Therapy can be found at local community mental health centers which provide therapy on a sliding scale fee basis. Also, pastors and family physicians are usually reliable sources of information for help. Listings of community mental health agencies can be obtained from the National Institute of Mental Health, Public Inquiries. 5600 Fishers Lane. Rockville. Maryland. 20857.
1. What are some signs that might help us recognize depression in another person?
2. Where might we find help in learning to recognize such signs?
3. How can we help depressed persons? How do our own feelings and attitudes help or hinder us?
Dr. Albert Rossi is an Associate Professor of Psychology at Pace University, Pleasantville, N.Y. and has a private practice in family counseling. He is a member of the Department of Lay Ministries.