I wanted to help a man who had major mood swings. For some months he would be depressed and unable to work. Then he would become 'high', having prodigious energy but in reality not being able to perform sensibly. The difficulty was that when he was low he couldn't bear to unburden himself to a doctor. And when he was high he had 'never felt better' and saw no need of one.
I have had to deal with a number of people with similar problems. There is a window of opportunity, as the individual swings from one extreme to another, when it may be easier to get through to them and explain their needs clearly. There are now good mood stabilizing drugs which can help such people - if they can be persuaded to take them regularly.
Every year the average general practitioner sees between 60 and 100 patients who are clinically depressed. Most do not experience swings of mood. They simply feel 'down' for weeks, months or even years. Many others are walking round with depression which has not been recognized.
Clinical depression must be distinguished from the perfectly normal, but temporary, feeling of depression which arises from something like a bereavement or a job loss. Depression, the illness, is quite different and may well arise out of a clear blue sky. One hazard is that people who have experienced 'normal' depression often think that this gives them valid experience in dealing with clinical depression.
Depression is hard to cope with if you suffer from it, difficult to understand if you don't, and frustrating for those close to a sufferer.
The attitudes of society to clinical depression, and indeed all mental illness, are often so lacking in understanding and compassion that they worsen the condition of the sufferers.
The way in which we handle mental illness is a good test of the maturity of our society. All illness used to be regarded as something visited on people. It could be the result of sin - either their own or others.' This 'model', which emerged in a more religious, but not more enlightened, age presumed a degree of fault somewhere. People who were healthy could easily regard themselves as 'spiritually' fitter than those who were sick. Today we would distance ourselves completely from this view. When it comes to physical illness the more likely response is 'there but for the grace of God...'
But what about mental illness? Does a vestige of this view linger? It is not so easy (yet) to explain such illnesses, and we can still ascribe fault to the sufferer. Who has not thought or said to someone with depression - 'pull yourself together,' 'don't be so selfish' or 'think of others'? No one would dream of saying such things to a friend suffering from a heart attack.
There are many risk factors for a heart attack, and it may be helpful to think of depression in a similar way. It, too, is an illness which may have been building up for some time. There may well be a genetic predisposition, or something may have happened in early life which remains hidden and unhealed - such as abuse. There may be new stresses, such as the loss of a loved one, or an intolerable job, which act as a trigger. Hormonal changes make a difference - hence post-natal depression, menopausal depression and the minor mood swings that many women experience at certain times of the month. There appear to be chemical changes in the brain, which can be partially reversed by antidepressant medication even though it is still not understood why the changes happen. It is likely that future research will provide ever more specific medication.
Because there are many causes there are many treatments, including anti-depressant medication, mood-stabilization medication, counselling for those who have had traumatic experiences, and formal psychotherapy for those with more profound damage. Hospitalization may be necessary as depression can, like a heart attack, be fatal. The possibility of suicide needs to be an ever-present concern.
Depression can affect those who care for the sufferers very deeply. Within a marriage, for example, the sufferer may be someone who has always enjoyed going out and having fun. A change to feeling unable and afraid to go out is very distressing for the patient. But it is also difficult for the partner who cannot continue doing the things that he or she loved. If they reveal their pain this makes the sufferer feel worse. If the relationship depended on what they did together it may be in danger - and that, too, deepens the depression.
The reaction of the partner, therefore, is crucial to the well-being of the sufferer. The partner thinking that the one they love is in some way to blame for not snapping out of it both makes the illness worse and threatens the relationship. It is surprising how often those involved in such situations fail to realize what is happening.
Amongst the people I have treated there have been a few who were desperately ill; rather more who were seriously affected and a large number who were inconvenienced but managed to navigate. The main difficulty has been in encouraging those who are ill to take treatment. So many are afraid of medication - perhaps because they fear side-effects or don't want to show 'weakness'. Some become so anxious that they are afraid of getting better and having to do the things that frighten them. They require a great deal of care. And that is often given by friends and relatives who are understanding, totally non-judgmental and who do not regard themselves as amateur psychologists and psychiatrists. Many who shy away from giving advice on most medical matters have a misplaced confidence when it comes to psychiatric advice.
What do I consider the best therapeutic agent? Many recognize the need for holistic medicine, for inner healing and wholeness as well as 'cures'. This is needed by each of us, not just those we designate as ill. Because we live in a secular age, some have lost touch with a deeper understanding which comes from faith. This does not just mean prayer for instant healing. Such a miracle may be given but sometimes the answer which we receive from our silent beseeching to the God we may just hope is there is a deep trust in his mercy. We come to know that he can heal us and will be with us through the difficulties. That sense of God's love, if it is given, is the most important of all therapy, though it helps to recognize that a feeling of an inability to reach God can itself be a feature of the illness.
Those who discover such truths for themselves seem able not only to withstand the distress of illness but also to grow through it and become more understanding, more compassionate and more sensitive. They become less of a burden on those who care for them. Unwelcome as the illness is, it can be used for good.
Mental illness still frightens us because it is strange and unknown. But perhaps we should be grateful for the things which we don't know and cannot control because they can help to lead us to different and profounder truths.
Having lived in big cities for years I became used to a rather empty night sky. When we moved to the country I was staggered by the brightness of the stars. Sometimes the light of conventional wisdom, which we use all the time to uncover answers to our problems, simply obscures the world beyond.
Looking at depression, rather than being depressing, can perhaps lift our eyes upwards to the great unknown!
