Wednesday, April 23, 2014

Depression - How To Identify It In Yourself And The Beginning Of Self-Help

Firstly, are you really depressed? Here are some simple little tests to help decide:

1. (a)Do you get relief from talking a lot about your problems? Or (b)have you become uncommunicative and say very little about anything at all?

2. (a)Do you get relief and perk up when friends visit? Or (b) would you rather your friends stayed away?

3. (a)Do you attribute your depression to the ill-will, hostility or incompetence of others with whom you are currently involved in your work or personal life? Or(b) do you blame yourself almost entirely and think badly of yourself?

If you answered "yes" to the second part (the "b"s) of these 3 questions then you might have very serious depression and should go see your doctor as soon as possible. If you said "yes" to the first part of these 3 questions or felt that neither part applied to you then you may have what used to be called "neurotic depression" and have a high chance of being helped by the methods in this program right now.

This even simpler test can give you a clues as to whether or not you need help to deal with depression:

1. Have you been feeling sad or depressed virtually all of each day for at least 2 weeks? 2. Have you lost interest in the things that once interested you and in fact have lost interest in just about everything?

If you answered "yes" to both of these questions then although the self help program may have a high chance of helping you, it is nevertheless very possible you suffer a major depressive illness and should consider seeing a mental health professional for further assessment.

For a more comprehensive but still brief free test for depression you could go here:

2. Reactive depression. I call it "bad luck depression". If you are sacked from your job especially when you have a big credit card or other debts and obligations, if you are going through divorce or your business has failed, or if your house has just burned down or your superannuation funds have collapsed, you failed your exams, or you've lost a court case, or your children have been in trouble with the police or school - then you can expect to be depressed! How serious is reactive depression? Once the life crisis passes we usually make a recovery and become our old selves. Nevertheless it can be severe enough to lead to suicide and if the stress goes on too long the depression sometimes becomes "endogenous" and hard to shift. We become chronically depressed and negativistic, can't shake ourselves out of it and treatment becomes necessary. Recognising the depression and following this program could help a lot. If you've been daydreaming about suicide as a way to end the suffering and the dilemmas in your life then you must go and see a mental health consultant.

There are 2 special kinds of reactive depression that need to be mentioned, and because they are special, and severe, the DSM1V puts them in a category of their own, even though at a common-sense level they are forms of reactive depression - because they result from meeting unfortunate and unhappy circumstances. These are bereavement with consequent grief, and posttraumatic stress disorder. The grief of bereavement can be very long lasting and sometimes needs medical intervention. The support of family and friends is important. Face to face counselling is strongly recommended. The support of a religious or positive life philosophy also helps many people deal with their grief. Don't "go it alone". With regard to posttraumatic stress syndrome, face to face intervention is needed. If you have "flash backs" to the time of a horrifying or life threatening event, avoid associated places and situations and have a fearful pessimistic view of your own future then it is likely you have posttraumatic stress disorder. Once again, you must not "go it alone" but rather consult your doctor or mental health professional such as a psychologist or psychiatrist as soon as possible. The bottom line to genuine posttraumatic stress disorder is that it needs medical intervention and long term monitoring.

Clinical Depression This term really means that you are not just naturally down because of the mortgage payments, the bill from the vet and the bad report card your child brought home but that you do indeed have depression to the extent that it can be considered an illness because it is a source of suffering and interfering with your productivity and enjoyment of life. However, if you find you cheer up when agreeable company calls, that you seem to get relief by talking a lot about your problems, and perhaps can identify people in your life who you think (rightly or wrongly) are committed to making you miserable or undermining you then your depression is unlikely to be the most serious type.

Some sufferers of depression are described as "cyclothymic", "bipolar", or "manic-depressive". The term cyclothymic is likely to be used for the less serious forms of mood swing. The term manic-depressive is used for the more serious cases which at the poles of depression and hypomania or mania are serious enough to be considered psychosis. The time lapse between these poles can vary very widely from person to person and there can be periods of normality in between. In the early stages of the manic phase the patient simply feels good, buoyant, energised and can be genuinely very productive. As the condition proceeds though the patient experiences a "head like a can of worms" and cannot focus attention. Grandiosity is sometimes a feature of the hypomanic phase with the patient adopting an air of supreme confidence, social boldness and careless spending. This can make the person seem charismatic to others who seek to feed off that confidence and aura of success.

The No-Win Dilemma Face a firing squad, or be hung? Sometimes life puts us in a situation of having to choose between alternatives none of which offer us escape from unpleasantness. One of my case histories resulted from a situation in which a very pleasant well liked man committed suicide. He had been carer for his disabled wife. None of their friends had ever guessed he was so depressed and filled with psychological pain he would even consider suicide. One can only speculate on his thinking. He might have felt himself to be trapped with no honourable way out. In suiciding, his wife was still left to find care plus having to cope with the psychological misery of totally unjustifiable self recriminations. When we get into a very anxious and depressed negativistic state we not only "catatastrophise" (a neologism used by American psychiatrist Albert Ellis) but our thinking and creativity becomes grossly restricted. We can't see the obvious and we become prone to "fixed pie" thinking. A parable to explain what I mean: Two sisters argued over an orange:

The sisters finally decided to end the argument by cutting it in half, each accepting just half of what she really wanted. Only then did they discover that one of them only wanted the juice for a drink and the other only wanted the skin to grate for a cake. It is no accident that Fritz Perls, an American psychiatrist famous for training psychotherapists made a training film entitled "The Philosophy of the Obvious". When we are depressed or anxious not only does our "vision" and creativity become very restricted i.e. we get "tunnel vision", but easy tasks look too hard to face up to - we suffer lowered ego strength. In situations like this it very important to get professional help. A psychologist can help you by boosting your ego strength which can put an end to procrastination enabling you to find the strength to do what has to be done, and help you with problem solving strategies.

The Curved Ball Shattering news from the doctor, or from a knock on the door: Everything I've said about dealing with the "no-win" dilemma applies here. Don't go it alone!

Existential Neurosis I used to call this "ageing intellectual" depression but in reality one doesn't need to be either ageing or an intellectual to suffer this kind of depression. Only a few text books mention this kind of "neurosis" as it does not fit squarely with official diagnostic syndromes. It was described by S. R. Maddi in the Journal of Abnormal Psychology, 1967, vol. 72. It involves in essence (a) a sense of meaninglessness and an inability to believe in the truth or value in anything one is doing or can imagine doing - a sense of the pointlessness of everything, (b) apathy interspersed with depression. Sufferers may see themselves as being nothing more than realists and support the view with virtually irrefutable logic. The approach I take in helping to deal with this debilitating and life draining condition is essentially the same as that taken by the famous irascible psychiatrist Albert Ellis in dealing with guilt: Basically, we are either going to continue living or we aren't and if we are then we might as well go about trying to get some satisfaction out of it. There are constructive things one can do instead of beating oneself up or bemoaning the essential futility of everything and all existence. Even if intellectually you sees life as an exercise in futility this is of no comfort to someone else who might be suffering in some way, and could benefit from your talents, time and efforts. Another famous existentialist American psychiatrist, Victor Frankl (Man's Search for Meaning) learned in Auschwitz the vital, life saving importance of helping people to find at least one thing in life that is worth staying alive for.

Advanced age has always been associated with depression and the connection might often be largely biochemical. Every age has it upside and downside. The youth suicide statistics suggest that although we like to remember our youth as our "halcyon days" in fact, being young comes with its own particular problems as well as benefits. And this is just as true for our older years when we get to enjoy the benefits that were out of range in youth. At every age we have a choice as to where we focus our minds. We can revel in the benefits we enjoy, or wallow in the problems and the gloomy side of things.

What causes depression? Brain chemistry and genetic predisposition have already been mentioned as an explanation at the physiological level. At the psychological level depression is caused by: (a) Loss: the loss or expected loss of something valued, or similarly a feeling of having missed out on something valuable at sometime in the past; or, (b) Lack of positive reinforcing feedback i.e. having gone too long without experiencing the pleasure of success - "everything I try turns to muck! I'm a born loser", or, (c) Stress in not being able to cope with environmental pressures. Knowing the above provides the clues as to how best deal with depression.

An atavistic theory of depression: According to this theory depression is a natural survival mechanism to ensure we don't expend precious energy on futile or dangerous activity. If the landscape is covered with snow, there are no fruits or berries around and game animals are hard to find, or if this is the season of too many flesh eating dinosaurs in our vicinity, then maybe the wisest thing we could do is huddle together around a campfire in the back of our cave and in between sleeping enjoy grouching about our rotten luck and how nothing these days is as good as it used to be! Depression according to this scenario is a sort of energy saving hibernation. Of course there are other, more scientific theories including "learned helplessness" a concept explained by famed Harvard psychologist Martin Seligman who found dogs could learn to accept helplessness even in the face of pain and would do nothing to help themselves even when the opportunity was available to them. But sometimes depression, especially the more serious forms, may have physiological issues as their primary cause.

What can you do about depression? Well, the simplest starting point, especially if you think you have a serious form of depression is to go see your doctor. You can also try to help yourself. For detailed guidance on this you can get my self help course (link below). Basically, start by trying to identify the source of your depression. It might stem from an unhappy situation at home, finances or from events in the past that have left you with a sense of outrage or of having missed out on something due to you. To help you look for the source of depression you can keep a diary and note down what was going on when your bout of depression started, i.e. look for triggering events and circumstances.

Tackle any tasks that you have not attended to due to procrastination. If you've identified problems or tasks hanging over your head get started on dealing with them.

You can also make a conscious effort to do the things one tends not to do when depressed - pay attention to personal grooming and the tidiness of your home and office.

Make an effort, despite perhaps not feeling like it, to socialise, catch up with people you haven't seen in a while. And providing that you discuss it with your doctor you could try naturopathic preparations.

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