Depression - FROM DARKNESS TO LIGHT
by Anupama Bhattacharya
SYMPTOMS OF DEPRESSION AND SUICIDAL TENDENCIES
• Feeling sad or irritable most of the time
• Losing interest in things that you enjoyed earlier
• Feeling fatigued and exhausted without any exertion
HOW YOU CAN HELP A DEPRESSED PERSON• Acknowledge his feelings without trivializing them
• Don't blame him for his morbidity and inability to do normal chores
• Give him support and
HOW TO COME OUT OF THE BLUES
• Write down all your feelings in a diary: this will act as a catharsis
• Accept the mood, enter into it fully by listening to sad music and gradually change it to light,
Like a dark cloud hovering over the sky, the feeling creeps into your being: drowning, devouring all sense of reality. "What am I living for, who cares for me?"—you wonder. In a torrent of lashing memories, everything comes back with a renewed vengeance. All the hurt, the pain, the inexpressible emotions, overwhelming in their intensity, pull you deeper and deeper into the fathomless chasms of misery until you lose all desire to live.
Only a numbness remains—leaving you empty, devoid of all feeling.
Somewhere deep within, we all identify with this state, even if for a split second. What differentiates most of us from those who are clinically categorized as depressed is that at such moments, we strive to gain our equilibrium instead of giving in. But not everyone is so lucky.
To what extent the reasons for feeling down are justified is always debatable. What is significant here is that at such moments some people let go of their will to fight back, and if the feeling is allowed to grow, it might lead to nervous breakdown or even suicide. Why do we feel depressed?
Why is it that at certain moments we feel ready to face any calamity while at some other time even an apparently insignificant word hurts us so much that it takes us to the brink of despair?
It is normal to feel depressed at times of adversity and such feelings are as much a part of everyday life as joy and contentment. It is only when the symptoms persist or become acute and self-destructive that professional help is required.
Unless triggered by a specific incident or event, depression usually has its root in the deep-seated psychological factors such as upbringing, relationship with parents and siblings and childhood traumas and fantasies. Clinical depression, in particular, for which sometimes the patient himself fails to find a concrete reason, is often a result of years of neglect, repression and feelings of uselessness and incapability, nurtured by uncaring parents and relatives. Depression can be set off by a number of factors; family history of depression, loss of somebody or something, weather, family atmosphere, failing to achieve something, childbirth, marital problems, hormonal changes, prolonged illness, thyroid problems or even diseases like the glandular fever.
When the cause of depression is purely biological, appropriate medication and counseling can cure it within a few weeks' time. The problem arises when it is caused by deep-seated traumas and current setbacks. "On the face of it, a person might feel depressed due to something as simple as failing to get a promotion or missing a coveted job," says Arpita Anand, counseling psychologist with Saarthak, an Indian voluntary organization. "But go deeper and you realize that this person's sense of worthlessness is actually caused by his assumption that unless he goes on achieving, he is not worthwhile."
Such assumptions, says Arpita, are nurtured by parents who express love or give rewards only when their child achieves something. Considering the increasingly competitive education system and society, it is hardly a wonder that the number of people suffering from depression is increasing at an alarming rate.
According to studies conducted by the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India, one in every 15 adult Indians suffers from depressive illness. At least 10 per cent of the population suffers from depression that needs professional and medical help, and as much as 40 per cent of the population is demoralized and likely to cross the line to clinical depression sometime.
A report released by the World Health Organization (WHO) states that depression threatens to be the world's most common illness by the end of the century. The increasing stress levels, demands of workplace and nuclear families, peer pressure, mechanization of life, along with disillusionment with the old-world values and systems, make a person a soft target for depression.
To add fuel to fire, it is considered uncouth to express sentiments that are not strictly in tune with the dictates of society Creating, in effect, human beings who are expected to behave like assembly-line products.
"I don't understand this obsession with trying to sound casual," says Seeman Narang, first-year student at Delhi University, India, who recently had a nervous breakdown since she could not adjust to her college atmosphere.
"My classmates call me melodramatic when I get emotional. I stay in a hostel and miss my parents. But if I express my feelings I'm branded a crybaby. Why should I be expected to behave as though I don't care when I actually care so much?"
It doesn't take long to see the truth in Seema's words. Being unable to express emotions, putting on a façade of sociability and living a life that is more pretension than reality, the modern man seems to have created a cocoon around himself where he is alienated from the world around him and becomes a prisoner of his own dreams. And in a society where everyone is racing to outdo the other, expectations of sympathy and solace are fast turning into a receding mirage.
I remember an acquaintance who would turn up with a scarf around his forehead every other day. And each time, he would complain of headache and seek attention. It took me a long time to figure out that he was actually expressing his feelings of depression and dejection through symptoms of physical pain.
Depression takes many forms. Starting from lethargy, somatic complaints such as body aches and pain to irritation and anger, depression can encompass the entire gamut of negative emotions. A proud individual who abhors attracting sympathy might express his feelings of dejection through sulking or aggressive behavior. An extrovert, on the other hand, is most likely to express his feelings openly. In children, depression takes the form of increased irritability and social withdrawal, and has to be distinguished from 'spoilt' behavior.
The communication of depression can also vary from culture to culture. According to Diagnostic and Statistical Manual of Mental Disorders published by American Psychiatric Association, complaints of nerves and headaches are more common in Latino and Mediterranean cultures, weakness, tiredness or imbalance in Asian cultures, and problems of the heart in the Middle Eastern cultures.
In depression, appetite is usually reduced though some may have increased appetite and crave for specific foods like carbohydrates. The most common sleep disorder associated with depression is insomnia. Most people have middle insomnia (waking up during the night and having difficulty going back to sleep) or terminal insomnia (waking up too early and being unable to go back to sleep). Initial insomnia (difficulty in falling asleep) may also occur as well as over-sleeping.
The psychomotor changes during depression include agitation, inability to sit still, hand wringing or lethargy and slowed speech, along with increased pauses before answering. A morbid self-involvement without consideration for others is another characteristic trait of depression.
FORMS OF DEPRESSION
Some women suffer from depression a week before menstruation. It is accompanied by marked fluctuation in mood, anxiety and decreased interest in activity. But this complaint disappears with the onset of menstruation.
In middle-aged women, menopause also brings in its wake depression as well as phobias and hysterical tempers caused by shifting levels of estrogen and progesterone—hormones that affect the mood. Studies indicate that women in urban areas and western countries are more prone to depression during menopause since the modern obsession with youth and beauty makes women judge their worth by similar standards. "It (menopause) is the time to re-look at your life," says Felicity Green, a Seattle-based yoga teacher. According to her, if menopause is welcomed as the phase of liberation, the hormonal changes don't result in depression.
The postpartum blues, or depression after childbirth, generally occurs four weeks after delivery. Along with other symptoms of depression, the mother often suffers from delusions such as the child is possessed, has special powers or is destined for a terrible fate. She might also feel suicidal, be repelled by the prospect of breast-feeding, use violence against the child, lack concentration and suffer from phychomotor agitation, severe anxiety, panic attacks and spontaneous crying. Mothers who have had a family history of depression or have stopped taking anti-depressants because of pregnancy are most vulnerable to such feelings, especially if the child is unwanted. The shift of attention from mother to child immediately after delivery also contributes to post-partum blues. Such cases are rarely severe. However, understanding and patience on the part of family members, especially the husband, is essential to help a new mother through this phase.
Seasonal affective disorder (SAD), a form of depression that affects women and younger people, can be recognized by major depressive episodes at certain times of the year. They begin around autumn and disappear by spring. However, they may also occur in summer. SAD is characterized by hypersomnia, prominent energy, overeating, weight gain, and craving for carbohydrates. It is caused by changes in diurnal cycles as well as patterns of sunlight and can easily be treated with light therapy.
Depression can also be bipolar in nature where severe depressive states are alternated with extreme euphoria known as the manic state. It is marked by heightened self-confidence, restlessness, ecstasy and delusions of being a messiah, and can often be mistaken for a spiritual experience, especially by the patient. Since such patients rarely accept their condition as a disease, it is necessary to humor them without encouraging them, and consult a counselor without delay.
According to Dr Sharad Chandra, a practicing psychiatrist, depression is an abstract feeling and cannot be recognized as such by children below the age of eight. "A child begins to get an awareness of abstract feelings not until he is eight and it takes him another 10 years for the full growth of his personality," he elaborates. However, that does not seem toward off the menace of depression in children.
New Delhi in India, alone had 15 cases of exam-related suicides in three months in 1997. Saarthak, which set up a 24 hour hotline called Operation Hope for students to cope with exam results in June 1997, received almost 2,000 calls from all over India. Five hundred of these came from teenagers with suicidal tendencies. The youngest child to have called Saarthak was Pooja, a six-year-old girl, who did not even understand what she was going through. She was just howling over the phone, saying that she felt neglected ever since she joined her new school since all her classmates seemed to look down on her inability to converse in English," recalls Arpita. "What made her situation worse was that her parents apparently did not consider the situation worth bothering about, leading to further frustration in the child."
Depression in children is caused by many related factors such as high expectations, increasing competitiveness, nuclear families where working parents often have not time for their children as well as loneliness in case of single children. The most critical period is that of puberty where a child undergoes many hormonal changes and is especially prone to mood fluctuations and social withdrawal. According to Arpita, "in such situations, parents need to understand their children instead of criticizing them for not being up to the mark".
Arpita describes the case of Simmi, 17, who became suicidal after being jilted by her boyfriend and not scoring well enough to match her parents' expectations. "What is tragic about such cases is that instead of giving support to their children when they need it the most, parents tend to burden them with even more guilt and loneliness," she continues.
It doesn't take long to understand the burden. You only have to look at a bunch of students stooping with the weight of their schoolbags to realize the situation. They have to excel in studies, games, art, music, dance et al—who cares if somewhere along the way they lose their joy of living!
THE INDIAN PERSPECTIVE
In traditional Indian beliefs, a man is determined not so much by his actions as by his birth, his stars and his gunas or qualities. This attitude, on one hand makes him less subjective about his personality and allows for detached observation, while on the other hand inculcates fatalism, a fertile ground for breeding depression.
"The doctrine of karma, especially the psychological notions associated with it, exercise a considerable influence on Hindu mental life," writes Dr Sudhir Kakar in his book The Inner World, because of which a person refuses to take responsibility for his actions and reactions to work out the conflicts and psychological problems. Instead, he takes refuge in citing past samskaras or traditions and creates a resistance to psychotherapy.
"According to ancient Indian texts, depression can be of two types: inner and outer," says K. Santhanam, an electrical engineer and an exponent of the Vedas. "The inner depression is caused by a conflict between the chitta (conscience) and the brain. When a person does something wrong, he might not accept it consciously but his conscience would always be guilt-ridden. This, ultimately, would result in depression and frustration."
Quoting Mahabharata, the great Indian epic, Santhanam says that Duryodhana, a character from the epic, is the epitome of depression: both internal and external.
"His external depression manifested in his ego and his impulsive desire to grab the kingdom, whereas his internal conflict manifested in his aggression, meanness and confused conduct," he explains.
Arjuna, one of the Pandava brothers, also falls into this trap before the epic war. "In Gita, Lord Krishna asks Arjuna how he, a noble warrior, contracted this disease of depression," says Santhanam. "Indeed, in ancient Indian doctrines, depression is considered a disease, a weakness (much as melancholia in western thought). Lord Krishna does not offer Arjuna sympathy or a shoulder to cry on.
Instead, he encourages Arjuna to come out of his unmanly state of mind and fulfill his role as a warrior." Quite a contrast when seen through the eyes of modern psychotherapy which prescribes sympathy and understanding as the primary means of helping a depressed individual.
Santhanam also believes that much of the depression in modern society is because women have forgotten their role as motivators and are trying to be implementers instead, a role traditionally meant for men. "The word ma means the all-encompassing giver who gives without any expectations or demands. But modern women are not willing to give any more." A slightly lopsided concept with a male-centric world-view? I wonder. More so when depression in most Indian women seems to be a result of their inability to cope with the unreasonable expectations of their family and society.
THE FEMININE ANGLE
Though Hinduism reveres the mother image, it also believes that a woman's life is fulfilled only through motherhood, more so if she can bear a male child. The Manu Samhita, an ancient Indian text, proclaims that a woman is first a daughter, then a wife and later a mother. In other words, her existence is recognized only in terms of her relation to men. In The Inner World, Dr Kakar writes that this gender bias results in depressive moodiness, extreme touchiness and morbid sensitivity in urban Indian women. In rural India, this takes the form of extreme fatalism where a woman herself looks down upon female existence and accepts male dominance without a murmur of protest.
For an urban working woman, balancing the job as well as the household may also result in depression. "A working woman has to do better than men to be noticed and appreciated. And if that wasn't tiring enough, a woman is still expected to look after the household by the in-laws as well as the husband," says Maya Srinivasan, an executive in a multinational firm. "This continuous tension of having to balance the two aspects of my life makes me feel useless and exploited. I am not normally prone to depression, but lately, I've begun to feel a certain amount of frustration."
Radha, a housemaid, doesn't understand what depression means. But in her own limited way, she conveys her growing cynicism about life. "I work for at least 15 houses every day. That means getting up as early as four in the morning, preparing breakfast and lunch, getting the children ready for school and then going off to work. My husband, who has lost his job, doesn't help me at all. He only mourns his fate," says Radha. "I'm living only for the sake of my children. There is no happiness in my life."
It has often been stated that women are more prone to depression than men. But Dr. R.K. Singh, professor and head of the department of psychiatry in Lady Hardinge Medical College, New Delhi, India, feels that this might be a wrong assumption. "Men are conditioned to deny their feelings whereas a woman feeling slightly upset is more likely to say that she is depressed. A man may express the same feeling either through anger or alcoholism. This doesn't mean that men feel any less depressed than women, "he argues.
Dr. Sadhana Vohra, a psychologist, feels that by nature women might not be prone to depression, but the society makes them so. "This is most noticeable during adolescence. A girl finds it more difficult to come to terms with the changes taking place in her body, which are much more sudden and obvious that those in a boy. To make matters worse, she is suddenly, treated like a different person and begins to attract catcalls when she goes out. Most fathers think that this is an appreciative gesture and refuse to be bothered by it. Very few try to understand the sense of humiliation and bewilderment the girl feels," explains Dr. Vohra. "As a result, the girl tries to hide within herself, feels insecure and vulnerable, and you have created the perfect setup for depression," she adds.
THE FIRST OTHER
Women play an important role in the psychological development of an individual, especially as mothers.
According to Dr. Kakar, in the first few months of life, an infant lives in a psychological state where there is no clear distinction between 'I' and 'not I'. It is only through the interaction with the mother that the concept of the 'other' emerges. And it is the imprint of the mother-image, the first 'other' that determines whether the outside world would seem friendly, rigid, threatening, rejecting suspicious or loving to the subconscious of an adult. Dr. Kakar further says that the way a child is looked upon determines the behavior pattern of his adult life. For example, a favored child believes in his capacity to win love and success and actually performs well whereas an ignored child often continues to feel neglected throughout life and has to work doubly hard to succeed.
In India, a child, especially a male child, remains in close contact with his mother till early adolescence. Though this makes him feel cared for and worthy of love, it also makes him expect the same selfless care from the people he interacts with later in his life, especially women. And his inability to get it often results in aggression, finally leading to depression. "My wife doesn't care for me as much as my mother used to," says Hargovind, rickshaw-puller. "My wife has so many demands, she wants so much of attention. She makes me feel that I don't matter at all." Comparing wives with mothers is a common phenomenon, where the husband feels neglected since she constantly feels that she can't live up to her husband's expectations.
Evidence from clinical, empirical and ethnological research shows that men have a genetic fear of being left alone which is suppressed in western cultures. In India, this fear is commonly accepted and often encouraged to keep families together. This is interpreted by social scientists as a weakness in the Indian personality. J. Hitchcock, a social scientist, writes in his book Pregnancy and Childbirth: "Training in self-reliance and achievement are conspicuous by their absence (in India). Children are not encouraged to be independent." While this attachment to home and hearth might restrict the adventurous and innovative instincts in a person, it also acts as a social support system against severe depression.
In modern India, however, the demands of the growing number of nuclear families and the necessity to settle in unfamiliar cities break the childhood pattern of easily available support systems without giving any alternative mode of support, adding to the causes of depression. So, it is best to inculcate feelings of independence in a child by letting him be on his own for long stretches of time with the assurance that he can turn to you in need. This would not only give him a firm belief in himself, but also create a lifelong support system against severe depression.
The easiest way out of depression is popping antidepressants. No wonder medicines like Prozac have become popular. However, if taken without a doctor's advice, antidepressants can have harmful side effects such as continuous drowsiness, addiction and sleep disturbance. Some reports also claim that Prozac may provoke suicidal and homicidal tendencies in a person.
Non-prescribed drugs like ISD also give a feeling of elation and are used by many as antidepressants. However using drugs to ward off depression is like using psychedelics as a short cut to enlightenment. ISD might give experiences that seem startlingly spiritual in nature, but it doesn't bring about lasting effects. The best treatment for depression, according to most psychiatrists, is going to the root of the problem and eliminating it, along with giving the patient support and understanding. David Campbell, a clinical psychologist from the Child & Family Department of the Tavistock Clinic in London, who was recently in India to attend a conference on mental health, feels that is necessary to teach families how to cope with depressed individuals.
"Often a person who is called depressed by his family and friends, cannot break away from that image and continues to nurture his depression," says Campbell.
"You should refrain from branding anybody as depressed. Instead, gradually change that person's self-image by asking him to remember moments when he wasn't depressed, when he felt happy. Then build upon that image," he adds.
It is also important to let a person talk. "You have to handle a depressed person with sympathy and understanding. Take his words seriously. Even a person who has decided to commit suicide would communicate this thought at least once," says Dr. Sharad Chandra.
"Sometimes, the words that one uses can be very significant, "says Elizabeth Vatsayan, an activist concerned with women's issues.
"When women feel angry, traditional elders prefer to call it sadness since it is not feminine to feel anger. This creates a lot of frustration in a woman." In a different perspective, a man's sadness is often interpreted as anger to conform to the masculine image, which ends up suppressing a man's feelings and creating frustration.
Nalini Mehta, 51, who has been undergoing treatment for depression since 1969 and is a regular patient at Saarthak, says: "I always had an independent nature but could hardly get my way around due to family pressures and societal demands. All this resulted in a breakdown and I had my first brush with psychotherapy through shock treatment, "she recalls. When she started to take antidepressants, she became addicted to them. "Now I have realized that it is talking and being active that really helps. We need understanding and encouragement, not impatience and ridicule."
Vijay Zutshi, who is working with the Commission of Central Excise, feels that the worst part of depression is the withdrawal symptoms. "You should think of others, who are in a worse state and try to help them," says she. She feels that keeping yourself busy with work helps in getting out of depression. Some women also find shopping or eating binges a great way to beat the blues.
Saarthak, which has opened a daycare center to help people cope with depression, has facilities for pottery, painting, games, learning computers and other creative activities. "Nothing lifts the clouds better than work not routine work but something creative, something that expresses our deepest emotions," says Manideepa Ray, a painter by hobby and an architect by profession. "I've been through depression but now I know how to cope with it. It only takes a little bit of sunshine, a loving word from somebody to see how wonderful it is to be alive."
Depression, according to esoteric thinkers, has karmic reasons. It is the result of exploiting one's spiritual faculties for limited ends that leaves a vacuous nothingness in its wake. Thus, depression is actually the soul mourning for its lost potential. This condition can only be improved by flooding the depressed person with higher and harmonious energy waves. One of the ways to do this is by Bach Flower Remedies. This system classifies depression into three categories: the negative Gentian (depression for a reason), the negative Sweet Chestnut (active and able to express the despair in words) and the negative Mustard (passive, emotional and sudden depression). These complaints can be treated by their corresponding flower essences.
Yoga, especially exercises that include forward bends, has a calming effect on the mind and helps alleviate depression. Yoga is particularly useful for menopausal depression. A biochemic medicine like Kaliphos also acts as a calming agent though it has no curative properties. "In homeopathy, it is necessary to understand the character and background of a person," says Dr. Poonam Jain, a homeopath. "We have remedies for each kind of depression, but prolonged consultations are required before any medicine can be prescribed," she says.
Herbal circulatory stimulants such as panax, ginseng, rosemary and ginger may also prove beneficial in cases of depression. Eating chocolates could also lift your mood temporarily though it is not recommended very often. However, ensuring a diet rich in vitamins, especially vitamin B, and proteins can give you a cheerful disposition.
Certain scents, too, can change your mood. "The best fragrance to help you come out of depression is rose," says Blossom Kochhar, whose aromatherapy products are flooding the market. She already has a ready product called Happiness that is specifically meant to lift your spirits. "It is a blend of essential oils extracted from Sandalwood, rose, lavender and geranium. You can inhale it, use it for massaging the sides of your temple or put a few drops of it in your bathwater," explains Kochhar.
"Ayurveda classifies people in three categories according to their constitution: vata, pitta and kapha," says Dr Akhilesh Sharma, an ayurvedic physician. "Depression is a vata-related problem and can be cured by specific ayurvedic remedies such as shirodhara (an oil drip on the head). Avoiding tamasik (fried, rotten, over-spiced etc.) food and consuming Brahmi tea can further alleviate depression," he adds.
Vaastu shastra (the Indian version of Feng Shui) offers some further tips. If your are prone to depression, check if your house slants downwards in the south or east. If so, level the ground. "You should never keep any gloomy pictures or an inverted swastika in the room," says Rakesh Chawla, a vaastu expert. He further suggests that keeping plants in the room, painting the walls pale green or dull pink and avoiding dark ceilings can go a long way in lifting your moods.
It is said that the darkest hour is just before dawn. And like everything else, this also passes. But often, in our ignorance and self-pity, we turn our backs to the light and see only the darkness.
Depression is a disease that not only makes us incapable of functioning in this world, but also puts a stop to our spiritual progress. The ancient Indian texts promote the feeling of detachment so that you act without expecting rewards. This enables you to separate your deeper self from the ups and downs of life—giving your soul enough breathing space to connect to the psyche wallows in despair, it forgets all else except its misery.
"As long as I identified with my depression, I could not come out of it," says Arti Chawla, a housewife who had been suffering from clinical depression. "I was nothing more than a weeping, self-pitying wretch. It was only when I accepted my feelings as a disease that I turned to meditation and sought help." It worked for Aarti, more so because she freed herself of her limited identity as a creation of her circumstances.
Any book on psychology can give us innumerable causes and cures for depression, but ultimately, what really helps is our desire to break free of the dark miasma of despair. Not to give in, not to drown—but to seek the strength within, to turn inward and allow everything else to pass by, as if in a dream. If you can believe in that strength, even for a little while, it would not take long to lift the clouds of despair and let the sunshine through. After all, 'tomorrow is yet another day'.
Subject: how can i come out depression - 14 September 2011
iam in new zealand i have depression because of loneliness and no work i member my india and when i see the picture of india i cry to go there but when i think about my daughter study in india then i stop i am in well it seem i can not come out from this well,new zealnd weather is very cold and More...
Subject: Depression - 21 May 2011
This is an important article from an Indian perspective. Whilst there are many articles on depression, not enough is written about it from an Indian cultural perspective. Quite a few important issues were highlighted and Indians need to confront these from a non-religious perspective. More...
Subject: Need Contact Details of Dr Arpita Anand - 28 January 2011
Hi ther.. can any body help me with the contact details of Dr. Arpita Anand. Its very urgent.. Thanks sujata...
Subject: its a nice article, but... - 28 April 2010
its a wonderful article, but it would be more uselful f you also advice on how to motivate yourself wen you dont feel like. how do you be happy when you don feel like. sometimes the family and friends do not understand, we live in a veyr materialist world, and if we have to meet a doctor or a More...
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