Depression, it's bigger than sad!

Depression is the loss of self worth and hope with sadness. Sadness, you will not likely get through life without, and, likely, you will not need professional help for it. With the sadness of grief you are mourning the loss of some thing outside of yourself. But, when there is a shift to losing your own self worth, and/or your hope(s) in life, and it lingers, then seek help. Since in a depression your affect tends to flatten, the sadness in grief may be more acute, yet our theme condition is more pervasive and may end tragically.

The road to a depression is not always short and direct. You might sometimes make a few detours before you get there. In considering such detours we also gain insight of how medicine evolved over centuries. Consider that over centuries the patients have come to the physician to describe their bodies reaction to life events, and the physician compiled this information into symptom complexes. This facilitates sharing the information and building up a body of knowledge. This knowledge sharing used to occur by the classical languages of Greek and Latin. Accordingly, medical descriptive lingo has ample sprinkling of Greek and Latin.

Thus, if life is confronting you with too many adversities, it is not unlikely that you will acquire a cluster of symptoms. These complaints may seem to come from below the body surface, it is probable that the complaints stem from below your cartilage, the costochondral cavity, your chest. If, with your complaints, the chest organs are healthy, you qualify as an authentic hypochondriac. Your symptoms lie below your cartilage.

The adversities of life may be seen as affecting your mind, your soul, and your nerves may end up sending wrong messages about your viscera, your organs, and if such organs be found healthy, you you qualify as being a bonafide psychoneurotic.

If such adversities are seen as a cause for your nerves sending wrong messages about your viscera, without physical cause, then may you be called neurotic. And, by my semantics, hypochondriac, psychoneurotic, neurotic, are one and the same bag of goods or (bads). These conditions do exist without extending into serious depression.

To digress a bit, let's ask what viscera are housed under your cartilage, within your chest, and how many emotions are housed there? Remember, what is clear today may have been an enigma in the past. You are hardly stumped about knowing the emotion behind these expressions: I can't stomach something; some one vented their spleen; somebody acted with gall; nor would you under- estimate the impact of giving a Valentine from the top of your kidney verses the bottom of your heart.

From the above discourse it may incline one to infer that depressions always occur in reaction to bad life situations, but that notion is to be dispelled forthwith. Serious depressions do occur which are inherited as a metabolic or biochemical derangement, and intervention with medication is paramount, and other modelities are added secondarily. Most notable here, is manic-depressive illness. In the manic state these individuals are overly active, their thinking and speach is sped up, and the brain activity may run away on them. If not intervened with they may do financial and other harm to themself and their family. They loose contact with reality, such condition is termed a psychosis. This may need treatment with urgency, but we are not here covering that subject.

Let us consider, instead, how in the literature people have dealt with the vicissitude of life. In the Old Testament we run across an account of Job and three friends, and they experience that there is a God. They interpret that God loves good, and rewards it; and he despises evil and punishes it. This precept is infallible. And, Satan, meanwhile, does a walk around. (I'm taking some poetic licence here.) And Satan tells God that Job has duped Him; that Job is not good intrinsically, and is benefiting by favoritism and immediate rewards for good behavior. God says, test him, but you can't touch his life. Job and friends were not privy to this talk, and when calamity befell Job, to his friends it was unfathomable that this could happen without an occult sin in Job's life. They did what seemed right, they defended God and accused Job.

This story may suggest to us that sometimes in our life we have a situation for which the friends we have we do not need. If you feel you are at the threshold, or into a depression, it may be good to avoid rebuking and critical friends.

In the story God establishes His credentials with an impressive curriculum vitae, then He declares His offence at Job's friends. Remember, they were the voluntary defenders of God. They, as it were, had laid Him onto a psychiatry couch, had read His motive and felt the need to give defence of Him. God imputes spiritual haughtiness, and requests that Job intercede on his friends behalf.

Are we to infer here that God stands on His own? Are we well served by brooding over what is the right answer to the wrong qestion? Is God good? Can a Christian have love, joy, --etc and go into depression? Christians and others do die of suicide. When you or someone else is on the threshold or is moving towards a depression, it is best to reach for help or to offer it, and, mostly, it is better to sidestep theologizing.

Yet, I will continue with a few thoughts along such theme. Suggestively, formulating from your rational faculty the image of a Divine Being and then presenting yourself as the ambassador of such, might leave you on shaky ground. But, how are you to love your neighbor? You are to love him as yourself. In Freudian terms you start from your ego. And, if you fulfil the love of your neighbor and add loving God with all your heart, soul, mind, and strength - is there anything more to add? Having disparaged from presenting as having divine intervener status, it seems relevant to ask - does God want you weak willed and amorphous? I think not. In the message to the churches it is declared that He prefers hot or cold to luke- warm. Assumedly, knowing who you are and what you stand for, and not compromising your principles, may have insulating but not total protective effect against depression.

Human behavior is not absolutely predictable, and suicide can be from a sudden impulsive act. It can happen before one becomes alerted that someone is becoming depressed. Sometimes it may follow a drastic change in fortune, as by natural disaster, or it may follow a willful and unfortunate outcome decision. It may imply a sense of guilt. The case of Judas Iscareot comes to mind here. It is tempting to infer a sense of guilt, he had compromised on what he stood for, and in Freudian terms his ego was shattered like a glass bulb. The time from the lead off to the dramatic end was relatively brief.

Ending your own life takes quite a strong volition. It happens that someone may go into a deep depression and they survive going into it. And, they may even stay in a depression for some time, without harm. The volition is too weak to do themseves in. This creates a therapeutic problem when such are to be treated at home alone. With treatment their volition returns, and a tragic end may happen on the way out of the it.

Anger may prelude a depression. The study by Elizabeth Kubler-Ross on Death & Dying supports this. But, a life ending cancer is not the reason for this reference. The reason for the reference are the preteens and the teens. The same stimulus that incites anger, if it be increased enough and sustained long enough, could cause a depression. Now, few preteens and teens go into a full adult style depression, but, just as in adults what happens beneath the cartilage is the harbinger of some unhappiness, the acting out in this age group carries the same import. And, when children act out, parents and schools, might consider looking at the pressures the child is under, and whether basic needs are met. Is there peer abuse in the school? Has the child a learning problem? Is there emotional nurturing at home?

As a short review here are a few obserations about depression:

Emotions - blue, sad, dismal, flat.

Ideation - slower thinking, reduced attention, reduced memory, low motivation, reduced decision making, low interest

Psychomotor - appetite may be increased or reduced, sleeps poorly, not falling asleep easily, waking at night or early morning, not well rested by sleep

Classification: Principles Of Internal Medicine Harrison et al I. Reactive Depressions; a) associated with medical disease b) associated with emotional problems II. Depression as a transitory symptom in psychoneuroses III. Depression as a concomitant of other demonstrable neurologic disease. IV. True or uncomplicated depression a) Manic-depressive psychosis-depressed phase b) Involutional melancholia