Friday, December 27, 2013

Psychiatrists How to Help the Depressed

By Louise from her own experience with depression
Written for Internet Mental Health
February 1998

The following are gentle suggestions for psychiatrists who may be treating the severely depressed. These arise from my own experience with depression. The suggestions are given in order to make the time of treatment and recovery as painless as possible for the depressed individual.
  1. First encounter. Treat the patient with the utmost dignity and respect. The depressed person may be exceedingly despondent or agitated. The person may be fearful and panic-stricken. The patient may find eye contact difficult. But what the person is in this depressed state is not what the recovered person will be. People sometimes assume a luxury with the sick. In a way they imagine that they can treat the sick person any way they please. This does great harm, preventing in some degree the patient's ability to assume once again a position of respect. The depressed person inwardly cries out: “I am not what you see.” Friends may have come to avoid the depressed individual. Some people may have been positively insulting. If psychiatrists treat the depressed as they would an ill member of their own family, they may have started their recovery.
  2. The psychiatrist should assume that the depressed person needs to have the nature of depression fully explained. The patient needs to hear that depression is a chemical imbalance in the brain. It is a disease that simply happens to someone. The length of a depression may last months or years, if it is a severe episode. Depression is a major cause of suicide. The psychiatrist should then suggest that the best form of treatment for depression is the use of antidepressants.
The psychiatrist next should counter a whole range of misapprehensions that the depressed person may have. It is highly likely that this person has shared his or her condition with others and has received much advice. This person may also have read a large number of books dealing with depression. The following aspects should be described.
    1. Right-thinking or visualization cannot heal a depression. The depressed person may hope that this is possible but the physical nature of the disease should be emphasized.
    2. Will-power cannot remove depression. People may have made the depressed person feel totally inadequate by suggesting that only strength of will is needed.
    3. Diet has little or nothing to do with depression.
    4. Faith may help someone through depression and provide an important anchor during the suffering of this disease. But it cannot right the balance in the brain.
    5. Exercise helps with general health but cannot cure depression.
    6. Meditation and relaxation techniques help bring calm but cannot heal depression.
  1. The psychiatrist should then describe in detail the side-effects of the antidepressants. The depressed person needs to know that these side-effects can be rather upsetting. The drugs do not act quickly. The depression itself continues and may even worsen in this first stage of treatment. The patient must receive much encouragement to stay on the medication.
  2. The depressed person should be allowed to come at least weekly during the early stages of treatment. Much gentleness and patience are needed. The patient may rebel at the side-effects that are being experienced. Suicidal tendencies may become stronger. The depressed person needs much affirmation of worth. Hope of recovery should be emphasized. If the depressed person has a supportive friend, it may prove very helpful for this individual to share the appointment time. This friend can then be aware of the nature of the course of the disease and offer support based on accurate information.
  3. The psychiatrist should be willing to listen to the description of side-effects. Even though these will gradually lessen, they are very real to the depressed person. Smiling encouragement about what the future will bring may be in sharp contrast to what the depressed person is feeling.
  4. The psychiatrist should monitor the symptoms of depression at each meeting. If these symptoms are becoming less, the patient should be told and given encouragement.
  5. Depressed persons frequently go off the antidepressants after three or four weeks. By patient and relentless effort, the psychiatrist should get the patient to resume medication.
  6. If the patient goes off the medication and if the depression is worsening (especially with regard to suicidal thoughts), the psychiatrist should make hospitalization a necessity. The mere mention of this may suffice to encourage the depressed person to resume medication and have the freedom of being treated as an outpatient.
  7. As the antidepressants begin to take effect after three or four weeks, the psychiatrist should be encouraging and hopeful. Since the depressed person heals very slowly and there are many ups and downs, the psychiatrist should also ask the patient about the bad times. These remain very real and should not be overlooked. The friends of the depressed person are impatient and expect a full and hasty recovery. The depressed person needs someone to listen about the bad times.
  8. Once the medication is taking effect, the psychiatrist can move into psychotherapy. The depressed person may still be very fearful, panic stricken, or anxious. Help with this behavior can now be given. The depressed person knows how irrational these feelings are and may be embarrassed to speak of them. Again these symptoms should be seen as part of the disease and hope for recovery given.
  9. The psychiatrist should be available until the depressed person seems fully recovered and then available with more widely spaced visits. Always the patient should be made aware that depression can be healed. Depressed persons need to learn that they can recover a sense of dignity and worth. Most importantly, they must come to believe that they will be able to cope with life and be creative once again.

Tuesday, December 24, 2013

Joy Comes with the Morning

What is this world that I behold, wrapped in golden light?
What this sense of joy that slowly arises in my heart
and spreads throughout my being?
What is this new surge of life, new yet old, vaguely remembered
yet earnestly sought for?
What is this mystery of life that wells up within,
that appears in the morning and does not fade with the day?
Why now do I hear birds' songs, notice the flowers, watch children laugh,
see the intricate beauty of this wondrous world?
Why at this time does creative energy grow within that wishes,
demands expression?
Why do I have confidence that time will bring some wonderful events,
some challenges, and , of course, some sorrows
and not wish to flee away but to stay and to live? 

It was not always thus in recent months.
Darkness has been my companion, dwelling at times within,
stalking my steps from behind, a dark specter
threatening, grasping, invading.
This gloom, this monster, so poisonous, so pervasive,
spreading its subtle and acid venom through my being,
bringing senseless tears to my eyes,
apathy to my body and mind,
a longing for death to my heart.
Easily it removes all joy from life.
It casts a gray mist over all
that is lovely or innocent,
makes nothing attractive, nothing appealing.
It gradually crushes all confidence, sense of worth, and
finally makes life so intolerable that death seems sweet.

Where has the darkness fled as I face this new day?
Is it still a hidden companion, ready to take hold of me
at any moment when I least suspect its arrival?
Can I be sure that this monster has been defeated or
will it ever lie in wait for me, coloring all my experiences
with silent fear and dreadful anticipation of the worst?
Means have been taken to drive the darkness out.
Medication works its wonders,
discussion with others opens new windows on life
and the difficult roads it may ask me to tread.
More than this I cannot expect.
But within a loud voice cries out:.
“Never darkness again! Never depression! Never, never, never!”

Whether the darkness will return or not, I cannot know.
All that I can do now is to be faithful,
faithful in taking the medication I need,
faithful in trusting that life has a meaning and purpose for me,
a unique individual, the only one such in this universe at any time.
I can also use all the strength of my will to affirm
what was slowly stolen from me.
What was this? Essentially a sense of life.
Depression crushes and destroys this.
But life is something that cannot die.
By destroying the body, one makes life depart
but as long as it is held
safe within the shell of the body, it will not be overcome.

When depression lifts, life returns.
It begins to show off its beauties everywhere.
What before could bring pain-the sight of people
vibrantly alive, eagerly taking up activities,
laughing, enjoying family and friendships,
creatively spending their days-now attracts.
Nature appears to be magnificent both in its grand manifestations
and in its intricate subtleties.
More importantly, the beauties inside one's own being
start to seem real.
“I can like myself.” “I can even love myself.”
“I too am a child of the universe, wondrous in my very existence.”
With life welling up within once more, the eyes look outward again.
The loveliness of others is recognized. The sweet smile of that friend.
The infectious laugh of that stranger. The grace of the runner.
The strength of the builder. The skill of those who work with their hands.
The attractive wisdom of the old. The potential of the young.

Once again light pervades the world.
It is not that the darkness of suffering and pain has disappeared from view.
This darkness is still present and calls aloud for redress.
But now the darkness is not within
nor is it a close companion of each moment.
Somehow, in some mysterious way, life has reasserted its presence.
One could dance and sing for joy: “I'm alive! I'm alive!”
Joy comes with the morning and
this morning is sheer joy.


By Louise from her own experience with depression
Written for Internet Mental Health
May 1998