Every third patient, sitting opposite me in a chair, says: “Doctor, I have depression.” And then you have to figure it out – is it really there, and if so, which one?
Facing a wall, or what is depression?
– Sergey Anatolyevich, our conversation about depression should start with the question of what does this concept mean from the point of view of a psychotherapist? I suppose that many do not quite understand how depression is different from other diseases.
“True, now this word is so commonplace that every third patient sitting opposite me in a chair says:“ Doctor, I have depression. ”
And then you have to figure it out – is it really there, and if so, which one? Often people generally come with the words: “My nerves are out of control, I need a neurologist.” And then it turns out that “nerves” refers to disorders in the field of emotions, that is, to the field of psychiatrists and psychotherapists.
The term “depression” gained a steady understanding at the time of the formation of psychiatry as a rigorous academic science at the beginning of the 19th century. Etymologically, depression means “no pressure” (Eng. “Pressing” -pressure). For a harmonious existence, that which comes to us from the outside, and that which emanates from us, must somehow be balanced; with depression, the world puts pressure on a person, but a person cannot cope with it.
I remember, in the Golden Calf, Ostap Bender, experiencing the pangs of unrequited love, a kind of depression, said: “- Don’t be angry, Zosya, Take into account the atmospheric pillar. It even seems to me that he presses on me much more strongly than on other citizens. This is out of love for you. And besides, I’m not a union member. From this too. ”
That is, with depression, a person suffers from a lack of internal tone, weakness, some unremovable internal incompleteness – this is the main characteristic of depression – for all the variety of types of this disease.
– And what depression can be?
– Firstly, it is of two types: endogenous depression (from Latin – “come from within”), that is, due to biochemical reasons and mainly independent of external factors of a person’s life, and exogenous depression (“come from outside”) or reactive, caused by a reaction to external factors beyond the reach of humans.
And the treatment tactics that a person will need more will depend on what category the depressive syndrome belongs to, first of all: taking medications, impartial, accurate analysis of the situation or a kind word …
Secondly, depression has a huge number of manifestations. We distinguish: anxiety depression, asthenic depression (when there is a lack of strength), apathetic depression (when a person is simply not interested in anything and he is lying turned to the wall), somatized depression (from the Greek. “Soma” – the body, that is, passing on the body – when emotional emotional problems are manifested by bodily disorders: sensation of heart failure, irritable bowel syndrome, numbness of arms and legs. When a person does not have enough words or the ability to use words to express his state of mind, communication is used with the help of bodily symptoms).
There are so-called “smiling depressions” when a person tries to hide his condition, play a relaxed person so that his suffering does not become apparent to those around him. Those. There are a huge number of types of depression. The common thing for them is that classical endogenous depression usually develops, like most psychological diseases, between 20 and 30 years.
Further, when a depressive state gives way to periods of recovery, we talk about the diagnosis of cyclotymia. Researchers suggest that the pride of our Russian poetry, A.S. Judging by his verses, Pushkin could well be diagnosed with cyclothymia. He writes: “in the spring I am sick.” This is spring depression. And at the same time, if we recall the “Boldinsky autumn”, when a huge number of works were written in a few weeks, and wonderful ones, we can think that throughout his life spring depressive states were replaced by autumn hypomaniacal (super-active) periods.
With depression, a shift in most of the needs and abilities of a person occurs: a decrease or increase in appetite, inability to cope with seemingly usual work, sleep disorder or increased drowsiness: people in depression sometimes sleep up to 20 hours.
I even observed (I haven’t seen it in literature, but observed in life) when patients say that sleep is the only thing that brings relief – this is a kind of symptom of flight to sleep.
With endogenous depression, cyclicity during the day is also often observed. Namely, the condition of patients always improves in the afternoon. For a depressed patient, the morning hours are especially unbearable, it is already tolerable by lunchtime, and by the evening the condition “well, you can still live” sometimes arises, but soon morning will inevitably come …
– However, how to separate whether the physical state is the source of depression, or is its source located solely in the mental properties of a person and his experiences?
– Oh, if I had answered this question accurately and comprehensively, tomorrow I could have gone to Stockholm for the Nobel Prize … There are at least a dozen, and maybe even more explanations for the mechanism of such a complex and multifaceted disease as depression.
If we are talking about endogenous depression, when the diagnosis is no longer in doubt, when you can’t describe it with such terms as: “I’m sad,” “I’m bored with something,” “I’m too lazy to do something,” and when a person just turns away against the wall, and nothing is nice to him, and he can lie like this for several months, then we already clearly understand that a person needs to be treated. And, perhaps, not always with his consent, because depression can end for a person very sadly – both the risk of suicide and simply death from exhaustion.
Another characteristic feature of depression is a feeling of self-change and depriving the world of emotional coloring. A person feels like in Vysotsky’s song : “Why is everything wrong? Everything seems to be as always: the same sky, again blue, the same forest, the same air, and the same water … ”, but the perception of all this is not the same.
Turning to another person, looking at a picture, at any phenomenon of this world, it is common for us to form some kind of relation to it. It is good or bad, it is beautiful or not, but it affects us to some extent. And now, this trait is broken during depression, which becomes unbearable: with your mind you understand that this tree is a person, but there is no emotional coloring, everything around is nothing, without any taste and impression.
And in the worst case, the so-called “Anesthesia of psychodelarosis” or painful insensibility, when a person cannot feel emotions at all, first in relation to the outside world, and then to himself. This is not dispassion, it is complete indifference. “Yes, I know that my name is Ivanov Ivan Ivanovich, but this is not the same Ivanov who was once. This is a moving, eating, sleeping, sometimes going to work body, but absolutely not felt, not experienced by me. I cannot feel pain, I cannot feel shame. Nothing is good or bad for me. ” This painful state of painless insensibility for humans is the apotheosis of depression, if left untreated.
King Saul’s lesson or sources and meanings of depression
– So, where can depression suddenly come from, how does its origin depend on the person himself and the circumstances of his life?
– Firstly, depression has a genetic condition and a predisposition to it can be inherited. As a hypothesis, we can even assume a clear “programmed” depression at a certain age.
And if there is a man and woman who are clearly prone to depression, they should seriously think, entering into a serious relationship and creating a family. They would come to me as a family counselor, I would advise them to carefully and longer evaluate everything – especially if it is not clear to them yet that they came to this world for each other.
By the way, at the same time, we have an observation in psychiatry: marriages concluded in depression are usually very stable, and marriages concluded in a light, cheerful state quickly collapse.
Secondly, depression is the result of a chronological physiological failure of rhythms, according to which a person lives.
Now a rather interesting direction is developing – chronobiology. She claims that the whole world, including our human being, is determined by a system of rhythms (moon, sun, change of seasons, change of sleep and wake cycles, heartbeats, menstrual cycles in women, etc.). And the cause of depression is a failure in some of the cycle systems. One of the well-known antidepressants is now designed specifically for rhythmology.
Thirdly, depression occurs in people who are alone in front of serious problems and who can neither get help nor express their pain.
– It is often believed that suppressing anger and suppressing emotions in general leads to depression, is that so?
“No, I would not say that.” Usually suppression of negative emotions: anger, aggression or resentment, leads not to depressive, but to anxiety disorders, to a fragile shy anxious compensatory state. In American psychiatry, depressive and anxious states are generally considered two phenomenologically and biochemically different things. And although we sometimes combine these phenomena, I must say that I saw anxiety phenomena without depression and vice versa, depression without anxiety.
The development of pride , self-fixation, too much listening to oneself will rather lead to depression — instead of a dialogue with the Creator, with the world, with other people, which is what religion implies.
And when a person for himself becomes the most interesting interlocutor and the best partner in the dialogue, he, not being divinely infinite, becomes boring for himself, reaches his own limits and loses the opportunity to receive nourishment of a joyful existence, some kind of external help. But he could have received her with a smile, a look, a gift of a flower, a kind word. Of course, if a person has the ability to express everything and not hide in himself, then he is less susceptible to such conditions and diseases. But he becomes not susceptible to everything external. And such self-fixation is more likely to lead to depression than suppression of anger.
– If we read the Bible, we will see a typical example of depression – the story of King Saul. His condition was due to the fact that he ceased to be pleasing to God, lost communion with God, and as a result – lost God’s help and luck in trips and difficult trials. And he realized that he irretrievably lost the most precious thing that supported him.
– Perhaps, by the example of Saul, we can learn that we can be providentially abandoned by God. We understand that God intentionally closes the door, does not allow us to communicate with Him.
Will it be bad for us? Yes. Will we be depressed at the same time, if earlier we had an inspirational conversation with Him? Obviously, we will. However, when we were called into this world, no one gave us a letter of guarantee: “You will live well.” And it was somewhat different: how bold you are, how patient you will be in sorrows, capable of repentance, courageous in trials and ambitious in a good way, so your life will be pleasing to God and simply filled …
In the story of Saul, whose illness receded when he listened to David’s game, we also learn that beauty treatment is an excellent tool for antidepressant therapy. Painting, music, delicious food cause obvious, and positive emotions that can ease emotional hunger – it is important to actualize joy, finding joy in simple things.
And in very different ways you can get out of depression. You can despair to the last limit, go into the depths of egocentric unbelief and say: “everything, nothing to do with this world, nor with this God” – which happened to Judas.
And you can cry like the apostle Peter, and cry for a long time. But to receive forgiveness and find inner peace, while remembering that at one point you behaved yourself unworthily. This awareness of one’s own unworthiness ennobles a person. Remember that depression can elevate a person.In this sense, depression, like any disease and sorrow, is a protection from something worse – from the degeneration of mankind. Someone said: “If there were no wars, people would be completely late.” That is, often neglected disease or suffering, or war, or depression leads to the release of the potential in the person, the image of repentance.