Sunday, December 03, 2006

Just a Little Misery



Dr. John Crippen (not his real name) over at NHSBlog talked yesterday about the proposal for mandatory psychiatric evaluations on all patients admitted for hospice care. Regarding a cancer patient, he writes:

Of course he is bloody well down. He is about to depart from life. He is about to leave his wife and children. Forever. He knows this. He is not just down. He is seriously pissed off. Dying is an unpleasant business. Best avoided. But, if you have to do it, do not expect it to be fun or a clap-happy "learning experience."

He goes on to ask:

Do patients with cancer suffer from severe depression? Of course they do. Occasionally. And when they do, they need help, and support and possibly medication. But this is a rare occurrence. Patients ingrownowing toe nails get depression too, but you are not going to attach a psychiatrist to every chiropody clinic. Are you?If this trend continues, we will end up imposing a psychiatrist on every patient with cancer. Unnecessary, patronising and offensive.


I was thrilled to think of myself, in my professional capacity, as being "attached" to chiropody clinics, "imposed" on patients, and a referral for my services is "unnecessary, patronising and offensive." Great. What more could my image want?

One of his commenters talks about his cat's death and asks facetiously, "We were all a bit miserable....Do we need psychiatric help?"

I posted about this topic a while back. See
Help Me If You Can, where I wrote about my childrens' comments that their classmates go to therapy for a year when their parents get divorced. It's all part of the same line of questioning: Does one NEED therapy (or medications or any other psychiatric intervention) when bad things happen, be it cancer, grief, divorce? Treatment may help those who do become depressed following a stressor: half of all patients suffering from an episode of depression will identify a clear precipitant. Treatment may help those who are reacting in a dysfunctional, unusual, or highly symptomatic way. Treatment may offer a degree of comfort to distressed people even in the absence of mental illness. But does everyone who is exposed to awful circumstances NEED treatment? Nope. Some times life is just hard and there's no escape from suffering. It's hard to know what to say to this: Grief runs its course, people generally adapt to difficult circumstances, but it's hard to say Don't Get Help, when really, some folks find it helps.

Shiny Happy Person returned this weekend, and she writes one of the most eloquent descriptions of depression, as opposed to simple misery, that I have ever seen:

Utterly miserable is what a lot of people mistake for depression, but they are not the same thing. God, I should know.

Depression is both the most godawful, visceral agony, and a numbness so overwhelming you can't imagine ever feeling real again. It is an inability to feel or be affected by anything other than your own intense pain. It is frostbite of the mind. It is that dream where you want to scream but no sound
comes out. Depression is the feeling of walking through glue, both physically and mentally, which reflects in the effort it takes to open your mouth to speak. Depression paints the world monochrome and muffles all sounds. Depression strips away your personality and leaves you two-dimensional. Normal human functioning diminishes; sleep dwindles to nothing, food becomes an alien notion, weight falls from your bones in a physical representation of your character and the person you have forgotten you used to be. Depression is crawling on hands and knees to get to the bathroom; it is lying in bed and wondering if you would be able to move if the house was on fire. It is trying to carry out a familiar activity and not having the first clue what to do.