How to overcome depression (translated) E-Book

Leonard Cammer

• Herausgeber: anna ruggieri
• Kategorie: Ratgeber
• Sprache: Englisch
• Veröffentlichungsjahr: 2021

Beschreibung

- This edition is unique;
- The translation is completely original and was carried out for the Ale. Mar. SAS;
- All rights reserved.

You may want to read this book because one of your family members has entered a crisis. It could be your mother, sister, uncle, or any of the family members, and you may have been wondering for weeks or months what was wrong. Your family member is always far away from everything and everyone, and as you look at him, immersed in his deep melancholy, you get the feeling that life has come to a dead end for him. You may begin to think that you are the cause of this particular mood, that you are somehow to blame. What is happening? Your family member is ill with depression. Yes, ill. Depression is not a mysterious intrusion of gods or demons, it is an illness, just like a heart or lung disorder, or any other illness you can think of. Paradoxically, however, this can be a cause for optimism. Paradoxically, however, this can be cause for optimism. As long as it is an insoluble conundrum you can only derive frustration. Once it becomes a precisely definable illness, it can be dealt with as such. Most depressed people recover, because it is a disorder that can be treated with a very good chance of success. However, there is one condition: that the help of the family should be an integral part of the recovery process. And it was the numerous meetings with many families, the questions and answers given, that provided the material for this book. In the course of this book, the author has aimed at a fundamental goal: to present facts that will enable you to cope with and understand your family member's condition, wherever he or she is treated, during and after treatment, and even before seeking medical advice. Treatment can do a great deal for the depressed person, but you yourself must play a role that is often decisive. If this book succeeds in breaking down the wall of hearsay surrounding depression and in relieving the family of the anguish into which it is thrown when one of its members suffers from this illness, if it can help to bring the depressed person back to a normal life, it will have achieved its aim.

Leseprobe

INDEX

PART ONE - UNDERSTANDING DEPRESSION

I. WHAT IS DEPRESSION?

II. SERIOUSNESS OF DEPRESSION

III. WHAT YOU SHOULD KNOW ABOUT ENDOGENOUS DEPRESSION

IV. WHAT YOU SHOULD KNOW ABOUT REACTIVE DEPRESSION: PAIN

V. WHAT YOU SHOULD KNOW ABOUT NEUROTIC DEPRESSIONS

VI. A TABLE: THE KEY TO UNDERSTANDING DIFFERENT TYPES OF DEPRESSION

VII. GENERAL SYMPTOMS: WHAT TO DO

VIII. SLOWED-DOWN SYMPTOMS. WHAT CAN BE DONE ABOUT IT

IX. DELUSIONAL SYMPTOMS AND WHAT TO DO ABOUT THEM

PART TWO - OVERCOMING DEPRESSION

X. PHARMACOTHERAPY

XI. YOUR ROLE IN PHARMACOTHERAPY

XII. PSYCHOTHERAPY

XIII. YOUR ROLE IN PSYCHOTHERAPY

XIV. TREATMENT: WHO CAN CURE?

CONCLUSION

Dr. Leonard Cammer

How to overcome depression

Translation and 2021 edition by Planet Editions

All rights reserved

PART ONE - UNDERSTANDING DEPRESSION

I. WHAT IS DEPRESSION?

Perhaps you are reading this book because one of your family members has entered a crisis. It could be your mother, sister, uncle, or any of the family members, and you may have been wondering for weeks or months what was wrong. I am sure that you have also been trying to bring this person out of his or her despondent state, suggesting walks or film shows, and begging friends to come and visit, to see if they could cheer him or her up a little.

But you see no results. Your family member is always far away from everything and everyone, and as you watch him, immersed in his deep melancholy, you get the feeling that life has come to a dead end for him. You remember that once the sister of a friend of yours went through a period of this kind; you did not pay much attention to it then, but now that it touches you more closely you are bewildered by it, and begin to wonder what could be the cause of such a condition. It may even be that, if you are like many people I have had occasion to meet, you begin to think that you are the cause of that particular state of mind, that in some way you are to blame.

"What is happening to us?"

Discontent enters your home. The opinions of family members are divided. Everyone has a say in what should or should not be done, and arguments and quarrels ensue. If there are children in the family, they feel the general uneasiness and become capricious and intractable. In short, what you are witnessing is the process of disintegration a family can go through when one of its members falls victim to a state of depression and there is no one to decide on a clear course of action.

At this point you may feel shaken and confused. How long is this going to last? And what is really wrong?

Your family member is suffering from depression

Yes, ill. For depression is not a mysterious intrusion of gods or demons, as many once believed. It is a disease, just like a heart or lung disorder, or any of the diseases you can think of.

Paradoxically, however, this can be a reason for optimism. As long as it is an insoluble conundrum, you can only derive frustration. Once it becomes a precisely definable disease, it can be dealt with as such. It may seem a depressing prospect ('a thing in the head' may have been your first distressing association), but please believe that it is by no means the end of the world. Most depressed people recover, because it is a disorder that can be treated with a very good chance of success. However, this is on one condition: that the help of the family is an integral part of the healing process.

Depression is not a product of modern times

This illness has been known to mankind since the beginning of written history. In the Bible, there are frequent descriptions of people distraught with grief, or of the anguished feelings of those who have lost faith in God and in themselves, and have lost all hope for the future.

In the fourth century BC, Hippocrates, the father of medicine, described four types of human temperament, one of which was the melancholic (depressed) character. The term melancholia is still used to characterise the depressed person's condition of despondency and mistrust.

Depression was also a known phenomenon in the Middle Ages, although, as in antiquity, it was attributed to the negative influence of some evil force. It was only towards the end of the 18th century that more extensive studies in institutions and hospitals specialising in the treatment of mental disorders revealed the medical nature of mental disorders.

Today we can attribute depression to the sum of the effects of certain biological and social factors which, in a complex context, adversely affect the functions of the individual nervous system. The depressive effect on the individual's activities in turn changes behaviour, feelings and mental processes. The totality of these dysfunctions gives the picture of the disease we call depression.

Depression strikes without regard

If you are told, for example, that your brother-in-law suffers from depression, don't rush to say: 'Oh, no, not Giovanni. He is too intelligent. He couldn't let himself go like that. Or, if it is your Aunt Giovanna, whom you adore: "Impossible. She's always so cheerful, in such a good mood. She wouldn't let herself be depressed by anything".

This is absolutely not true. Depression can affect anyone - a housewife, a taxi driver, a businessman, a teacher, a gambler, an actress, a bricklayer, a shop assistant, a university student, a longshoreman, and so on. It appears in balanced adults as well as in neurotics and children. It can strike at every level of the economic, intellectual and social ladder, and in every personality type. One cannot simply close one's eyes to a phenomenon of this magnitude.

There are various types of depression, which I will discuss in the chapters to come, case by case. I would like to limit myself here to briefly outlining their general characteristics in order to facilitate the reader's understanding of certain passages.

Depression starts with a bad mood

In the introductory paragraphs I mentioned the occasional periods of bad mood that we all go through from time to time. But when these periods last and you can't get over them, and if your everyday life begins to be affected, they can lead to depression proper.

If the period of bad mood is prolonged

The sadness that pervades the person may already constitute the core of depression. The person in this condition becomes aware of his or her feelings, and may ask in despair: 'Why do I have to feel so bad?

Even when the depressed person is not aware of the particular quality of his or her emotional situation, he or she still feels that something is wrong, something is pulling him or her down. And it can be expressed more or less like this: 'I feel tired, heavy'.

The feeling of heaviness means exhaustion, exhaustion. People in this state can spend their days dragging themselves from one place to another, wondering how they can get out of it. If the depressive state is more advanced, he may even refrain from moving at all. It is easy to notice his indolence, because the slightest obstacle becomes insurmountable in his eyes. His thinking faculties seem to be dulled, and his conversation has sudden gaps, absences. At the same time he may continue to complain: 'I feel restless, nervous'.

The mental suffering of depression

It is a psychic state with a very special emotional quality, a mixture of anguish, despair, self-loathing and intense feelings of guilt mixed with anger and fear. This mental pain can also manifest itself as agitation and despair. The sufferer claims that he or she never wanted to be born, or that he or she would like to escape existence.

The physical state of depression

Depression is accompanied by numerous physical reactions, but in almost all cases these are functional impairments (see Chapter VII for an extensive discussion of this term). Your family member may complain of discomfort and pain in the bones or joints, feelings of nausea and dizziness, heartburn, feelings of pressure on the head, or various other physical symptoms that do not, however, appear to be related to an illness on physical examination. Nevertheless, there is something wrong with his physical state, even if it is not something that X-rays can reveal, as depression as an active disturbance of nerve functions can give rise to physical symptoms.

In other words, the nervous system, which is a physical system and part of the body, may experience certain difficulties in functioning. Neural circuits are disturbed and inhibited because brain chemistry does not take place with the balance required for a harmonious emotional process.

Whether depression, however, is understood as a physical disorder or an emotional disorder is a purely academic question. From a technical point of view, one or the other or both may be true. The most important thing is that in each case there is a tendency to think of depression as a nervous condition, particularly in the expression 'nervous breakdown'. Have you not found yourself repeating these very words?

DEPRESSION AND NERVOUS EXHAUSTION

Allow me here an analogy. When someone says 'I've caught a virus', the meaning of this expression can range from the common cold to sinusitis to an attack of diarrhoea. Similarly, the colloquial 'nervous breakdown' can mean any kind of negative emotional experience.

One of my patients described to me the mild depression that followed the break-up of her engagement as "a terrible nervous breakdown". Another patient, who had gone through a severe (though short-lived) psychotic depression accompanied by collapses, spoke of it as "a slight nervous breakdown... nothing serious".

What I think I can say is that when people generally talk about 'nervous breakdown' what they are really referring to is an emotional disturbance that is so serious that it gets in the way of normal work and everyday life. In this respect, the definition is correct. Depression that distracts a person from his or her responsibilities can certainly be referred to as a nervous breakdown. But this term is still too vague, too general, to be of any use. What I would like to do, however, is to suggest a better method of understanding what happens in nervous breakdown which finds its final outlet in the depressive state. First, therefore, I will describe the functioning of the nervous (or tensional) energy system.

Tensional (nervous) energy in depression

Each of us moves, thinks, works, feels and so on, thanks to the constant influx of energy that the body can provide as a result of assimilating food.

In this case it is caloric energy, produced by the muscles.

But before this can happen, the brain and the nervous system, in coordination with the various glandular secretions and other chemical processes, must activate the muscles by means of tension energy.

It is a process that can be compared to the operation of a car engine. The calorific fuel in this case is petrol, but it is an electrical system consisting of a generator, spark plugs and distributor that provides the controlled energy that ignites the fuel. These two systems must work in close coordination.

At each successive moment of our day we discharge (consume) a certain amount of tensional energy. This is a normal fact. None of us could function as an organism in the absence of tensional energy, or even following a drop in this energy below a certain level, which can vary from individual to individual. If we want to move forward we must have, so to speak, a well warmed-up engine and the gear engaged. The crux of the matter with regard to tensional energy is therefore: how much of it do we produce, and how do we use it?

Some people produce and distribute their daily quota of energy wisely, thus managing to perform all their tasks. These people arrive at the end of a normal day with a reasonable level of tiredness.

On the other hand, one may be faced with the case of a person who produces a normal amount of tensional energy, but discharges it excessively, and thus exhausts it too quickly.

In another case, a person with a normal tension threshold may find himself in a situation of prolonged stress: the bitterness (so to speak) of the 'struggle for survival' wears him down and oppresses him more and more; in this way he consumes increasing amounts of tension energy to sustain the competitive situation, and the result is a state of chronic fatigue.

In yet another case, the person may produce an excessive amount of tensional energy without being able to discharge it adequately. At first a whole series of psychosomatic symptoms may appear; but later, in trying to cope with the symptoms, they too will reach exhaustion.

In the course of days, weeks, or months these people will dissipate ever-increasing amounts of tension energy, either by the excessive or uncontrolled expenditure of their emotions; or, conversely, by accumulating these emotions within themselves, only to see them transformed into physical ailments. Eventually every reserve of emotional strength will dry up; or, in other words, following the definition I gave in another book, a depletion of adaptive energy will occur.

We all need this particular type of energy in order to adapt to the various situations that life presents us with at each successive moment. If the individual loses or exhausts his or her ability to adapt, a depressive state results. (See Chapter V for a further discussion of adaptive energy).

Depression, therefore, indicates a failure of the entire individual being to adapt to the stresses of life. This does not mean that the person affected should be blamed for it. Rather, we say that his or her system for transforming tensional energy is no longer able to function as it should, and that the result of this is depression. The machine is worn out, exhausted; from this follows 'nervous exhaustion'.

CORRELATION BETWEEN ANXIETY, FEAR AND ANGER

If you try to understand depression in its deepest sense, the underlying cause of your family member's disorder is a nervous imbalance.

However, this illness can be related to three other components, namely reactions of anxiety, fear and anger. In most cases, there is a tendency to cover these emotional reactions with depression, and to use the term 'nervousness' or 'excessive tension' to describe all these unpleasant feelings. Example. A woman comes to me for counselling, and at first she doesn't say anything like: 'doctor, I am depressed'. Instead, her description will be: 'I am so nervous, I am afraid to go out alone' (fear). "The idea of coming here worried me. I had to have my son bring me because I was upset" (anxiety). "The smallest things make me afraid" (anxiety and fear again). "And when I am in this state I get angry, and I take it out on others too" (anger).

The son confirms his words. When these statements are finally confronted and analysed, what becomes clear is the depressive state underlying such emotional reactions and the related depletion of the adaptation reserves.

In order to recognise and understand depression, it is essential that you are not led astray by the emotions linked to it. That is why you need to know the role they play, both under normal conditions and when they are overused.

Anxiety, fear and anger under normal conditions

In general, the emotions produced by the nervous system are an entirely normal fact that has its own specific usefulness. Each has the specific task of protecting us in certain stressful conditions, thus ensuring our survival. Thus, when some threat is brought to our life or safety, one of these emotions is mobilised in order to push us to act in directions that will allow us to escape the threat.

Anxiety, under normal conditions, mobilises us to make decisions and take a constructive course of action. A person, for example, feels anxious about his job, and anticipates the possibility of dismissal. The normal reaction is for this person to respond to the anxiety by taking some work home, studying the problems in the field, or trying to increase his skills and abilities. Anxiety thus helps him to secure his job.

Fear also has its uses. It causes us to retreat until the danger has passed. A person may be afraid to drive a car in heavy traffic if he thinks he might panic and lose control. He will therefore avoid busy arteries until he is sufficiently familiar with his vehicle. Fear can also prevent a person from acting impulsively in areas where he feels immature or lacks adequate knowledge. In this way he will gain time, and be able to accumulate more experience.

Anger is also a protective factor. There are many situations in life in which we find that we have to fight for our rights and our safety. Anger sharpens our senses for this purpose. A soldier may not realise that the real reason for his hatred of the enemy lies in a biological mechanism that enables him to cope effectively with the dangerous situation, but that is exactly what it is about: anger merely mobilises his adaptive energy for self-preservation.

However, one can overreact

In fact, it may be that we develop too much anxiety, too many fears, and that the anger we feel in certain situations clearly oversteps the mark. This happens when the person can no longer cope with the threats that seem to be hanging over them.

An illness - of any kind - is indeed a threat. If this illness is depression, the individual will react as to any other illness with anxiety, fear and anger that often grow to uncontrollable proportions.

How anxiety, fear and anger manifest themselves in depression

Anxiety manifests itself in the form of restlessness and panic attacks. The person always tends to expect the worst, feels nervous and uneasy about the slightest event. He or she is always on tenterhooks, and the physical symptoms of anxiety such as sweaty palms, headaches, palpitations, etc. also appear.

Fear is manifested by the person's refusal to be alone, and at the same time by his withdrawal into himself when he is among people. Fears of failure are also expressed. "I should quit my job, they will fire me anyway", or "I'd better give up that business. I'll never get it done".

Anger is expressed as rage against the disease. The person expresses self-destructive intentions: he/she would like to slap him/herself, hurt him/herself. He has frequent outbursts of anger, during which he directs his sarcasm (and sometimes even physical attacks) at anyone in range. She may even decide that "they" are part of a conspiracy to persecute and destroy her, and that they are plotting to do so.

It is of paramount importance that you do not get sidetracked by such manifestations of anxiety, fear and anger and conclude that your family member is perhaps throwing a tantrum or playing the 'prima donna'. I am not saying that this can be as easy a task for you as identifying items one, two and three on the shopping list. These are subtle and deceptive symptoms. But if you look closely you will eventually uncover the depression that lies beneath, especially when you realise that despite the unpleasant and moody aspects of this person's behaviour they are sad, exhausted and inert, they berate and despise themselves, and they communicate less and less with the world around them.

THE FEAR OF MENTAL ILLNESS

When someone is depressed, it is not only feelings that are distorted, but also thought processes. He may toy with the idea of downing a bottle of barbiturates or throwing himself out of a window. Or he may brood day and night over irrelevant problems that 'won't go away'. The person realises that the persistence of such thoughts is not natural. He will meditate on this fact, perhaps alone and in the dark, and eventually come to what seems to be the only logical conclusion: "I am certainly going mad". Her conclusions about madness do not yet have the character of certainty, because she realises that she always knows who she is, what time it is, where she is, and who the people around her are. But what remains is the fear that her crazy thoughts may eventually lead her to mental illness.

Don't expect your family member to express all that

He may appear very uncommunicative, but that is not the point. He is simply afraid to express the feeling of impending menace that pervades him, firstly because he thinks he will be mocked, or thought to be insane and committed to an asylum, and secondly because a certain superstitious fear suggests that if such thoughts are verbalised they will turn into real forces that will take hold of him and keep him in their control.

The ideas that torment him are also of another kind. "If I go mad, this disease will be passed on to my children. However unfounded such fears may be, they contribute to the guilt that develops with depression. This sets off a chain reaction - from depression to fear to guilt to deeper depression.

It is by no means true that a depressed person 'goes mad'. But the fear of such developments may in itself be a symptom of a depressive state.

DEPRESSION AND HEREDITY

When an illness affects a certain person, and the victim is unable to understand its nature, he or she may begin to wonder whether the illness is not due to hereditary factors. This is especially true with regard to emotional disorders, including depression, which have always appeared as the most threatening and mysterious disorders. There are many reasons for this. In the past, when little was known about the causes of diseases of emotional mechanisms, people linked them to heredity, and consequently to evil. The line of reasoning was more or less this: if a person was well and productive he must have inherited good qualities; if he was emotionally disturbed he must have inherited bad qualities. Mental illness was then put on a par with evil. And consequently the depressed person, powerless to recover from his condition, was stamped with the stigmata of wickedness, and every door was closed to him as wicked.

Since until relatively recently there was no treatment for this kind of disorder, the stigma could persist for a long time, so it is hardly surprising that when a person believed in an inherited and 'incurable' depressive illness and fell victim to it, he felt his fate was sealed, as did those around him.

Heredity and genetics

The beginnings of genetics as a science can be dated to the late nineteenth and early twentieth centuries. And it is only a few years ago that we began to explore the molecular structure of genes, which in turn determines the genetic code. It is this code that can provide us with accurate information about the inheritance of various traits and individual characteristics and predispositions of the human individual, as determined by the union of the egg with the sperm.

We thus know that a person can inherit a certain predisposition to disorders such as obesity, allergies, particular sensitivity to certain medicines, and so on. But it is by no means certain that such predispositions actually have to come about. Just because your mother, grandmother or aunt suffers from diabetes does not mean that you do. This is true for many other diseases, including depression. There is no evidence to suggest that depression can be directly passed on through inheritance. An ancestor may have suffered from it, but that does not mean that you have to. I say this because we now know that it is also possible to modify situations of hereditary predisposition. It is a fact that biologists have not yet been able to establish whether the hereditary heritage or the environment in which a person is born and grows up is more important for him or her. Studies in the field of genetics can ultimately only inform us about the 'clay' of which we are made. Pending further discoveries, if a person you know is particularly concerned that their depressive episodes may be passed on to their children, the only thing really advisable is a clarifying discussion with their doctor.

In the light of our current knowledge, however, we have no grounds for excessive concern about the heritability of depressive illness. The evidence we have seems to point rather to the possibility that the environment may more than compensate for a hereditary predisposition to depression, as well as to other illnesses. There are too many factors that can play into the integrity of the person today. Developments in science and social institutions are an essential protective factor that adds to the strengths of the individual constitution and helps stabilise biological functions against all kinds of disorders, whatever their predispositions. In addition, people are gradually learning to communicate their mental and emotional problems more openly to others. One of the results of this situation is that both public and private employers have come to recognise that depression is an illness that can affect anyone; and also to understand the need of the individual suffering from this illness to be relieved of the burden of excessive stress. Many employers are therefore willing to cooperate with therapeutic treatment by granting the sufferer periods of rest while keeping him or her in employment. This illness, therefore, no longer has to be kept as a secret to be ashamed of; it can be tackled and overcome without the burden of secrecy being added to the cure.

Psychosis is the scientific term for a serious mental disorder. The characteristic symptoms of psychosis are hallucinations, delusions and loss of contact with reality. To these can also be added a profound state of depression. But you should not be frightened by the word psychosis, or by the diagnosis of this disorder in one of your family members. You may have heard that a person suffering from psychotic depression goes through a long period of hospitalisation. This may have been true twenty or thirty years ago, but not any more. Such an episode can be overcome by psychiatric treatment. It is worth remembering that in the vast majority of cases, recovery occurs in a relatively short time, regardless of the intensity of the symptoms during the critical period.

II. SERIOUSNESS OF DEPRESSION

When I say that depression is serious, I do not mean that it is an irreversible disorder. The depressed person can recover. What I am saying is that you have to take depression very seriously, because people who experience depression can fall into such a state of suffering that they will resort to any means to alleviate the pain in their mind. They may, for example, attempt suicide; intoxicate themselves with alcohol; seek oblivion through drugs; retreat into a life of total isolation.

HOW TO RECOGNISE SUICIDAL TENDENCIES

I want to run the risk of being blunt, because many people have a tendency to shy away from the idea of such an eventuality, as if it might then become less real.

The percentage of cases of depressive illness that end in suicide is alarming. This is the most direct way I know of of of saying that depression can be a fatal disease. It can lead to death, even if it is a death that the person inflicts on himself. Every day we read in the newspapers about a housewife who seals her windows and kitchen door and turns on the gas, an actress who swallows a whole tube of sleeping pills, a businessman who hangs himself. And since depression affects children, adolescents, adults and the elderly alike, suicide also knows no age limits.

If you have even the slightest suspicion that your family member is in danger of destroying himself or herself, and is perhaps dangerously close to the fatal step, do not hesitate to act on your suspicions. You may be closer to the truth than you think.

Unfortunately, there are many myths circulating about suicide that make the average person less ready to grasp its possibility. I will therefore try to enucleate the commonly circulating misinformation on the subject, and please take note of it as carefully as possible.

Mistakes and truths about suicide

ERROR: When a person threatens to commit suicide, does not talking about it exclude the real possibility of the act?

TRUTH: Not at all. The depressed person almost always 'invokes' protection either directly or more covertly, against what is an actual impulse. Out of ten people who attempt suicide, eight have forewarned others of their intention. "Talking about it" is the person's way of letting you know that suicide is imminent. There are many people who could be saved on a daily basis, if other people had been able to understand what they were trying to say. But if there is no one to pick up the message and if no one is able to offer help, suicide becomes a reality.

ERROR: But isn't it possible that the person who says he wants to commit suicide or harm himself is simply pretending? Isn't this a way of demanding attention and manipulating those around him?

TRUTH: Every depressed person demands the attention of others, and uses every psychological stratagem to satisfy this need. But if these stratagems are ignored or rejected, even if the person in question employs them to attract the attention of others or to manipulate others, he may then be overcome with despair. By rejecting such a person, one is only challenging him to desperate actions. And these are by no means uncommon. When one has the gun to one's head and pulls the trigger, unfortunately there is no time to change one's mind.

ERROR: Isn't it true that when someone has attempted suicide once, they never try it again?