The silent killer

 

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Category: Reflections Date: 17 Dec 95


The worst part about depression is that it isolates the sufferer. It typically produces reactions of irritation and criticism in those close to the victim

 

The first time he didn’t show up to work - he missed three meetings that day - and was found lolling at home reading science fiction, we chastised him for being irresponsible. The second time he stayed in bed for three days, took the phone off the hook, drew the curtains...let the dishes pile up;  he who loves the light, designs cool Caribbean houses with rooms without doors, Grecian arches wound with pale pink delicate flowers - a foil for the thick, tall palm tree, plain brown, its green foliage stiff, angular. He has an eye for that sort of thing.

 

This is written in-between waiting for him. This time he’s been gone almost three days. At one in the afternoon, his aunt, more like his other mother, calls weeping that another night is falling. The first time he withdrew at least he was home. He seemed busy, amenable and we did not want to intrude. Once, when he got quiet, I offered him this book called Overcoming Depression by Dr Caroline Shreeve (the irony was that the first page of this book was that those who would benefit from it are usually the last to read it because they are struck by apathy - but I didn’t know that then). He refused it. Now as we all wait, I anxiously scan it. Paragraphs I hadn’t absorbed now leap out. “All diseases are cruel in their way, but sometimes depression seems to be one of the cruellest. No normal person would dream of telling a blind person they could dispense with their guide dog or Braille books. It is just as inhuman to row with or criticise a depressive for his lack of interest in his surroundings, his tardy mental functioning and his occasional outbursts of irritation.”

 

Dr Shreeve writes that a deeply depressed person cannot - by the very nature of his sickness - make any effort to help himself by reading about it, or making and keeping an appointment with a psychiatrist because, unlike the person suffering from a physical illness, the depressed person typically lacks motivation.

As one depressed person put it:

“If you want to know what depression feels like, I can only say that it feels like dying...I am constantly having to battle with a lack of energy and enthusiasm, awful periods of self- doubt and bouts of irritability which are foreign to my make-up.”

 

In other words there is little a person can do about these feelings. They are as foreign as cancer. There is depression which is considered “normal” (psychiatrists call it “reactive”), brought on by external factors, mourning for the death of someone close to you, poverty, old-age, loneliness, joblessness. The one which baffles us is the “endogenous” kind which is not related to any trigger. Psychiatrists delve into why it happens, treat with sessions and anti-depressants. But I finally understand that depression is an illness (not an indulgence) all the more insidious because its symptoms remain obtuse. There are no physical scars which makes it immediately identifiable, unlike a physical illness - measles or a heart attack - where the patient gets immediate help.

 

The person suffering from depression feels typically total despair and hopelessness.  It deprives the victim of both belief and hope. Apathy and inertia are also prominent features. The severely depressed have a very poor self-image. Dr Shreeve writes that they “contemplate suicide solely on the grounds of self-hatred, blame and guilt. These feelings often have nothing to do with their actual circumstances.” They may actually be extremely bright. Then the book goes into complicated differences between neurosis and psychosis. The physical symptoms are more likely to push people away than signal a need for help. The appetite decreases or conversely may increase with compulsive eating. The person is sluggish, may suffer from headaches, constipation, insomnia, sleep excessively, be tearful, and easily irritated.  Physical clumsiness and inertia are also common. But the worst part about depression is that it isolates the sufferer. It typically produces reactions of irritation and criticism in those close to the victim. “People”, says Dr Shreeve, “simply cannot accept that... you do not have anything obviously the matter with you, but remain incapable of pulling yourself together.”

 

But she says we need to be able to identify it and then ensure a victim of depression gets help, because as she  chillingly puts it, it is a “silent killer.” All those bewildered families who have suffered the loss of a seemingly “healthy” but “difficult” friend or relative will bear testimony to that. I don’t know which parts of the book have to do with him, but I keep writing. It passes the time. He illuminates us in his absence; people who haven’t talked for years clasp hands, artifice is shed. Layers are peeled off. Now at the core we ask ourselves what we want as opposed to what we need. He had the courage to act out what we all long for - a few days of escape, solitude, quiet. Now as we wait, anxiety hammering inside us, unspeakable images of him torture us, friends and family are puzzled. He has everything... well-off, highly educated, urbane, endearing even, backed by a large close knit family. He is often cheerful. He simply withdraws when an attack comes on. And now why is he doing this to us, does he not think of our anxiety?

 

But I tell them this book says there is a wall between us - of indifference and apathy. He sees our frantic gesticulations but it is an inscrutable mime to him.  He does not hear us, we are absurd, irrelevant. That’s what the illness does. His aunt calls again, her “belly feels scraped out... I want back my child”. His mother, numb. I will stop writing now. He came home. Unshaven, quiet but OK. We swirled around him forming a protective sheath, wanting to swaddle. His return was like giving birth; agony followed by relief, then joy. And beneath this penumbra of his homecoming-the extreme relief - lurks another shadow of another attack. Now he’s made it visible for us.  We can no longer say he has nothing to be depressed about, we cannot call him irresponsible because he is not aware of us when the illness swallows him.

 

This super-intelligent, creative, successful man suffers from an illness that flares past the boundaries of race and class and gender. This time he’s not alone.

 

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All Articles Copyright Ira Mathur