The World Health Day: Depression

“If you know someone who has not been themselves lately, please go and have a conversation with them and if required guide them towards help”, says World Health Organization as a part of its World Health Day celebration set to Friday, 7th April.

Learning that the abductor of Sita went southwards, Rama along with Lakshmana, arrives at Lake Pampa to strike friendship with Sugriva and seek his help in locating Sita’s whereabouts. On arriving at and seeing the magnificent Pampa Lake with its crystal-clear waters, with fully bloomed lotuses along with many trees around it, Rama with his senses already oppressed by virtue of Sita’s abduction, bursts into tears. Drawing the attention of Lakshmana to the beauty of the spring around Pampa Lake, Rama pines thus: “The fire of spring with clusters of Asoka flowers as its charcoal, its copper-colored tender leaves as flames, the buzz of bees as its crackle will, as if, consume me” (4.1.29).

He goes on to lament thus: “O Saumitri! My life is meaningless if I cannot see my beloved Sita with her delicate eyelashes, beautiful locks of hair, and her sweet voice.” Drawing the attention of Lakshmana at the (male) deer happily roaming here and there together with the female deer on the colorful mountain slopes, Rama wails: “Separated from the fawn-eyed Vaidehi, this sight fills my heart with agony.” He goes on lamenting, “O Saumitri! I can be alive and happy if Sita of slender waist enjoys here with me the sweet breeze of Pampa”; “If righteous and truthful Janaka enquires about Sita’s wellbeing in the assembly of people, what am I to speak?”; “She followed me, O Lakshmana! As I was deposed from the kingdom … Now helpless, how can I live without her?”; “Unable to see her beautiful, face with auspicious eyes like fragrant lotuses, I feel (so) depressed”; “O Prince, what can I tell the high-minded Kausalya at Ayodhya when she asks the whereabouts of her daughter-in-law?”; “You may go to Ayodhya, O Lakshmana, to see our loving brother, Bharata. It is not possible for me to survive without the daughter of Janaka” (4.1.30-113).

This kind of a response to an unpleasant event that has happened—abduction of Sita, wife of Rama, by Ravana in the instant case—is what is called in medical terminology as ‘depression’. It is painful as is resonated in the voice of Rama. For, in depression, one encounters a feeling of separation from other people and a loss of emotional contact with them accompanied by a sense of aloneness and utter isolation. Secondary to the loss of interest in what is going on around oneself, the world appears to the victim to be dull, drab, dead, uninteresting and unexciting place. Cumulatively, they result in narrowing and lessening of one’s sense of oneself, the constriction and diminution of oneself as a person. This helplessness and inefficiency, particularly as mental powers are concerned, everything becomes an effort, concentration becomes poor and logical thought becomes difficult. As a result, thoughts become gloomy and melancholy as is reflected in the lamentations of Rama. Most of us encounter such feelings particularly, when we encounter events of sad note like absence/loss of the loved one, and it is a part of life normally faced by many of us but it would become pretty disturbing when they hold on to an individual and take a while to go away—to be clinically precise, if they are present for at least two weeks—for it then turns into a disease, depression.

Depression is more than just the feeling of sadness; it is a medical condition where most people end up in a realm: “A night without a morning / A trouble without end / A life of bitter scorning / A world without a friend”. This development has already assumed the status of a disease. But the good news is: with the right treatment and most importantly the right support, depression can be fully treated.

Interestingly, psychiatrists say that when one goes through depression, the constant presence of a loved person—who is understanding, supportive and nurturing—is not only reassuring but also often proves to be therapeutic. Modern research also established that people in caring relationships run lower risk of depression, and even if depression strikes them, they usually have a better chance of coming out of it than those without such relationships. Psychiatrists also advise that when one is feeling low, it makes a great sense to share one’s thoughts and feelings with their trusted one, for: one, it serves a cathartic purpose and thereby lessens the intensity of depressed mood; and two, such sharing affords the comfort that one doesn’t have to deal with it all alone.

Incidentally, this is what we witness happening in the scene cited above from the Ramayana. As Rama shared his experiencing a deep sense of purposelessness and loneliness with Lakshmana, his brother, he appealingly chips in to revive Rama’s spirits by exhorting him thus: “O Rama, the foremost of men, control yourself. Be blessed. People who are pure at heart do not feel depressed at heart.” He then draws his attention to infallible words:             

“smṛtvā viyōgajaṅ duḥkhaṅ tyaja snēhaṅ priyē janē. 
atisnēhapariṣvaṅgādvartirārdrāpi dahyatē ৷৷  (4.1.116)

—Remembrance of loved ones causes sorrow. Even a wet cotton wick gets burnt by embracing excessive oil. Hence abandon grief.”

He then nudges him towards action saying: “O noble prince! Be blessed. Maintain composure. Without making any effort it is not possible to achieve the objective and recoup loss”; “O revered Sire, enterprise is supreme strength. Nothing is difficult in this world for one who is up and doing”; and “pardon grief, give up emotion. You are a great soul. You are not aware of your great accomplishments” (4.1.115-123). Having thus been persuaded by Lakshmana, Rama, shedding his grief and delusion and regaining his usual composure, moves forward in search of Sita. Incidentally, Rama suffers such bouts of depression subsequent to that too but at each time, Lakshmana, his loving brother, always puts him back on the rails with encouraging words and supportive action.

WHO’s statistics indicate that over five crore Indians suffer from depression. But the unfortunate fact is: 85% of such people are reported to be not seeking medical treatment. It is important that these people understand that depression is not a reflection of any weakness in one’s individuality or flaw in the character but a medical condition triggered by a combination of factors such as genetic, biological and environmental and importantly muster courage to seek medical intervention.

Now the big question is: How to know that one is suffering from depression? As already seen above, when you come across a person with some of the following symptoms: difficulty in sleeping or sleeping more than usual, changes in appetite, withdrawal from social interaction, loss of interest in things that used to be pleasurable, lack of energy, difficulty concentrating or remembering things, feeling worthless and helpless, etc. point towards depression. Incidentally, most of the new moms experience “baby blues,” and they usually pass a week or two after delivery, but if symptoms persist or worsen, it could be postpartum depression. Depression can also be noticed even among the children. Depressed children try to avoid school, complain of feeling ill or become clingy with parents. Coming to adolescents, they turn sulky and often defiant. People with depression typically avoid treatment, for “The depression itself makes them less likely to get the treatment too” and that is where “Family and friends have a big influence on getting the person help,” says Dr Kuntz, an Assistant Professor of clinical psychiatry at Ohio State University.

Normally, it is the trauma of the loss of loved one, financial troubles, loss of job, etc., which are considered as the main triggers of depression. Some depressions are also caused by physical factors: changes in the level of biogenic amines in the brain and disturbances of water and electrolytes balance or from a condition called hypoglycaemia, etc. But if one suspects that there is an event in one’s life that in fact started depression, then it could obviously be more out of any one of the following psychological factors: ‘Self-blame’—constantly criticizing oneself, hating oneself, thinking that he/she is the worst human being alive, simply put, blame yourself persistently and you have a depression coming on; two, ‘Self-pity—to feel sorry for yourself when your kindness is not returned by others with kindness, putting long face to get sympathy from others, think the world is unfair to you, etc., and three, ‘Other pity’—identifying with the endless troubles of people around you. Now the big question is: Why do we think at all on these lines? Dr David D Burns says that owing to certain self-defeating thought patterns we end up in such ‘cognitive distortions’—the way in which one’s mind convinces one of something that is not really true. These inaccurate thoughts reinforce negative thinking/emotions that ultimately make one feel bad about oneself.

To overcome these negative thoughts, Burns suggests some provocative positive insights as a replacement for the negative thoughts: One, remember feelings are not facts! They only mirror one’s thinking process. When one’s thoughts make no sense, the resulting feelings will become just as absurd. Two, as Lakshmana pleaded with Rama, believe that one can cope with any grief. When one eliminates distortions, coping with the real problem becomes less painful. Three, not to base one’s opinion of one’s worth on one’s achievements. For, self-worth based on accomplishments is pseudo-esteem, not the genuine one. For, one cannot base one’s self-worth on looks, talents, fame or fortune. The central philosophy of this cognitive therapy is self-esteem. Burns says that self-esteem can be viewed as one’s decision to treat oneself like a beloved friend. Just as one treats a guest to make him feel comfortable, one must treat oneself similarly. Burns advises that one should do this all the time!

So, what is important is: accept depression as an ailment and seek medical aid immediately, for it can be cured for ever, while the kith and kin support the depressed rationally and with empathy for quick recovery—simply put be a Lakshmana to your depressed bandhu….