My great-great grandfather, William Ashburner, was a master English shipbuilder in the late 19th century. He specialized in schooners, swift racing vessels propelled by up to seven masts. A shrewd businessman and innovator, he earned himself a small fortune, investing it in a mansion for his family in the North of England.Unfortunately the advent of steamships doomed the schooners to irrelevance and he quickly went bankrupt. He looked to the colonies for employment, quickly setting his sights on South Africa. He moved his family to the city of Johannesburg, where he took up work in the gold mines. Life was tough in this rugged new environment, but he and his ten children managed to thrive.
Unfortunately, his wife Anne did not. According to family legend, she went to her bed and “wept for two years”. She’d simply lie there all day, every day, crying constantly and barely able to do basic tasks like folding her own clothes. She was inconsolable, and the family was naturally devastated.
Reflecting back on this story over a century later, it's plainly evident that Anne suffered from clinical depression, a biological illness that affects millions of people. While effective treatments are available today, back then, all William and the children could do was watch their wife and mother languish in her bed.
I was reminded of this story last month after meeting a young woman, call her Katherine, who had been struck by severe depression for nearly a decade. She used to live a normal life, full of rewarding friendships and a meaningful career, but things changed after she delivered her first child. She would just spend day after day lying in bed feeling exhausted and empty. She couldn’t understand why; after all, she had a loving husband and a healthy new baby. On the surface, everything was wonderful in her life.
Doubtful about mainstream medicine, Katherine did not seek any treatment. Instead, she tried to plunge herself into a vigorous exercise routine, went on expensive vacations and devoured self-help books. And yet her depression raged on year after year until her life gradually fell apart, losing her job and falling back on a small disability pension. Where once she was an outgoing person, she now found it hard to even smile.
I met Katherine shortly after she was placed on a “Form 1” by her doctor, an order that forced her into a psychiatric ward. She had attempted suicide, an unsurprising consequence of a decade of suffering.
Her doctors quickly diagnosed her with clinical depression and put her on an SSRI, a potent class of medication that normalizes brain levels of serotonin. Within a week, Katherine reported a “burning” sensation of warmth in her chest when she saw her son. She was taken aback by this new, unusual feeling. But then she realized that it was actually the sensation of joyfulness, something she hadn’t felt for years.
Since then, Katherine has been discharged from the ward and her life has blossomed. She has reconnected with long lost friends and rediscovered her energetic, outgoing spirit. Whereas her eyes had seemed distant and glazed over before, they now sparkle with a happy expression, as if they are smiling right alongside her. For so long she had defined herself as an antisocial, sad person, while in reality, her real self had been imprisoned by mental illness.
Along with recovery comes reflection. Katherine looks back on the past decade with a deep sense of regret. So many years wasted, so many opportunities for new friendships and experiences lost. So many beautiful memories that could have been made. She barely knows her son, since she has been emotionally absent since his birth.
And yet Katherine could have avoided all of this suffering if she had just sought treatment at the first signs of her depression. What went wrong? While she herself may be blamed for her initial stubborn distrust of mainstream medicine, that decision was influenced by our society’s stigma of mental illness. So many patients fail to seek psychiatric treatment out of shame, feeling that it reflects some inherent character weakness.
But there shouldn’t be any shame. Just as diabetics must take insulin, so must clinically depressed patients take antidepressants. Both are biological illnesses in which pharmaceutical treatment is necessary.
In the past, the mentally ill were often crippled by their condition for their entire lives. Now, with appropriate treatment, Katherine has a bright future. She looks forward to doing all the things that she missed out on over the years, especially getting to know her son.
For the first time in over a decade, she truly feels alive.
I was reminded of this story last month after meeting a young woman, call her Katherine, who had been struck by severe depression for nearly a decade. She used to live a normal life, full of rewarding friendships and a meaningful career, but things changed after she delivered her first child. She would just spend day after day lying in bed feeling exhausted and empty. She couldn’t understand why; after all, she had a loving husband and a healthy new baby. On the surface, everything was wonderful in her life.
Doubtful about mainstream medicine, Katherine did not seek any treatment. Instead, she tried to plunge herself into a vigorous exercise routine, went on expensive vacations and devoured self-help books. And yet her depression raged on year after year until her life gradually fell apart, losing her job and falling back on a small disability pension. Where once she was an outgoing person, she now found it hard to even smile.
I met Katherine shortly after she was placed on a “Form 1” by her doctor, an order that forced her into a psychiatric ward. She had attempted suicide, an unsurprising consequence of a decade of suffering.
Her doctors quickly diagnosed her with clinical depression and put her on an SSRI, a potent class of medication that normalizes brain levels of serotonin. Within a week, Katherine reported a “burning” sensation of warmth in her chest when she saw her son. She was taken aback by this new, unusual feeling. But then she realized that it was actually the sensation of joyfulness, something she hadn’t felt for years.
Since then, Katherine has been discharged from the ward and her life has blossomed. She has reconnected with long lost friends and rediscovered her energetic, outgoing spirit. Whereas her eyes had seemed distant and glazed over before, they now sparkle with a happy expression, as if they are smiling right alongside her. For so long she had defined herself as an antisocial, sad person, while in reality, her real self had been imprisoned by mental illness.
Along with recovery comes reflection. Katherine looks back on the past decade with a deep sense of regret. So many years wasted, so many opportunities for new friendships and experiences lost. So many beautiful memories that could have been made. She barely knows her son, since she has been emotionally absent since his birth.
And yet Katherine could have avoided all of this suffering if she had just sought treatment at the first signs of her depression. What went wrong? While she herself may be blamed for her initial stubborn distrust of mainstream medicine, that decision was influenced by our society’s stigma of mental illness. So many patients fail to seek psychiatric treatment out of shame, feeling that it reflects some inherent character weakness.
But there shouldn’t be any shame. Just as diabetics must take insulin, so must clinically depressed patients take antidepressants. Both are biological illnesses in which pharmaceutical treatment is necessary.
In the past, the mentally ill were often crippled by their condition for their entire lives. Now, with appropriate treatment, Katherine has a bright future. She looks forward to doing all the things that she missed out on over the years, especially getting to know her son.
For the first time in over a decade, she truly feels alive.
Disorders of mood and emotions are the commonest and often most intractable cause of the burden of illness on human populations everywhere, not just in modern high income countries. It is an indictment of the medical profession and of society at large that this extremely common cause of so much misery often stigmatizes the sufferer (and by extension, the family)and is ignored or glossed over by physicians and the health care system. We members of the medical profession often fail to detect distress signals, fail to support people suffering from depression, and our health care systems have gone out of their way to make life even more difficult by dismantling institutions that formerly sheltered some sufferers - although that said, community-based care is probably best for most. The subject is far too complex and important for me to do justice to it in this brief comment. I applaud you, Raman, for tackling it in this post on your blog.
ReplyDeleteJohn Last
Dear Dr. Last,
ReplyDeleteThanks for your input!
Raman
this is beautiful raman :) thanks for sharing!
ReplyDeleteExcellent work Raman! I disagree with one thing though in your "The Weird and the Wonderful" post - there is always more time available for videogames.
ReplyDeletelove it (as usual raman!)
ReplyDelete