Depression: A Wake-Up Call From Nature - Essay Example

? Depression: A Wake Up Call From Nature of the and number submitted Introduction Depression has become one of the major problems in the competitive and stressful world of today. Desire to ‘reach the top’ quickly takes a toll on the mind and the body of people. When people stop ‘living’ their lives in an effort to ‘have it all’, they become robot like and their life becomes ‘dead’. Depression is like a wake up call for people to realize that life is a gift and loving your work and maintaining nourishing relationships is the greatest success in life. This paper discusses the case of Tina, a girl in her early twenties suffering from mental disorder. Tina’s case teaches us that it is high time that people consider depression as a wake up call and realize that the real meaning of life is found not in ‘reaching the top quickly’, but in unconditional life, happiness, contentment and healthy nourishing relationships. The Multiaxial System Depression is a condition which is very difficult to diagnose. People suffering from depression usually think that it is a ‘low phase’ and they will become normal once the phase is over. However, they fail to realize that the ‘low phase’ is ‘depression’ and it has a tendency of periodic relapse if not treated properly. In Tina’s case, one can see that people around Tina failed to realize that Tina was suffering from mental disorder. Even her friends and people at work failed to realize that Tina needed a professional help. For a mental disorder from getting severe, it is extremely important to understand the symptoms of the mental disorder and to plan a proper prognosis. However, for a proper prognosis, what is most important is accurate diagnosis of the disorder. The tool that has got recognition as an effective tool for making thorough diagnosis possible is ‘The Multiracial System’. The Multiaxial System is the part of the DSM-IV-TR system designed to help the mental health professionals in doing a thorough diagnosis of mental disorders (Munson, 2001, p.69). The system consists of five levels (called Axis) of assessment in order to achieve high accuracy in diagnosis (Munson, 2001, p.69). The multiaxial system was in fact introduced in DSM-III when people working in the mental health field realized that the diagnosis of mental disorder is difficult and complex as it is interrelated with many internal and external factors of the patient’s life (Munson, 2001, p.69). Hence, to make the diagnosis easy, the multiaxial system was designed with every level in the system handling different factors of patient’s condition (Munson, 2001, p.69). Generally, Axis I and Axis II are used to record 340 mental disorders which were classified in the past as ‘neuroses’, ‘psychosis’ and ‘character’ disorders (Munson, 2001, p.71). Axis III is used to record the co-existing physical disorder (Munson, 2001, p.71). Axis IV is used to record environmental and social aspects of the disorder (p.85) and Axis V is used to record the functioning ability of patient in different areas of life (Dziegielewski, 2010, p. 86). The five levels are discussed ahead. Axis I Axis I is used to record the mental disorders which causes impairment of all areas of functioning in a person’s life (Munson, 2001, p.71). However, the disorders which are recorded in Axis I are those disorders which are the result of deficiency and limitations in psychological aspect of patient and hence, can be relieved with timely intervention (Munson, 2001, p.71). Hence, the clinical disorders which can be cured with the help of intervention are recorded in Axis I (Munson, 2001, p.71). The symptoms of the disorder recorded in Axis I are evident in the behavior and thinking pattern of person and hence, are easy to assess. In case of Tina, the symptoms were visible in sudden change in her behavior, lifestyle and thinking pattern. Tina is an active 23 year old female from Black ethnic background. She is separated from her husband of five years. She was doing two jobs which kept her extremely busy for all the seven days of a week. However, the separation from her husband and the self condemnation led to psychological problem. For four weeks, she became irregular at her work and later, she didn’t go to work for two days. Moreover, she had also stopped going to the gym, which was her favorite activity previously. So Tina, who was active, bubbly and energetic person once, had become physically slow and aloof. Her situation became so bad that she started spending most of her time in her apartment. All these signs in Tina’s behavior were assessed to do a proper diagnosis. The symptoms showed that Tina was suffering from major depressive disorder (MDD). Tina displayed all the symptoms of MDD which are listed by DSM-IV (DePaulo & Horvitz, 2002, p.51). People suffering from MDD show great amount of changes in their mood and vitality level. For example, they become sad, anxious and disappointed very easily (DePaulo & Horvitz, 2002, p.51). Their energy level goes down, their concentration weakens and they lose interest in almost everything in their life (DePaulo & Horvitz, 2002, p.51). However, the change that proves to be most harmful is the change is their self-concept and self-regard. People suffering from MDD start condemning themselves for the problems in life (DePaulo & Horvitz, 2002, p.51). They feel guilty and think that they are the cause of the problem (DePaulo & Horvitz, 2002, p.51). The negative thinking pattern make them feel useless and unworthy (DePaulo & Horvitz, 2002, p.51). Tina’s thinking pattern also showed negative self regard. Tina blamed herself for the separation from her husband. She thought that if she was prettier or sexier, Joe (Tina’s husband) would have never left her. Moreover, the fact that Joe left her for another woman made things worse for her. She started comparing the situation of Joe leaving her with the situation in her childhood when her father left her and her mother alone. Tina was seven years old then and always believed that her father left her because she was not good enough for him. This showed that the feeling of ‘not being good enough’ made her to go out of her way to keep Joe happy. She had married Joe as soon as they completed high school and since then, the couple had depended on Tina’s earning as Joe did not work and spent time hanging around with friends. However, the deep fear of losing Joe made Tina suffer silently. In fact, she not only worked hard at job but also worked hard at home to keep her home good and Joe happy. Tina thought that it was because of her busy schedule that she was not able to fulfill Joe’s sexual desire which made him to go to another woman. In this way, Tina blamed herself completely and spent her time thinking what different she could have done to make Joe stay with her. The constant thinking disturbed her sleep pattern too. One of the additional symptoms of MDD is the changes in sleep pattern (DePaulo & Horvitz, 2002, p.51). Tina displayed disturbance in her sleep pattern as she was not able to sleep for more than four hours at a stretch and also, slept during the day sometimes and in the evening the other times. Moreover, Tina was losing weight even when her eating habits had not changed. This was also a sign of depression as a change in appetite and weight is one of the important symptoms of MDD (DePaulo & Horvitz, 2002, p.51). The changes in her sleeping pattern, lack of interest in work and lack of physical activities led Tina to experience fatigue and sadness. In this way, after a proper assessment of all the symptoms, Tina was diagnosed with MDD. Later, the assessment was done to see if her condition is equivalent to the disorders which are recorded in Axis II. Axis II Axis II in multiaxial system is used to record those mental disorders which are difficult to cure as they are ingrained during the developmental phase of childhood and hence, the dysfunction caused by them in most aspects of life is major and lifelong (Munson, 2001, p.71). Hence, the personality disorder and mental retardation come under this category (Munson, 2001, p.71). The symptoms related to mental retardation and personality disorder show inability to adapt to the surrounding and complete inadequacy in performing different functions in life (Munson, 2001, p.71). However, Tina showed no signs of maladaptive behavior and defense mechanism, which usually show personality disorder (Munson, 2001, p.71). Hence, she fell in the category of Axis I and not in Axis II. Axis III When a person suffering from mental disorder also has a co-existing physical disorder, then it affects the treatment of the mental disorder (Munson, 2001, p.71). It doesn’t matter if the physical disorder is associated with mental disorder or is independent of it (Munson, 2001, p.71). It still affects the treatment procedure (Munson, 2001, p.71). To achieve a comprehensive diagnostic assessment, it is very necessary to create a connection between mind and body as they are interdependent aspects of human being (Dziegielewski, 2010, p. 81). The relationship between mind and body says a lot about the mental condition of a person. Hence, if a medical disorder is found existing along with the mental disorder, then it changes the whole course of action. Having a medical disorder can affect the mental condition of a person (Dziegielewski, 2010, p. 81). Similarly, the medical conditions like heart disease, diabetes, HIV etc. can be influenced by the mental health conditions (Dziegielewski, 2010, p. 81). Hence, it is very necessary to know if mental health condition is accompanied by medical condition in the client. People, who are found to have mental disorder and medical conditions coexisting in them, are recorded in Axis III. Tina was not suffering from any medical condition. She was fit and strong before going into depression. She was active, hard working and enjoyed the physical vitality which helped her in doing 2 jobs while maintaining her home. Tina had no medical condition and hence, she did not fall in Axis III criteria. Axis IV The condition of mental disorder is severely affected by the social and environmental factors. Hence, it is very important to understand the role of the environment and social aspects in the condition of mental disorder. Hence, Axis IV was designed to assess how the stressors in the environment are affecting the mental condition of a person and to see if their influence is direct or indirect (Dziegielewski, 2010, p. 85). If the stressor is assessed, then the severity and the length of the stressor’s prevalence in person’s life reveal a lot about the mental disorder (Dziegielewski, 2010, p. 85). In Tina’s case, the environmental and social stressors were playing a major role in onset of MDD. A substantial adverse event in life like loss of an important human relationship through death or separation mostly causes MDD in a person (American Psychological Association, 2006, p.792). Hence, it is important to give attention to all prior and current life events which might have triggered the onset of MDD in person. In Tina’s case, it is evident that the loss of relationship with her father and with her husband through separation was the cause of an onset of MDD. The two events (father leaving in childhood and Joe leaving her for another woman) caused immense distress to her emotional life and she felt lonely. Her belief that her friends were there to help her was shattered when they stopped talking to her after Joe left her. Moreover, absence of family members in her life made things worse for her. Tina had a history of depression in family as her sister had committed suicide while she was in depression. Hence, there was a strong relationship between the stressors in environment and Tina’s onset of mental disorder. Bereavement is considered to be a severe stressor for onset of MDD (APA, 2006, p.792). Tina was deprived of the emotional and psychological bonding with her father. Later, she was deprived of financial security when her father left her. In this way, the lack of emotional and social security led to a depressive condition. However, the positive thing about Tina’s case was that it was possible to treat MDD with the help of psychotherapy as the onset of MDD was mostly triggered by stressors in her environment. Moreover, Tina’s condition was under control as even though she had thought about suicide, she had not tried to commit suicide till now. This showed that there was a strong hope of recovery. Therapies. It is evident from Tina’s case history that the roots of her mental disorder were in her childhood events. However, Tina never showed any signs of depression or other mental disorder until Joe left her. This showed that she was mentally a healthy person. However, the repetition of childhood situation suddenly triggered the deep rooted feeling of worthlessness in her and caused an onset of MDD. Studies have revealed that if mild depression is not treated on time, then 20% of people suffering from mild depression progress to MDD (Sadock, B., Kaplan & Sadock, V., 2007, p. 565). This shows that if Tina had got the attention from teachers or relatives in her childhood, then she would have not progressed to MDD. At the same time, it is important to mention that as Tina had led a physically active life, she had great chances of recovering fast. Her healthy body was a great advantage for her. Hence, the therapies which were appropriate for her were cognitive therapy and behavior therapy. Also, cognitive and behavior therapy are well known for preventing recurrences of MDD (Greden, 2001, p. 146). Cognitive therapy. The major causes of Tina’s mental disorder were her negative beliefs and low self-esteem. Her negative belief that she was no good and people would have stayed with her if she was better in every way, was destroying her self worth. In cognitive therapy, the client is made to replace the old negative beliefs and attitudes about self, world and the future with new, positive, empowering and strong beliefs and behavior (Sadock, B., Kaplan & Sadock, V., 2007, p. 565). For Tina, it was very important to understand that she was not the cause of any problems in her life. In fact, she is a strong and able person as she has survived so many problems without any harm to her body and mind. Behavior therapy. Behavior therapy is based on the theory that loss of positive reinforcement due to separation, death or sudden environmental changes causes MDD (Sadock, B., Kaplan & Sadock, V., 2007, p. 565). Through behavior therapy, the client is made to focus on the goals aimed at increasing the pleasurable experiences in life and to trigger the positive side of life. Tina can be made to focus on her qualities of discipline and determination by bringing her attention to the fact that she used to go to the gym regularly even when she was doing two jobs at a time. Not everyone has stamina to do that. Also, she was a sole earner in her family right from her teenage. Moreover, it was she who gave shelter and support to Joe and not the other way round. In this way, she can be empowered by making her to focus on positive things. Also, goals can be set for her to start going to gym again and eventually, when she gains her self esteem back, to accept a job that she enjoys doing. In this way, Tina can be cured from MDD with the help of cognitive and behavior therapy. Axis V Axis V is designed to assess client’s level of functioning throughout past year in order to compare the functioning levels of the period before and after the onset of disorder (Dziegielewski, 2010, p. 85). Tina’s functioning levels were compared and it was found that even though she had become irregular in her work and personal life, she was carrying out her domestic chores normally. There was no major difference in her functioning, barring the contact with social life. Conclusion Tina’s case study reveals that even though Tina was a strong person and a survivor, her desire to please her husband at any cost and to sacrifice her life in an attempt to keep him in a relationship (which was poisonous for her), destroyed her mental health. From Tina’s case, one learns that if a person tries to go ‘out of sync’ with nature, then nature tries to give her a message through loss of mental peace. In Tina’s case, depression was a message that she was going out of sync with her ‘own nature’ and that she will find true harmony, happiness, contentment and nourishing relationship in life only when she leads an unconditional life, which did not depend on approval from others. References American Psychological Association. (2006). American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders. Arlington, VA: American Psychiatric Association. DePaulo, J.R. and Horvitz, L.A. (2002). Understanding Depression: What we know and what you can do about it. New York, NY: John Wiley & Sons, Inc. Dziegielewski, S.F. (2010). DSM-IV-TR in Action (2nd ed.). Hoboken, New Jersey: John Wiley & Sons, Inc. Greden, J.F. (2001). Treatment of Recurrent Depression. Washington, DC: American Psychiatric Publishing, Inc. Munson, C.E. (2001). The Mental Health Diagnostic Desk Reference: Visual Guides and More for Learning to Use the Diagnostic and Statistical Manual (DSM-IV-TR (2nd ed.). Binghamton, NY: Haworth Press, Inc. Sadock, B.J., Kaplan, H.I. and Sadock, V.A. (2007). Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/ Clinical Psychiatry (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Read More