Originally published in The Ottawa Citizen October 29, 2003
Original Title: Melancholy Blues but the Roses are Still Red

It is not a human weakness, and taking medication is not an admission of failure.

Although great strides in public education about depressive illness has led to better treatment and less suffering, I think we must prevent the pendulum from swinging too far whereby people lose their innate ability to distinguish normal grief from clinical depression.

There are people who give of themselves without any thought of reward. Mr. Rock (not his real name), went to England to care for his ailing father. He took charge of his father’s care. Shortly thereafter his father succumbed to his illness. Mr. Rock had to organize the funeral arrangements.

On the day of the funeral, he drove around the countryside picking up many his father’s elderly friends so they could attend the funeral service. He provided emotional support for many of them. He was the only family member left alive.

Out of concern for his health he came to see me. In telling this story he started to cry; the first time he had had the opportunity to do so. In his desire to help everyone else and the whirlwind of activity ensuing after his father’s death, he did not take time for himself. He put his grief on hold because others needed him.

He could not sleep or focus on his work. He felt that he should be able to continue as he always had done.

He was aware of the normal grieving process but failed to recognize he was just as deserving of support as anyone else. Sometimes even the most stalwart and stoic need a hug.

It is not a sign of weakness to experience and express sadness. He felt better knowing his was a normal human response that did not require medical therapy.

Another wonderful patient came to see me around Christmas. Inundated with responsibilities several weeks prior to the holidays, she continued to function well but she was unhappy and feared that this was abnormal. She wanted to know whether treatment was required. Family members and friends suggested she might need medication. She sought reassurance that her response was normal.

Indeed it was. The Diagnostic and Statistical Manual outlines specific criteria for clinical depression. Treatment is suggested when a person experiences at least five symptoms for more than two weeks (depressed mood, loss of pleasure or interest in all activities, suicidal thoughts, significant weight loss or weight gain, isolation from friends and family, feelings of worthlessness, guilt, poor personal hygiene, inability to concentrate, lack of motivation and fatigue, mood swings, poor memory, agitation or anxious mood, inability to sleep and poor or increased appetite).

One of the five must be depressed mood or loss of pleasure or interest in daily activities.

Depression occurs when one experiences profound loss: the death of a loved one, financial ruin, divorce, failing at school, relationship break-ups or losing one’s job, among others.

Some may have a genetic predisposition for major depression which is triggered by these events. These people can also experience depression without warning or notable cause.

People react differently in these situations. Some will go through the five stages of depression: denial, anger, bargaining, depression and acceptance and move on.

Denial is the antithesis of anger. The former is a defensive measure, the latter offensive in nature. At first, a person may deny a problem exists.

This short-term primary defense mechanism is a shield against potentially overwhelming pain. Once reality pokes through this shield, anger ensues to fight back the pain, “Why is this happening? This is not fair! I’ll show them. They can’t do this to me!”

Anger eventually subsides and bargaining follows. The person tries to alter the course of events by pleading their case to a greater power, “Please God, if you spare his life I will never speak ill of him again.” They think by altering their behaviour they can bring about positive change, “If I show her I love her, she will see I am a good person and she will take me back”.

Depression begins once bargaining has run its inevitable course. Most people begin to recover after several months. Their appetite returns; one of the first signs of recovery. Sleep habits improve, energy levels and motivation to participate in cherished activities increase, loss of pleasure wanes, work or school functioning improves and concentration and memory sharpen. They begin to laugh again. They accept and adjust to what has happened.

The past decade has seen the emergence of grief counselors. They provide comfort and counsel to those affected by sudden unforeseen traumatizing events.

I wonder if the individual’s ability to experience and adapt to adversity is compromised by this well-intentioned effort. Should adults be given time to think about what has happened to them?

Many people would rather talk to a family member or friend rather than a complete stranger. Should an individual have the opportunity to ask for help when they want it?

Depression and sadness are not human weaknesses. Taking medication, if indicated, is not an admission of failure.

Rather, those individuals who recognize it and do what is appropriate to help themselves are in control of their lives. They learn about their personal limitations and grow from their experience.

Ask questions, take control and ease the suffering.

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© Dr. Barry Dworkin 2002