Thursday, 14 January 2010

Reconsidering Risk in Rwanda-Urundi

Had I been a boiling frog??

Sometimes when you try something radical to change your life, despite what all the self-help books might have to think, it just doesn’t workout and you find yourself still trawling through central African backwaters. To be precise you find yourself back riding through various hairy traffic situations on the back of a motorbike. Only now the driving seems worse and the near death is flirted with alarming regularity. Every journey seems fraught with danger and every arrival brings a rush of relief. IT never used to be like this, before I spent 2 years back in Europe I was zen as a buddist monk on my motos and boda-bodas. Had my perception of risk so radically altered?

There is a certain theory that if you live with risk of any kind for long enough it becomes routine. This is a necessary adaptation but if I could loose my risk tolarance from time spent in a risk lower risk environment I wondered if we ever truly get conditioned to risk. Just because we have become accustomed to an elevated level of adrenaline, does not mean it isn’t affecting the body in some way. Had my adaption to daily risk contributed to stress and depression?

Tuesday, 5 January 2010

Chronic Fatigue of the Brain

Depression has got to be the Chronic Fatigue Syndrome (or ME or yuppie flu or post viral or whatever you know it as) of mental illness. Just as those with chronic fatigue don’t display any outward signs of a serious disorder, depressed people aren’t displaying mental illness in the way the general public are accustomed to thinking about it.

Thankfully, in most places the image of the mentally ill as psychotic killers and/or the village crazy have abated. The general criteria for ‘sanity’ in modern medicine is the ability to cope independently with everyday tasks and everyday life. Can the patient feed itself? Keep the home tidy? Dress and bathe? Next level is can they hold down a job ? Or maintain stable social relationships?

On this scale many depressed people seem as ‘sane’ as the non-depressed. We can function at a minimal level, we often have jobs and even occasionally get the energy to tidy up or go on social outings or even enjoy ourselves and laugh. But what the non-depressed fail to appreciate is what a fucking effort doing many of these things are…mentally is the equivalent of running a marathon.

If mild depression could be described as “life without the salt”, major depression is like trying to operate with a giant foot bearing down on your chest, crushing you. Everything you do is an enormous effort, even breathing.

With mild depression I remember a general feeling of anhedonia, or the lack of ablity to feel pleasure. Food tasted likes cardboard and I eat out of habit…I socially isolate myself and spend stupid amounts of time watching TV and Movies.

In major depression I feel like I’m sleep walking through my own life, except if that really was the case it wouldn’t feel so painful. I’m tired by the thought of life, I often don’t get of bed for several days and go long times without eating. I beat myself up for being the weak one, the one people worry about and have to support. I cry for no reason and can’t seem to get excited about anything. If I have work to do, I can still function but I find it almost impossible to learn something new or perform on tests. And any work done is exhausting, physically and mentally. Exercise does help but its also exhausting, my limbs feel heavy and without a friend to coerce me, I would never do it.

And yet, from even the most educated of friends, the only consolation we get is to ‘think positive’ and ‘snap out of it’. You may as well tell a diabetic to think themselves into producing more insulin.

When you are depressed you are completely wrapped up in the pain of the present. Any advice or well meaning attempts to tell us that the future will be better or just hang in there will not work – because it does not address the pain of the present. We need encouragement and maybe a little arm twisting to spend some time with friends….it helps even though we may not be the best company. Whereas it does help to talk with us one on one about our feelings we don’t generally like being the centre of attention when with a group of friends. That’s because we don’t like to think that we are dragging down the group, its enough for us to be in the company of ‘normal’ (ie non depressed people) and be around social activity.

So if you are out with your depressed friend and he or she is unusually quiet DO NOT ask continually whats up….in the same way you wouldn’t bug a chemo patient as to why they are not walking around the ward. Don’t let your fear for them interfere in your normal night out. As much as you can, ignore the depression part and deal with the person as normal, making allowances for the fact that they may not be as lively as you remember them.

In most cases this will be a great help, however it would be remiss of me not to mention when you should worry about someone you know who is depressed. If your friend (or yourself) is majorly depressed person and starts to feel like the there is little hope that the future will feel any different its time to watch out. At this point some will start to toy with the idea of a rational decision to die, which is generally not a good path to trod. If that does happen, as a sufferer you think to think about getting help, either in nicely packaged pills and/or a pro to talk to….as our friend the best you can do is try to underline to the depressed person how much they are needed by others and how much they still contribute even when depressed. Many of us are suckers for being needed, we find relief and meaning in helping others because it seems we can’t help ourselves. We need to be reminded that the world would indeed NOT be better off without us and perhaps very gently nudged towards the idea that life could get better. Finally if appropriate, keep us off alcohol and suggest that anti-depressants might be worth thinking about.

For the lucky ones, depression will be triggered by a life event or prolonged stress which then reduces. For those of us unlucky enough to be missing a few choice brain chemicals, it’s a condition that needs managing throughout our lives and we need all the support we can get!