Saturday, November 21, 2020

Major Depression-A Case History

Deepak is 80 yrs old and clinically depressed.He has been unwell for more than a year now.It started with anxiety,excessive quietude,reticence and lethargy.Six months ago this transformed into major depression.Since the last 4 months it has been at its peak.

He spends the whole day lying down with his eyes shut.He barely gets up for his meals for an hour and then it is back to bed again.He will neither talk nor respond to anyone.He has become totally apathetic and docile.Personal hygiene is at its minimum.His appetite and weight have decreased drastically.But he is not bothered about this depreciation in his health or personality.Nothing at all interests him.

He underwent a physical examination and thankfully he was found physically fit.

He and his wife Bina have been our friends for eons.She is a bit of a psychologist.She noted the changes in his personality at the very beginning and tried through various means to extricate him from anxiety but it did not work.Then they consulted their family doctor who gave him a psychiatric medicine.It did not agree with him,he became disoriented and developed fecal incontinence.

He was referred to a psychiatrist whose medicines led him to sleeping round the clock.The psychiatrist eliminated the barbiturate from his medicines.Thankfully the antidepressant agreed with him and there were no adverse effects.After taking the medicine for six months there were small signs of improvement off and on but soon he would revert to his old condition.The doctor,upon being contacted,refused to change the medicine,saying increasing the dose or potency would make him more somnolent.He advised him to gear up and be more active.

This was easier said than done.Deepak was just not interested in taking up any physical or mental activity.Even talking was too much of an effort for him.When cajoled to get up and do something he would say that he did not have the strength to do so--this,when he was physically fit.He had no desire to awaken his old booming blustering self. 

The  worst part was that there was no external problem which could be amended to grant him relief.His family and life conditions were perfect.The cause seemed to be endogenous.Perhaps it was his personality which had rendered him vulnerable to anxiety and depression.He had never shared his emotions with anyone or laughed heartily.His approach to everything had always been negative.Likewise,his reactions.All this might have led to a festering of wounds inside.

After about seven months of medication he showed signs of improvement in small measures.He agreed to go out and sit in the balcony.By and by he was persuaded to take at least 10 minutes' walk every day.It took a long time to entrench this into his routine.Then he started walking in the evening too but this left so many hours of the day to be spent positively,otherwise he was sure to give in to the urge to go and lie down on his bed.But he was not interested in taking up any activity.He refused to participate in an indoor game,read something or watch TV. 

After the passage of another two months he began to watch religious channels on TV and tried to extend his waking hours which finally settled at fourteen.Good progress,but it was extremely slow and transient.Very frustrating for the family members to watch and maintain a hopeful facade.

Talking or meeting outsiders was still difficult for him.It is rather challenging for a mental patient to accost outsiders.After countless months of isolation he cannot suddenly turn outgoing and jovial.Others take it as a cue to stand off.Sad,but this is what mostly happens.The onus to cajole and help him to join the mainstream once again rests solely on the family members.Without their support nothing can be achieved.The patient has to be encouraged to believe that he can and he will get well.He should be helped to take constructive steps one at a time.It is just like a baby learning to walk.He needs all the help he can muster.The journey is long but essential.

Saturday, May 23, 2020

Now Where Did I Put My Happiness?

I remember very well when I was young,during my school going years,it used to reside in two places-my home and my school.

Then I grew up.The friends left one by one and horror of horrors-even my parents left for their eternal abode.It was difficult to spy my happiness during that time,but my children and grandchildren filled the gap.

By and by they too got caught up with their lives and I had to look for it at close quarters.Where was it near me?I found it in the rush of kitty parties and socialization.

This was satisfying no doubt,but old age pitched in to obstruct the flow.Old age and the quirks of those we socialized with.Going to parties,communicating with them was no longer pure happiness.It was an amalgam of positive and negative emotions.

Anyhow,I prodded myself to evolve and be more accepting.But where was my happiness?I had misplaced it again.

Intensive introspection revealed that if I wanted it to remain always with me I had to look for it within me,to latch it on to my thoughts and activities-activities which did not require external support.

So friends,I picked up occupations which give me optimum satisfaction and adhered to them.Thankfully I have a plethora of hobbies-things which keep me usefully occupied and also grant a sense of achievement.In the ultimate analysis it is best to be self reliant,to peg your happiness to your own self.The externals dissipate one by one.Keep it where it cannot be stolen.

Saturday, April 11, 2020

A Four Fold Path to #Happiness

We all want to be happy.All our activities are designed towards that end.Yet this elusive state of mind sometimes fails to oblige.Scientists say that there is an inbound capacity for happiness in every human being.Our observations too,affirm that some people are always brimming with joy while some others are generally morose and pessimistic.Events which the former would have taken in their stride are sometimes given by latter as the cause of their despondence.

I think our personal attributes-in addition of course to our life experiences- play a major role in deciding whether we are happy or miserable.Let me share with you four habits which,if incorporated,will enable us to maintain a cool state of mind even when things do not go our way.Here goes:---

Adopt a rational attitude towards life: 
Life is never static,it keeps moving-and changing.We are effused with joy one day and down in the dumps the next.When misfortune comes after a good phase it causes a lot of heartache.But we fail to realize that everybody has to go through both kinds of experiences and we are not someone special that we should be spared the thorns and showered with roses.

We can not,and should not expect the good times to last for ever.That would be unreasonable as well as insidious,because what we expect from life,what we think we ought to have been blessed with but are not getting;is enough to leave us disgruntled and unhappy even when things are pretty good by any standard.Reasonable expectations protect us from breaking down at every minor or moderate disappointment.  

Be Flexible:
Life has a mind of its own.It will not follow a script written by you.An ambitious project could bite dust,a new relationship may turn out to be the opposite of what you had expected,a dear one could pass away or a disease may change your lifestyle for ever.Disappointments pop up unannounced and one has to rebuild ones life around them.If a cherished dream fails to actualize replace it with something which has better chances of fructifying,nurture a fresh one.  

Flexibility alone can help you to accept the inevitable and forge a way of adapting to the new scene.Look for the positive aspects of a challenging situation.See how you can use them to your advantage and carry on with hope and enthusiasm.

Curtail Overthinking and Rumination:
Cogitating about each and everything fills the mind with a quagmire of doubts,suspicions,worries and fears:Not a happy condition,you will agree.Overthinking creates problems where none exist.It blocks action and can even spoil your relationships by generating unjustifiable biases about others. 

Ruminating about an existent problem or a recent fiasco is beneficial only to the extent that it assists you to find a solution.If carried on indefinitely,it unleashes a whirlwind of negative emotions which deepen anxiety.If you want to be happy curtail overthinking and rumination.

Practice Gratitude:
There is no denying the fact that some people have little cause for cheer in their lives.It could even be a prolonged phase for some.Happiness would be a tall order for them.But we all have to make the best use of what has been given to us in order to conserve our mental health.One way of doing this is to think of the positive features of our lives.This could be in the form of a good relationship,a roof over our heads,an able body,a sound mind,or that competence to fight against odds and yet keep whole.None of these can be devalued.A feeling of gratitude for the blessings we enjoy prevents the picture from becoming blackish grey.It mitigates anxiety.

We cannot control what life throws at us but we can construct a kind of buffer against those volleys and minimize their ill effects.