Pull yourself together!

At the start of the twentieth century, if you spent an extraordinarily excessive amount of time stating how brilliant you were, you would simply have been dismissed as simply being arrogant and a bit bigheaded. Now, it may be possible that you are suffering from Narcissistic Personality Disorder. We have all heard the stories of First World War soldiers being court martialed and executed by firing squad for supposed cowardice, when in reality the intensity of fighting and the stress it brought led them to suffer from shell shock, now thought to be a subset of Post-Traumatic Stress Disorder. Depressive people were simply told to pull themselves together.

A soldier faces the firing squad
A soldier faces the firing squad

Back then there were very few recognised mental illnesses and those that were recognised usually merited the sufferers’ committal to an asylum. Today – according to the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition – there are over 300 defined. According to a report by The Office for National Statistics Psychiatric Morbidity, one in four British adults experience at least one diagnosable mental health problem in any one year, and one in six experiences this at any given time. The term, ‘mental health problem’ covers a wide range of problems which affect someone’s ability to get on with their daily life. Mental health problems can affect anyone, of any age and background, as well as having an impact on the people around them such as their family, friends and carers.

Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of people who experience more than one mental health problem. Out of all mental illnesses, depression is, perhaps, the most recognised. Everyone can identify with the feeling of being a little bit down, but, for some people, that feeling of depression440being down in the doldrums is a severe problem that interferes with everyday life. This is sometimes referred to as ‘clinical depression’; it is defined as ‘a persistent exaggeration of the everyday feelings that accompany sadness’. Roughly 8-12% of the population experience depression in any year. It can affect anyone, of any culture, age or background.

Sarah White, a 34-year-old white mother of three, suffered depression for five years before seeking help: “I can be on the top of the world one day and the next wake up with this over whelming urge to cry, to not do anything, and not know why I went to bed the night before happy and woke up like nothing is going to go right. “The world around you feels like it is gray, you don’t realize the beautiful things that are going on around you. You don’t notice the butterflies or the wonderful rainbows in the sky after a rain. You feel like you are alone even in a crowd. You don’t feel like you are worth it, or that no one loves you even when in truth those around them will tell them they are loved. You don’t feel successful, you feel like a constant failure, even if you are not.

“You don’t feel joy out of the small things; you don’t really notice what is going on around you. You fail to find joy out of a flower or butterflies; the day to day life just passes you by.”

Clinical depression is currently the leading cause of disability; it is expected to become the second leading cause of 3e5e95cac9be1-39-1disability worldwide (after heart disease) by the year 2020, according to the World Health Organization. During a severe depressive episode, sufferers may have feelings of hopelessness and despair, of lethargy, broken sleep, overwhelming negativity and difficulty in carrying on with the activities of day-to-day life. When suffering from depression the sufferer may want to withdraw from society or may even contemplate suicide.

A large number of depression cases can be attributed to postnatal depression. About one in 10 women experience postnatal depression in the first year after having a baby. Owing to physical, mental and emotional exhaustion combined with sleep-deprivation, motherhood can “set women up”, so to speak, for clinical depression.

Another of the well known mental ilnesses is manic depression, otherwise known as bipolar disorder. This is the illness some people refer to as schizophrenia, although in reality, schizophrenia is an entierly different illness. Bi-polar sufferers alternate between moods of extreme lows and euphoria. In the manic phase sufferers may have excessive amounts of energy and feel little need for sleep. Thinking and speech tend to be faster than usual, and their thoughts can jump rapidly from one subject to another, making conversation difficult. Inflated self-esteem, loss of inhibitions, and grandiose ideas or delusions are typical features. When manic, sufferers can behave in ways which have serious consequences when the episode is past, for example, leaving their job, spending a lot of money, or giving away possessions. About one in 100 people are diagnosed as having bi-polar disorder. The depressive phase usually comes first and about ten per cent of people thought to have pure depression have a manic episode six to ten years later. About 15% of those who have an episode of mania never experience another.

There are great variations in the pattern of mood swings in bi-polar disorder. For example, in some people, the swings in mood can occur every few days. Some people can have long periods without experiencing problems, and many will hold down demanding jobs. However, a significant minority have their lives ruined by the disorder, and may be as disabled as someone with a diagnosis of severe schizophrenia.

Cyclothymia, also called cyclothymic disorder, is a less intense version of bi-polar disorder. The highs and lows of cyclothymia are less extreme than the highs and lows of bi-polar disorder, although they are more troublesome than the usual ups and downs of life. Depression is common in the relatives of patients with bipolar affective disorder and some individuals with cyclothymia eventually develop bipolar affective disorder themselves.

To the uninitiated, these illnesses may sound terrifying but they are all highly treatable if the sufferer receives medical help. Despite the stigma of mental ill health sufferers can live a normal life once treatment has been given.

Next week: the treatment methods available and their effectiveness

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Depression 3 part series:

Part 1

Part 2

Part 3