A calm exterior can hide a turbulent mind (Thinkstock photos/Getty Images)In her famous semi-autobiographical novel, The Bell Jar, American writer Sylvia Plath had expressed the anguish of a depressed mind as it hurtled downward with great exactitude. She described the feeling as one of being trapped inside a bell jar – a dour, claustrophobic experience that cannot be wished away.
Most people who suffer from depression are said to experience the same all- encompassing entrapment. For them, it is not an existential crisis but an emotional turbulence that cannot be quietened by external stimuli. Yet, most people suffering from depression appear “normal” to other people around them, though normalcy is, by and large, a comparative state of being.
Our social conditioning and general perceptions of acceptable behaviour guide us when it comes to putting up a front in public. This is no different for a person suffering from depression. S/he will consciously try to behave as normally as possible, only because everyone is expected to be in a state of normalcy all the time and any sign of emotional instability is dubbed abnormal. The person may not even be aware of the extra effort that is going into appearing normal.
For a person with depression, behaving acceptably is an imbibed affectation and may not always be reflective of the person’s actual state of mind. A smiling, calm exterior may not be the true behavioural marker of what is going on inside, though depression does take its toll and manifests itself despite attempts by the person to deliberately control temperamental changes.
Human emotions are symbiotic and we tend to pick up emotional cues from each other that can affect our mood graph for a period of time. A boss who has had a fight with his/her spouse can let off steam on team members and make them feel agitated or tremulous for the rest of the day, and maybe for the next few days as well. The boss’ spouse may have been affected by their child’s incessant tantrums the previous evening. The child may have been feeling unwell or deprived or have had a bad day in school. The chain of reactive changes in moods goes around in multiple loops. As much as one happy person can improve the moods of most people around in a domino effect, the reverse is also true. It is this awareness, that our individual behaviour affects the emotional well-being of those around us, that can tether a person to behaving in a certain way, and subsequently create perceptions of normalcy.
The first and primary criterion that enables a person to realize that he/she may be suffering from depression is self-assessment of mental well-being. Others, like family members, friends and colleagues, may notice a slight shift in temperament. But as mentioned above, masking depressive phases by pretending that “all is well” is so deeply ingrained into our psyche that often a person is able to put up a front that makes it difficult for others to assess his/her true mental condition.
Self-assessment is crucial. Feeling low, sad, withdrawn, or any other feeling that is unusual in any set circumstance or situation calls for self-assessment. Only the individual can analyse, without biases, whether that feeling is his/her normal reaction or not. If the feeling of distress is prolonged and affects everyday life, the cause should be examined carefully. It should also be examined whether the feeling or phase is being triggered by a particular situation or memory, or is omnipresent.
Depression can be broadly classified into exogenous and endogenous depression. Exogenous depression is reactive depression, a fluctuating cause and effect situation. It may arise from a particular incident – loss of a loved one, difficult changes in life or lifestyle, incidents of violence, abuse or neglect, pregnancy, and many such external factors. The incident or incidences may not trigger depression immediately, and can take time, sometimes years, to manifest itself. Identifying the trigger and creating a plan to subvert the effects of the trigger forms an integral part of the treatment procedure.
Endogenous depression is caused by changes in the genetic structure and/or chemical imbalances in the brain. External causes rarely contribute to the situation, and the debilitating feelings usually do not get impacted by external emotional triggers. The broad symptoms of both types of depression being similar, a person suffering from endogenous depression will not be able to side-step the sadness momentarily and react to mood altering situations.
For family members or close acquaintances to be able to understand whether a person is suffering from depression or is simply going through a low phase, they should first be able to distinguish between the two. A change in mood, whether it is sadness, anxiety or social withdrawal is precipitated by a reason; but so can exogenous depression. The difference between the two is a thin line.Any symptom of depression, or a combination of them, like fatigue, low energy, anxiety, change in sleep cycle or duration, lack of interest in pleasurable activities, body aches or cramps, feeling hopeless, helpless or worthless, decreased memory and mental skills, that persist longer than two weeks should be verified by a mental healthprofessional.
Women usually express depression related anguish and distress more evidently, by crying, throwing tantrums or becoming socially reclusive. Men become either excessively aggressive and have violent and frequent outbursts, or withdraw into impenetrable shells of brooding silence. These symptoms individually and in short phases may be triggered by a recent incident or situation related to the person’s personal or professional life. But if there are no such recent, recurrent or persistent triggers and yet the person is exhibiting two or more of these symptoms for more than a fortnight, it is advisable to seek professional help, just as we do for cough and cold or fever that lasts longer than few days.
Mental health issues need to be de-stigmatised and the first step towards that can be taken only by the family members and close associates of the afflicted person. The reason why many people suffering from depression are forced to pretend or behave normally, suppressing their symptoms, is due to the stigma and labels attached tothe condition. Mental health issues are not accorded the same level of empathy as physical health issues. For a person suffering from negative emotions related to depression, fighting stigma becomes an additional challenge. Being labeled mentally unsound is a situation every person wants to avoid. To eradicate this irrational and unjustified burden that is placed on those suffering from a disorder like depression (which could be neurotic or psychotic), society by and large has to show more compassion and inclusiveness.