The question now arises as to why I have related the above account concerning Stephen as part of my discourse on depression? Well, it is because it does, in point of fact, provide a very good case record and example of what I referred to, also in an earlier blog as ‘psychogenically’ induced or “reactive” depression. Yet again I would emphasize that there is, of course, an underlying biochemistry to whatever we experience in our day-to-day lives. However, the principal cause (or ‘trigger’) in psychogenic depression is much more likely to be external happenings and events concerned with loss or deprivation of some kind. In Stephen and Marjorie’s case, it was the loss of their lovely little daughter Gillian. Also (and until it became clear that the prognosis was as optimistic and sound as it did in fact turn out to be) there would doubtless be some period of anticipatory grieving due to Stephen’s illness. All were in some way implicated.
As anyone who has worked in the field of human bereavement and loss well knows, there is a sequence of stages, which require to be acknowledged and overcome by the grieving person(s). (I intend to write more on this topic in the future. However, in the meantime, you might wish to take a look at blogs written by me in April 2013, i.e. “Why Me?) The first stage, as I have already stated in that earlier sequence of communications, is mind-numbing shock and stunning disbelief; “This cannot have happened”: and in the case of the death of a child, is – as a friend of “short time knowledge” but “long memory” once described it to me, “Totally against the run of play!”) This must be a bad dream, more than it can have anything to do with reality” – and as we have also already commented upon, it helps to “buy time” and facilitate management.
In the normal grieving process (and remember, it is a ‘process’ and not a ‘state’) this, as we have seen in the “Why Me?” blog, will inevitably be followed by the dawning realization that alas, it is no dream. This stage, not uncommonly, is characterized by outbursts of anger, accusation (not infrequently against the self) thus tinged with guilt. Then comes depression, which is a reaction to events and which, if you can see what I mean, is, in reality, evidence of progression and of a fuller recognition of the actual and inevitable state of affairs. In reality therefore, it signifies genuine and indeed, necessary movement forward, through the process of grief and bereavement.
Where this kind, i.e. reactive – or what we have referred to as psychogenic – depression appertains, the most effective form of ‘treatment’ (in the broadest meaning of the word) is TLC• and where necessary, appropriate and sensitively/skilfully applied psychologic treatment, in the form of counselling and other proven and interwoven applied methods of psychotherapeutic intervention.
Finally, let me once again reinforce the important point, namely that serious illness, which poses a perceived threat to one’s own or another’s longevity, daily routine and functioning – and possibly, self-perceived image, status and overall peace of mind – also often entails profound elements of grief, all-be-they of an “anticipatory” nature. So much then for psychogenic depression: in my next blog, I intend to write about a form of depression that is, initially, triggered in an entirely different way.