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    Wisconsin Lawyer
    December 01, 2000

    Wisconsin Lawyer December 2000: Quality of Life: My experience with depression

    Understanding Depression

    by Gregory J. Van Rybroek

    "The depression that engulfed me was not of the manic type - the one accompanied by euphoric highs - which would have most probably presented itself earlier in my life. I was 60 when the illness struck for the first time, in the `unipolar' form, which leads straight down. I shall never learn what `caused' my depression, as no one will ever learn about their own. To be able to do so will likely forever prove to be an impossibility, so complex are the intermingled factors of abnormal chemistry, behavior, and genetics. Plainly, multiple components are involved - perhaps three or four, most probably more, in fathomless permutations. That is why the greatest fallacy about suicide lies in the belief that there is a single immediate answer - or perhaps combined answers - as to why the deed was done."
    -
    William Styron, Darkness Visible: A Memoir of Madness

    Musician Big Bill Broonzy sang "Lord I'm so low down, baby, I declare I'm looking up at down." But depression is not the "blues" everyone experiences from time to time. In fact, it can be debilitating to the point of rendering one unable to move.

    Gregory J. Van Rybroek, U.W. 1990, also holds a Ph.D. and is a licensed psychologist. He is the director of the Mendota Mental Health Institute and teaches in the U.W.-Madison departments of psychology and psychiatry, at the U.W. Law School, and at the Medical College of Milwaukee Department of Psychiatry and Behavioral Medicine. He provides professional advice to the Wisconsin Lawyers Assistance Program, speaking to and helping to train WisLAP volunteers.

    This malady, so mysteriously destructive, hits millions indiscriminately and has the power to shatter the lives of its victims and their friends and family members. And, as mysteriously as it strikes, it also runs a course and leaves. It is in between onset and relief where victims can experience a murky, anxious anguish that descends into so much pain, only suicide presents as an adequate solution. It is said that the pain of depression cannot be sufficiently described to those who have not suffered from it. To the unafflicted there is the common belief that one can simply "get over it." The truth is that clinical depression can be far worse than the periodic blues about life's travails, and should be treated.

    Depression can have many causes. There is no one theory that sufficiently explains its multitude of presentations. In fact, the experience of depression can be very idiosyncratic. The best science can tell us is that depression seems to arise out of both environmental and biochemical causes. Psychosocial causes that appear to be precipitants often are attributed to significant childhood losses and other serious traumas. The biochemical cause is related to reduced activity or defective regulation of certain brain chemicals such as norepinephrine or serotonin.

    The duration and intensity of most depressions can be reduced by treatment. While treatment may not be completely effective, scientific studies have demonstrated that some interventions are better than others. Most typical interventions are a combination of psychotherapy to deal with any underlying psychological conflicts contributing to a depressed state and antidepressant medications used to correct brain chemical imbalances.

    Research also demonstrates that electroconvulsive therapy, despite its bad image, is the most effective intervention for severe, intractable depression where no other treatment has provided relief. Finally, in very serious circumstances (particularly where suicide looms), admission to a hospital should be explored. The hospital provides a safe haven and a certain sanctuary of relief from the pain and terror of depression at its worst.

    Wisconsin Lawyer


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