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
