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Essay on Depression and Its Treatment!
Depressive neuroses is a behavioural disorder the characteristic of which is extreme depression due to certain stressful experiences. It is usually accompanied by anxiety. In depressive neuroses the anxiety of the individual is turned inward in the form of depression. This typically is an excessively sad and defective reaction to a distressing stress situation and an internal conflict.
The reaction is unusual and this unusual depression leads to disturbance in the normal psychological functioning of the individual. For instance, failure in the examination, death of the child or a near and dear one may lead to temporary depression which is an exaggeration of the normal response. It may continue for weeks and months; but finally it is cleared up.
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Though every individual encounters such stress situation and unfortunate happenings in the go of life and feels pain, he faces them with courage, fortitude and stamina. But the neurotic depressive reacts with excessive sadness and the most urgent aspect of it is that it continues for too long a period.
They are unusually apprehensive, have diminished activity, lowered self confidence and are over dependent on others. There is also difficulty in concentration. The loneliness and despair of a neurotic depressive is his chief characteristic symptoms.
Attempted suicides are the extreme reactions of depressive neurotics. However, according to Nemiah (1975, c) the danger of successful suicide is comparatively low. But McCal (1963) on the contrary holds that the potential is quite high in depressive neurotics. Finally, Duke holds that “in any case of depression it is wiser to overestimate than under estimate the suicide danger”.
With the increase in the anxiety state of people, currently neurotic depressive reactions are increasing day by day and so much so that about more than 30 per cent of all neurotic disorders can be specified as depressive neurotics. Further, its incidence is more in females in comparison to their male counterparts.
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Hospitalization is necessary only in severe cases. Otherwise, however, the neurotic depressive’s energy and vigour is gradually lowered and consequently it becomes difficult (though not impossible) for him to perform his daily routine work.
The neurotic and psychotic depressives differ in many respects. Among the notable differences the anxiety component and the neurotic component are very strong in a neurotic depressive while they are weak in a psychotic depressive. Delusions are absent in a neurotic depressive, but sometimes present in a psychotic depressive. Concentration is intact in a neurotic depressive while it is poor in the psychotic depressive.
Lastly, according to Duke and Nowicki “neurotic depression usually occurs in response to some environmental stimulus and is characterized by insight into the condition and by a virtual absence of disordered thought processes.”
According to Shanmugam “Neurotic depressive reaction is different from corresponding psychotic depressive reaction in that there is an absence of malignant symptoms such as agitation, disturbances of thinking, perceptual disorders, slowing of thinking and action etc.”
Aetiology:
The capacity to tolerate frustration and stress is low in case of depressive neurotics, the unpleasant and stressful experiences of the past may further help in aggravating the feeling of anxiety, insecurity and finally depression.
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Neurotic depression may also be the function of the guilt feelings of the person concerned. The secondary gains obtained from the neurotic depressive symptoms are sympathy, attention and support which may help in increasing the sense of security of the patient of course temporarily.
Treatment:
To reduce depression, currently antidepressant drugs and supportive measures are used. In some cases short term psychotherapy may also be helpful in clearing depression and making better adjustment possible. But in severe depressions and emergency cases for clearing up the depressive symptoms electroshock therapy may be used.
In-spite of everything, it can however be held that only through effective psychotherapy, the personality structure of the depressive neurotic can be changed.
Neurasthenia:
It is the most common form of all personality disorders. A constructive estimate of its frequency should be about 7 to 8 per cent of the total adult population. Neurasthenia literally means nervous weakness.
American psychiatrist Beard (1905) was the first to refer to this disorder as fatigue syndrome resulting from prolonged conflict and overwork, which according to him depletes the nerve cells of essential biochemical elements. But the nervous system is not involved acutely in this disease. Freud also mentioned about neurasthenia in his earlier forms of writing.
Chronic weakness, physical and mental fatigue and exhaustion and depression are the major symptoms of neurasthenic neuroses. Also there is complain of physical pain and aches in the body. Somatic symptoms like stiffness of the head, indigestion, hyper-sensitivity to minor irritations are also found.
They always want to shift the responsibility of care on others. But they are at the same time selective in their neurotic disorders. On some occasions they do not complain of any physical or mental fatigue, while on other occasions they may appear to be tired, exhausted and mentally fatigued.
Coleman reports that “neurasthenia accounts for about 10 per cent or more of neurotic disorder”. He further points out that it is most common on lower socio-economic levels and generally found in middle aged adults and frustrated housewives in particular.
Chief Symptoms of Neurasthenia:
(a) Fatigue:
It is different from the fatigue of the normal person. The fatigue in case of neurasthenia is found to be greater in the morning than at night. Rest has little or no effect on it.
(b) Headache:
It is frequently associated with eye strain and blurred vision. Headache tends to be frequently constant and intense at least for a period.
(c) Aches and pains:
Aches and pains in every part of the body particularly in the back is felt which resembles rheumatic disturbances localized in the joints.
(d) Digestion disturbances:
Many of them suffer from digestion disorders.
(e) Loss of appetite:
Intense food fads are noticed:
(f) Insomnia:
They remain awake for several hours even up to morning when they finally sleep. Sleep is also disturbed by unpleasant dreams. Many of these patients become excessively cautious of their health, mental and physical conditions.
One patient once told the author that she thought she is the most unfortunate, miserable and useless person in the world, though in every respect she was better off than other persons in the society.
Analysis of the symptoms of neurasthenia suggests that it is purely a psychological condition and it helps in getting away from the unpleasant situations, conflicts, frustrations and negligence’s arising out of one’s day to day life. The secondary gains of this disease is gaining sympathy and concern over others, additional attention and by this the patient may try to get the time of the family and control the family’s social life.
Aetiology:
Various theories have been developed to explain the causes of neurasthenia. Freudian psychology has tried to give very limited explanation of neurasthenia, i.e., conflict around masturbation which contributes to the symptoms of neurasthenia.
Increased feeling of guilt due to masturbation may be another cause of depressive neuroses. But it has been argued that masturbation is a normal phase in sexual development and hence it cannot be the cause.
Weak health, parental overprotection during early periods of life, prolonged frustration and reduced motivation due to the constant feeling that life is meaningless lead to the on-set of neurasthenia. This aggravates the symptoms of neurotic disorder. Besides, continuous guilt feeling for not able to achieve the aspired goals and sustained emotional conflicts are some other causes.
There is no organic pathology in neurasthenia, though the patient always feels sure that his symptoms have some underlying organic causes and it gives him a sense of relief when medical examination reveals some organic pathology.
According to Franz (1950) the inferiority complex of the neurasthenic accounts not only for his guarded attitude and suspicion but for constant and continuous highly emotional state. There is continuous mental conflict which gradually becomes intense and causes the patient to withdraw from the surroundings.
The neurasthenic most often over reacts emotionally than their normal counterparts. He also feels deeply about things which have got personal significance.
Treatment:
Psychotherapeutic treatment seems to be the best to cure a neurasthenic in comparison to drug therapy for the fact that psychoanalysis and psychotherapy help the patient to develop an insight into his own problems. This helps developing self-confidence and stamina to face the stresses and strains of life.
Drugs may help to reduce anxiety, but only on a temporary basis. Drugs do not help in unfolding and curing the underlying causes of neurasthenia. Psychotherapy according to Coleman helps the patient to get back into the battle of life. Chrzanowski (1959) thus holds that tranquilizing drugs have not proved effective in the treatment of neurasthenic reactions.