The Anatomy And Physiology Of Depression

As we waited in traffic for a signal from the warden to move, my friend nudged me and whispered: “boys abrɛ”. Not what you think! Sitting by a kiosk by the road was a middle aged man – fast asleep. Beside him was a carton filled with several collections of our locally produced so-so-and-so “Part 1 or Part 2, 3 and 4” movies. Only half of his body was shaded from the blazing sun. Apparently he has been taking a nap for a while – having zoomed through the vehicles selling his stuff all day. I took a glance – and gave a faint smile.

I cannot tell what my friend saw. But I saw a man who might have borrowed some money from a friend, a relative or from a 'Susu' Credit Union to start some business. His customers? The drivers and passengers caught in traffic. He has to bargain for good price and maneuver his way when the traffic gives way. His profit? A 50p profit on every sale. On a good day he sells 22 CDs. His responsibilities? His daughter in Senior High School and son in Primary 5. He must be responsible – each month he sends money home as his development and funeral levy. If he was not asleep, he would have been smiling at his customers to 'win' a purchase or to his other numerous 'colleagues' who were also pacing in between the vehicles caught in traffic. He would not have appeared forlorn or despondent. Would he? Shouldn't he?

The story is told of an ancient Greek philosopher called Epictetus. Born a slave and chained to an iron stake, he worked in his master's field all day each day. One day his master approached him with the idea of tightening his leg shackle. Epictetus suggested that making the shackle tighter was not needed to keep him from running away, but would merely break his leg. The master was not persuaded, and sure enough Epictetus's leg was broken. But he neither protested nor was he depressed. His master asked him why he was not bothered. He made a profound statement that became the foundation to the first Cognitive-Behavior therapy in Clinical Psychology. He said to his master: “Men are disturbed not by the things, but by the views they take of them”. His master became so impressed by this demonstration of imperturbability that he eventually set Epictetus free, and sent him away with money so he could become an itinerant philosopher.

Could you have maintained Epictetus' composure? Can you run a 'traffic-business' with all smiles should the situation demand? What does it take to face daunting difficulties without yielding to depression?

Although the most diagnosed mental health condition the world over, depression may be one of the most misunderstood health issues in the world. Depression—a sad or discontented mood—can leave a person feeling lethargic, unmotivated, or hopeless, and in some cases – contemplate suicide. Studies posit that about 80% of people who committed suicide were depressed. Depression may occur in a severe form, as in Major Depressive Disorder, or in a more chronic, mild-to-moderate form, as is the case with Persistent Depressive Disorder. Fortunately there are a number of Psychological and Behavioral Assessments performed by Clinical Psychologists to measure one's depressive state. Interestingly, some Ghanaian folks could score as high as 25+ which indicates severe depression on the Beck Depression Inventory, for instance, yet they appear 'almost' normal – a mystery that need a place in the Guinness' Book of Records. At that level of score, most people may contemplate, attempt or actually succeed with suicide since living becomes 'worthless' at that point in time.

You have every reason to feel depressed. When you were a kid you were told you looked ugly, that you are uneducable, that you are a failure, that you cannot have what you need, that you are a big fool (as if small fools are better off), that if you ever succeed come get a clap, that you … . Your friends said it, your siblings emphasized it, your parents exclaimed it – and yes… one teacher at school even confirmed it. You think you have forgotten them – sorry! They are repressed in your unconscious mind.

Congratulations! You didn't go through that ordeal – you are an adult now. Sorry – have you heard about genetic and family history, psychological vulnerability, traumatic life events and stressors, and biological factors? My point? Every one stands a risk for depression – your pet included!

As a trainee Clinical Psychologist, I have provided counseling and psychotherapy to many people diagnosed with depression. Whilst some have 'genuine' reasons, others have no reason – or at most some funny ones. A young lady could report with severe depression because she has some few pimples or scars on her face – she perceives the situation as dreadful! A young man could be moderately depressed for several years (without his knowing) and thus unable to function to his full potential because he believes his upper lip is too big and 'know' people talk about it.

The last day of March was a bad one for a friend. A favorite teacher at Adisadel College had committed suicide! Reason? Allegedly, he was in some debt – coupled with some unbearable 'pressure' from his family. Some colleagues noted a change in his behavior prior to his action. “Why would someone opt for a permanent solution to a temporal problem?”, my friend asked. “It's how he perceived the problem. I guess someone with a 'quadruple-share' of his problem is still kicking”, I retorted. But is it that simple? Are all problems 'containable'? Are there any 'depression-proof' strategies against the odds? Yes! Clinical and Health Psychologists have developed several evidence-based therapeutic modules that treat depression and the other innumerable psychological problems. In particular, there are Cognitive and Behavioral therapies devised to manage the irrational/distorted thinking (that are usually associated with depression) and the other factors and symptoms associated with the condition. Additionally, there are a number of anti-depressants prescribed by Psychiatrists and Physicians to manage the condition.

Presently, “ketamine”, an illegal party drug, is on clinical trial in the UK for the treatment of depression. The results looked astounding – described as 'exciting' and 'dramatic' by researchers. Patients who have faced incurable depression for decades have had symptoms disappear within hours after taking low doses of the drug. Excellent! But there's more – consumers stand a chance of interrupting blood supply to their brain, plus a potential for disturbing psychological adverse effects! Could there ever be a cure for depression? I'm hopeful. But until then, you may help yourself with some 'Psychological Inoculation' which has been very helpful to most clients that I shared with. ? I must hasten to add that this approach may not be suitable for certain clinical conditions such as in people with anxiety disorder.

I never cease to be amazed by some folks! They wouldn't discuss their problems (even in their own minds) – much less buy the idea of 'expecting a misfortune'. The most effective antidote to stressors (the main precipitators to depression and all) is not to 'forget-and contain' or pretend a problem does not exist. That's denial! The problem only keeps growing! What may work, among others interventions and techniques, are what I termed: “The Expectation-Insurance Rule” and the “The Filtering-and-Position Game”.

For the most part, people blame themselves (and become depressed) because they were suddenly overwhelmed by a situation. They did not anticipate it – or rather refused to anticipate it. Each moment you are working to reach your best potential, or to make the best out of every situation. But are there consequences to our choices and decisions? Yes! Are there any better alternatives? Not always! What then? Prepare for it – imagine the worst case scenario. Expect it. You were told to always think positive. Excellent! But you better know how to expect the negatives too. My point? Take stock of your 'potential calamities' as you look forward to celebrate your success. Could you fail this examination – as much as you wish to pass? Could your spouse decide to walk out of the marriage? Could you be diagnosed with a chronic, terminal disease?

One of my most memorable times I have had as a trainee Clinical Psychologist was with a client who had had a below-knee amputation following a road traffic accident. Aged 51 years and about 5.8 feet tall, he was a ranking executive of one of the most prestigious banks in this country. When I introduced myself, he smiled and offered me a sit. “I told Dr. Agyei I wouldn't need a psychologist”, he said. And he was right. Well over an hour – I became a patient whilst he became the clinician. When I asked him the reasons for his strong will and unflappability, he responded: “Only a fool won't expect some of these things in life”. Then I remembered Epictetus! Like Epictetus, expect the worse – and work at it. But should it happen anyway, you will do quite well – at least psychologically, which could mean less depression – and less suicide ideation and all. Any venture or decision demands a 'functional analysis' – spend a good time to reminisce the good and the bad – and prepare for the bad as much you expect the good. I guess Epictetus would have been depressed if he hadn't expected that his leg could get broken! Insure your 'psych' – be optimistic most of the time (not all the time). The psychiatric hospitals are partly filled with folks who became 'overwhelmed' by a situation they could not make provisions for – disappointments, 'broken-minds', and all. Be optimistic – expect the good. Be realistic – prepare for the bad. That could be your 'Psych-Insurance' against depression.

The Filter-and-Position Game reminds me of a story about a cousin. It was a Saturday – uncle T. T's wedding day. Everyone was well dressed and ready, except Phillip. He had his pair of trouser and coat on but no footwear. Why? None of his old pairs would fit (or so he claims – I think he used the day to his advantage). At age 9 and about 5.4 feet tall, he appeared older than his age. A young lady was asked to accompany him to get a new, fitting pair! An hour and half later, my aunt received a call: “Phillip hadn't found a suitable pair in the Children's Section. They are all small for his size”, the lady shouted. “Then send him to the Adults Section for a pair”, my aunt replied. We laughed our hearts off.

Most things come in sizes. Everything! From footwear through handkerchiefs to candle sticks. So are our problems! Each moment we are faced with daunting challenges – from monthly fuel increment through having to download a pdf copy of ECG's power rationing schedule to joining an unending queue to purchase a Fire Service Recruitment Application form. Sorry – are these even considered problems in Ghana? Whichever the case, problems do come – in sizes. Granted that you lost a job, a loved one and the house you just bought and moved in was being pulled down by the AMA, all in a day (I guess this would even be too much for the Biblical Job). What can you do? Maybe this could help. 'Filter' these three misfortunes – which is the most serious, and the least. Well, maybe the building is an emergency! You have your CV and the morgue for the rest (easier said than done, right?). You decide to call a friend to let you and your family lodge in their guest room whilst you contact your lawyer, your agent, and the AMA for a resolution (if there would ever be one).

What next. You do a mental calculation to 'Position' the problems against time and the needed resources to 'contain', or to resolve them. Here, you look for strengths and support. At this juncture, most folks could sincerely forget that they are a part of a family, or belongs to a Credit Union, or belongs to a Church or other religious faith, or qualifies to borrow from their banks. Indeed, in times of sudden problems, it's quite difficult to reason rationally. What you could do next is to accept the situation, allow enough time to grief over it, estimate the time needed to resolve the problems (if possible) and remain optimistic – whilst not forgetting the worst that could still happen. Filter and position! What kind (or type) of problem is this? What resources will I need? Is this a solvable problem? How long would it take resolve this problem? What would be the opportunity cost in solving this problem?

Certainly our expectation of the bad enables us to well appreciate the good. If you need help – admit it and call for it. You could relieve some of your stress if you share with others and seek for professional help. Speak to a Clinical or Health Psychologist when you cannot bear the psychological distress and depression. At a point in time – no one can! You are not alone!