Depression

Mental Health and Depression

Work in Progress / In Arbeit

Disclaimer: I am NOT a healthcare professional and have no qualifications to give help or advice to people with mental health issues! 

I am a mental health patient myself with long personal experience of MDD Major Depressive Disorder. I am therefore ONLY able to discuss this disorder from a patient's perspective and provide my subjective views on the condition and it's treatment in the German health system.

If you have any mental health issues and may be triggered by discussions in this area please leave the page now! 

If you are having a mental health crisis please contact you GP, psychiatrist, psychologist or any other healthcare professional who may be treating you at this time. If you are having an existential crisis, please contact the emergency medical services where you are immediately and get help. Harming yourself in any way does not alleviate your problems and will cause pain, worry and suffering to people you are near to or who care about you. Don't do it to them. Help is available. Reach out and get it.

Ok. Now for some of my subjective thoughts!

There is already plenty of information about depression on the internet. There are many people, who write about living with depression. There is also lots of advice about how to deal with depression and how it can be treated.

For many people, however, none of this helps. This blog is for those for whom this is the case. For people who have already tried various treatments but remain depressed or experience recurring depressive episodes. For those who have lost hope ever to be able to live a normal life again, to be able to free themselves from this paralysing, clinging lack of motivation, emotion and desire - except for the desire to protect oneself through withdrawal.

One of the most common problems, is the expectation that patients independently organise and press ahead with their own treatment. And that is the paradox. For depressed people like me are incapable of organising themselves or pushing ahead with anything. Despite this being one of the major symptoms of a depression, this problem is all too often underestimated, or considered as a prerequisite for treatment, by psychiatric and psychological personnel as well as next of kin.

It is expected that patients take care of obtaining appointments with therapists themselves. The fact that this is difficult enough for well functioning people, due to the long waiting lists and overworked therapists with no free capacity to take on new patients, is often neglected. That determination and endurance - two more properties that are not normally associated with depressed people - are other prerequisites is similarly ignored. Simply working through a list of therapists, calling each of them - sometimes at certain, limited availability times, is often an insurmountable obstacle for many depressed people. Even thinking about a single call often causes prolonged pondering without reaching a result. Which therapist should I call? What do I tell them? How can I explain my problems, my needs? What are my needs anyway? Do I have any? What treatment do I actually need (this question is not made easier if different psychiatrists and psychologists have provided different recommendations)? What do I do if my request is rejected? What do I do if I get an appointment, but a long time in the future? Do I accept and try to get further appointments? What do I do if I get a number of appointments with different therapists? Do I attend all of them? Is that even allowed? Do I need a transfer from my specialist or GP? One transfer per appointment? These questions chase each other in circles. The answers come back in fragments, incomplete, broken off, already overtaken by the next question before an answer is reached. You are incapacitated.

There are often further aggravating circumstances. In my case, my psychotherapist broke off my therapy because she felt it wasn't "productive", that she had the impression she wasn't able to reach me on an emotional level and that the therapy was therefore not working. I therefore have a course of therapy, agreed by the health insurance, but broken off mid-treatment. I should therefore find out if I can change to another therapist, or form of therapy. Additionally, I had a pending application for a disability pension, which apparently can also hamper starting therapy with a different therapist. This need for clarification, however, is another obstacle to getting the treatment I need (whatever that may be) leading to further pondering and paralysis.

In my experience, people who have not experienced it, even mental health experts, cannot comprehend or relate to this paralysing brooding. In fact, even people who have experienced it and recovered can hardly understand retrospectively. At least, that is what it's like for me when I am doing ok. I am unable to understand, to empathise, with the extreme inability to reach decisions that I experience during my depressive phases. Daily decisions are then child's play and are reached without, or with hardly any, contemplation. You just do it. For a depressed person, this is simply not possible. Every individual decision, no matter how small or insignificant, is coupled with extended contemplation and brooding. Shall I get up? Shall I eat something? Shall I go to the toilet? Shall I have a cigarette? What shall I do now? Shall I watch TV? Get dressed? Even these decisions are very challenging for a depressed person, which leads to this unbelievable paralysis and prevents any decisions which are objectively somewhat more difficult.

And why are all such decisions so troublesome for a depressed person? Because a depressed person is a person without feelings, without will and without desires. They have no impetus. They actually don't want anything. They just exist. Only basic physical needs (eating, drinking, going to the toilet etc) lead to action when the distress exceeds the inertia. They have no needs, over and above existing. And the need that this suffering somehow, sometime reaches an end.

Even when someone ends up in a psychiatric hospital, it is expected that patients can involve themselves, open themselves up, in order to be able to be helped. It is insinuated that a patient who does not involve themselves in the therapy does not want to be helped. It is assumed that a depression patient is able to put themselves into a state in which, for example, group therapy can start. A patient that does not do so is accused of being resistant to therapy. This is wrong! It is not about the patient not wanting to participate in the therapy but being unable to do so. Effectively you are told to heal yourself enough to be able to successfully take part in therapy. There is not enough thought put into the question of how to enable patients to be able to take part in therapy!

And what sort of therapies are we talking about? ... but I'll get to that later. Just one thing up front: the therapies are a uniform, standard program hardly targeted at all to the needs of the patients. Let's be straight about this. It is not necessary to explain what emotions are to depressed people! What causes them, what do they feel like and how to deal with them. A depressed person knows very well what emotions are and how they feel it's just that at the moment, they cannot sense any and repeatedly having to name some emotion in a flashlight round doesn't change that. It is simply not the case that we have to relearn what emotions are or that we have forgotten what they feel like or have lost touch with them. On the contrary. We are well aware of emotions and how they feel. We just don't have any during a depression! When we say that we cannot enjoy anything, look forward to anything, this is not just a manner of speaking. We really do not feel anything. This status is also incomprehensible for healthy people and even for recovered people, hardly understandable. That is why depression is an illness of the psyche. It is madness! Help us overcome this madness. It's not possible to simply talk it out of us.