Depression or the helpless despair and anguish of madness? I suspect that it is very difficult to tell one from the other; especially if the madness is the more common quiet and hypo-active type. I also suspect that our collective instinct is to avoid knowing if the person is suffering from the later [hypo-active madness] because we would feel both scared and helpless. I think that part of the solution to this mental block is to begin the discussion of madness with the person we are worried about.
Knowing that depression can sometimes be depression over loosing one’s mind is the first step. Knowing that both states feel awful and cause massive anxiety opens the discussion to finding out which is the problem. Was Paula sad because she had a problem in her life or was Paula sad because she had lost her mind? It is important , it seems to me, to eliminate the possibility of altered mental status or extended but reversible delirium.
It is easy to ask..Paula, are you able to think?
What is your address-do you remember it?
Can you remember how to do your job [even though you remembered that yesterday- there is no guarantee that altered mental status could happen to a person overnight.] Paula mentioned that it [whatever it is] happened overnight after a series of minor illnesses.
We assume continuity of mind [Brittanica-Mind] but this is a false comfort. Illness can cause physical deterioration at any time and at any age and can cause a decline in the function of mind.
When I was with my friend Paula, I had no idea that she had lost her mind. I had no idea because she had no idea either. She had no words to describe her experience. And when she managed to come up with words, no one understood their significance. I know I didn’t.
When she said she felt awful, I assumed she felt depressed. What is worse, is that she was depressed….over the issue of having lost her mind.
Language is a funny thing. We think we understand each other and we often do, but when something out of the ordinary occurs – language becomes open to interpretation – interpretation based on personal experience. Very few of us have had the experience of loosing our mind, our memory and our intellect. Feeling sad, feeling despair over relationships, career, school, and life experiences is something that all of us share. It is the first thing that comes to mind when someone says they feel awful. No one can imagine that the person feeling awful is talking about a type of internal poisoning instead of a break-up or having problems with a mean boss.
What’s wrong, I asked? Did you have a fight with your husband? Paula was silent. I took this as a Yes. I had disagreements with my boyfriends all the time. And I felt awful when my relationships ended. I was certain I knew what Paula meant. I saw Paula every day at work. She looked dejected, sullen, silent, incommunicative, sad, distracted. She didn’t seem to be able to concentrate on her work. I tried to tell her that co-workers were noticing, that they were talking behind her back, even laughing at her because she seemed so inept.
Why didn’t we realize that Paula was sick? There seems to be an overlap between physical illness and depression. Poor health and being sick can cause huge distress, complete despair, and difficulty performing one’s daily tasks, personal and professional. Guilt over not being able to perform can be immense. Loss of weight, poor appetite, pale complexion, lethargy, lack of energy, slumped posture, malaise, silence, etc…can suggest depression due to physical illness. I think that underlying physical illness is one of the main causes of depression, in the young as well as in the old. I also think that addressing these physical problems will lift the depression, and restore quality of life.
It requires recognizing madness or altered mental status. I did not recognize it, but I felt that Paula was “off” in some way, that she was not herself, that it was urgent. I did not know what to do. I did not know to get her basic physiological indicators to search for clues.
I did not know someone could loose their mind overnight. I didn’t know that loosing your mind could be treated. I didn’t know that loosing your mind is reversible. Mind comes back, if you treat what is wrong in the body when physiology is deranged. .