Alex Tang
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Books Recommendation
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Medical Students /Paediatric notes
Understanding the Darkness Within
Dr Alex Tang
Imagine yourself at the bottom of a very deep well. You are so far underground
that you can hardly see the pinpoint of light that is the opening of the well.
Both your feet are stuck in knee-high mud that impedes and slow your movements.
The air around you is humid, hot and pungent. You find it difficult to breathe.
The darkness that surrounds you presses heavily onto your body that you feel you
are being suffocated. You feel tired and drained. You do not know how long you
have been stuck at the bottom of this well and you just do not care. You wish
you were dead. There is no hope, no future and no colors. Just never-ending
darkness. Those of you who have experienced depression will understand what I
have just described. It would be a struggle to get out of bed every morning and
you dread the coming day.
Depression is the most common mental condition in the world today. It is also
the most under-diagnosed treatable emotional problem. Many people do not know
they are depressed and many doctors do not think of depression when they review
the symptoms of their patients. A medical journal in Malaysia states that
depression occurs in 5-10% of patient treated by the general practitioners (GP)
and 6-14% of hospitalized patients in this country. The World Health
Organization estimated 121 million people suffer from depression and one million
people die from suicide due to depression. Yet, studies have shown that 60% of
people who suffered from depression recover with adequate counseling and
medication.
Are You Depressed?
The prophet Elijah had a spectacular power encounter with the Baal prophets on
Mount Carmel (1 Kings 18:16-40). This encounter resulted in a great victory and
the slaughter of the Baal prophets. It also resulted in rain coming after three
years of draught. You would have think Elijah will be happy and jubilant.
Instead, on hearing that Queen Jezebel had put a contract on his life, Elijah
was afraid and ran for his life. The Chronicler noted that “When he came to
Beersheba in Judah, he left his servant there, while he himself went a day's
journey into the desert. He came to a broom tree, sat down under it and prayed
that he might die. "I have had enough, LORD," he said. "Take my life; I am no
better than my ancestors." Then he lay down under the tree and fell asleep” (1
Kings 19:3-5). What a strange thing for Elijah to do. Yet depression makes us
behave strangely. And Elijah was depressed.
Elijah exhibited some of the most common features of depression:
• Elijah ran out of fear. Then he sat under a tree and wanted to die. Sadness is
the most common emotion experienced while other people may experience
irritability and stress.
• Shying away from human company is another common behaviour. A depressed person
does not want to be with other people. They want to be alone. They wish they can
withdraw into their own cocoons. Others long for the comfort of the womb and
will assume a ‘fetal’ position. Elijah went alone into the desert.
• Feelings of worthlessness, hopelessness and despair are common. Elijah felt he
is no better than his ancestors. A depressed person feels that he or she is the
most worthless person in the universe.
• Elijah slept. Loss of energy and feeling tired despite resting are other
common features. A depressed person feels lethargic. His usual hobbies give him
no pleasure. Where music used to stir her soul, a depressed person feels nothing
inside. They describe themselves as numb or dead inside. There may also be a
change in sleeping pattern. Some depressed person sleep more; others become
insomniacs or wake very early in the morning.
• A depressed person often harbors thoughts of suicide. To them, there is no
hope so that only way out was to kill themselves.
• Others may find difficulty in concentrating. They may find it difficult to
read the newspaper. Most will also have problems making simple decisions. Making
a choice in choosing to wear a blue or green blouse may be a difficult decision.
Those are the most common features of depression. Most depressed people has all
the above mentioned features that Elijah experienced. Does having these features
means you are depressed? The answer is no. Negative feelings or feelings of
being ‘down’ or under the weather are common to all of us. We may feel sad if
our favorite dog died or we did not get our expected cash bonus. That is our
normal human emotional response. It becomes depression if these negative
feelings last more than two weeks. Depressed people experience these negative
feelings for week, months and even years.
What is depression?
Neuroscientists have discovered that our brain cells communicate with each other
using chemical compounds called neurotransmitters. They also discovered these
neurotransmitters also affect our moods. Too much causes over-stimulation or
euphoria and too little causes depression. Depression is due to a
neurotransmitter imbalance. It is not a state of mind. Thus we cannot command a
depressed person to ‘snap out of it’. Fortunately, there are now medications
that can restore the balance of neurotransmitter levels.
Who are susceptible to depression?
Much research has been done on depression and doctors and neuroscientists know
more about the condition than before.
• Genetics is an important cause of depression. That is why in certain families,
its members are more prone to suffer from depression than others. Unfortunately,
neuroscientists are still not able to pinpoint the specific gene that causes
depression. It will be a relief for many people if one day, doctors by gene
therapy are able to switch off certain genes that cause depression.
• People with certain personalities are more prone to suffer from depression.
These people often have low self-esteem and are perpetual pessimists. They
always imagine the worst case scenarios.
• Physical conditions like chronic medical illness such as heart diseases,
cancers and AIDS can cause depression. In chronic illnesses, various organs are
involved and inevitably the neurotransmitter balance in the brain is involved
too. This will commonly lead to depression.
• The most common cause of depression is the fast pace of our modern lifestyle.
Our fast pace lifestyle leads to stress. Stress provokes a ‘fight or flight’
response in our bodies. This is the way we are created to respond to our
environment. Slow runners were often eaten by carnivorous dinosaurs. Our hectic
lifestyles are very stressful. Stresses for short periods are helpful. Stress
increase the level of neurotransmitters in our brain which sharpens our response
time and make us more alert. However, prolonged stress is harmful. Our bodies
were not created to handle prolonged stress. Our Creator has built into our
bodies, a need to rest; a time for Sabbath rest. During periods of rest, we
de-stress and the neurotransmitters in our brain stabilize and toxins are
excreted. If we do not have sufficient rest and are exposed to prolonged stress,
our brains secrete a lot of neurotransmitters. Over time, our neurotransmitters
level becomes depleted because the brain cells cannot produce as much as we
need. We then become ‘burnt out’. In the past, we called this condition, a
‘nervous breakdown’. Essentially being ‘burnt out’ or having a ‘nervous
breakdown’ is due to chronic prolonged stress. Is it any wonder the incidence of
depression is increasing in the world?
• Other causes of depression are drug abuse; especially mood modifiers, anxiety
disorders, and schizophrenia.
Conclusion - Don’t Worry, Be Happy
In this world, we want to be happy. “Don’t worry, Be happy” seems to be the
motto of our modern society. As a result, people with depression often feel out
of place. Depressed people are often considered failures or losers. This is not
true. No one would consider the prophet Elijah a failure. Yet Elijah suffers
from depression like many of us. As we have seen, there are some causes of
depression we can do nothing about such as genetics and physical causes. These
need medications to get well. Other causes such as depression
prone-personalities can be helped by counseling and spiritual direction. This
leaves the most common cause of depression- chronic stress from a hectic
lifestyle. This is one condition we can prevent and cure. We can change our
lifestyle to be less stressful. The only way is to follow the Sabbath rhythm of
life- a time to work and a time for rest.
Soli Deo Gloria
|posted 30 August 2006|
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