اندیشهفلسفهخردگفتگوحکمتمعناپرسشفرهنگ
Psychology
The Article “Depression: One Word, Several Meanings” by Dr. Mohammad Reza Sargolzaei
Depression is not always an illness; sometimes it is a reaction to failure, and sometimes a disease experienced by only ten percent of people. Distinguishing depression as a symptom, an experience, and an illness—and its varieties from reaction to character—explains the complexities of treatment.
The word depression has been used so much that it seems like a simple subject, but the story of a patient who visits a doctor complaining of depression or with symptoms of depression is a complex one. Statistics from England show that only 30% of patients who suffer from depression visit medical centers, and only 30% of those who visit medical centers receive a correct diagnosis, and only 30% of those who receive a diagnosis of depression get correct treatment from doctors! Why is the matter so complicated? Because "depression" as a "symptom" is something different from "depression" as a "diagnosis." Just as all humans have experienced "pain" many times in their lives, they have also gone through "depression" as an "experience," meaning they have at times entered a state characterized by feelings of sadness, melancholy, listlessness, and lack of motivation, and in this state, their view of themselves, others, and life has become a particular view. A view characterized by hopelessness, a negative assessment of events, a loss of the perception of beauty, and a sensitivity to unpleasant stimuli. But we cannot say that all humans have also experienced depression as an "illness." Research has shown that only 10% of humans experience depression as an "illness" in their lifetime. Here, I will name the various states that can be experienced as depression and then proceed to explain each one: 1- Depression as a reaction 2- Depression as grief 3- Depression as a temperament 4- Depression as a character 5- Depression as a disease 1- Depression as a reaction We all feel frustrated in the face of unpleasant events. We expected to pass an exam, but our name was not on the list of those who passed; we have lost an object that was important to us; we did not receive the attention and kindness we expected from someone who matters to us. Our first reaction in such a situation is "anger." When we become "angry," our mind signals to us that the issue is worth fighting for. In fact, anger is the body's preparation to enter the field of battle. But when we realize that fighting is futile or its cost is more than we are willing to pay, we then feel "frustration." In fact, "frustration" is the declaration of accepting defeat and the command to retreat. This state is characterized by a sad face, listlessness, despair, and hopelessness, and others feel that we are not in good spirits. But this situation does not last long. The self-regulating system of our mind shrinks and distances the matter in our thoughts, and we rise again to get on with life. In depression as a reaction, depression does not overwhelm us but accompanies us. We do not lose the ability to enjoy life, our biological patterns such as eating, sleeping, and activity do not change significantly, and we do not question the entirety of life. This state usually does not last more than a few days and disappears before reaching a week. Of course, sometimes an individual faces a series of unpleasant events. Events that, like the different acts of a play, come to the stage one by one, and before the reaction to the previous act has ended, the reaction to the next act begins. In such circumstances, it is natural that the duration of this reaction will also be prolonged. What can a doctor's or a psychologist's approach to such a situation be? The quickest and most effective help for the patient is to assist them in clarifying their position regarding the unpleasant event, or in other words, to settle accounts with the matter. We call such an approach a problem-oriented approach. How do we do this? 1- By listening eagerly, we encourage the client to recount the matter in as much detail as possible. This stage has several advantages: first, sometimes the compulsion to recount the matter causes the individual to find a new perspective on the issue.
در هنگام نقل ماجرا برای دیگری و برای فهماندن تجربه خود به او ، گاهی به جزئیات یا جنبه هایی از ماجرا برخورد می كند که تاكنون به آن توجه نشان نداده بود و گاهی یك جنبۀ جزئی و كوچك كشف نشده احساس ما را نسبت به یك ماجرای بزرگ تغییر میدهد همانطور كه افزودن ذره ای نمك به یك ظرف غذای بزرگ احساس ما را نسبت به آن تغییر می دهد . گذشته از این ، بازگو كردن تجربه برای دیگران كمك كند که از احساس تنهایی و انزوا خلاص شویم انگار بار خود را با دیگری تقسیم كرده ایم . اغلب می بینیم مراجع پس از بازگو كردن ماجرا برای دیگران نفس عمیقی می كشد انگار با زبان بدن خود می گوید : «آخیش ! راحت شدم!» ممكن است بپرسید اینكه كار بزرگی نیست ، چرا باید چنین كاری را یك درمانگر حرفه ای انجام دهد، هر كس دوستان و آشنایان و نزدیكان بسیاری دارد كه می تواند با آنها درد دل كند . میگوییم صحیح است اما گاهی این نزدیكان شنوندگان خوبی نیستند، قبل از اینكه به سخنان گوینده گوش بسپارند، به نصیحت ، سرزنش ، ارائه راهكار و قضاوت در مورد ماجرا می پردازند و گاهی حتی برای قبولاندن نقطه نظر خود به گوینده ، با او وارد بحث و جدل و حتی درگیری لفظی می شوند و به جای ترغیب گوینده به تخلیه اطلاعاتی و احساسی ، او را در ابتدای راه متوقف می كنند و راه دیگری باز می كنند . انگار به جای رسیدگی به پرونده ذهن گوینده ، پرونده مشتركی را می گشایند و به رسیدگی آن اقدام می كنند ! چرا این اتفاق می افتد؟ مگر نزدیكان او دلسوز و مهربان نیستند؟ چرا با او چنین می كنند؟! پاسخ این است كه دقیقاً به این خاطر چنین می كنند كه دلسوز و مهربانند! آنقدر این فرد برایشان مهم است كه ماجرای او هم برایشان بسیار مهم است انگار این ماجرا تبدیل به ماجرای خود آنها میگردد و آنها چنان به حل مسئله «حریص» می شوند كه دچار خشم یا ناكامی می شوند! یك درمانگر حرفه ای، با یك دوست متفاوت است چراكه فرد را همراه با مسأله اش برای خود تعریف كرده است بنابراین نگاهش نگاه مسأله گشاست نه نگاه نجات دهنده ! او علاقمند و كنجكاو است اما حریص و عجول نیست ! البته ، یك درمانگر حرفه ای نیز یك انسان است و در مواقعی دچار حرص و عجله می شود ! چه وقت چنین اتفاقی می افتد ؟ آنگاه كه مسألۀ مراجع، در ذهن درمانگر یكی از مسائل شخصی خودش را تداعی كند . لازم نیست عین آن مسأله در زندگی درمانگر حضور داشته باشد فقط لازم است وجهی از مسأله به گونه ای وجهی از یك مسأله شخصی درمانگر را تداعی نماید . برخلاف تصور، مغز ما اصلاً منطقی كار نمی كند ! مغز با تداعی ها كار می كند و گاهی تنها عینك یك نفر چنان عینك مادربزرگ ما را تداعی می كند كه بدون هیچ شباهت منطقی بین آن فرد و مادربزرگ ، چنان احساسی نسبت به او پیدا می كنیم كه انگار واقعاً او مادربزرگ ماست ! بنابراین توصیه من به درمانگران این است كه هرگاه حس كردند راجع به حل مسألۀ مراجع شان حرص و عجله دارند ، توقف كنند و نگاه كنند این مسأله آنها را به یاد كدام ماجرای قبلی در زندگی شان می اندازد ؟ این مراجع آنها را به یاد چه كسی می اندازد و نسبت به او چه احساسی دارند و اگر به گذشته ، به ماجرای قبلی و به آن فرد بازگردند چگونه با آن فرد و آن ماجرا تسویه حساب می كنند . اگر این فرایند بتواند احساس او را نسبت به درمانجو تغییر دهد ادامه كار با او مناسب است در غیر اینصورت ادامه كار با این مراجع نه به نفع مراجع است ، نه به نفع درمانگر ! گرچه فرایند فوق، فرایند ساده ای به نظر می رسد، در ذهن درمانگر فرایند پیچیده ای را فعال می كند كه قادر است «مغز غیر منطقی» را به نگاهی متفاوت از قبل ، هدایت كند . 2- به مراجع كمك می كنیم تا تكلیف خود را روشن كند كه آیا می خواهد برای این ماجرا «بجنگد» یا نه . رویكرد انسانها با بسیاری از مسائل زندگی شان رویكرد « پاندولی » است آنها به مسأله نزدیك می شوند و باز از آن دور می گردند ، دوباره نزدیك می شوند و دوباره دور می شوند ، نه برای حل مسأله «دل به دریا می زنند» و نه از آن «دل» می كنند ! درمانگر به درمانجو كمك می كند تا امكانات خود را برای حل مسأله روی دایره بریزد ، هزینه هر یك از اقدامات خود را محاسبه كند و به این جمع بندی برسد كه بر مبنای «اولویت بندی» ذهن خود آیا حاضر است برای حل مسأله «این بها» را بپردازد یا ترجیح می دهد كه مسأله را «بگذارد و بگذرد». مثلاً درمانجو، كارمند یك اداره است كه ماجرای پیش آمده برای او چنین است : فرد جدیدی وارد محیط كاری شده كه باعث شده اهمیت این فرد در این اداره كمرنگ تر شود . توجه ، پاداش و تأییدی كه برای مراجع ما قبلاً بدون تلاش بدست می آمد حالا نیاز به یک رقابت جدی دارد .Our client first feels anger toward this individual and then experiences a sense of failure. We help them to "clarify their priorities" in life: if they had to choose only one between the role of a successful, winning person and a calm, worry-free life, which would they choose? If, in their scoring, they give a higher score to a life of social success, fame, and victory, they must pay the price of fighting for victory, whereas if a calm, worry-free life scores higher, they need to let go of this competition. 3- If the client adopts the stance of "struggle," the therapist's task is to teach them how to consider various choices and a broad range of strategies. The therapist opens and broadens the client's perspective, guiding their view from a "linear" outlook to a "multifaceted" one, and if the client adopts the stance of "farewell," the therapist helps them to "lighten the narrative in their mind." We are not faced with the "event" but with the "mental image of the event"; therefore, the therapist does not have to "wrestle" with the reality of the event in the external world but rather needs to "engage" with the "mental image of the event" in the client's mind. As I said, our brain does not operate logically but through associations; it is enough to somehow "hook" the client's narrative to a narrative that is similar but "light" and "slippery," and we will see that their "farewell" is astonishingly accelerated and facilitated. 2- Depression as Mourning This model of depression is very similar to the previous one, except that the event that created the feeling of failure was an event that had an "identity connection" with our client. What is an "identity connection"? Each of us has a "definition of self" in our mind; this definition is specified by components. For example, I define myself by being a psychiatrist, being a writer, and so on, but I do not define myself by my clothes. If I had a new suit that burned, I would be upset, but if I lost the ability to write, I would experience "mourning"! A "mother" defines herself by her children: losing her children causes her to mourn. A "sports champion" defines themselves by the "championship title"! Losing this title causes them to mourn. A religious person lives by their "beliefs": the shaking of their beliefs causes them to mourn. The process of "mourning" is more intense and prolonged than a "failure reaction" because the individual questions their "self," is confused and lost, loses confidence in themselves, and their worldview suffers "instability," like someone who has "lost the way home"! So you see that not every "bereaved" person is a "mourner," and conversely, it is not necessary for someone to have lost a loved one to be in a state of "mourning." What is our task with our "mourning clients"? 1- Never try to minimize or trivialize their issue. This is not helping them but rather "disrespecting" them. I had a client who had recently lost their father and was going through an intense mourning process. They said one of the hardest moments for me is when I share my feelings with someone and they ask: "How old was your late father?" and when I answer seventy, they immediately say: "Well, he had lived his life, why are you so upset?" If what our client has lost is not very important to us, that does not mean it should not be important to them. 2- We give the client examples of similar cases so they know that this state has happened to many people many times and "life has gone on." This is to alleviate their "feeling of loneliness." When we think we are the only one who has experienced such a situation, we come under heavy pressure. Sometimes we come to believe that "life is unfair and unjust," "I didn't deserve this," and "why me?!" Sometimes we come to believe that "I am being punished," we feel "guilt," we blame ourselves and consider ourselves deserving of this punishment; sometimes we imagine that "no one understands me," and other beliefs, each of which adds suffering to the suffering of our mourning. Mentioning examples of similar situations in others alleviates this "compounded suffering." But the important point here is that doing each of the things mentioned involves "subtleties."مثلاً اگر بنشینیم و به طور مستقیم به مراجع بگوییم: «بگذارید مشكلات دیگران را برایتان بگویم تا بدانید كه تنها نیستید» آنقدر این كار را «زمخت» انجام داده ایم كه در ذهن مراجع نمی تواند بنشیند؛ به جای آن بطور مثال می گوییم : «وقتی داشتید ماجرا را برایم تعریف می كردید یاد مراجعی افتادم كه 3-2 سال پیش آمده بود چرا كه او هم …… » و آنگاه كه «داستان مشابه» نقل شد به جای گفتن اینكه «زندگی ادامه پیدا می كند» ، می گوییم «چند هفته پیش كه تصادفاً او را دیدم لبخندی زد و گفت آن ماجرا زندگی مرا به كلی تغییر داد ، حالا به مسأله طور دیگری نگاه می كنم ، اگر آن ماجرا پیش نیامده بود من شاید هیچوقت یاد نمی گرفتم كه ………» 3- به همان روش فوق مراجع را آماده می كنیم كه به جای تلاش برای «برگشت به گذشته»،كنجكاوانه ـ و نه عجول و حریصانه ـ منتظر بماند تا «تعریف جدید» را دریابد . انسانها به گونه های مختلفی برای «برگشت به گذشته» تلاش می كنند : گاهی سعی می كنند گذشته را «مومیایی» كنند، دلمشغول اشیا و خاطرات گذشته می شوند ، هیچ چیز را تغییر نمی دهند، « انتظار رجعت » از دست رفته را می كشند و به محركها و وقایع جدید علاقه نشان نمی دهند . گاهی نیز سعی می كنند به سرعت «جایگزین» پیدا كنند . « جایگزین » هر چیزی است كه فرد به جای «شیء از دست رفته» در « مجموعه هویتی » خود می گذارد . یك فرد جدید ، یك عشق تازه ، یك مأموریت جدید ، یك ایدئولوژی تازه یا هر چیز دیگر . مسأله این است كه اغلب آدمها، برای كمك كردن به فردی كه سر در گم و « خود از دست داده » است، تلاش می كنند بخشی از «مجموعه هویتی» خودشان را به او پیشنهاد دهند ، بخصوص كسانیكه «حرص كمك كردن» دارند حاضر می شوند «خود» نقش شیء از دست رفته را بازی كنند ! این بازی به نفع هیچیك از طرفین نیست . درمانگر لازم است به مراجع بیاموزد كه با «بازماندۀ مجموعه» همراه شود ، آن را بپذیرد و دوست بدارد و بداند كه این پیشامد در زندگی او همچون یك « كانال زایمانی » است كه او را به «دنیای تازه ای» رهنمون خواهد شد . هیچكس و از جمله درمانگر نمی دانند این دنیای تازه چه مختصاتی دارد ، آنچه درمانگر میداند این است كه این دنیا وسیع تر و با آگاهی گسترده تری نسبت به دنیای قبل همراه است همچون هر «زایمان» دیگری در هستی . تنها درمانگری می تواند در حل و فصل این مرحله به درمانجو كمك كند كه از « وسوسه ارائه دنیای خود » به درمانجو به عنوان «جایگزین» و « حرص كمك كردن » گذر كرده باشد. رسیدن به چنین حالی منوط به ایجاد تعادل بین « علاقه مندی » و «شكیبایی» است . اگر درمانگر به كمك كردن علاقه نداشته باشد این مجموعه نامتعادل و ناپایدار خواهد بود اما اگر شكیبایی خود را از دست دهد ، « حرص كمك كردن » نیز تعادل مجموعه را به هم خواهد ریخت . رسیدن به این « تعادل »، جدا از «شخصیت درمانگر» نیازمند «تجربه درمانگری» است . اغلب درمانگران جوان دچار حرص درمانگری میشوند و از این طریق در حل مسأله ناتوان می شوند . این وضعیت مرا به یاد این ضرب المثل می اندازد كه « پناه بر خدا از آرایشگران پیر و پزشكان جوان » ! گذشته از این ، آموزش این « قانون هستی » به مراجع كه «پایان شب سیه سپید است» و «هر چه از دست می دهیم مقدمه ای است برای بدست آوردن چیزی بهتر» كار آسانی نیست چرا كه «سخنی كز دل برآید لاجرم بردل نشیند» بنابراین درمانگری كه خود یك فرایند سوگ را با موفقیت پشت سر گذاشته و این باور را نه بعنوان یك «شعار»كه بعنوان یك «شعور» دریافته است می تواند چنین باوری را در مراجعش ایجاد نماید . «ویكتور فرانكل» د ركتاب «انسان در جستجوی معنی» این مفهوم را بیان می كند كه اگر نتوانیم برای رنج های زندگی معنایی بیابیم ، خوشی های زندگی هم پوچ و بی معنا خواهند بود ،یا تمام این بازی معنا دارد ، كه در آن صورت فراز و نشیبش دارای معناست و یا این بازی فاقد معناست كه در آنصورت خوشی های زندگی نیز مسخره خواهند بود . «دكتر ترور گریفیت» در كتاب «از دست رفته و بازیافته» (The lost and then found) به مراحل سوگواری به تفصیل اشاره می كند و همچون « الیزابت كابلرراس » به این نقطه نظر می رسد كه حل و فصل سوگ زمانی با موفقیت انجام میشود كه ابتدا فرد از بازگرداندن جهان به آنچه پیش از این بود كاملاً ناامید و مأیوس شود (Despair) و جهان را با مختصات جدید بپذیرد (acceptance) خطری كه در این مرحله از حل و فصل سوگ وجود دارد این است كه فرد «معنویت»(spirituality) را جایگزین شی از دست رفته « مجموعه هویتی » خود نماید ، فرایندی كه « آماس معنویت » می نامیم ! معنویت جایگزین هیچیك از اجزای زندگی نیست ، معنویت «معنای مجموعه» است .3- Depression as Temperament A group of individuals constantly experience mood swings such that these fluctuations cause noticeable changes in their behavior. For a few days, these individuals are cheerful, energetic, and lively; without any clear reason, for a few days they are listless and apathetic. The "severity" and "duration" of these changes are not such that this process fits within the definition of "illness," and on the other hand, this process does not "afflict" the individual like a disease; rather, it is the individual's "nature" and "temperament," and these changes have existed naturally from the beginning of life. Depending on their reaction to their emotional changes, this group of individuals has different "destinies." A group of them, due to this instability, "jumping from one branch to another" and "capriciousness," have an unstable life, while in another group of individuals, this instability is itself an "opportunity"! The individuals in the first group are called moody people; they are unpredictable and never reach any destination. However, the individuals in the second group possess a special characteristic called Self-directiveness, meaning they are themselves aware of their "atmospheric" changes and "manage" them, like a pilot who adjusts their aircraft's navigation systems according to changes in weather conditions. This group of individuals are called Enlightened. Because they view life from different and even contradictory perspectives during their emotional changes, they have a broader outlook on life. Research by some scholars has shown that many of the world's prominent and creative individuals have suffered from emotional instability, such that these researchers have proven a significant "correlation" between "creativity" and "emotional instability." They believe that during periods of "low mood," these prominent individuals develop a negative and critical view of their previous works and their working style; therefore, in periods of "positive mood," when they become productive and active, instead of repeating previous works, they give a new style and approach to their activities. Among these individuals, one can mention "Leonardo da Vinci" and "Winston Churchill." The Japanese have recently conducted extensive research in the field of emotional changes. They have concluded that just as the various phases of the moon, the earth's rotation around the sun, and the changes of seasons have a specific "rhythm" and "cadence," the emotional changes of every human also have a specific "cadence." If a person becomes aware of this cadence and arranges their daily plans based on its prediction, "inner and outer harmony" occurs. But if a person is unaware of this cadence and encounters it unexpectedly, their life situation becomes irregular and disharmonious: when they need movement and dynamism, they are listless, and at another time, without any necessity, they are overly excited and restless! Discovering the state of "temperamental depression" is made possible by recording emotional changes in a "calendar chart." The individual can plot the date based on the days of the month on the horizontal axis and their emotional state based on a grading of "joy" or "sadness" on the vertical axis: J
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The above chart shows that this individual experiences 4–5 day periods of sadness, 1–2 day neutral periods, and 3–7 day periods of elation without any specific trigger. If he draws this chart over several consecutive months, he will be able to predict that the first to fourth, thirteenth to sixteenth, and twenty-third to twenty-sixth days of each month bring the most elation and energy, so he can schedule his most important and complex activities for those days. But if the individual is overwhelmed by these emotional changes and cannot align his life plan with his internal rhythm, it might be better not to experience these fluctuations. Since these changes are temperamental, psychological treatments are ineffective in controlling them, and only pharmacological treatments can have an effect. Mood stabilizers, new antidepressants, dopamine-serotonin antagonists, and calcium channel blockers are among the medications suggested for controlling emotional instability. A discussion of how to prescribe these drugs is beyond the scope of this article and is comprehensively discussed in psychiatric textbooks. 4- Depression as Character This type of depression is similar in one respect to “depression as temperament,” and that is its “chronic” pattern. That is, unlike “depression as reaction” and “depression as mourning,” it cannot be considered a response to an “event” in life, nor can a “time of onset” be specified for it. On the other hand, however, unlike temperamental depression, this type of depression has no biological basis and does not respond to drug treatment at all! Why? Because this type of depression is not a change in the brain’s neurotransmitters but a “chosen role,” and we cannot change people’s “choices” with medication. How does an individual choose depression as a “role”?! Each of us, based on the “validation” we receive from others, gradually learns what “definition” of “self” to present to others. In an environment where the “ambitious,” “competitive,” and “success-seeking” person is validated and rewarded, naturally many people learn to define themselves with these traits in that environment. But in another environment, “weak” and “incapable” individuals receive more attention and affection. In such an environment, it is not at all unlikely that people will present themselves as “wretched,” “afflicted,” and “depressed,” and gradually become so accustomed to this role that they define themselves this way even to themselves! Then they themselves believe they are depressed and even continue it in environments where this role creates no validation or attention, because they have come to believe this about themselves! Eric Berne, in his books “Games People Play” and “What Do You Say After You Say Hello?,” explains these “roles” in detail. Part of James Redfield’s comprehensive theory also elaborates on this same matter. His “serial” books that explain his comprehensive theory are, in order: “The Celestine Prophecy,” “The Tenth Insight,” “The Celestine Prophecy: An Experiential Guide,” and “The Secret of Shambhala.” Apart from describing the process that leads to “choosing the depressed role,” what is the therapist’s task with such clients? Once the therapist is confident that they are facing such a case, treatment has two stages. The first stage is to bring the client to the awareness that they are not ill but rather have chosen and continue to choose this role themselves. This is not an easy task, as expressing this idea to the client does not create a positive effect; the therapist needs to help them “arrive at” this idea. “Hearing” the therapist’s opinion alone does not solve the problem; it is important that the client can “see” life through the therapist’s eyes. Sometimes the therapist needs to patiently and deliberately, over months, with clever, targeted questions—which we call Socratic questions—lead the client to their point of view, and sometimes, conversely, the client needs an immediate and sometimes intense “nudge” to be “shaken up.” Only the “experience of therapy” can bring the therapist to the point of discerning where it is necessary to proceed with deliberation and tolerance and where they must “strike a blow.” Hermann Hesse, in the story “The Secret Sharer” in the book “Three Tales,” beautifully describes this truth that some human beings need “firmness” to change, while others need “gentleness.”
مرحله دوم درمان زمانی اتفاق می افتد که مراجع با «سناریویی» که تاکنون بازی کرده است آشنا می شود و در می یابد که مسئول تغییر دادن این نمایش خود اوست ؛ در اینجا نقش درمانگر کمی تغییر می کند و به جای نقش اکتشافی (explorative) اولیه و رویکرد سقراطی (Socratic approach) ، لازم است درمانگر در موضع طراح و کارگردان سناریوی جدید (Designer) قرار گیرد و روابط جدید مراجع را با جهان پیرامونش سازماندهی کند . گاهی لازم است برای خو کردن مراجع به نقش جدید ، این نقش در فضای درمان تمرین شود ، فرایندی که به آن playing Role می گوییم . اغلب لازم است که برای ایفای نقش جدید ، به درمانجو تکالیفی را برای انجام در فواصل جلسات درمان «حکم» کنیم و به اجرای آنها پافشاری کنیم و از او گزارش بگیریم و هرگاه مراجع با خزیدن به « لاک ناتوانی » شانه از زیر تکالیف خالی می کند مجدداً به او کمک کنیم تا «ببیند» که این کار نیز شکلی است از بازی «ننه من غریبم» و «کار من با این چیزا درست نمی شه ، باید یه فکر اساسی کنیم » !
5- Depression as an Illness Finally, in some patients, depression is not a reaction, not grief, not a temperament, and not a character trait, but truly an illness, just like "hypothyroidism," "glaucoma," "Crohn's disease," and "lupus"! An individual who previously "lacked depressive symptoms" develops symptoms such as feelings of sadness and hopelessness, apathy, an inability to enjoy things that were previously pleasurable, fatigue and weakness, difficulty concentrating and with memory, disturbances in basic bodily functions such as sleep, appetite, libido, and energy and activity, decreased self-confidence, a lack of interest in life, thoughts of death, and even a mental preoccupation with suicide. Although an unpleasant environmental factor (stressor) may play a role in the onset of the illness, this factor acts merely as a trigger; in fact, it is like pushing someone who was already on the edge of a well. So, if the stressor only plays an accelerating role, then what is the main factor? The most recognized factor appears to be a hereditary predisposition. It is necessary to know that depression as an illness also has various patterns. I will just list them: this depression can have a bipolar pattern (meaning we also expect the occurrence of "Mania," which is the opposite state of depression, in the patient) and it can have a unipolar pattern. The bipolar pattern includes Bipolar I, II, and III disorders, and the unipolar pattern includes Major Depressive Disorder, Minor Depressive Disorder, Brief Recurrent Depressive Disorder, Premenstrual Dysphoric Disorder, Postpartum Depression, Seasonal Affective Disorder, and other unclassified forms. Sometimes, the "illness of depression" occurs secondary to other diseases (such as hyperthyroidism, Parkinson's, Multiple Sclerosis, malignancies, etc.) or secondary to the use of medications (such as corticosteroids, interferon, etc.) or substances (opiate compounds, alcohol, etc.). In any case, whether the "illness of depression" is unipolar or bipolar; whether it is primary or secondary to a medical disorder, medication, or substance, this "illness" is a medical issue and requires pharmacological intervention. Naturally, the topic of pharmacological treatment for this illness is beyond the scope of this article. Psychological treatment for this illness is in no way a substitute for pharmacological treatment; rather, the therapist's psychological knowledge should be devoted to stabilizing the doctor-patient relationship (Rapport), increasing the patient's cooperation with pharmacological treatment (compliance), and ensuring the patient receives correct and practical education about the course of their illness, and with the therapist's reassurance
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Dr. Mohammad Reza Sargolzaei — Psychiatrist
Bahman 1384
Source: Personal website of Dr. Mohammad Reza Sargolzaei
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Discussion2 comments
واقعا ممنونم خیلی آموزنده بود.
بحث در این زمینه بسیار برایم جالب و مفید بود و مطلب وسیعی بزبان ساده و نسبتا جامع که برای افراد غیرمتخصص قابل استفاده باشدارائه گردیده . افسردگی امروزه در ایران هم بسیار شایع است و از اینکه به مسئله ی مهم و مبتلابه اکثریت پرداخته شد تشکر فراوان میکنم. خسته نباشید.