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Depression-Maciocia-Online.Pdf THE TREATMENT OF DEPRESSION WITH CHINESE MEDICINE 馬 萬 Copyright Giovanni Maciocia 里 WESTERN VIEW A depressive illness is primarily characterized by a change in mood consisting of a feeling of sadness which may vary from mild despondency to the most abject despair. The change in mood is relatively fixed and persists over a period of days, weeks, months or years. Associated with the change in mood are characteristic changes in behaviour, attitude, thinking, efficiency and physiological functioning. In distinguishing the normal reaction from pathological depression, a quantitative judgement has to be made. If the precipitant seems inadequate, the depression too severe and too long lasting, the condition is regarded as abnormal. In addition, the severity and incapacity in depressive illness differs qualitatively as well as quantitatively from depressed feelings which are part of normal experience. Depression accounts for 35-40% of all psychiatric illnesses. It is twice as common in women as in men. The onset of depression increases towards middle age with a maximum onset in the 55-60 age group. Depressive illness which is predominantly determined by genetic- constitutional factors is referred to as endogenous depression. This is characterized by being worse in the morning. Depressive illness which is predominantly a reaction to environmental influences is referred to as reactive depression. NOTE In my opinion, the distinction between endogenous and reactive depression is not significant in Chinese medicine. We would view every patient with depression as a combination of these two factors. Types of depression: Psychotic Neurotic Reactive Endogenous Involutional Psychogenic Pre-Senile Acute Chronic Manic-depressive Alcoholic M. Seligman, Helplessness, W.H. Freeman and Co., San Francisco, 1975. The most useful typology of depression (in Western medicine) is that of endogenous and reactive. Reactive depression is the most common. Roughly 75% of all depressions are reactions to some external event, such as the death of a family member. Reactive depression does not cycle regularly in time, is not usually responsive to drugs, is not genetically predisposed. Endogenous depression is a response to some unknown internal process. This depression is not triggered by any external event; it just sweeps over the sufferer. M. Seligman, Helplessness, W.H. Freeman and Co., San Francisco, 1975. “Learned helplessness” suggests that one of the causes of depression is the belief that action is futile. Events that set off reactive depression include: - Failure at work or school - Death of a loved one - Physical disease - Financial difficulty - Being faced with insoluble problems - Old age. What links these experiences and lies at the heart of depression is unitary: the depressed patient believes or has learned that he cannot control those elements of his/her life that relieve suffering, bring gratification or provide nurture, in short, he/she believes that he/she is helpless. Endogenous depression, while not set off by an explicit helplessness- inducing event, also may involve the belief in helplessness. M. Seligman, Helplessness, W.H. Freeman and Co., San Francisco, 1975. E. Bibring: What has been described as the basic mechanism of depression, the ego’s shocking awareness of its helplessness in regard to its aspirations, is assumed to represent the core of depression. F. Melges and J. Bowlby: Our thesis is that while a depressed patient’s goals remain relatively unchanged his/her estimate of the likelihood of achieving them is diminished…The depressed person believes that his/her plans of action are no longer effective in reaching his/her continuing and long-range goals. From this state of mind is derived depression, indecisiveness, inability to act, feeling of worthlessness and of guilt. Note indecisiveness, inability to act, M. Seligman: Depression is both a cognitive and emotional feeling of guilt. disorder. Cognition of helplessness lower mood and a lowered mood increases the susceptibility to cognition of helplessness: this is the most insidious vicious circle in depression. When Note combination of cognitive and depression is observed close up, the exquisite interdependence emotional aspects. of feelings and thought is undeniable: one does not feel depressed without depressing thoughts, nor does one have depressing thoughts without feeling depressed. In depression, there are many bodily changes: • Increased aches and pains, which occur in about two out of three people with depression • Chronic fatigue • Decreased interest in sex • Decreased appetite • Insomnia, lack of deep sleep, or oversleeping • Gastrointestinal problems In the primary care setting, a high percentage of patients with depression present exclusively with physical symptoms. Simon et al. analyzed a World Health Organization study of somatic symptoms in the presentation of depression. Of the 1146 patients in 14 countries included in the survey who met the criteria for depression, 69% reported only somatic symptoms as the reason for their visit.1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC486942/ 1. Simon GE, Von Korff M, and Piccinelli M. et al. An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999 341:658–659. The main symptoms and signs of depression are: - Painful thoughts - Anxiety and agitation - Loss of interest - Loss of self-esteem - Derealization and depersonalization (Shen Obstructed) - Hypochondriasis - Disorders of perception (Shen Obstructed) - Insomnia - Loss of appetite - Diurnal variation (worse in the morning) According to Bowlby depression is a mood that most people experience on occasion, is an inevitable accompaniment of any state in which behaviour becomes disorganized, as it is likely to do after a loss.1 1. Bowlby J 1980 Loss Sadness and Depression, The Hogarth Press, London, p. 246. So long as there is active interchange between ourselves and the external world, either in thought or in action, our subjective 神 experience is not one of depression: hope, fear, anger, satisfaction, frustration, or any combination of these may be experienced. It is when interchange has ceased that depression occurs until such time as new patterns of interchange have become organized towards a new object or goal. It is characteristic of the mentally healthy person what they can bear with this phase of depression and disorganization and emerge from it after not too long a time with behaviour, thought and feeling beginning to be reorganized for interactions of a new sort. A person prone to depression will not be able to reorganize new patterns of interaction between themselves and the external world. SHEN 申 伸 To extend, reach out, stretch, express SHEN. Shen, spirit, mind, consciousness, vitality, 神 expression, soul, energy, god, God. Shi “Influx from heaven; auspicious or inauspicious signs by = which the will of Heaven is known to mankind.” Altar (for 示 sacrifices). Spirit tablet. Shen = to state, express, explain, to stretch, extend, the 9th Earthly 申 伸 Branch According to Seligman depression is characterized by a feeling of helplessness, principally the issue about which a person feels helpless is his ability to make and to maintain affectional relationships. The feeling of helplessness can be attributed to experiences in the family of origin from childhood to adolescence: 1) He or she is likely to have had the bitter experience of never having attained a stable and secure relationship with his parents despite having made repeated efforts to do so. These childhood experiences result in their developing a strong bias to interpret any loss they may later suffer as yet another of his failures to make or maintain a stable affectional relationship. 2) He or she may have been told repeatedly how unlovable, and/or how inadequate, and/or how incompetent they are. Were they to have had these experiences they would result in his developing a model of himself as unlovable and unwanted, and a model of attachment figures as likely to be unavailable, or rejecting, or punitive. Whenever such a person suffers adversity, therefore, far from expecting others to be helpful they expect them to be hostile and rejecting. 3) He or she is more likely than others to have experienced actual loss of a parent during childhood. 4) Helplessness. According to Seligman, depression may be due to learned helplessness, i.e. the conviction that one’s behaviour will not affect the situation. They have little motivation in trying to change a situation because they think that nothing will change despite their efforts. (Zhi of the Kidneys). Therefore the particular pattern of depressive illness that a person develops will turn on the particular pattern of childhood experiences they have had. Exposure to such experiences in childhood also explains why in depressive-prone individuals there is a strong tendency for the sadness, yearning and perhaps anger aroused by a loss, to become disconnected from the situation that aroused them. Symptoms of depression according to Seligman: - Painful thoughts Self dislike - Anxiety and agitation Worthlessness - Loss of interest Guilt - Loss of self-esteem Future looks black - Derealization and depersonalization Crying - Hypochondriasis Insomnia - Disorders of perception Lack of sexual desire - Insomnia - Loss of appetite Negative cognitive set - Diurnal variation (worse in Lowered initiation of voluntary responses the morning) M. Seligman, Helplessness, W.H. Freeman and Co., San Francisco, 1975. Isolated and withdrawn, prefers to remain by himself/herself, stays in bed much of the time. Gait and general behaviour slow and retarded. Volume of voice decreased, sits alone very quietly. Feels unable to act, feels unable to make decisions. Gives the appearance of an empty person who has given up. Paralysis of the will is a striking feature of severe depression: In severe cases, there often is complete paralysis of the will. The patient has no desire to do anything, even those things which are essential to life. Consequently, he/she may be relatively immobile unless prodded or pushed into activity by others. It is sometimes necessary to pull the patient out of bed, wash, dress and feed him/her.
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