Feeling sad is not an illness. Every individual, including children and adolescents, experience sadness, grief, social withdrawal and irritability in varying degrees, on and off in their lives.
Such feelings are part of the normal emotional graph and human beings are generally well-equipped to handle them. But, when it becomes difficult – or well neigh impossible - to overcome a temporary setback after a reasonable period of time, it may be an indication of a serious problem.
Being in a negative emotional space without the presence of external impetus, or being unable to shake off emotional disjointedness, can be symptomatic of deep seated mental health issues like depression, generalised anxiety disorder, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder and others. Out of these, depression is the most common mental health issue that can affect a person.
Perception and reality
Depression is unrelated to age, and is caused by a combination of biological, lifestyle, educational, professional and social stress. Exogenous depression or reactive depression is caused by triggers or incidents that change the way our brain reacts to situations, and in such cases, improvement in mood is not time bound or automatic. Exogenous depression is associated with traumatic experiences like abuse, violence, physical and/or mental trauma, natural calamities and death of a loved one; or it can be a derivative of a pre-existing or recent medical condition, low self-esteem and even pregnancy.
Duration, degree and quantification of symptoms help distinguish exogenous depression and what can be called a low phase. If two or more symptoms like changes in appetite, feeling sad, lonely or grief-stricken, unreasonable anger or frustration, changes in duration or quality of sleep, being in a state of mental and physical lethargy, social withdrawal, lack of decisiveness and concentration, feeling helpless, worthless or hopeless, and recurrent thoughts of suicide appear for more than two weeks persistently, the person maybe suffering from depression.
Having a negative reaction to a tragedy is absolutely normal, more so if it happens to have everlasting consequences. Death of a loved one is usually one of the most emotionally exhausting experiences. The time needed to move on varies from person to person; but it is universally accepted that sooner or later, people come to terms with death, though the emotional void remains. Similarly, for a person who has been through trauma of any kind, like serious illness in a child or an accident or abuse, it is natural to feel overwhelmed and anxious for some time.
But if denial, sadness, anxiety or fear starts to infringe on one’s normal functioning even after a reasonable period of time has passed, it can become a cause of concern in the long run. If a person tries to resume their normal routine despite occasional failures, it means that they are trying to overcome emotional distress. But if no attempt is made by the person to do so, and encouragement or gentle prodding seems to have little or no effect on their state of being, it may be symptomatic of a mental illness.
Assessment of symptoms
General practitioners are able to assess reactive symptoms atypical to situations and can prescribe medications that can control aggravation of general symptoms like palpitations, hypertension, sleeplessness and epigastric discomfort. If it is found that despite medication the person finds little relief, the general practitioner can refer the person to a psychologist or psychiatrist, depending on the severity of the symptoms.
Treatment protocol under a psychiatrist may (or may not) include psychosomatic drugs and counselling sessions. It is usually seen that patients respond well to a combination of both, starting off with short-term medication to provide immediate relief, followed by mid-term to long-term counselling and therapy sessions. The fulcrum of the treatment protocol is the patient’s acceptance of the situation, and their willingness to participate in the recovery process defines the scale of improvement.
Personality quirks vs symptoms
Some people are introverted, aggressive or anxious by nature and such traits are not indicative of mental illness. A person who gets aggressive at the slightest provocation may need help in controlling his or her temper but that person cannot be considered mentally unwell. Until and unless their temperamental deviations affect their day-to-day lives to a point of debilitation, a person cannot be considered mentally ill.
The definitions of mental illnesses are distinct enough for those trained to identify them, but for a person not fully acquainted with the nuances of the symptoms, it can be a frightful experience. Hence, it is always safer to err on the side of caution and tread gently while assessing a person’s behavioural changes.
(The author is chairperson, Board of Trustees, The Live Love Laugh Foundation)