WOMEN, DEPRESSION AND TIME

Autor: Ubaldo Sagripanti, Psychiatrist; A.S. L. 8 Department of  Mental Healt, Civitanova Marche, Italy

Nowadays, depression seems to be a very appealing topic at a  technical-scientific level, as well as at a mere general informative level but it still lacks an appropriate analysis.

At the basis of this problem there are several causes at different levels: the gap between the informer and the receiver, the inefficacy of the means of communication but on top of that everyone's difficulty in defining one's inner experiences, feeling and emotions.

Everybody falls in love and knows what it means. However, he/she is not able to get others to feel the same emotions through a simple description of his/her frame of mind.

Depression, like falling in love, are moods and both belong to the so-called "unspeakable" world. Only poets can get in touch with this world and metaphorically describe to the others an image, a sound, an evocation of it.

Specialists and researchers generally adopt a technical language based on presuppositions that are necessarily different. As a consequence, they involuntary generate a paradox similar to Einstein's about mathematical language: "When mathematical prepositions refer to reality, they are not certain; when propositions are certain; they do not refer to reality".

Beyond the awareness of epistemological limit and because of the inner nature of this phenomenon, when mass media propose depression to public opinion a simple, human and worried question almost always arises: "Oh, well, I feel that, too. May I suffer from depression, then?".

Most of the cases, people answer each other without going to a family doctor's or to a specialist's. They usually tend to minimize, remove or even worse to find a solution to the problem by saying: "I will succeed by myself".

Among those who decide to seek a medical advice, only 25% of cases receive a treatment and only 10% ask for a specialist.

Most of those who ask a psychiatrist for advice the first time, they interpret this situation like a sentence: " I am before a psychiatrist, it means that I am seriously ill".

As a matter of fact, only few cases are serious: only a minority suffer from an acute depression and 70% of cases positively respond to a treatment. However, it often happens that most of severe depressive disorders could have been avoided if promptly and adequately treated.

On the other hand, psychiatrist is a mental health specialist who treat various disorders differing each other on different quantity and quality of symptoms.

Physical health may suffer  from a range of illnesses including cold as well as cancer; mental health is exactly the same.

All this aspects affect that phenomenon called "depression" and contribute to widen its dimensions, as the following data clearly underline:

-         the risk of being affected by depression over the course of a lifetime is 7% to 25% in men and 20% to 25% in women (Canegalli F., La rivista del Medico pratico, oct. 1999);

-         among those who are treated by their own family doctors, 12.4% suffer from a mental disorder and 18% show some of its symptoms. The most frequent disturbs are: anxiety, depression and neurasthenia (Berardi D. et Al Int J Psychiatry Med 1999; 29 (2) 133-48);

-         among those admitted in the medical and surgical wards of 17 Italian hospitals, 19.4% suffered from anxious and depressive disturbs and 60.1% of them were women aged 55-75 (Gala C. et Al; Gen Hosp Psy 21, 310-317 1999).

The above mentioned data about depression and its connections are only a selection of those appeared on the international scientific literature so far. However, they witness the great importance of this phenomenon and prompt to consider its nature and the distribution of its effects through a series of necessary explanations.

-         Depression is not a unitary phenomenon. It shows many forms, with various degrees of severity and different courses requiring appropriate treatments.

-         It affects people in different ways and may be connected to other physical or psychic troubles. These troubles may sometimes prevail so much that depression may be even "concealed".

-         Among psychic symptoms, anxiety plays a particular role because, according to several authoritative researchers, anxiety and depression are two different aspects of the same psychic disorder.

Depression can show different aspects and assume some of the  features characterizing a patient's personality. Thus, sadness, irritability, anger, tiredness, tedium, insomnia, loss or increase of appetite, isolation, loss of interest and inability to experience pleasure, feelings of inadequacy, incompetence and self-depreciation mix themselves with individual characteristics and form the portrait of that single person in his/her suffering state.

However, there is not a mere list of symptoms at the basis of a diagnosis of depression. Asking for a doctor should not  be the consequence of a series of symptoms but of the awareness of a certain uneasiness, instead.

This condition can be unique and totally new in our experience of life but it more often retraces similar situations or past stressful events such as a bereavement, a separation or the loss of someone or something very important. All these events are typical of human life and they do not represent illnesses in themselves. However, they may leave an enduring trace we can easily recognize. When we are in a strange mood without a plausible cause or when we realize the origin of our suffering but we are not able to come out of it, we may suffer from a depressive state.

In this case, it is necessary to ask for a competent advice to have our possible diagnosis confirmed or not.

According to the reported data, it seems clear that depression is a diffused phenomenon as well as living in a depressive state.

Relapses on social and econimic condition, individual and collective, are evidents.

We will hereby try to briefly sum up the causes, acknowledged so far, and their possible relationship with the date showing how women have a prevalence rate for depression up to twice that of men.

The causes generating depression have been so far located at different levels.

The hereditary factor plays an important role even if most of its mechanisms are so far unknown and its influence has been considered meaningful only in the measure of 21% to 45% in various forms of depressions. However, by common consent depression is not hereditary in itself, but rather the predisposition to be affected by it.

In the gap between the disposition and manifestation of this disturb, society, family, school and the working environment are active and acknowledged factors in everyone's life and psychological evolution. However, they do not affect women and men in the same way.

Men's and women's mind share the same cognitive potentialities but they differ from each other on various characteristics and abilities.  Most of depressive states affect mainly women and in stages that are typical of a woman's life such as: the premenstrual phase, puerperium and the age of menopause.

These events cannot be considered only a mere variation of  hormonal levels but they represent absolutely meaningful phases of a human lifetime. Women are the only ones who are able to give birth to another human being and their so-called mind with its somatic, biological, and psychological features are typical of that "female organization" which identifies women: "Everything was together; then , there came mind and put them in  order" (Anassagora).

When women experience these dramatic changes in psychoactive hormones that consent reproduction and life, their mind receives several messages from their organism which are reflected in an existential dimension of time. Menarche and menopause represent the limits of the reproductive season and the menstrual cycle implies a series of events that can be compared to the four seasons of the year. In fact, manifold cultures all over the world have symbolically represented the menstrual cycle as a bridge linking woman's and nature's stages.

Under this point of view, female mind had and should still have an acknowledged temporal dimension on its own in the world it lives in. Nowadays, on the contrary, time more often follows the market laws forgetting the law of nature; thus, space and human life are progressively going towards an undifferentiated "unisex" dimension.

Beyond its interactions with body, female mind presents innate features that do not descend from common senses or from a total consciousness of itself. According to Leibniz, these features come about in their relation with another person: "There is no doubt that everything is in human intellect comes from sense; except for intellect itself".

And woman shows it daily, at least in very common circumstances.

A new mother naturally knows that mysterious language that let her recognize her new-born child needs: she perfectly knows whether her baby is hungry, tired or does not feel well on the basis of its crying.

An external observer can only hear a baby's crying without understanding its meaning.

Nowadays, the female identity, which is the result of a millennial evolution, faces a world where:

-         socially speaking, proper laws about maternity, the puerperal phase and the premenstrual syndrome are absolutely recent;

-         within a family life, she is often torn between the traditional role and a productive dimension that differ from each other on value and social recognition.;

-         on a personal level, she frequently lives a dramatic distance from the female image promoted by fashion and media, which is usually much more virtual than real.

It is reasonable to suppose that all these conditions generate a stressful climate which may be correlated to a major prevalence of depressive disorders in women than in men.

Once occurred the pathological event, it needs to be adequately treated.

A common depression treatment is nowadays generally conceived as a pharmacological therapy integrated with a psychotherapy (when prescribed) suitable to every single case.

The medications at present available help nervous system restore equilibrium to the neurotransmitter activity that rule the message transmission to the different cerebral structures.

They are meant as a means suitable to the organic substratum of the illness and they present less adverse-effects than those belonging to previous generations.

A treatment based on these medications lasts at least 6 to 12 months and may require 2 weeks before benefits are apparent. Moreover, it requires regular clinical controls.

Only under a limited number of conditions, it is necessary to extend the treatment; however, it always depends on the peculiar characteristics of the disturb.

It sometimes happens that when a patient feels better, he/she tend to suspend the therapy: this behavior often causes the risk of relapse and increases patient's vulnerability to new episodes of depression.

Human mind is a complex system: on one hand, a mental disorder is an organic alteration; on the other hand, the same disturb is perceived as a past experience. Psychotherapy promotes and facilitates the reintegration of those particular experiences in the continuity of human life.

There are many psychotherapy techniques and only the specialists can advise the most suitable ones. The therapy may be led by the same specialist or, at the same time, by another qualified mental health operator.

To sum up, a sentence by Vincenzo Cerami may be illuminating: "Emotion is a moment of knowledge".

Cerami, as an artist, defines emotion by using the term "moment": a temporal expression related to knowledge.

It is exactly in this dimension, between inner time and its relationship with outer world, that depression penetrates and breaks that continuity that identifies every human being.

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