Depression: dealing with the darkness.

TOPIC. A client's personal experience of depression presented in her own words SOURCE. Case study PURPOSE. To assist nurses to understand, accept, and reassure depressed clients and "offer themselves" in a caring and continuing relationship CONCLUSION. Understanding depression allows nurses to respond in a way that is therapeutic. Key words: Despair, lived experience, major depression Major depression affects 7% of the adult population in the United States; the lifetime risk for depression is 8% to 12% in men and 20% to 21% in women (Kizilay, 1992). But statistics fail to convey the poignancy of the individual's experience with depression. I first met Ginny in my depression support group. She knew I was a psychiatric nurse and wanted me to understand her "lived experience" of depression. She said that health-care professionals, as well as the public, needed to understand the experience of the depressed person, from his/her perspective. Ginny experienced her first major episode of clinical depression in 1989. She had had other short episodes in the years before that, but had attributed them to general dissatisfaction with her life circumstances at the time. These short episodes had "passed" without any great disruption to her life, but having experienced depression, she made it her "mission" to learn as much about it as possible. Reading had helped her understand more about depression and "exposed" her to what others had experienced. She began to speak publicly about depression, which allowed her "to bring something good from something bad." In her talks, Ginny shared how many people were "uneasy" around her when she was ill with depression. Some people had known about her illness and felt helpless or frightened; others had not known she was ill and were confused by her "strange" behavior. I asked Ginny if she could share her experience of depression with me, and she readily agreed to do so. The following is an excerpt of Ginny sharing, in her own words, of her experience of depression. The Lived Experience Being overwhelmed. I first sensed a decline in the joy of living, a gnawing loss of spirit and drive. A cloud of uneasiness began to form over me. I became obsessed--needlessly--with my financial state, especially being convinced that I could no longer afford to keep a car. I put it up for sale and began to walk everywhere. In social settings I was quiet and preoccupied. I was unenthusiastic about almost everything and irritable to the point of finding fault. I avoided looking at people, forced myself to be cordial, and silently resented everyone. Sometimes I said things that were hurtful; I verbally attacked the people I loved. I was confused in thought, negative in outlook, and disquieted in spirit. I had difficulty answering questions and making decisions. The ordinary circumstances of my life became unsurmountable problems and restrictive dead ends, far out of proportion. Very often I would cry over something, over nothing, over everything. My body was bent over in a combination of lethargy and hopelessness. Eventually, I had to force myself to do anything, as all motivation and incentive disappeared. I held fast to irrational ideas, arguing zealously with anyone who opposed me. I believed people were conspiring against me because they were envious of my abilities. My perception of situations was distorted, my view of reality was twisted, yet all the while I insisted that I held everything in the proper perspective. Much of the time I pretended that nothing was wrong. I often said I was fine, but of course I was lying. I was living with agonies that caused me to pull at my hair and pound my head on the wall. Uncontrollable thought patterns repeated continuously in my mind; I worked small, insignificant events of life over and over until they became monumental sources of torture. I often lost control and sobbed in despair. …