Not just the blues


  • Health
  • Sunday, 13 Apr 2003

IT came as a shock to most people, and no wonder. Leslie Cheung, arguably one of Asia’s top entertainers, dived off a balcony and created headlines of a different kind for all too brief a moment. The rest is history, but during the furore over his suicide, intense media and public scrutiny focused on the supposed reasons for his abrupt end – a love triangle, what more with homosexual overtones. 

To some sections of the media, this does not get any juicier – a bona fide star, love and jealousy, homoeroticism. Unfortunate, but all too true. Some say he was too sensitive for his own good. Many theories have been put forward, most having to deal with his love life. But in the end, and literally, it was the end, the culprit is depression. 

There are many words used in every day living that take on a life of their own when used in different circumstances. Depression is one of these. In everyday usage, it means feeling down or low. When people read the papers and see the words “depression” as written in the note by the singer before he plunged to his death, they take it as “depression” as it is often used in everyday language. But put the word in a clinical setting, and it’s a different creature altogether.  

Clinical depression is a potentially life-threatening mood disorder that affects up to 10% of the population. It causes extreme suffering to the person who has to live with it, and can also potentially destroy family relationships or work dynamics between the patient and others.  

There is persistent ignorance and misperceptions of the disease by the public, including many health providers. It is often viewed as a character fault, a weakness of the personality that, if the person is strong enough, can be willed away. It is precisely such beliefs that have led to many people not seeking treatment because they feel that the “fault” is their own. There’s no definite known cause for depression, though it is thought to be multifactorial. It could involve changes of certain neurotransmitters in the brain. There is a familial element, meaning that a family history of depression is common. More women than men seek treatment for depression, but this is not necessarily reflective of the true incidence of the disease.  

The main danger of depression is suicide. It is said that the mean age for successful completed suicides is 40 years. Successful in the sense that many may have tried and failed, and underwent treatment to cure the disorder.  

A clinically depressed person looks just like you or I. However, certain traits may often be seen. He/she may have slowed speech, with long pauses. Body movements are slowed. However, pacing, hand wringing, and pulling on hair can be present. The person may appear preoccupied, and avoids eye contact. There may be memory loss, poor concentration, and poor abstract reasoning. 

Depression is often difficult to diagnose because it can manifest in so many different ways. For example, some depressed individuals seem to withdraw into apathy, while others may become irritable or even agitated.  

Eating and sleeping patterns can be exaggerated to either extreme, either excessive or almost eliminated. Depression is more a “holistic” disorder, generally affecting body, feelings, thoughts, and behaviours to varying degrees.  

The person may be persistently sad or anxious. He/she may often complain of feeling “empty”. There is loss of pleasure in usual activities, and feelings of helplessness, guilt, or worthlessness. The person often cries, and feels he/she is hopeless. Fatigue or decreased energy is common, with loss of memory, concentration, or decision-making capability. The person could be restless or irritable, with sleep disturbances and changes in appetite. And he/she admits to having thoughts of suicide, death, or suicide attempts. That’s the one thing that should set the alarm bells ringing, and ringing very loudly. 

Depression can cause significant personality changes and changes in work habits. This often makes it harder for orders to empathise with the depressed individual. In very severe cases, people with depression may be unable to eat or even to get out of bed. 

Depression could be a one-off occurrence. However, it could also be recurrent, chronic, or longstanding. In some cases, it seems to last forever. Occasionally, symptoms are triggered by life crises or other illnesses; at other times, they occur at random. 

The diagnosis of depression is a clinical one. There is no chemical or blood marker that indicates that a person has clinical depression. Tests are usually done to rule out other illnesses. 

Doctors should have a high index of suspicion for depression. Depression should be strongly suspected as an underlying factor in drug abuse or overdose (including alcohol) and with self-inflicted injury. In such instances, the relevant questions and screening for depression is mandatory. 

Depression is an eminently treatable illness. There are drugs to treat this condition. There is what is called electroconvulsive therapy (ECT), which in a clinical setting is safe and can be very quickly effective. However, it is usually used only in cases that do not respond to treatment, and cases where drug intervention has failed.  

Treatment together with the proper support from family, friends and colleagues, can effectively control or cure clinical depression. To the person, he/she may feel that it’s an uphill struggle all the way. He or she will feel trapped in a situation where there is no way out, and the condition can rapidly spiral down to a point where taking his or her own life seems the only option.  

In this day and age, for suicide to occur as a result of depression, and for people to think that it’s a weakness of character that was the cause, it’s a testimony to how much more we should take the trouble to understand certain basic conditions. Do not point at troubled love lives or what not as the blame. It’s not a weakness of character that is the cause. It’s a disease, pure and simple. 

That thing that everybody calls depression? It’s nothing at all in comparison. It’s a normal variation of human character, with the highs and lows influenced by what is happening around us. But depression in its clinical sense is a creature that eats up the individual, casting a spell of gloom that grips the individual and leads him or her to a doom that no one expects, no one wants, and everyone can avoid. That’s depression, and that is the creature that has claimed the life of one of Asia’s brightest stars. 

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