My initial intention for this post was to expand on the meaning of Major Depressive Disorder through reference to academic and professional resources. However, I found that all of them tended to accomplish this through presentation of a fact situation from which elements would be drawn to give support to a diagnosis. With this in mind, I give you John Smith.
John Smith is a 50+ year old male, separated, overweight, unattached and unemployed. He appeared to be alert and eager to cooperate. He was appropriately dressed for the weather and was clean and neat in appearance. He had good posture and was attentive to my inquiries. During his interview, he exhibited strong eye contact.
Upon being asked the purpose behind his attendance, John revealed that one month earlier he’d been hospitalized after an attempted suicide from a deliberate overdose of medications. He confirmed that he’d prepared a suicide note apologizing for his actions and asking that his son be taken care of. He believed that he would not be missed and that his son would be better off without him. John made it clear that he’d had thoughts of suicide for some time prior to his attempt. He planned to die and made it clear that he wanted to die.
John states that prior to his suicide attempt, he was in a “bad place” mentally. He indicated that for some days before his hospitalization he hadn’t eaten because he didn’t have any food in his home. Despite his lack of food, John found himself unable to leave his apartment. He couldn’t motivate himself to bathe, get dressed and go out to buy food. In fact, he couldn’t motivate himself to do anything.
He explained that he was constantly fatigued, yet he was unable to rest. H explained that his body felt “leaden”. He complained about his thinking being slow and said he had problems with his memory and comprehension. When asked, he agreed that he’d been feeling this way for months, if not years,and that the feeling had grown worse before the suicide attempt. He said he still felt that way, but that it wasn’t as severe. He attributed the difference to medication prescribed by his family doctor and the unexpected support of his parents.
On this last point John explained that he’d isolated himself from everyone. He’d had no contact with friends for some years and expressed that he didn’t know how to contact them, or even if he should. He believed that any approach would be unwelcome. Similarly, he’d isolated himself from his family to the point that his access visits with his son had slowed dramatically. He confirmed that he had a strained relationship with his spouse, from whom he is separated, and no relationship with his step-daughters.
John admitted that his appearance has improved since he started treatment. He confirmed that both his personal and residence hygiene was non-existent. He described his apartment as being cluttered and very unkempt (his word).
When asked about his medical history, John said that he believed that he suffers from depression and that he has since his teenage years. He described incidents in his past, what he called “Black Days”, when he would isolate himself until the mood passed. John also mentioned that his family has a history of suicide with a close family member having made two attempts. He also advised that he’d been prescribed an anti-depressant after his separation but he only took the medication for about a year.
He denied any alcohol abuse but admitted to occasional use of marijuana. He denied having had any other episodes of self-harm but admitted that he sees himself as unworthy. He denied having experienced any manic episodes or any delusions or hallucinations. He did exhibit some elements of paranoia in his thinking.
John mentioned that nothing gave him pleasure. He described incidents here he would watch comedies and feel tears running down his face. He used to read, but gave it up because he was unable to remember the plot or understand the story. He admitted to being frustrated at this. He also admitted to being frustrated at being unable to overcome his low mood. He didn’t see any cause for it and grew increasingly annoyed at his lack of motivation and ability to “snap out of it”. He said that he was ashamed at his inability to be a good father or provider for his son.
John Smith and Major Depressive Disorder
John Smith has experienced, and may still be experiencing, Major Depressive Disorder.
He has had depressed mood for a period longer than two weeks (criterion 1). He gains no pleasure from formerly pleasurable activities (criterion 2). He is overweight (criterion 3), suffers from poor sleep (criterion 4), and he expresses impaired motor ability (although it is unclear if this has been noticed by others) (possibly criterion 5).
John also satisfies criteria 6 (fatigue), 7 (feelings of worthlessness), 8 (diminished thinking ability), and 9 (suicidal ideation, in this case with a specific plan).
His isolation is clear evidence of impairment. Since there is no evidence of alcohol or substance abuse, delusions or hallucinations or any episodes of mania, there does not seem to be any risk of another condition having any involvement.
I remind you that I’m not a mental health professional. I live with Major Depressive Disorder and, from time to time, I experience depressive episodes. In point of fact, I’m John Smith (although that’s not my real name!) All of the facts I presented, and they represent only part of the totality of what I experienced, are mine.
The most recent depressive episode prompted my reaching out for help. My own research, the guidance and lessons shared by fellow-sufferers, the compassion of therapists, and so much more, have all inspired me to share what I’ve learned with you. It is information. It is not a diagnosis. If you believe that you’re in need of help, I urge you to speak to your family doctor.
In my next post, I will explore in more detail the true extent of the debilitation MDD can cause.