Sunday, July 31, 2016

A Stigma-Free Label for Depression

We have words to describe what the medical world normally labels as “depression.” Since that word conjures up weakness and even mental illness, we’ve found words that suggest that we are just working too damned hard: burnout or exhaustion. Makes those who have burned out or are simply exhausted simply in need of a little time off to be better. Oh sure, you can in fact exhaust yourself with long hours performing strenuous labor, but these words often apply to those engaged in normal work hours, at least for their respective fields of endeavor. There is a difference. The prospect of years of the same old, same old, no relief in sight… or the notion of “is that all there is” can sink in as long hours turn into escalating depression. Or you can just be tired.
Given that depression also tends to involve lethargy and detachment, some have argued that burnout is just a stigma-free label for the same condition. In her book, [literary critic and medical historian at the University of Kent in the UK and burnout sufferer, Anna Katharina] Schaffner quotes one German newspaper article that claimed burnout is just a ‘luxury version’ of depression for high-flying professionals. ‘Only losers become depressive,’ the article continued. ‘Burnout is a diagnosis for winners, or, more specifically, for former winners.’
“In general, however, the two conditions are generally considered to be distinct. ‘Theorists generally agree that depression entails a loss of self-confidence, or even self-hatred or self-contempt, which is not the case for burnout, where the image of the self often remains intact,’ Schaffner says. ‘Anger in burnout is generally not turned against the self but rather against the organisation for which one works, or the clients with whom one works, or the wider socio-political or economic system.’ Nor should burnout be confused with chronic fatigue syndrome (CFS), which involves prolonged periods of excruciating physical and mental exhaustion for at least six months, with many patients reporting physical pain at the slightest activity…
These feelings will be familiar to countless others, from Pope Benedict XVI to Mariah Carey, who have been diagnosed with exhaustion. If the media are to be believed, it is a purely modern ailment; almost every time Schaffner turned on the TV, she would see a debate on the trials we face in our 24/7 culture. ‘All the commentators represented our age as the most terrible one out there – that it’s the absolute apocalypse for our energy reserves,’ she says.”, July 22nd.
We live longer, have more stuff, and whether it is simply paying property taxes on property we fully own, or a mortgage or rent, a car loan or lease payment, student loans or the costs of educating one’s children, we need to be generating enough money just to meet our perceived obligations. And we live in truly complex and dangerous times. So we work, and where we can make more money, often work harder. But then, for some anyway, there are the lifestyle-threatening questions. And perhaps even physical illness finds its way into a body weakened by depression. So this just must the price of living in our hyper-accelerated, modern, over-connected world? Right?
“There is no doubt that exhaustion is a pressing concern today, with some particularly startling figures emerging from emotionally draining sectors such as healthcare. A study of German doctors found that nearly 50% of physicians appeared to be suffering ‘burnout’, reporting, for instance, that they feel tired during every single hour of the day and that the mere thought of work in the morning left them feeling exhausted. Interestingly, men and women seem to deal with burnout in different ways: one recent Finnish survey found that male employees reporting exhaustion were far more likely to take extended sick leave than burned out women, for instance…
“According to one argument, our brains are simply ill evolved to deal with the modern working environment. The increasing emphasis on productivity – and the emotional need to prove one’s worth through one’s job – leaves workers in a permanent state of ‘fight or flight’. This state originally evolved to deal with acute danger. But if we face that kind of pressure day in, day out, we endure a steady surge of stress hormones – an onslaught that our bodies struggle to continually fight
“For many, moreover, the pressure does not end with work. Cities (and technological devices) are always buzzing with life, and this ‘24/7’ culture can make it difficult to rest at any hour of the day or night. With no chance to recharge our minds and bodies, our batteries are constantly running dangerously low.” Except, burnout and exhaustion, depression style, seems to have been a human condition for at least as long as we have had written history.
“When Schaffner explored the historic literature, however, she found that people suffered from extreme fatigue long before the rise of the modern workplace. One of the earliest discussions of exhaustion was written by the Roman physician Galen. Like Hippocrates, he believed that all physical and mental ailments could be traced to the relative balance of the four humours – blood, yellow bile, black bile and phlegm. A build-up of black bile, he said, slowed the body’s circulation and clogged up the brain’s pathways, bringing about lethargy, torpor, weariness, sluggishness and melancholy. Although we now know it has no scientific basis, the idea that our brains are filled with a tar-like liquid certainly captures the foggy, clouded thinking that many people with exhaustion report today.
“By the time Christianity had taken hold of Western culture, exhaustion was seen as a sign of spiritual weakness. Schaffner points to the writing of Evagrius Ponticus in the 4th Century, which described the ‘noonday demon’, for instance, that leads the monk to stare listlessly out of the window. ‘It was very much seen as a lack of faith and a lack of willpower – the spirit versus the flesh,’ says Schaffner. She points out that one monk reported compulsively and restlessly seeking out his brethren for idle chit-chat rather than engaging in useful employment – in much the same way that 21st-century sufferers may find themselves compulsively checking social media.
“Religious and astrological explanations continued to abound until the birth of modern medicine, when doctors began diagnosing symptoms of fatigue as ‘neurasthenia’. Physicians now understood nerves transmitted electrical signals, and they believed that someone with weak nerves may therefore dissipate energy like a badly insulated wire. Intellectual figures from Oscar Wilde to Charles Darwin, Thomas Mann and Virginia Woolf were all diagnosed with neurasthenia. Doctors blamed it on the social changes of the industrial revolution, although delicate nerves were also seen as a sign of refinement and intelligence – some patients languished with pride in their condition.
“Although few countries tend to diagnosis neurasthenia today, the term is often used by doctors in China and Japan – again, with the occasional accusation that it is an alternative, stigma-free way of labeling depression.” Feel better now? I didn’t think so, but hey, at least you might understand that lethargy in a whole new (old?) light.
I’m Peter Dekom, and I am really, really sleepy….

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