What does “depression” really mean? We may mean sadness, blues, grief, loneliness, the medical illness of depression, and perhaps dozens of other human conditions. As a medical doctor, my interest is to help separate the medical illness from other conditions.
There are three important types of medical illness to consider. Dysthymia is a chronic lifelong condition of the “blues.” For the dysthymic person, everything in life seems unhappy. As far back as you can remember, you saw life as gloomy–yet it doesn’t prevent function. Sometimes artists are motivated by this misery to create ways to overcome it, or share its meaning with others. Even laughter and rejoicing can happen from time to time. The difference between this illness and the misfortune of having been dealt a life that simply doesn’t provide much pleasure, is that dysthymic people have a lot of trouble responding to pleasure and enjoyment, .
The second type of depression is major depressive disorder, or MDD, a potentially life-threatening disease that robs the patient of the ability to function. It will strike one person in five, and may last for months, or a lifetime. MDD is characterized by at least two continuous weeks when one feels very sad, and has no interest in any activities. The person must also have at least four additional symptoms from a list, including changes in eating or sleep patterns (especially waking up before dawn if that is not your habit), slowed thinking, problems concentrating, thoughts of suicide, low energy, or feelings of worthlessness or guilt. Grief after a catastrophically bad audition (to say nothing of loss of a loved one) can mimic MDD, but the distinction is that MDD doesn’t let up. The patient just can’t function, week after week. Not even the warmest lover, friend, pet, or voice coach can break through and really cheer them up more than briefly.
The third type is manic depression, or bipolar disorder. Bipolar disorder is typified by depressive periods (MDD), and by very “up” times, that can become quite psychotic and delusional. To be manic or psychotic, a person must believe that some idea is true, and then make mistakes in unrelated everyday living as a result. For example, if he or she really believes they are an opera singer reincarnated from the past, that is not psychotic–but if that person then believes that he or she no longer needs to practice, but will appear at the Met soon anyway, that is psychotic. The manic person may believe he no longer needs to sleep regular hours, has immense genius and creativity, or has great sexual prowess and desirability. How do we distinguish such a person from a temperamental artist? The manic person may become enraged and perhaps violent over nothing; will very likely speak faster than those who must carry out his bidding can follow; and may not believe it is important to handle mundanities, such as paying the rent.
You probably have already realized that some so-called “crazy” things are assets under certain circumstances. Thus, treating an illness must include the assurance that the symptoms will not be treated without first carefully reviewing what effect that treatment will have on the patient’s life. Despite much fear on the part of the average person, treating medical illness does not rob a person of creativity. Effective treatment should enhance the capacity of the artist to develop skill or otherwise enhance life. If it is not doing that, it may be ineffective therapy from the point of view of the artist.
Three types of medical help are available. Psychiatrists, with M.D. degrees, may be trained both in giving medication (psychopharmacology), and also in several types of psychotherapy or counseling. Psychologists, with Ph.D. degrees, are prohibited from prescribing medications, but may have the same excellent training in psychotherapy as psychiatrists. Often less well- trained than doctors or psychologists, social workers who specialize in the needs of the artist, or in treatment of depression, may offer as much skill in psychotherapy. Cost and insurance reimbursement are often factors to be taken into consideration.
The best advice is to pick a person affiliated with the best medical or academic teaching centers nearby. Word-of-mouth also helps. The most precarious method of choosing a medical practitioner is by picking from the phone book. Consider consulting your family doctor–many general practitioners can help when the illness is uncomplicated. In any case, the prospective patient or client should listen to the comments of the treating person to be sure they sound on target. Some improvement must be seen within months, or something is wrong. Believe that something is wrong with the therapist, rather than yourself, and get a second opinion if no improvement at all occurs in three months.
Treatment may include counseling, medications, or both. The most powerful talking therapy is cognitive-behavioral therapy; this type of treatment focuses on the thoughts and mental processes which keep a person ill, and helps change behaviors that lead to illness rather than health. Passive listening-type therapy has only a 5 percent cure rate. Many relatively safe antidepressant medications are now available. Although the average person will not have serious side effects from them, slight tension caused by a particular pill might tighten one’s vocal cords unacceptably. The doctor must be willing to try alternatives. The good news is that medications will relieve illness in three to four weeks in 84 percent of those who need them; psychotherapy will have the same benefit, but in six to 12 months.
Mental health symptoms should not be ignored. Today there are many, many different options for people suffering from various forms of depressive illness. If you have questions or concerns, take them seriously.
