3 Recognising emotional disorders
We all have set-backs that can make us feel low, sad or anxious. What is the difference between these states, and states of low mood that are officially considered to be disorders? You might be surprised to learn that in real life there is no clear dividing line to distinguish ‘normal’ from the disordered experience of these emotions, However, we often know when all is not as it should be. First-person accounts, or personal narratives like the one given in Vignette 1 are illuminating in this regard.
Vignette 1 An experience of depression: Lewis Wolpert
Professor Lewis Wolpert (1929–), a distinguished British biologist, generally stable, happily married and with a good job at a university, descended into what was diagnosed as an episode of severe depression. A self-confessed hypochondriac, in the weeks before the episode he had been anxious about the effects of a new drug (flecainide) prescribed by his cardiologist to control his long-standing irregular heartbeat or atrial fibrillation. (The old drug, which he had taken for several years, had become ineffective.) He speculates that this change may have triggered his depression. The new drug gave him morning sickness and severe stomach cramps, which accentuated his hypochondriac streak and made him fear he might have a stroke. Worried, and against his doctor’s advice, he cancelled a trip abroad to a science conference. Instead of making him feel better, this made him feel even more distressed and anxious, as he felt he had let down his colleagues. He began having difficulties sleeping and started to think a lot about death. Then one night he had a dream about devils and woke up with a compulsion to kill himself. He writes:
[…] my mental state bore no resemblance to anything I had experienced before. I had had periods of feeling low but they were nothing like my depressed state. I was totally self-involved and negative and thought about suicide all the time. I just wanted to be left alone and remain curled up in my bed all day. I could not ride my bicycle and had panic attacks if left alone too long.
I also had numerous physical symptoms – my whole skin would seem to be on fire and I would on occasion twitch uncontrollably. Each new physical sign caused extreme anxiety. Sleep was very difficult and sleeping pills only seemed to work for a few hours. The future seemed hopeless and I was convinced that I would never recover and would probably end up completely mad
[…] I thought of suicide all the time but did not know how to do it. As I was too scared of heights, jumping from my window which was high up was ruled out […] Nothing gave me pleasure and every decision, no matter how small, increased my anxiety. I had no emotions and was unable to cry but I did retain a macabre sense of humor […] I got a bit better during the day and by evening could read and watch TV, but next morning I was back in the original bad state […] My memory seemed to be failing and I was frightened that I was going insane.
(Wolpert, 2009, pp.1–2)
Lewis Wolpert (Figure 10) found his recovery from the episode was tortuous, involving drugs and psychotherapy. Wolpert was aware that 90% of those who suffer a severe depressive episode have a relapse. Indeed, four years later some of the symptoms of his depression recurred; once again he received treatment and recovered. Since then he has suffered other episodes though none as severe as the first (Wolpert, 2009).
As Wolpert’s case shows, depressive episodes do not just include despair, they can also include feelings of panic and anxiety. Indeed feelings of anxiety are almost always present in depression, though anxiety can occur without depression.