The Monster Within: Understanding the Narratives of Depression

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<ul><li><p>RESEARCH IN PROGRESS</p><p>The Monster Within: Understanding the Narratives of Depression</p><p>Shubhra Hajela</p><p>Received: 18 June 2012 /Accepted: 13 September 2012 /Published online: 6 November 2012# National Academy of Psychology (NAOP) India 2012</p><p>Abstract The study examines how lay people under-stand and recover from depression. Narrative interviewsexploring the same were conducted with twenty fiveparticipants. Each narrative offered an idiosyncratic un-derstanding of the unique journey of depression. Severalpatterns from the narrative emerged which were collect-ed as themesdepression was seen as a normal, ex-plainable and sometimes even expected phenomenon incase of extreme negative events, psychiatrists were con-sidered opaque in understanding the experience of de-pression, and lay understanding of depression of theparticipant and their social group deeply affected self-recovery. The study offers insight into how a vastmajority of the population goes through depressive ex-perience in face of personal tragedies and recoverswithout much professional help. It thus has implicationsfor augmenting the recovery of lay people from depres-sive symptoms.</p><p>Keywords Depression . Narratives . Laypsychology .</p><p>Self recovery</p><p>The madman as defined by others is part of societyscultural heritage. Whether madness is explained byreligious authorities (i.e., as demonic possession), by</p><p>secular authorities (as disturbance of the public order),or by medical authorities (as mental illness), the madthemselves have remained largely voiceless.(Chamberlain 1990, p. 323)</p><p>The opinion of the experts such as psychiatrist, psy-chologist, and researcher is considered to be conclusivein the mainstream academic psychology and psychiatricliterature. The viewpoint of the person suffering frommental illness although considered important is many atimes considered as subjective and unreliable. This re-search is undertaken to understand the lived experienceof depression and self-recovery from it using narrativesof participants who had recently suffered and recoveredfrom depression.</p><p>Lay Perspective in Psychology</p><p>The concept oflay/nave psychology as a legitimatefield of study was promoted by Heider (1958). Hebelieved that an ordinary person has a profound under-standing of himself and of other people, which was byand large unformulated and vaguely conceived. He con-sidered people as lay (nave) psychologists who actedon and made meaning of their experiences on the basisof their beliefs and assumptions about themselves,others and the world.</p><p>Kelley (1992) similarly proposed the concept of personalconstructivism and conceptualized ordinary man as a scien-tist, a concept well worked upon by Lillard (1998). Heemphasized that a study of lay psychology would be closerto the study ofreal experiences of people, in that theknowledge generated would be an insider perspective ratherthan the outsider view of the researcher.</p><p>S. Hajela (*)Indian Institute of Management, Raipur,Raipur, Indiae-mail:</p><p>S. Hajelae-mail:</p><p>Psychol Stud (JanuaryMarch 2013) 58(1):1019DOI 10.1007/s12646-012-0164-8</p></li><li><p>Hutto and Ratcliffe (2007) opined that lay psycholo-gy had its foundation in the basic belief that, as humanbeings, we all spend considerable amount of time andenergy in trying to understand ourselves and others,which helps us navigate through our social worlds.Lay psychology is therefore said to serve as heuristicsthat influence peoples judgments, social action andbehavior (Geary 2005).</p><p>Despite its advocacy, attempts continued to discreditlay psychology on the ground of being subjective andunscientific. However, with the growing influence ofphenomenology, postmodernism, constructionism, cross-cultural studies in clinical psychology which pointed outtowards differences in the experience and expression ofpsychological phenomenon, the importance of lay psy-chology was accepted. All these developments gave animpetus to the view that an individual or the lay personplays an active role in understanding (Richardson andUebel 2007).</p><p>Reactive Depression: A Major Health Problem</p><p>We seem to live in an age of depression. Within thedomain of clinical psychology and psychiatry, depres-sion is predominantly studied as a universal form ofmental disorder with affective (sadness, irritability, joy-lessness),cognitive (difficulty concentrating, memorydisturbance), behavioral, and vegetative (sleep, appetite,energy disturbances) complaints, with an atypical courseand predictable response to treatment and therapy(Chodoff 2002; Gottlieb et al. 2011). It is believed thatthe aforesaid characteristics are typical of any type ofdepression and may be present in various combinationsin individual patients.</p><p>In the practice and study of clinical psychology andpsychiatry various systems of categorization of depres-sion have been forwarded. One of it is on the basis ofunderlying cause of depression. According to it,endoge-nous depression is seen as a result of some biologicalcause, is acute in nature while reactive depression arisesout of certain life incidents or stressors and is also lessacute (Sartorius et al. 2002).</p><p>Whatever be the type, depression takes its toll onboth the personal and economic fronts. On a personallevel,depression involves serious personal, interperson-al consequences. It causes significant psychologicaldistress, reduces quality of life, and increases themortality from cardio vascular diseases (Shah et al.2011). It may also contribute to family and maritalbreakdown. On an economic level, depression causesabsenteeism from work, low motivation, and lowproductivity.</p><p>Depression rate in India seems to be alarming. It isreported that depression in any form (grief reaction, adjust-ment disorderdepressive type, major depression, bipolaraffective disorder) affects 10 % of the entire population ofIndia (Chandrashekhar 2007). Moreover, out of everytwenty-five patients who come to psychiatric O.P.D of pri-vate hospitals, ten suffer from clinical depression. One inevery five Indians suffer from depression at some point orthe other in his/her life. Fifteen percent of the depressed endin suicide while 80 % of those who had committed suicidewere depressed (Times of India, August 22, 2004).</p><p>The growing incidence of depression as a major healthhazard was emphasized by World Health Organization. Itpredicted that depression would be the second major diseaseafter heart disease by 2020 (Gilbert 2001). It pointed out thegrowing incidence of depression in South East Asia, andheld rapid urbanization, industrialization, more stress onindividual achievement, breaking of joint family structuresand social conditions like riots, terrorism as major contrib-utors to the increased rates of depression (Times of India,August 22, 2004).</p><p>The problem of depression becomes all the more acute incase of India where statistics point out towards the paucityof mental health manpower (only 2500 psychiatrists, 600clinical psychologists, 500 psychiatric social workers, 600psychiatric nurses available for the entire country with apopulation of more than 102 crores) (Chandrashekhar2007). This paucity has been cited as one of the reasonsfor the neglect of depressed people. It has been consideredthat people suffering from depression do not get enoughsupport from the less number of professionals available.This is further complicated by the fact that the awarenessregarding depression and mental health in India is consid-ered to be low. Moreover the stigma of going to a psychia-trist makes the situation even worse by sometimesrestricting the depressed opting for help.</p><p>In the present context, therefore, it becomes impor-tant to know as to how the lay people perceive depres-sion. How they experience it and more importantly howdo they assign meaning to it, live with it and deal andovercome it. It can be hypothesized that the informationthey give and the knowledge generated from this work,regarding depressive behavior, construal of depressiveexperience and coping patterns could be of some usein the formation of guidelines that might help the de-pressed, their families, counsellors/clinicians be moreeffective and sensitive towards the depressed.</p><p>Let Me Tell you a Story: Why Narratives?</p><p>The present study makes use of narratives as a tool forunderstanding the experience of depression. The reason</p><p>Psychol Stud (JanuaryMarch 2013) 58(1):1019 11</p></li><li><p>being narratives are one of the most natural and significantways people make and express meaning. They are based onthe philosophical position that we are essentially story-tellers, we live in a storied world, and that our own livesand experiences are storied (Lszl 2008; Rankin 2002;Fochtman 2008). Narratives are thus considered indispens-able in studies that intend to explore the personal, uniqueand contextualized understanding of a phenomenon.</p><p>It is precisely due to these reasons that narratives are usedextensively in identity research (Bar-on and Gilad 1994),nursing (Raholm 2008), counseling and therapy (Botella etal. 2004), trauma studies (Hall 2010; Haene et al. 2010),marital violence (Riessman 1993), occupational identity andcareer choices (Roberts and Rosenwald 2001).</p><p>The Participants</p><p>Narratives of twenty five participants were selected for thepresent study. These narratives were chosen out of a largerpool of narratives (32) because they were considered moreemotionally open, elaborate and detailed.</p><p>The selection criteria for the original sample (32) fromwhich these twenty five narratives have been chosen werebased on three dimensions: first, was evidence of self-recovery from depression (Approximately 37 general physi-cians and Psychiatrists were contacted from different citiesfrom whom the contact details of drop out depressedpatients were known. These were the potential participantsof the study. On contacting them only those who had recov-ered from depression without any medical help and whowere ready to be a part of the study were explained the aimsof the study, nature of their contribution and the process ofnarrative interview), second, the psychiatrists/general physi-cians were asked to give the contact of only those drop outpatients who had suffered from mild depression. This wasalso checked with the participants who confirmed (on thebasis of the diagnosis made to them) that they had sufferedfrom mild depression. It was also ascertained from theirprevious medical history that they had no previous episodeof depression nor were aware of any family member whohad suffered from depression. The third criterion was therecency of the depressive episode (1830 months from thetime of taking the narrative interview).</p><p>The participants whose narratives are taken for thepresent study belonged to Allahabad, Lucknow, Benaras,Gorakhpur, Delhi, Hyderabad and Bangalore. All of themhad recently (1824 months from the time of taking narra-tive interviews) suffered from depression owing to a tragicevent in their lives. This event has been termed as Criticalevent as it is considered very important and life definingevent by the participants. Such an event was characterisedby emotional upheaval and turmoil and had changed the life</p><p>trajectory of the participant. Broadly the critical event wascategorised into two patternsone, the loss of a closerelationship, either due to sudden death or estrangement orsecond, the loss of a deeply loved and believed dream,aspiration, or professional goal. This critical event was seenas a starting point of depression by the participant. They hadall consulted the psychiatrists and general practitioners forsymptoms like general persistent lethargy, sleeplessness, notfeeling hungry, weight loss, apathy and loss of interest andwill power in their lives.</p><p>According to the participants they had suffered from milddepression, as their psychiatrists/general practitioners hadput it. All of them had sought medical help in the form ofpsychiatric help or by consulting general practitioners whenthey or their family members could, no longer tolerate thedeterioration of health and everyday joy in life, endlesspining, regular crying, erratic behaviour and death wishesthat loomed large and prominent, in their lives.</p><p>All the participants had after two or three visits stoppedconsulting their psychiatrist/general practitioner on accountof them feeling, misunderstood and lost, awkward, self-conscious, not respected, and feeling as though one is inan opaque relationship with the psychiatrist, lack of emo-tional closeness with the psychiatrist/doctor and not beingable to see self as a patient. These remarks could suggestthe psychiatrists/physicians lack of empathy with the partic-ipants. The participants also seemed to terminate the treat-ment as they showed an unwillingness and disbelief totaking medicines as a cure to their depression. Many sawmedication unnecessary and irrelevant in understanding andproviding answers to their emotional problems or empti-ness in living or because they could not see themselves asmental patients and medicines as relieving them of theirproblems in living.</p><p>The participants also seemed to terminate the treatment asthey found it difficult managing the after effects of themedicines. Still others reported inability to comprehendand deal with the after effects of the medication provided.They typically reported feeling dry mouth, nervous, restless,queasiness in stomach, nauseous and sleepy the entire dayan additional challenge that they had to bear everydaybesides fighting their depression. There were also few otherinstances in which they were given more medicines by theirdoctors to help them manage the after effects of originalmedicines given. This was seen as unnecessary over med-ication by them and the treatment was later left.</p><p>None of the participant reported getting depressed in theirlives before this critical event, nor did they report any familyhistory of depression. They had suffered from depression foran average of 2 to 3 months and had at the time of narrativeinterview sessions recovered from it. Recovery was definedby them as getting back with life, moving ahead in life,getting hold of a sense of life, regaining life and was</p><p>12 Psychol Stud (JanuaryMarch 2013) 58(1):1019</p></li><li><p>conceptualized as a subjective sense of getting out of thesituation, and being released from the emotional grip andtrauma of the depressive episode.</p><p>At the time of narrative interviews the participants agerange was 2435 years, eighteen were females and the restmales. All the participants were undergraduates in arts,science or engineering with the exception to one who wasenrolled as a doctoral student.</p><p>Protection of the Participants</p><p>Narrative is replete with personal meaning; so it becomesnecessary to protect and respect the personal lives of theparticipants. It was specially so in this case where thenarratives were about painful events in their past. Alsonarratives involve much contribution and active involve-ment of the participants as such it became a necessity tofully inform and prot...</p></li></ul>