Tuesday, April 17, 2012

Depression? Oh, Grow Up!

Assalammualaikum :)

"Doc, I've been having a rough time lately.
It's all so bad I can't take it anymore. My kids are not performing well at school, and Wendy keeps falling sick. I have to constantly take leave to cater for her.

James not helping either. His company is retrenching so he is always working late, trying to prove his value to the company. All this is taking its toll on me. I feel low all the time"

And so, the GP will prescribe her low dose antidepressant (citalopram, yeayyy!!).

-not a true case, only adapted-

During my 8 weeks in GP placement (4 last year and 4 this year), I saw countless depression cases. There will be AT LEAST two or three cases in a day, either a follow-up or a newly diagnosed depressed patient.

Every time before a patient walk in, the doctor will usually go thru the patient's medical record in the computer system, trying to recall who this patient is, and trying to figure out what might be the reason of his/her visit that day. And every time I saw "DEPRESSION" under the "Active Problems" heading, I became depressed. "Oh NOOOO!!! Another depression case! Get me out of here!!"

I am not sure if depression is not prevalent in Malaysia, or the society do not recognise it as a medical condition but I've never ever see neither hear anyone coming in to see the GP with depression or low mood as the chief complaint.

"Doktor, makcik tak sehat ni.. Makcik asyik sakit belakang, sakit lutut. Nk bangun dari katil pun susah. Makcik tau ni semua sebab makcik dah tua, makcik faham tu. Tapi ni, anak makcik tu kerja kt KL kaya raya, tapi jarangnye la hai nk dtg jenguk makcik ni. Tu ayam itik je la teman makcik. Pedih hati makcik ni doktor... Sedih memanjang, makan pun x lalu. Rindu dengan cucu2 makcik tu....
Makcik rasa makcik perlu ubat untuk gembira skit la doktor. Ada tak?"

Ahahaha.. Even imagining and typing the above dialogue out tickled me.
No, the conversation above never happened. No makcik does that.

In my country, people having a rough time with difficult lives either fall apart completely, or pull themselves back together after some time and brace through their lives, without the help of anti-depressants. They work to make ends meet without citalopram or sertraline.

Seeing the number of depression cases in the GP setting made me see the Western community as a weak, too dependent community. I am not sure how distorted is this view of mine, being an Asian myself. Are these people that dependent, or are their lives that miserable?

Then I got the chance to speak to a Russian GP. She was born, bred and trained in Russia before migrating to Britain decades ago. With thick Russian accent, she jumped at me when I asked if these depression cases she's seeing are true cases. She jumped because she felt the exact same way! She said in Russia, people pull themselves together and get through their lives independently. Life was a lot harder there, even I can imagine that. In Russia, no one comes to the GP for depression. They don't even come for coughs and colds.
Here in Britain, the people always need assurance, huggings, delicate sentences and the mushy2 motivations (quoted from her). They are soft and dependent.
And so she looked very delighted because I shared the same opinion with her, having come from a different culture. But I think I'm even more delighted to know that I am not the only person who think these depression cases I'm observing are merely weak people.

I do not deny that there are truly depressed people out there. But personally I do not believe in drugs and medicines to cure the depression. Medicines might treat Parkinson's or Huntingtons, but not depression. Depressed or happy results from your own response to the stimuli around you, not solely on the concentration of neurotransmitters in your brain.

To add to my agony, my main learning issue for this week's PBL is DEPRESSION. And I'm supposed to chair the discussion on DEPRESSION tomorrow. How on earth am I supposed to discuss DEPRESSION when I do not even see it as a true medical condition? It exists, but it doesn't exist. I can't really explain it. But uh, I can never be a psychiatrist. I'll always come to only two conclusions; either this patient in front of me is making up his stories, or he's mad.

Life is not a bed of roses.
Life's hard? Oh come on, grow up!

I wonder what does Psychiatry say about religion?
Can religion/supplication/meditation replace pharmacological anti-depressants?
The feeling of submitting oneself to a higher being, depending on Him, loving Him and be loved by Him, can that be an anti-depressant?
I wonder....

p/s: Aarrghhh!! I prefer studying cirrhosis, stomach ulcers, or even diarrhoea than depression.

-Because life is a test-

Tuesday, April 10, 2012

The Bless of Forge'ing

Spaghetti becomes spage'i, later becomes la'er, and pancreatitis becomes pancrea'i'is.
So, it is fair enough that forgetting becomes forge'ing. *laughs*

Often, we curse ourselves for forgetting to bring the house keys out, or for completely forgotten about that reflective piece the lecturer asked us to write 3 weeks ago, or when we fail to remember that password to log into the student portal (and the password needs alphanumeric WITH some capital letters AND symbols), or even for being unable to recall the topic we studied the night before.
How many of us actually have a photographic memory?
I've never met one, I know they exist but thank God I haven't met them yet, it's gonna freak me out.

To forget is to err, as I thought before.
But then, I'm sure every creation of God has two sides to it; the good and the bad side.
Being loud is bad when you annoy people, but it is good when you are able to stand up for yourself and people around you.
Being beautiful is good that people become soft-hearted towards you in dealings but it's bad when other people start to harbour bad intentions on you.
And thus, to forget is bad when you can't answer you exam paper despite having read the topic few nights before, but is good when you need to forget unpleasant things.

How many of us failed in exams before?
Have many of us lost their parents or siblings?
How many of us had their hearts broken?

All these, while are not to be forgotten completely, can be forgotten intermittently.
If someone were to remember the feeling of losing his/her mother every second of every minute of every day, his/her life will fall apart.
If someone were to have the loss of his/her life partner reminded every mili-second, he/she will never be on his/her top form again.

So we are blessed with being able to forget.
We're blessed with being able to distract our minds from the things that hurt the most, for 10 minutes initially, then a half-hour, then an hour until at one point, we remember the incident only a few times in a day.

When our best friend calls, our minds are focused on the conversation, putting the mourn behind.
While crying for the loss, then we have to search for the tissue, we forgot about the loss until we found the tissue.

Imagine remembering EVERYTHING, ALL THE TIME.
How long can we endure the pain?

So yes, don't curse yourself when you forget. And don't hope for being able to remember everything. You can't stand it.

-Because life is a test-

Saturday, April 7, 2012

Story 2: Caterpillar

Melati is a caterpillar. She can't remember her life before being a caterpillar, all she knows is she has to eat a lot now because people say one day she will have to be confined in a small pouch. And she won't be able to find food in the pouch thus, she is now eating for her future.

But she hates the fact that one day she will have to be kept in that pouch. For her, that's ridiculous. She's blessed with defensive fine hairs that will irritate any creatures that dare to come near her, with venom potent enough to terrify any known living organisms nearby.

She doesn't see the purpose of going into the pouch; to make her more mature and complete, so said her friends. She's happy living on her own, taking care of herself. She can't understand why are her friends so excited with the pouch thingy. They talk about it most of the time, making it sound like heaven on earth; not having to find food on their own, stay there and be protected from the world.

Sometimes she wonders, what happens after the pouch?
There were no elders to talk to her about that.
Sometimes, she saw misfortune happening to her friends. They were hurt when they were in the pouch. Crushed, eaten or stamped on, being helpless and too dependent her friends weren't able to defend themselves neither can they be prepared for it. They were blind. And in blindness, they face their deaths.
Why would she put herself at risk?

But then it occurred all too suddenly and naturally.
It was as if this was her destiny, she went into the pouch phase.
She felt blissful. She didn't have to find food on her own. She felt protected from the outside world, seeing only her pouch every single day. Finally, she understood what her friends meant by heaven on earth. It was indeed the closest to heaven she can possibly hope for.
She was euphoric, kept signaling her caterpillar friends to enter their own pouch.
She evolved to be one of those pupae she used to mock. Life was good.

Gradually, however, she started to feel breathless and suffocated. She starts to wonder if going into the pouch in the first place was the correct thing to do.
She saw her caterpillar friends playing around freely, while she was kept committed in the pouch.
She started to long for the outside world.
But at the same time, she was terrified of it.
She lost her fine hair and venom. She depended too much on the pouch, became too comfortable in it.
She can't possibly imagine how to survive without it. Not that the pouch has been feeding her, she has been surviving with the food she kept when she was a free young caterpillar. But the pouch blinded her, making her forget what life really was before. And most importantly, she knows she is not going to be the same caterpillar she was if she ever goes out of this pouch. You can't turn life back, that is one thing she knows for sure.
What happened after the pouch? No one can answer that.
So she endured in agony, thinking every second whether she should leave the pouch and face the unknown, or stay there suffocated.

After a long self-debate, she felt ready and mature enough to finally leave the pouch. The pouch is not where she wants to spend her whole life, she finally realised that.
It took her an immeasurable effort to leave the pouch, it was so painful and hard, to begin with, it was as if her body was crushed and squashed.
During the process, she almost gave up. But giving up at that stage is a death sentence, so she persevered.

Much to her delight, she came out as a beautiful, unique butterfly with her own wings enabling her to fly anywhere she wanted. S
he can find food of her own.
She doesn't have her fine hair anymore but she still has her venom although not as potent.
But she learned the most important skills, to fly and to evade trouble and predators. She now sees the world from a completely different point of view, "the bigger picture of it" if such a description exists for a butterfly.

She can see her caterpillar juniors, and how some of them getting themselves all ready to pupate while some of them keep mocking the prepared ones.
Now she knows why didn't the Elders tell her about what happened after the pouch, as much as she wants to tell her juniors, she can't do so. They don't talk the same language anymore, they can't understand her.

She now recalled seeing beautiful butterflies flying nearby, without knowing these butterflies are what came out from the pouch. Maybe those butterflies were screaming their lungs out, warning her to take the pouch with a pinch of salt, for the phase after the pouch was invaluable.

Theme of the story: The Life Cycle


Saturday 7th April 2012
11.37 am
Preston, Lancashire