The fine line between demoralisation and depression

I am not a Mark Latham fan. I don’t like bullies (I was bullied as a child by an overbearing headmaster). Mark has the demeanour of a bully and on occasion has behaved like one. The infamous pressure and disrespectful handshake he bestowed on John Howard who was the Prime Minister at the time typified Mark’s bullying behaviour. In recent times Mark has been the purveyor of extreme, simplistic and unsophisticated ravings about mental health and women in particular.

It therefore rankles that I may agree with him when I see a ring of truth in his recent ravings about the over-prescription of anti-depressant medications and the over-diagnosis of depression in the general population.

Having been employed in a family support organisation I suspected that there was a tendency to incorrectly diagnose demoralised persons as being depressed. While demoralisation may go hand in hand with depression, it can also be a single manifestation that may be more readily treated than clinical depression.

While the same low feelings may be evident in both depression and demoralisation, demoralisation could and should best be treated without medication. Medication prescribed for depression does not always provide results, may have undesirable side effects, and may in the first few weeks make the condition worse and make a demoralised person depressed. It is questionable whether medication is appropriate for a person who is demoralised. Busy General Practitioners may not have the time or the expertise to differentiate between a demoralised and a depressed person and therefore inadvertently contribute to the over-prescription of medications referred to by Mark.

We all know that on occasion life events get too much for us, when the load is too heavy for any number of reasons we can become dispirited, disheartened and cannot see a way forward. We may be demoralised, but are we depressed? Most times in general we buck up. Something or someone will pull us out of it. We may get a better perspective when we see persons worse off than we are at the time.

One of the factors resulting in demoralisation is social isolation. The more a person is socially isolated the more they are likely to suffer a higher level of demoralisation. Studies have shown that demoralisation can increase in proportion to how isolated a person is. As the population ages so does the number of people living alone increase and as women live longer than men, there are more elderly women living by themselves than menfolk.

Poor or declining health is also a predictor for demoralisation along with isolation. The two may go together but not necessarily.

Persons of working age who are unemployed are often demoralised when they cannot find work. So too the under-utilisation of skills and time can be demoralising in the older person if there is too much time on one’s hands and nothing is being accomplished or seen as a worthwhile activity.

Not often mentioned is the high suicide rate in the elderly – which exceeds the youth suicide rate and is highest in single men over 85. Isolation is one of the major causes of these suicides and we hear sometimes of the elderly sometimes being found in their homes, days and weeks after their demise.

Prevention of demoralisation is obviously better than cure and particularly the elderly should pay attention to alleviating isolation and watch their diet and participate in exercise for good health. Isolation can be alleviated by joining in activities at community centres and neighbourhood centres, volunteering, talking to neighbours (if you can) reconnecting with friends etc. In the event that ill health prevents participation, community centres run visiting programmes such as neighbour aid in which volunteers visit people in their own homes.

Once demoralisation has set in may be typified by the loss of meaning of life than of course help needs to be provided so clinical depression does not eventuate. If life has lost it meaning than talk to someone such as Lifeline, Beyond Blue, your doctor, a friend. There is always help available even if you think otherwise and talking to someone is the place to start if you can’t tackle the problem alone. Being over 60 does not make us invulnerable and we should not be too proud to seek help when needed.

Do you agree with Michael’s thoughts on demoralisation vs. depression? Is there truly a distinction between the two?

Click here for more information on dealing with depression past the age of 60.