The normality of depression

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• Priscilla Ebersole, PhD, RN, FAAN

He or she who is not depressed is truly cognitively impaired! An alert person could not possibly maintain emotional equilibrium in the face of the world in which we presently live. The great majority of the world lives in dire poverty and unspeakable conditions; greed and aggression run rampant; ethical behaviors are sold for a song. This reminder is not to make one more depressed but merely to face reality. Fortunately, we are seldom forced to do that as we have constant distractions: games, entertainment, new technological toys. Blessedly, in late life our awareness often begins to fade and selective memory kicks in. We can alter brain metabolism with a pill so that things feel and look different.

No, I'm not going to recall the good old days. They weren't really better and in many ways were a good deal worse. There were simply different things to be depressed about, but for old people the universals have changed little. What, then, should nurses do about the numerous older individuals who are depressed about personal relationships, deteriorating health, their living situation, declining abilities, and compounded losses? In addition, the distractions that so many of us employ may not be as readily available to the old, because of illness, sensory decrements, poverty, or restrictive environments. I wish there was a ready answer.

Nurses first must look at their own depression. What can be done that will bring joy and perspective into a demanding and often thankless job? The joy comes when we see the light return to someone's eyes, the smile of appreciation, or simply a companionable touch from a colleague, friend, or patient. Reaching out beyond one's self-absorption is easy to say but often hard to accomplish.

We recognize that as depression sets in, one's world shrinks. Soon nothing is visible but the deep, dark hole in which one dwells. An experience from childhood is always a reminder to me that it is only my limited vision that impairs possibilities. The experience remains vivid after 70 years. Country farmers had to find their own water by digging a well or locating a spring. My father, an impatient man, didn't dig a well. He blasted one out with dynamite until he hit water at bedrock. He then lowered my brother and I into the well, one at a time, in a bucket on a rope. My brother remembered that he made the hole by using dynamite; I remembered that from the bottom of the hole I could see the stars although I had not been able to see them from the surface—an amazing discovery. I knew the stars were always there but in the daylight, when we were absorbed with surface activities, they disappeared. Only in the depths of the hole or at night did the stars appear. My brother doesn't remember the stars but only the sound of the dynamite. I attribute this to gender differences!

Although not a very good analogy, this story possibly forms an approach to a depressed individual, one that is rightly depressed. Metabolic depression, fairly common in old age, may respond well to newer antidepressants, but “reality depression” must simply be recognized and accepted. Few old persons have never experienced depression, but chronic depression may make them forget everything else. Delve in—although patience and persistence are necessary with the depressed; listen and discuss an earlier time. What was the rope that pulled them up out of the depression? What little bucket of safety did they have? When in the very depths of the hole, what stars flickered that kept hope alive and the life force in them?

And, for the depressed nurse, how often has a vital older person with a grand sense of humor been the rope that pulled you out of the depths?