Doctor as Patient II - Depression

It is best to begin at the beginning.

The aetiology of depression is loosely described as biopsychosocial.

Biological

There is certainly an hereditary element to depression. A genetic predisposition. A biological component, independent of circumstances good or bad. Exactly where and how and to what extent is not well understood. Suffice it to say that the degree to which depression is biological varies from person to person.

Psychological
Much of the above paragraph can be reiterated with 'psychological' replacing 'biological'. the extent of causative contribution is quite variable. To simplify, one could say a pessimistic propensity is at play (Dr Dork never turns down an alliterative opportunity). Negative thinking patterns, whatever their genesis, are self-reinforcing.

Social
One way Dr Dork conceptualizes this impact is that, for a given degree of depression, the extent to which it is impairing can partially relate to one's social circumstances. For example, someone socially isolated is more prone to a greater degree of social withdrawal when depression develops than is someone with a close, supportive family and social network. Social factors such as excessive work demands, interpersonal conflicts, bereavements and the like can precipitate or exacerbate depression.

Alcohol and other psychoactive drugs, licit or illicit, could be classed as both a social contributor and a biological contributor, Dr Dork thinks. Alcohol, for example, can be alluring to the depressed and/or anxious for it's transient elevation of mood and anxiolysis, yet alcohol is a depressant of the central nervous system, and is known to accelerate, exacerbate and possibly initiate depression.

This triumvirate, the biopsychosocial model, is a fundamental element of medical school teaching. Although most salient in psychiatry, every doctor is taught to consider healthcare for each patient within the context of their individual biopsychosocial milieu. A patient is more than a broken machine, and doctors are more than technicians.

Depression, for Dr Dork, has been aetiologically related to all three elements.

Depression, for Dr Dork, has also had ramifications biological, psychological, and social.

In the extended Dork family, depression is not uncommon. There is something in his families neurochemical makeup that lends a certain predisposition to this particular ailment. When depressed, all sorts of 'physical' aspects manifest directly, what psychiatrists refer to as physiological shift symptoms.

Psychologically, Dr Dork shares many traits common amongst doctors. Perfectionism, fear of failure, unforgiving of one's foibles, with a record of placing one's own needs for sleep, nutrition, exercise and rest a distant second to his vocational demands. Furthermore, Dr Dork is in many ways the typical Australian male: poor at openly discussing his emotional needs, in denial of his own distress, maintaining a resolute facade to all, and attempting to drown his demons at times.

Socially, the tendency to overload himself has been a contributory factor at times. For Dr Dork, this has been another method of 'escape', at times, which is also doomed to fail. And in his dark times, the costs to relationships, family, career and finances have been steep.

For these many reasons has the black dog lingered long, in the shadow of Dr Dork.

That is enough for today. This is a long tale to tell, and not altogether pleasant in the telling.

More another day.