05 Apr 2018
A Route Through Depression
Illness is a prevalent issue in today’s society. It encompasses a wide array of problems and it refers to “the subjective response of the patient to being unwell; how he, and those around him, perceive the origin and significance of this event; how it affects his behaviour or relationships with other people; and the steps he takes to remedy this situation” (Helman, 1981, p.1). Illness is distinct from disease which refers to the medical labels put on pathological entities with specific properties and identity (i.e diabetes). Illness includes not only a person’s experience with the ill-health, but also the meaning given to that experience.
This essay will attempt to present one such experience with depressive symptoms.
Presenting someone’s experience through an illness narrative provides the patient with the opportunity to expose a more nuanced aspect of their illness. Greenhalgh and Hurwitz (1999) stated that “narrative provides meaning, context, and perspective for the patient’s predicament”. It also provides the opportunity to create an empathic bond between the sharer that the listener (Wear and Varley 2008).
This essay will utilise a narrative style framework in an attempt to make sense of someone’s experience. Distinct narrative types will be identified based on how the patient recollects their experience. In a restitution narrative, one can identify as a primary goal the motivation to get better, to overcome the illness, which is seen as a roadblock or a detour in someone’s life journey. In a chaos narrative, a person does not seem to see a “light at the end of the tunnel”, they see the illness as a permanent, rather than temporary, state (Weingarten, 2001). Stable, progressive and regressive narratives have also been identified. Respectively, they refer to stories in which an individual’s path is constant – the illness does not get better or worse; a story in which a clear path towards improvement can be identified; and one in which the person seems to be on a downwards spiral – getting worse and not seeing any possibilities of improvement (Weingarten, 2001).
This paper will, therefore, discuss Cicero’s experience with depressive symptoms and analyse it through the lenses of a narrative framework. It will try to portray Cicero’s subjective feelings throughout his journey, the effect of the social environment, and its negative or potentially positive aspects.
Cicero, a nineteen year old boy, engaged in a recollection of his experience with illness. The narrative started with his present, moment in which he seemed quite detached from the past illness – viewing his depression as an “endemic part” of his life, as something he just had to “deal with” at the time. His story started by explaining how that episode is now compartmentalised, it is not something that has a serious effect on his current life, as he chose to ignore it, to forget it.
These feelings, however, seemed different when Cicero started to reconstruct the memories of the illness’ emergence. Symptoms first began when he was 13 years old. Pinpointing the exact moment of occurrence seemed difficult, as his symptoms accumulated in time, not due to a succinct occurrence.
The domestic environment was what led to their appearance, as parental misunderstandings, which ultimately led to their divorce, catalysed the negative experience of Cicero. The parental issues had started five years before the divorce, when Cicero was still in secondary school. During this time, there were no indications of maladjustment or ill-health. Cicero saw himself as a lively boy; other children liked him, he partook in football matches, he was a sociable child. But this ended around the time he began high-school. He was around 10 years old when his domestic environment seemed to worsen as parental misunderstandings were increasing in frequency and intensity. Cicero recalled how his younger self became more reserved as time passed. The initial symptoms of withdrawal were followed by negative results in academics and less social involvement. Cicero was trying to explain these symptoms to himself and first attributed them to the beginning of puberty, and not to what was occurring at home.
The narrative then fast-forwards to age thirteen, as Cicero put it, it was “the moment when us, the kids, reached an age when it was possible to divorce – the parents reached an agreement to end it, to exit the marriage”. His parents got a divorce that year, which marked the moment when Cicero’s symptoms got noticeably worse. He recalled how he reached full social isolation, sometimes actively looking for someone to just “hang out with”. His grades were getting progressively worse. He met no deadlines which resulted in him needing to retake a year of high-school.
He then recalled how he got tired of the lonely lunches, of the friendless days and found some comfort in joining a subculture, a group of gothic kids that would gather in a town park. Even though Cicero was not particularly interested in the subculture’s ideas, these people “would immediately like you even if you only knew one person in the group… and then you’d feel you have all those thirty people around you as friends”. Cicero did not seem to believe that this group accepted him for himself, his views were negative in the sense that he saw himself as just another pawn filling a space in a certain group.
Even if his social life seemed to be improving, his school situation enabled his parents’ suggestion to see a psychologist. Cicero gladly accepted the proposition, being motivated by his desire to perform better in school and saw this as an opportunity to regain his academic excellence. At the same time, however, he had no real expectations to get better. Maybe this constitutes the reason why his subsequent experience with the therapeutic setting was “awful”. Individual sessions consisted primarily of endless psychometric tests, while the group therapy he was undergoing did not really elicit any genuine responses. In group therapy, he never felt as if he answered questions truthfully, resorting to giving “empty, satisfactory” responses in order to avoid further inquiry. He felt as if the others could not understand him and based these thoughts on the seemingly trivial complaints the other children had. He spent three months in group therapy, and then was when his “memory got hazy”. He felt that “my mind was going; my mind was fading away”. This seemed to be the lower peak of his experience with the illness, as it seemed like he was losing himself. Cicero compared that period with how he used to be before the illness developed. He recalled he was very organised, he seemed to remember everything and this had then gone away. It was striking how his narration style seemed to mirror the recalled experience. A hint of uncertainty was noticeable in the manner he was reconstructing his memories. He himself then stated that he felt as though he had lived those three months for two years.
The tests and group therapy eventually ended. The Psychologist suggested a diagnosis which was not accepted by him or his parents. Initially, the therapist told them Cicero’s symptoms fell in the autistic spectrum – news which had a large impact on both his family and him. No one was willing to accept this diagnosis and were convinced it was wrong. Cicero felt as if his world had shattered, he felt he was not sick, he was “not lying in bed with cancer”; he was not getting treated for autism. This opinion was shared by his father, who also took a negative stance on the diagnosis. The mother agreed it was questionable, and with more experience in the matter, eventually suggested two possibilities. She proposed that the autistic symptoms could be there and related to depressive symptoms; or that everything could be just a phase which will eventually pass.
At this point, Cicero recalled feeling overwhelmed, prepared to accept any explanation. The mother’s stance on the matter, however, prevented that. Cicero stated that what essentially got him through was his mother’s proposition that everything could be “just a phase”. This led to him regarding the experience as something temporary, as something caused by external circumstances. He believed it would either fade away or he would find a way to conceal it until it would not peak through to the surface.
Cicero pinpointed a specific moment which he regarded as highly significant in his improvement. The decision to buy bright coloured polo shirts instead of the old black clothing was the moment when he recalls making a big decision. He figured that “if he was going to pretend to be normal, he might as well look normal”. This was a big step, as the new clothing got him compliments at school which slowly led to him extending his social boundaries and eventually to his recovery.
Distinct types of narratives can be identified when analysing this story. It can be seen how a change in narrative style was indicative of Cicero getting better. At first, the narrative was not clear, as the recollection of certain events led to him remembering earlier ones, indicating the haziness and compactness of the experience. A chaos narrative can be identified in this situation, as his experience was overwhelming him, preventing him to think clearly, making him feel like his mind was fading away. The uncertainty and lack of awareness of the chronological timing of events further indicates a chaotic experience. A change from a chaotic to a restitution narrative establishes the moment when he took the decision to overcome his illness. He began to see the illness as a phase, as something that could be overcome and wanted to be normal again. Moreover, a progressive narrative style could also be identified. After the initial regressive narration, a movement towards an incremental improvement characterised Cicero’s story as his social circle and academic performance started increasing.
Cicero’s narrative was also coherent, as his feelings were attuned to the domestic situation. His progressively more negative affect paralleled the deteriorating domestic environment. The parental response was also synchronized with the development of events. They offered support when the situation seemed to worsen, and were alarmed when hearing the suggested diagnosis. A clear narrative closure cannot be identified, as the symptoms seem to have just tapered off. Even Cicero stated “I don’t know if I’m okay now, maybe I just know how to hide it. I guess I’m over it but I will never know how it actually feels to be normal. What is feeling normal, anyway?”.
Cicero did not seem to lack social support. Both parents, regardless of their relationship, managed to put aside their misunderstandings and offered combined support to Cicero. Both were involved in the whole process, and both did their best to guide the young boy through that difficult period. Other sources of support were his group of gothic friends, who were always expressing how important therapy was. An older girl, who Cicero liked at the time, seemed to have also provided him with positive feedback on starting therapy and receiving treatment.
Thinking back on his experience, Cicero does not see it in a completely negative light. The worst aspect seemed to be the feeling of having an empty mind. Suddenly not recognising yourself and your thoughts were frightening. Doing well in school was also amongst his priorities, and feeling like he was disappointing himself only worsened his feelings. At the same time, however, he mentioned a positive aspect of his experience. Cicero values the opportunity to learn how it feels to have an empty mind. In his view, it is the only way to appreciate “how good it feels when you can think again”.
In conclusion, this essay attempted to portray Cicero’s experience with mental illness. His story was analysed using a narrative style framework in order to gain a deeper understanding of what this life period meant to the boy. It can be seen how such an illness has a significant impact on someone’s daily functioning and well-being.
Greenhalgh, T., & Hurwitz, B. (1999). Narrative based medicine: Why study narrative?. BMJ, 318(7175), 48-50. doi:10.1136/bmj.318.7175.48
Helman, C. (1981). Disease versus illness in generl practice. Journal Of The Royal College Of General Practitioners, 31, 548=552.
Wear, D., & Varley, J. (2008). Rituals of verification: The role of simulation in developing and evaluating empathic communication. Patient Education And Counseling, 71(2), 153-156. doi:10.1016/j.pec.2008.01.005
Weingarten, K. (2001). Making sense of illness narratives: Braiding theory, practice and the embodied life (1st ed.). Dulwich Centre Publications. Retrieved from http://www.dulwichcentre.com.au/illness-narratives.html
 The name of the patient has been changed in order to maintain confidentiality.
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