The Sorrow of a Depressed Person Has No Reason and No Season

Accepting and understanding depressed patients requires great patience. Many families of depressed patients think the patient is merely "putting on an act." They do look as if they are, because their depressive mood comes on without warning, for no reason and at no fixed time. One moment the sky is cloudless, the next they may sink into deep sorrow, so negative as to be unbearable. But that is the nature of depression.

The Australian writer Matthew Johnstone once likened depression to a black dog that waits by the patient day and night; the slightest lapse and it drags the patient into negative, sorrowful mood. For depressed patients, what torments them most is endless loneliness. They feel no one in the world can understand them; even those who love them most seem to stand on another distant shore, separated by a sea. So the vast majority of depressed patients eventually retreat into an extremely dejected, self-enclosed world.

I first felt this deeply because many of the cancer patients I treat have depressive disorders. According to statistics, common psychiatric disorders in malignant tumor patients include anxiety disorders, depressive disorders and delirium, with prevalence ranging roughly from 10% to 30%. Prevalence of depression is higher in end-stage malignancy or certain tumor types; delirium in end-stage patients reaches as high as 85%. Anxiety and depression increase the risk of death from malignancy by 27%. (For the data, see Chinese Guidelines for Psychosocial Care in Oncology, compiled by the Psychosocial Oncology Branch of the Chinese Anti-Cancer Association.)

Such widespread depression forced me to pay attention to and study it. Through my writing I try to help the patients and families I serve understand what depression is and how to relieve the depressed mood. Because problems in malignant-tumor patients require multidisciplinary solutions, most such patients, when they develop psychiatric problems, receive no help at all; instead they are scolded by the relatives caring for them, because those relatives cannot understand depression.

Depressive mood is not something the patient can control. Medicine still has no clear explanation for the origin of depression. One thing is certain: patients have long been easily affected by negative emotions. We often see people who are dissatisfied with everything about themselves, always blaming heaven and others and lamenting their misfortune. No matter how much wealth they have, they can hardly feel happy. Such people more or less have a depressive disorder; once a major life event occurs—a loved one's death, failure in raising children, or a serious illness of their own—they develop moderate or severe depressive disorder.

Unless there is deep love between family members and the patient, depressed patients can easily, through their emotional irritability, make a mess of their relationships. They may blame their illness on everyone connected to them. For example, I once saw a colorectal cancer patient who, sitting across from me, wept the whole time that her husband and mother-in-law had together tormented her into cancer. Before falling ill she had already got along poorly with her husband's family, and after falling ill she could handle the relationship even less.

The emotions of depressed patients are sensitive and uncontrollable; when they grieve, they are completely unable to restrain themselves, and no amount of comfort from others can easily pull them out. If a family member accuses them of "putting on an act," they become even more pessimistic and hopeless. Typically, depressed patients tend to reinforce the negative impression they have of themselves.

Accompanying depressed patients requires patience. We can tell them that we are always with them; even silent support makes them feel a little better. Companions must accept that the depressed person is not happy; we can tell them they need not be cheerful every day to please others. Generally, once the extreme depressive mood is eased, they can themselves come out of it little by little. Families may ask the patient to make a list of things that make them happy, and, when depression flares up, do one of those things for them. But what is most needed is to give the patient affirming strength—to tell them that they have many good points.

From my own observation, depression is more common in families whose parents like to use belittling language to goad their children, and usually several family members are simultaneously depressed or anxious. Some family members keep dredging up the same old trivial matters from inside the home to argue about, and like to extrapolate from one point into a whole set of grand principles to negate others. In such families, members are more prone to depression.

Chinese people are both ignorant about depression and strongly stigmatized by it, so many Chinese families cannot face the existence of depression. We still discriminate against mental illness; patients with various mental disorders are usually treated as "lunatics," and "lunatic" in Chinese culture is an insult. This leads most depressed patients in China to be discriminated against, afraid to seek care, and unable to get professional help.

Chinese cancer patients are especially pitiable; currently, in roughly half of China's provinces there is no psychological clinic specifically for cancer patients at all. I usually advise patients in low spirits to join various anti-cancer organizations, because there they can get some help.

Many Chinese oncologists have no time to read the psychosocial oncology literature and in clinic usually provide only simple medical care, unwilling to enter the patient's inner world or relieve depression and anxiety. This often makes treatment beset with obstacles; patient compliance is poor, and doctor-patient conflicts easily arise from emotional fluctuations in patients and families. Surveys show that relatives of cancer patients are even more easily overcome by depression and anxiety—especially the patient's spouse, who may be more anxious and depressed than the patient.

I have met many patients and families in depressed or agitated states; for a long time such encounters affected my own mental well-being, but gradually I grew used to them. Generally, when possible, the doctor should at such times say more affirming words to patients or families to help them through their emotional ordeal, which benefits them greatly. After a patient dies, the family's extreme behavior during bereavement should be met with understanding and forbearance, not conflict. Generally, after the bereavement period, the family's extreme emotions ease.

Reading literature and popular science about depression helps depressed patients and their families greatly, and connecting with a psychiatrist can also help. But depressed patients are very individual; they do not necessarily adhere to one psychiatrist. Some depressed patients I see may adhere to me more than to a psychiatrist. If possible, I suggest that oncologists who have much contact with depressed patients supplement their knowledge by reading medical literature; at a critical moment, a single sentence from us may save a life that wanted to end itself.