Section 1: Introduction
Yvonne suffered a spinal cord injury at the age of 55 after falling off stairs and now uses a wheelchair. She was a teaching assistant but now lives on disability benefits. Recently widowed, she lives alone. Her son and daughter living nearby are married and work full-time. She misses the company and activity that her work gave her. A support worker visits every other day to help her bath.
Due, most likely, to the combination of the accident and losing her husband, Yvonne is on antidepressants prescribed by a GP. Yvonne’s sense of self-worth and pride has taken a serious knock because she feels dependent on her relations. For ten years past, she has enjoyed using her PC to research local and family history and to pursue her love of jazz music. Since feeling depressed, she now rarely uses her computer. However, a family friend has indicated that if she were willing to enroll in a formal course to learn computing and ICT skills, he would consider offering her a job. She is interested in taking up this opportunity and feels that it might give her a new lease of life. Her children are opposed to the idea, with the believe that due to her age and the disability benefits, there is no point of getting a new job.
Yvonne’s daughter and daughter-in-law take turns in calling at around 9.30 AM to help her wake up and feed throughout the day. They could not come any earlier, which would be necessary if she was to take up training and employment. They have a family friend who might help her but suspect he will exploit their mother’s situation for his ends. Yvonne’s is an example of person that require support in dealing with; therefore, the explored areas include:
- What are the options for Yvonne and her family, considering that she is in a vulnerable state, and literary stuck?
- How can Yvonne be supported to deal with her depression and life a happy and fulfilled life?
Benefiting from this report are psychiatrists and social support workers.
Figure 1: Conceptual framework
Section 2: Context
2.1. Case perspectives: Depression and the mental health of the elderly
Psychological perspectives on depression. We start with psychology; because it has in part formed a major discourse. Accordingly, then, psychiatry has shaped the views of others on depression, or has provoked alternative opposing perspectives. While patients experiencing depression and those in multidisciplinary mental health have evidence complex range of views on the nature of depression, each of the models presented competes for authority and recognition alongside the traditional and dominant medical approach to the treatment of depression.
Psychology holds that depressive experiences among persons vary, but then people have episodes of depression, the world feels, viewed and is understood in an entirely different manner than before the episode (Cohen & Eisdorfer 2011). Over the course of the episodes, the world is seen as a dark place. Things that these individuals used to see as beautiful may look flat, ugly and sinister. A person undergoing a major episode of depression may believe that their loved ones, even their children, would be happier without them. Things cease to be loveable, pleasurable, comforting or worth living for (Williams Jr 2005). These persons have little to no hope of in the change for the better of things, and that history is experienced and rewritten as a substantiation that all has always been wretched, and that it will always be.
When such these shifts, in reality, take place, these people find it difficult to remember or believe whatever used to be normative before the adverse events. Depressive events are seen as realistic, and that whatever tends to conflict these are perceived as unbelievable as a message or a memory telling her that the sky is purple. For example, the person may fail to feel love for her children, and the person may come to firmly believe that they had been pretending to themselves and others. The person cannot remember feeling proper love, and this is reflected during the episode – that they do not feel love – and thus come to a conclusion that they have never felt it. The same process adversely affects their pleasure and happiness. Attempts at telling these people that they once used to find happiness in some things and that they will feel comfortable again have the potential of making the person feeling more misunderstood and isolated as they are convinced that this is never true.
Psychiatric (medical) perspectives. Psychiatry is a branch of medicine. From a psychiatric point of view, then social and psychological support are the recommended regimen in helping people as Yvonne deal with her case. As in other branches of conventional medicine, practitioners in psychiatry are trained to see themselves as persons tasked with the identification (diagnosing), prediction of the future course of the disease (prognosis), speculation on the cause (disease aetiologies) and prescribing an appropriate treatment for the amelioration of the symptoms (treatment). The identity of the user is that they are placed in the ‘sick role,’ a role likely to be long lasting rather than temporary (Cohen and Eisdorfer 2011). The affected person may be unable to work, or on the least if they work, they may then be expected to take low stressing and probably other low status jobs, rely on benefits supplied by the state, and enrol on a program of continued support from health and social care services. Then this medical point of view at best potentially can replace the moral notions of weaknesses, badness and blame that have long been associated with major depressive episodes among the elderly, framing those suffering no different from other illnesses such as diabetes, HIV/AIDS, and asthma.
Consequently, then, it would not be of surprise that some of these psychiatrists do not think in terms of illnesses when they encounter variations in in the conduct which are troublesome to people. Psychiatrists rejecting this illness framework, wholesomely or in part, tend to have been exposed to, and have accepted an alternate view derived from other discourses (sociology, philosophy or psychology).
Then these depressive events, as Cohen and Eisdorfer (2011) explain in their psychiatric analysis, are felt like an intensified feeling of pain that cannot be pointed to a particular body part. The usually comforting and pleasant touch turns to a painful feeling, almost leading to tearing. The affected individuals become withdrawing, engorged in their distant world. According to Williams Jr (2005), other persons try to have the affected person have a look at the brighter side of life, be grateful, meditate, change their thoughts, or that they lesser or attempt to frown upon the realities of these people, they are on the least likely to achieve their goal. Contrary, they – both them and the individuals in suffering – are more apt to feel more alienated and frustrated from one another. The role of cognitive therapy, therefore, cannot be overemphasized in the life of these individuals (Book 4).
Section 3: Discussion
3.1. The Theoretical Approaches
Much of the research conducted on coping with depression and the management of mental problems associated with major loses has focused on individualistic survivors. According to Kail and Cavanaugh (2016), the Victorian belief on significant losses in life (grief) was a symbolistic representation of broken hearts that result from the death of a loved one and was subsequently superseded by the psychodynamic perspective that some of these events were painful because they entail letting go of already established attachments. This letting go becomes to be viewed as one of the essential parts necessary to move on with life, to eventually recover from the depressions of the loss and return to normative functioning (Blazer 2003).
Later, theories developed on depression were tooled to include an emphasis on the differences with normal (uncomplicated) and pathological (complicated) reactions to traumatic experiences and went further on to put emphasis on the stages, phases or trajectories that were associated with dealing with these losses. The best-known model lay out a five-stage hierarchical pattern of steps; from shock to denial to anger to bargaining to depression and finally accepting the happenings (Williams Jr 2005). Contemporary media, lay people, and professionals then viewed these stages as the ways of successfully dealing with loss. This model is still gravitated for its simplistic linear approach, being used as a descriptive measure in people dealing with and the progression of traumatic experiences. The model, since its publication, has gained application to other situations including chronic illnesses, grieving and even infertility (Blazer 2003).
Whereas these models have gained popularity in contemporary media; some researchers have come out to critique them sharply. Greenglass, Fiksenbaum, and Eaton (2006) explain that studies conducted on the stages of dealing with losses have come short in posting any ascertained sequel of events that underline the emotional phases of adapting to failures, or any clear end point of addressing these losses. Contrary to a passive linear staircase climb, the distinctiveness of variations on how people deal with traumatic experience may be more closely related to the unsteady turning and twisting of pathways requiring continued change and adaptation, but with no specific terminal point (Book 4; Burton and Ludwig 2014). Additionally, proper evidence has not been posted on the position that a person deviating from these normative stages experiences a pathological symptomatology of complications to dealing with traumatic events, so that researchers have underlined the need for the de-emphasizing on the ecumenical syndromes of pathological complications to loss, and have a recognition of the various practices among subcultural groups.
According to Cohen and Eisdorfer (2011), challenges also have risen on the concepts of losses that underlie the theories – it is assumed that the affected individuals must engage in cognitive activities as a sign of confronting these traumatic events and that coming short of undergoing a complete healing is a predisposition to pathological deficiencies. These notions that a person most cognitively be involved in work – or at least show effort – in handling traumatic experiences are is never a concept universally accepted, and that in it most probable sense is a reflection of the wider emphasis by the globalized western world gains can only be made when proper effort and hard work is put into it (Williams Jr 2005).
Kail and Cavanaugh (2016) note that newer models on how people cope with traumatic experiences and depression tend to focus on: a). The circumstances of these losses; b). On the variability of the experiences of an individual on how to cope with major lassoes; c). On what meaning the event holds for the surviving people and their families; d). Because rather than completely withdrawing from the attachment to a lost person or object, there exist an incessant symbolic bond between the person and the lives before the experiences or attachment to the lost item or person; e). And on adjustment to the new world that comes into existence after major losses – which includes gaining new interpretations of the surroundings and any other new elements in defining one’s identity. Emphasizing on this appears to shift its focus from identification of the symptomatology to the procedural outlines of dealing with the loss itself (Burton and Ludwig 2014).
Exemplifying this is the Dual Process Model of Coping explained by Martz and Livneh (2007) which suggest that actively confronting a loss may not necessarily result in a positive outcome. There may be instances that the avoidance of reminders and denying the loss may be necessary. Commonly, most affected persons tend to oscillate between losing orientation (dealing with denials, coping with losses and avoidance of changes) and a (later) restoration of their orientation (making an adjustment to the many changes that the loss triggered, including changing routines). This theory is a major reflection of a shift between efforts at trying to cope with the new situation and moving forward after traumatic events, but that the degree to which an individual need either of the presented dimensions differs from one person to another.
On the other hand, theories on families have slowly developed elements addressing loses. The theory of Family Systems (with emphasis on having a view on the responses to losses by the members of the family as a major disruption in the equilibrium and structure of the systems of the family which necessitates for a reorganization of functions and roles of one member of the family or another) is well suited in the explanation of a loss (Price, S Price, C and McKenry 2010). However, the emphasis of this theory on how currently and presently the members of the family interact appears to have severely slowed in development along the trajectory. Notable exceptions, however, include the suggestion that a family’s historical experiences on dealing with traumatic experiences influence the adaptation of the grouping to other subsequent traumatic experiences as well as legacies of having a perception of themselves as either cursed – unable to rise from the traumatic experiences – or survivors passed on to subsequent generations (Cohen and Eisdorfer 2011).
According to Price, S Price, C and McKenry (2010), the integration of individual and family life-cycle development to the theory of family systems in the discussion of a major as a crisis of attachment and identity, in which the loss disrupts that equilibrium of the family but also presents the opportunity of developing new growth-enhancing stabilities. Contrary to tooling focus on the affected person, the family is viewed as one of the central resources that are both affected by and influenced by whatever course the loss takes.
3.2. Consequences
Price, S Price, C and McKenry (2010) note that whereas losses tend to punctuate or lives, adverse social, psychological, and physical outcomes can affect those surviving, as well as a dramatic reduction in the resources of an individual or the family, whether materialistic, symbolic or personal. The life of a person is characterized by a continued tendency to build up memories associated with catastrophes – some being painful and others being positive in the essence that they confer positive feelings of growth on how to react to situations in a consistent manner in line with the values held. Sometimes, some of these memories can be actuated by cues encountered in our day to day activities, by familiar places, by rituals, by anniversaries and by hearing other people use specific word phrases or hearing the wind blowing just before a major event that happened in our lives (Book 4).
Despite concerted efforts by authors to create a comprehensive field of the social psychologies associated with losses, the present research on the outcome of losses is obtained from research carried out on participants who have undergone a grief probably because researchers believe that this is one among the few losses that one can recover from (Cohen and Eisdorfer 2011). Traumatic experiences can lead to major negative consequences on the physical health of a person. These include becoming more susceptible to illnesses, development of new symptoms, disturbances in normal sleep pattern, loss of energy and other long-term effects such changes in the expression of genes, a dramatic fall in the serum levels of the NK cells and major brain degeneration (Burton and Ludwig 2014).
The reported psychiatric changes in mental health include cognitive epiphanies – the affected persons becoming pathologically preoccupied with the thoughts of past events, feelings of hopelessness, helplessness, reduced self-esteem and tendencies to self-reproach (Blazer 2003). Affective alterations that occur include anger, guilt, anxiety, loneliness and depression. And changes in behaviors to include agitation, crying, fatigue, and social withdrawal. However, research does not clearly outline to what extent that variations in the mental and physical health take place and how much of this change leads to other downstream changes in life (including resorting to drugs such as tobacco, alcohol and poor eating habits). Persons with underlying disorders of personality have a heightened predisposition to suffer complications of these unexpected life events (Biering-Sorensen et al. 2006). However, neither clinicians nor researchers have done a satisfying job in clearly distinguishing the cause of depression associated with major life losses, nor have they accurately recognized the traumatic causes of depression from the normal causes of depression (such as grief) (Cohen and Eisdorfer 2011; Williams Jr 2005).
3.3. Coping with Traumatic Experiences
Psychologically, the effective handling of the negative social impacts of losses in life has sometimes proved an uphill task. This is more so as the affected individuals have been noted to report a dearth of clearness on their roles and dire deficiencies of support from their immediate families and the societies they live in. These traumatic events may have led to a significant shift in their incomes, social status or personal identities.
Despite literature greatly emphasizing on the problematic outcomes of major losses in life, emergent research has continued to emphasize on growth that results from their major life experiences. Exemplifying this is post-traumatic growth believed to ensure when, at a certain point, after significant losses, growth takes place beyond the individual’s previous levels of functioning (Greenglass, Fiksenbaum and Eaton 2006). This increase can then be accompanied by changes in how, firstly, the affected individuals perceive themselves – that is, as survivors rather than being victims or as becoming more self-reliant while recognizing the heightened vulnerabilities (Book 4).
Secondly, changes occur in the interpersonal relationships that the affected individuals make – that they have an increased ability to express emotions and become more compassionate. Thirdly, Price, S Price, C and McKenry (2010) note that they undergo philosophical changes in life – they may gain a higher sense of wisdom or spiritual change, gaining new purpose and meaning in life, or reorganizing their priorities. However, experiences of these traumatic events do not heal the perceived problems in family relationships; many other changes in emotions, behaviors and cognitive changes are also required to take place (Biering-Sorensen et al. 2006).
Section 4: Recommendations and Conclusion
4.1. Support for Yvonne
Psychotropic medication. In working with people with major episodes of depression, the role of psychotropic medication has been explored. Currently, researchers posit that the institution of these drugs is one of the management therapies that has been proved to be effective. Yvonne is currently on antidepressants. In managing her condition, her family needs to be aware of the side-effects associated with the drug and any compliance issues that may arise.
Activity therapy. According to Greenglass, Fiksenbaum, and Eaton (2006), many older people respond positively when they ‘got more involved in life.’ Western civilization is characterized by a view of the elderly persons as weak, senile and immobile – including other negative views. Whereas Yvonne’s’ children may have at their heart the best interest for her, it is important that recognize her individualistic needs that need to be addressed. For a person like Yvonne, who has become too much inactive from her incapacities should take the opportunity and learn ICT and programming.
The shortcoming of this theorizing is that it may be a demonstration of the people involved in the care of elderly patients calling upon theories that are in support of particular arguments when making decisions on ‘what ought to be done.’ This may be so, considering that the family is considering the support of a professional therapist. Secondly, that they tend to make an assumption that other, apparently similar, situations are analogous to the ones they already are familiar with; more so the therapist who has had experiences helping similar cases may want to blanket extrapolate the value of the therapy to other persons (Price S, Price C, and McKenry 2010). On the other hand, instituting too much change may produce an adverse reaction in seniors. However, this may be a right prescription in the practice of psychology, and since Yvonne is willing, the therapy can be adapted to her needs.
The role of loved ones. The immediate family, and loved ones can show commitment and love to the person feeling unhappy, depressed and lost a sense of life; care should be taken not take the reality of the affected person in addition to not arguing with them about it (Eisdorfer 2011). The immediate family can also gently remind the person that depression leads to a change of perspective on things and that they are unable to think outside of the depressive modes of treatment. This is a time for such individuals to avoid making decisions, or avoid doing things that significantly require non-depressive perspectives. If this is a repeated experience for the person, it could be helpful if all these is discussed between the depressive episodes so that they are more prepared when caught in the quicksand (Martz and Livneh 2007).
For the people tasked with dealing with an individual with depression, the experience may be an emotional roller-coaster, challenge, and its stress. Such a helper then ay also need to focus on their personal needs and self-care, and reach out for help such as seeking the professional services of counselors or therapists.
4.2. Conclusion
Indeed, whereas there exist some commonalities in the individualistic responses to losses, there exist no global ways of predicting emotional trajectories, and a varying range of outcomes, behaviors, and effects that people experience is hugely malleable. For us to gain a better insight into the process that follows traumatic events, and how they are dealt with, the dialects associated with losses and growth, and the meanings attached to life experiences, it is of paramount importance that a consideration be made to the affected persons as embedded within a family, the family grouping in itself forming a larger community and the community in itself being part of more major cultural and social systems.
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