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Periodical Depression

Fits of periodical depression, familiarly known as "the blues," occur
in the experience of practically everyone. In some people they are
only slight and passing. In others they last for hours and make the
individual quite miserable. In still others, without actually running
into melancholia, they produce serious discouragement and continuous
discomfort which persists even for days and makes life intolerable.
They come and go quite unaccountably. During their occurrence all
vitality is lowered, appetite lessened, aches and pains are
emphasized, sleep may be disturbed, exercise becomes distasteful, and
they usually present an interval when health is at a low ebb.
Ordinarily when described as "the blues" they have no definite
connection with any known physical cause. They are passing incidents
which seem to recur at irregular intervals. When connected with
physical ills they are thought of directly as symptoms of these ills.
All forms of disease may be associated with such fits of depression
and many physical symptoms seem to be due to the fact that during
these periods there is a distinct lowering of physical vitality so
that the nerve impulses which ordinarily enable functions to be
performed without interference are interrupted, or at least are
inhibited, to a noteworthy degree. While to a certain extent the
condition is a mental disease, it may be modified by the correction of
physical derangements, by stimulation and, above all, by suggestion
and a change in the point of view.

Serious Pathological Conditions.--Of course, such periodical fits of
depression are associated with various serious progressive ailments
and then are primarily physical, and are only secondarily psychic.
From the standpoint of psychotherapy it is important to remember that
certain serious organic lesions may show their first signs in the
patient's mental state. It is not unusual, for instance, for the
disposition of a patient suffering from kidney disease to change so
materially that the attention of friends is called to the change
before any physical symptom of the nephritis has been noted. Sometimes
for a year there will be a progressive clouding of what had previously
been a rather happy disposition. Decisions will be made more slowly
than before. The judgment will be impaired. There are some striking
examples of this in history, of which the unfortunate Athenian
general, Nicias, put to death for incapacity that was undoubtedly
pathological, is one. Pleasures will be taken half-heartedly; men who
have been bright and jovial will now become saturnine. Men who have
been the life of parties will try to hold the place they acquired
before, though all around them will perceive how difficult it is for
them to maintain the role they have set for themselves. Whenever there
is a notable change in disposition, it is well not to attribute it to
some passing mental condition and, above all, not to dismiss it
as a peculiarity unamenable to treatment, but to look for the
underlying pathological basis of the new condition.

In this way physical disease will sometimes be discovered long before
it otherwise would be. This must be particularly noted when there have
been a series of worries. Occasionally it seems enough to many people
to ascribe a change of disposition to the troubles that have come over
a patient. If a business man fails or passes through a crisis in his
affairs in which failure is very near, or he has many business worries
over a prolonged period, these are sometimes thought to be quite
enough to explain a change of disposition. They are, but not to the
degree that is often noted, for, in excess, melancholic tendencies are
always pathological, that is, they have some basis in a serious mental
or physical change. If there is an insidious nephritis already at
work, its symptoms will be much exaggerated and its progress
accelerated by the worries and disquietude of such a time. If a wife
loses her husband, or an only son, or a favorite child, the occurrence
of a prolonged period of depression should lead to a careful
investigation of physical conditions and of the underlying mental
state in the hope of guarding against serious developments.

Heart Disease.--Periods of depression are also common in heart
disease and are often the first symptom of the beginning of a break in
compensation. This effect is not so simple and direct, however, as in
the case of the kidneys. Probably the first physical symptom of a
break in compensation, where there is real valvular heart disease, is
a decrease in the amount of urine. This points to an insufficient
elimination of the products of metabolism and to the retention in the
circulation of toxic substances. The reason for this is the lessened
circulation through the kidneys because of the diseased heart. There
is also a lessened circulation through the brain. This impairs the
function of the brain and quite naturally leads to mental depression,
slowness of decision, and unwillingness to occupy one's self with many
things. Besides, because of the lessened function of the kidney the
circulating blood not only does not nourish so well but it tends still
further to depress the brain cells by the toxic substances that are in
it. Depression in such cases is rather to be expected and at the
beginning is not continuous but comes in ever longer periods with
shortening intervals as the disturbance of the circulation progresses.
At first, like other diminutions of function, it is conservative in
order to spare the heart work.

Respiratory Affections.--Very curiously an affection of the lungs
has exactly the opposite effect and is likely to create in the patient
an artificial sense of well-being. Spes phthisica, the
characteristic hope of consumptive patients, is well known, and has
been described by many a careful observer from Hippocrates and Galen
to our own time. A lessened amount of oxygen in the blood produces a
certain sleepiness, but this seems to be preceded by a period of
slight excitation. The most familiar example of this occurs at the
beginning of the inhalation of laughing gas. Practically the only
direct physical effect of the inhalation of nitrous-dioxide is to shut
off our oxygen and it is a slight period of deoxygenation that
produces the anesthesia by this agent. Whether we have not in this the
explanation of the feeling of the consumptive, so that often on the
day before his death he plans a number of things that he is going to
do next year, may require more careful investigation, but the
suggestion may serve to show how much disposition, both lively and
serious, depends on physical factors as well as on the natural state
of mind.

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