EDITORIALS

Depression, Suicide and Loneliness

IS depression an illness, or a normal reaction? How common is it and how disabling? What provokes suicide, or an attempt towards it? Can

relieving loneliness mitigate depres- sion and diminish suicide?

These are some of the questions which need to be answered by anyone who sets out to help the depressed, or to instruct others how to do so. Un-

fortunately not all the answers are

known, and even those that are, are

not widely disseminated. We can therefore recommend our

readers to obtain a copy of the excel-

lent pamphlet Depression and

Suicide*, published by the Mental Health Research Fund which gives all the answers it can.

Layman's dilemma It is difficult for the layman to know

what he can do: he is on the horns of a dilemma, for if he fails to com- fort or support the depressed his

neglect may make them worse: while if he interferes with acute psychiatric problems (as has been told) he may drive them over the borderline into

"insanity" or suicide. With this prob- lem unresolved, it is small wonder that lay attempts to deal with such cases have, in the past, been spasmodic and short-lived.

Recently however, there has grown up the Samaritans' organisation in London and this is gradually spread- ing. There are now 25 branches in Britain alone, and others in Bombay, Karachi, Hong Kong, Salisbury, Istanbul. Mexico City, Kyoto and

many cities in the U.S.A. We are

glad to publish reports on its work in Bournemouth and Camberwell as well as an account of the aims of the

parent body written by its founder the Reverend Chad Varah.

There can be no doubt from these that much misery has been alleviated ?'

and the figures from Bournemouth give some idea of how much can be done, and how much waits to be done, in a town which is not regarded as

especially depressing. Certainly there is room for the growth of the Samaritans' services in other places. But there is no full answer here: the

actual suicide rate in Bournemouth was not significantly altered, though the rate of attempts was. And one

symptom of depression is to withdraw' from everyone and to refuse to seek help: so that many cases, will always slip through the network of helpers* however close the mesh. Obviously the lonely are more likely to do so.

Pathological depression Though some grief is the lot oi

every human being, pathological de~

pression is not, and we must admit that there is no clear agreement amoflS psychiatrists as to the latter's causes. Some blame the repression of aggre? sion over years, others postulate

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biochemical change. Both may "e

true. But there is general agreeme? on the remarkable results obtained ^ some patients by drugs, and in even more by electroplexy, whose action is not yet fully understood. Tn effect of certain types of leucotomy

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preventing further attacks of depres- sion is also on record.

It is therefore essential that aI1^ severely depressed patient shall hav^ medical advice; and the layman haS

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clear duty to persuade him to go ^

his doctor as soon as possible. ^ .

true that some patients feel tn

general practitioners do not u . L,

stand or sympathise with depressiv. While this may have been true in

*Copies are available from the Mental Health Appeal, 8 Wimpole Street, London, W.l; the first copy is free of charge except for 4}d. postage. Additional copies are Is. 4?d. (post free).

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Past, it must be only very occasion-

ally true now, with changes in medical education on the one hand, and bom- bardment through the post every day by pharmaceutical chemists on the other. Early treatment with drugs or electricity has certainly saved many People's lives.

But the friends and relations of the Patient can do more than get him to See his doctor. They can provide sympathy, distraction and hope, as the Samaritans are obviously doing. Even while the patient is under treatment he

may still be at home, and there are

S\>U many hours between the doctor's v'sits or treatments.

Suicide Law The changes in our English law on

s^icide are to be welcomed, and all those concerned deserve congratula- tes (many members of the NAMH

'V^ong them). But some people fear that not to regard suicide as a crime

jy'U remove the brake and so allow a

eNV more people to commit suicide

than before. This seems unlikely, for suicide never was a crime in Scotland :

but if it be true at all it deserves an answer?which is surely to try to

replace the brake lost in this way by another in the shape of hope.

It is by no means easy to instill

hope into the depressive?his gloom may infect his friends. Bunyan, who must have known the condition at

first-hand?and had also been in

prison?wrote feelingly of Giant Des- pair in Doubting Castle. The patient does not always seem to notice the comfort given by his friends?and if he does, he contradicts and opposes their suggestions, and, most trying of all, seems to take a perverse pleasure in doing so; perhaps it is the only pleasure he has left, to wallow in the Slough of Despond, in another of

Bunyan's allegories. Friends and relations may need each other's sup- port to get him out and to give hope; for hope can be confidently expressed, and the prognosis in depression is

mostly good.