Sunday, March 18, 2018

Depression among doctors is a growing problem: Genesis of depression

Dr KK Aggarwal

Mail Today recently featured a cover story of how mounting stress level due to work pressure is taking a toll on the mental health of doctors at All India Institute of Medical Sciences (AIIMS), Delhi. Some of them are admitted in the psychiatric ward of the institute and are undergoing treatment, the story further said.

Depression among doctors is a growing problem and it is now increasingly being reported. According to a study published in JAMA (JAMA. 2015;314(22):2373-2383), between 20.9% and 43.2% of trainees screened positive for depression or depressive symptoms during residency.

As per quantum physics matter can be sequentially broken into atoms and then to subatomic particles (protons, electrons and neutrons), photons, quantum and wave. A photon is both a wave and a particle at the same time (wave particle duality). The human body is also a particle and a wave at the same time. In terms of science, this duality exists as a balance between sympathetic and parasympathetic states.

According to the Vedas, thoughts arise from our consciousness. Thoughts lead to action. Every action leads to a memory, which in turn leads to a desire. A cycle of action, memory and desire is subsequently set into motion. Fulfilled desires result in actions to realize that desire again or fulfil a new desire. Repeated fulfilment of desires leads to habits, addictions and behavior. Unfulfilled desires lead to anger, which can be expressive anger or suppressive anger.

Expressive anger (anger-out), or uncontrolled outbursts of anger, becomes evident as aggressive behavior and/or violence. Suppressive anger (anger-in), can be acute or chronic. Acute suppressed anger can manifest as acute heart attack, acute asthmatic or anxiety attack. While, chronic suppressed anger may lead to depression in due course of time.

Non fulfilment of desires, expectations and aspiration over a period of time therefore is the main cause of depression.

The desires are need-based. Human behaviour is governed by needs, which can be at the level of physical body, mind, intellect, ego or the soul. These needs result in desires, expectations and aspirations.

These can be in the form of respect, recognition and prestige, once the basic physical needs of food, clothing etc. are satisfied.

The feeling of discontent may also be a result of humiliation from seniors/faculty, exam pattern, hurt ego (by patients and/or their families), the daily trauma of dealing with sickness/death, long gruelling shifts, sleep deprivation, social isolation topped with the perennial sword of litigation.

As a way to deal with this stress, some are pushed to self-destructive habits and addictions (alcohol and substance abuse) and some may even resort to the ultimate step of taking one’s own life.

Become a doctor demands lot of self-sacrifice. The extreme stress tests one’s fortitude and perseverance every day.

Overworked and exhausted doctors are bound to mistakes as happened in the case of Dr Bawa-Garba, NHS in UK. She was convicted of manslaughter by gross negligence following the death of a 6-year-old boy with Down syndrome. Her name was erased from the medical register following an appeal from the GMC. Missing the diagnosis of sepsis and thus delaying initiating antibiotic treatment was one among several charges of negligence levelled against her. The charge of manslaughter against their colleague will also adversely affect the morale of other doctors.

Depression therefore is an outcome of the chronic suppression of emotions or need-based desires or their non-fulfilment, particularly for those who have high expectations or high aspirations.

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