The Appearance of a Depressed Person
Robin Kahler: Mon, Mar 21st 2011
I never attended a School of Medicine, but I imagine there is a professor somewhere who teaches a class titled:
"THE APPEARANCE OF THE PATIENT IN DEPRESSION"
When I was in my mid twenties I worked at the front desk of a large corporation. One of my job requirements was that I look "Trump" special every day.
I had some problems with depression then and I made some appointments with a young doctor who had set up his new practice in a building next to ours. After I few months, I decided that I wasn't making any progress and I stopped seeing him. A year later I slipped into my severe manic state - the one where I thought I was from another planet - and another doctor diagnosed me with "Affective Bipolar Disorder" and prescribed lithium.
A few months after that I ran into the young doctor in the parking lot and I shared my diagnosis with him. He literally stepped back two feet and he said with shock on his face, "I would have never diagnosed you as bipolar-you were always dressed so well."
I was stunned for a moment and then I said to him, "I work for "Fancy Company" and in fact, I am "Mr. Big's" receptionist. My appointments with you were on my lunch hour!"
I fumed as I walked away; had he really thought that I could not be depressed because I dressed for work?
Over the years I've thought about that experience and I've come to the conclusion that there must be a professor somewhere who teaches in his APPEARANCE; 101 class, "The depressed patient may often appear slovenly in appearance. Perhaps they have not bathed for weeks, their fingernails may have dirt caked under them."
I remembered a certain spring day a few years ago. During the winter months, I had moved into a new home that had a perfect area in the back yard for a nice garden. It had a small green house and I'd started some seeds in small pots and they were ready to go into the ground then. It was just after St. Patrick's Day, and like any good New Jersey gardener, I had already planted my peas.
I was busy transferring my strawberries and larkspur and I was covered from head to foot in the black dusty soot that peat moss produces. Suddenly I remembered an early morning appointment I had with my doctor. I could not miss it without my insurance company charging me a nice sum as a penalty. I ran into the house and to my dismay I saw that I only had a few minutes to rush to his office. I tore off my gardening apron and my muddy clogs and I rinsed some of the dust from my arms and rushed off to the appointment. After I checked in at his desk I went to the restroom and there I looked into the mirror.
Black dust lingered on my blouse and slacks and when I brushed at it with my hand, it left black streaks. I washed my hands, but the peat moss was caked hard under my fingernails and (of course) there was no "gardener's hand brush) in the doctor's rest room. I took a hairbrush to my hair and did the best that I could and when I was ushered into his office he looked up in surprise and said in a tone that you hear at funerals, "Good Morning, How are you?"
He looked so surprised that I burst out laughing and I explained about the peat moss and my rush to keep my appointment and he relaxed a little bit. I assured him that I was not depressed, nor was I manic.
As I drove home that day I thought about my friend. She is the one who suffers with chronic depression. She rarely leaves her home. She keeps the blinds pulled tightly closed at her windows and she spends the day in her bathrobe and slippers. Except when she has a doctor's appointment. Once in a while she'll. make one to try to find some help for her sadness.
Four days prior to her appointment she will begin to prepare. She will spend her time the first day deciding which outfit she'll. wear. The second day she will decide which accessories would match. She'll. lay out the necklace, the earrings, bracelet, shoes, belt, and even the purse.
I remind you; these efforts require a full day for each. When she was young, she too worked at a "Front Desk".
On the third day she will paint her nails and wash and curl her hair and decide which perfume she will use. On the day of her appointment she will rise at 7 in order to be completely dressed for her appointment at 4.
She has gone undiagnosed for years and a doctor once told her, "I don't believe you are severely depressed. You always appear so well groomed."
I think of people like Patty Duke who went undiagnosed for many years. An actress who most likely always appeared nicely dressed.
I am reminded of the very old saying: "Never judge a book by its cover." You see, my imagined Professor, your depressed patient may very well NOT be the rushed gardener with peat moss under her fingernails; it may be the one who (unknown to you) took four days to appear well groomed.
lost in translation - - May 6th 2011
Thank you for this. Knowing I couldn't communicate my issues well while in a deep depression that lasted for months on end, I waited years to finally be seen by a mental health specialist. The allowed 12 visits by insurance went by and I was pronounced fine. I needed to learn some methods to cope for when the mental exhaustion would return. That was my goal and I communicated it to the doctor. Mentioning any concerns to a PCP had never yielded even the suggestion of a prescription.
Then recently I had a palpable lump so made an appointment, this was my only concern. The day to go came around and I had a rare allergy attack with tearing eyes and sinus congestion and was feeling quite chilly. Nothing was fitting right and the cute outfit I had on ended up being covered by a large gray pullover sweater. I had even staighten my hair but used no makeup because I feel a doc can make a fuller diagnosis if they need to address conditions of the skin.
I have never seen this doc before and the first thing I remember him asking was if I ever felt like harming myself. Having no clue about my religious affiliations, he told me the Psalms are comforting and that even David had many struggles and suggested reading about him. He was all ready to write up and call in a prescription to make me feel better.
Your experinces here really sheds a light that more of the medical world should pay attention to. At least I know now that it is not just me.
High-functioning, well-groomed, depressed. - Sarah - Apr 2nd 2011
Thanks so much for this article, it's fantastic that this issue is being raised. In Australia therapy sessions are rebated so I only have to pay $50 per session. I am on medication and having CBT which has helped me a lot. I have often grappled with my diagnosis of clinical depression because I was always able to get up and dressed with make up and hair style ready for work. I rarely take sick days for dark mood days because I tell myself that it isn't a legitimate reason for a sick day. My psychologist has told me that when my mood is low I do look different, my face is pale and my eyes are dull. But I always make an effort to dress in a way that won't make my illness 'visible'. My need to please everybody - the classic personality of a person with low self-esteem - forces me to go to work and put on my best face because I don't want to let people down or for them to think less of me. I function well at work while depressed because of my illness, in spite of it, because I feel I have to. If I go to work it creates a distraction where I don't have to be 'with myself', and as a side effect it actually improves my mood. It doesn't mean I'm any less depressed when I'm not at work.
Different Indicators - - Apr 1st 2011
This story shows us that there are different levels of coping with depression and ability to function. Severe depression makes sufferers unable to do even the basics of daily life and certainly they cannot groom themselves and go to work. I have seen men who look like Howard Hughes in his later years they are so sick. Because I was able to work I was told I was not sick enough to qualify for disability. Because I wasn't hospitalized I was told I didn't meet the criteria for major depressive episode. If you are put on medication and show improvement you are considered well enough to return to work. I had to qualify for treatment. Later when I needed more treatment I couldn't get it because I had had treatment within the past year and only emergencies are given priority due to insufficient services. I was able to stop working which made a big dfference in my day-to-day wellbeing. But it took alot of hard work and sacrifice. Stay well.
Depression in Seniors - Stav - Mar 21st 2011
Thank you so much for your column. I think it is an important topic especially for family caregivers who may see their parents well dressed and put together and not see the signs of depression.
Visiting Nurse Service of New York blogger Debbie Stricoff wrote about some of the ways that they see and ease depression in older adults in her adult day care services. You can read it here: http://blogs.vnsny.org/2010/10/06/adult-day-services-how-we-can-help-depression/.