SOCIAL FACTORS

A Bereaved Father

A successful businessman working for 12 to 14 hours a day had suddenly stopped going to work and was not attending to his business for the last three months. He had lost sleep, his appetite was poor and had lost about 5 kgs in weight. He used to lie in bed, not communicate with anyone and was constantly lost in his own thoughts. He was frequently crying and often expressed a desire to commit suicide.

This sudden change in the behavior had taken place following the sudden death of his 22 year young promising son in a car accident. Family and friends had tried to persuade him to work at least for a few hours a day or to take a vacation, but had failed to convince him to do so.

He was diagnosed to be suffering for severe Depressive Disease. With treatment he improved and resumed his activities within six weeks. He remarked, "I did not know what happened to me. I had no energy to go out or talk to anyone. My body was not under my control."

It is important to understand that this patient was suffering from Depressive disease. He was not shirking his work purposefully nor had he suddenly become lazy. Although, the triggering factor was obvious (untimely death of a young promising son), giving him good and well meant advice of doing something (Vacation or going back to work) was not the treatment he needed. Rather than sympathizing with the person ("DEPRESSION" is a natural reaction after such a tragedy") it is important to realize that this is an illness and that medical treatment will help the patient get well.

Depressive illness is often triggered off by stressful events in life. The major precipitating social factors for depressive disease are:

• Any loss i.e. loss by death of a close one, loss of prestige, failure in business or examination.
• Occurrence of stressful events that affect emotions negatively.
• Sudden death of family members or friend or serious illness of oneself or family members to whom person is closely attached.
• Quarrel with significant person.
• Children not coming up to expectation either in education or in occupation.
• Sometimes positive events like promotion in job.

In the author’s study of 100 cases of Depressive Disease in Mumbai, the main social factor precipitating Depressive disease were

1. Sudden death,
2. Serious illness
3. Interpersonal difficulties with significant members and
4. Worries about children.

BIO-PSYCHO-SOCIAL ILLNESS

Like any other medical illness, the Depressive disease is a bio-psycho-social disease. In Typhoid fever and jaundice there are certain chemical changes in the body. Similarly in Depressive Disease there are chemical changes in the cells of the brains.

| Genetic | Bio-chemical | Psychological | Social factors |