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Depression
Published in Ad (Sandy) Macleod, Ian Maddocks, The Psychiatry of Palliative Medicine, 2018
Ad (Sandy) Macleod, Ian Maddocks
Demoralisation is a concept, recently championed by Kissane,30 of particular relevance to palliative care patients. Demoralisation is a form of existential despair. The demoralised patient expresses non-specific dysphoria, such as distress, irritability, guilt or regret, and a growing sense of disheartenment. Loss of purpose and meaning can lead to helplessness, hopelessness, worthlessness and an impatient desire to die or hasten death.30 Clinicians can perceive the demoralised to be contemplating ‘rational’ suicide. Up to 8% experience severe demoralisation, which interferes with competency to make informed and autonomous choice, and may coexist with or be a harbinger of clinical depression. Change in morale spans a spectrum of mental attitudes from disheartenment (mild loss of confidence), through despondency (starting to give up) and despair (losing hope) to demoralisation (having given up). Historical terms such as spiritual torpor, mopishness and acedia describe similar states of pointlessness and a non-caring attitude to living. The philosopher Kierkegaard describing the greatest despair of all stated that ‘when death is the greatest danger, we hope for life; but when we learn to know even greater danger, we hope for death. When the danger is so great that death becomes the hope, then despair is the hopelessness of not even being able to die’.31 Clinically it is possible to differentiate demoralisation and depression.32 Demoralised patients, while feeling hopeless about their future, feel immediately content with their present. The core features of depression are anhedonia, the loss of both anticipatory and consummatory pleasure, and the loss of interest in life’s activities. The demoralised feel no anticipatory pleasure, and are trapped and helpless. Still interactive with their environment, they are unable to conceive an escape from their distress except by death.30 Whether demoralisation is a form of ‘subthreshold’ depression, an adjustment disorder, a form of reactive dysthymia, or a separate diagnosis is uncertain. Psychotherapeutic and social interventions of a supportive, empathic and reality-focused style may be of benefit rediscovering a meaning for the remainder of life.
A Conceptual History of Anxiety and Depression
Published in Siegfried Kasper, Johan A. den Boer, J. M. Ad Sitsen, Handbook of Depression and Anxiety, 2003
At about the same time, the work of the Greek authors began to be translated into the Semitic languages by Christians who had fled the Byzantine Empire, as well as by Arab authors. In this way Arabic medicine came to assimilate its Byzantine inheritance, in addition to influences from India and even China. By the end of the first millennium, writers from the Eastern Caliphate (Baghdad), such as Rhazes (865-923) and Avicenna (980-1037), had produced medical treatises of their own. Avicenna's Canon of Medicine, in particular, was to dominate medical ideas for centuries to come. From Persia came another significant figure, Ishaq ibn Imran (early 10th century), who has been referred to previously. His work on melancholia inspired the great and influential treatises on the subject by the encyclopedist Constantinus Africanus (1020?-1087). Originally from North Africa, Constantinus subsequently lived in Salerno and later moved to Monte Cassano. His work reflects that of Ishaq, in that he also devoted an extraordinary amount of consideration to psychogenic causes of melancholia. Later on, famous scholars from the Western Caliphate (Spain), such as Averroes (1126-1198) and Maimonides (1135-1204), also exerted an influence on medicine. In the late Middle Ages, however, authors dealing with melancholia mainly referred to the works of Avicenna and Constantinus [32]. In the late Middle Ages, medical knowledge was mainly concentrated in monasteries and in cathedral schools. Moreover, various university medical schools were founded, the best known of these being Montpellier, Bologna, and Padua. In addition to continued classification, some scholars now began to apply morality to humoral pathology [33]. This led to melancholics being described by some as degenerate, along with phlegmatics and cholerics. Sanguinics, on the other hand, were considered to represent man, as God had intended him to be, at the Creation. Melancholia was also associated with acedia, a type of listlessness and restless boredom, accompanied by a longing for change of environment. As long ago as the 4th century, Cassianus described this condition in the monks of desert monasteries not far from Alexandria. The afternoon demon would appear around the sixth hour. It bred in the monks a loathing for their own cells, a disdain of the other brothers, and a slothful unwillingness to take part in the routine activities of monastic life. Acedia, in the guise of Sloth, was to become one of the Seven Deadly Sins of the Middle Ages [34,35]. One particular development in the continuing systematization of humoral pathology was an accentuation of the difference between two forms of melancholia. In additon to melancholia as a result of an excess of natural black bile, a second form was discerned, caused by an excess of unnatural black bile. Unnatural black bile was thought to be produced by the combustion, or degeneration, of one of the four bodily fluids.
‘Brain fag’: a syndrome associated with ‘overstudy’ and mental exhaustion in 19th century Britain
Published in International Review of Psychiatry, 2020
Disorders Linked with Overstudy in Brainworkers (19th century) (Tuke, 1892)CerebropathyBrain fagBrain tireNervous diathesisNervous exhaustionAtaxia spirituumReceptive dyaesthesiaAcediaEncephalopathia literatorumAlopecia accidentalisApoplexia mentalisApoplexia sanguinea
The biology of burnout: Causes and consequences
Published in The World Journal of Biological Psychiatry, 2021
Adam Bayes, Gabriela Tavella, Gordon Parker
The term ‘burnout’ was introduced by American psychologist Freudenberger (1974), but was much earlier termed ‘acedia’ to describe states of listlessness and mental torpor in monastics in the fourth century AD (Finlay-Jones 1983). In contemporary times burnout is generally positioned as a state of exhaustion resulting from prolonged and excessive workplace stress.