Home   |  Issues  |  The Daily Star Home | Volume 4, Issue 7, Tuesday February 20, 2007



Interpreter Of Maladies

Hi. I'm an unmarried female in my early twenties. I've had more than an average share of ups and downs in my life. I've read many articles and watched many shows about depression. They say that if even two of the symptoms match, you should seek help. For me, almost 90% of the symptoms match. Every time I get depressed I just shut down and feel very angry, especially at God. At such times, I distract myself and think of how my attitude might be hurting others and tackle myself. From the outside, I'm a very jolly and optimistic person, never failing to inspire others. But from the inside, I feel an utter and overwhelming feeling of hopelessness. I've too many regrets about my past. I feel no hope for my future. I just think how much worse can it get? There are times when I feel like packing my bags and going somewhere where nobody knows me. Sometimes when I'm sitting in the car, I feel like if the bus comes and hits my car right now, it wouldn't be so bad. Every time I start something good, like yoga or even go shopping, I just feel like what's the point? Could you please help me and tell me if this is depression? Or is it just the usual blues that people often feel? Thank you.

Ans: I'm sorry to hear that at this youthful stage of life you are feeling so miserable. It appears to me that there is a predominance of negative thinking pattern, which is probably contributing to this depressed mood. You have mentioned "I've had more than an average share of ups and downs in my life". In depression, the mind gets selectively consumed by the down memories alone and overlooks the up ones. It also sounds like you have suppressed anger and are unable to process it or express it in a right manner. Suppressed or inwardly directed anger is a common cause for depression in women. Socially, women are not expected to express their anger (gender role attribution by the society) and are trained from childhood to suppress anger. It is claimed that inwardly directed suppressed anger eventually results in depression in a later stage of life. This is one of the reasons (sociological theory) why women suffer from depression more often than men.

Sometimes unresolved issues from the past resurface again under stressful life situations. Self-image distortion and impulsivity (e.g. a desire to run away to a place where nobody knows you) results when emotion overrides the rational thinking capacity. Hopelessness, too much regrets about the past, wishing to be dead, lack of initiative or interest and so on are symptoms of depression. Outwardly you pretend to be a jolly, optimistic and inspiring person, which could be a sign of masked depression, personality disorder or simple environmental reactivity. However, the diagnosis of depression does not depend only on fulfilling the criteria mentioned in a standard diagnostic tool (DSMIV, ICD10). Besides those internationally accepted guidelines, the mental state examination, detailed history taking and necessary investigations are also equally important components of a diagnostic procedure. Although the symptoms you have mentioned here are highly indicative of depressive illness, further exploration will be required to exclude Dysthymic disorder, borderline personality disorder, substance use disorder or some other medical conditions that can induce a depressive state like this.

Although life events (particularly experiences of loss) often play a pivotal role in precipitating clinical depression, other factors like genetic predisposition, pre-morbid personality are also important factors in bringing out the symptoms. Some biological indicators of Major Depressive disorder are sleep disturbance, appetite change and weight change and psychomotor retardation/agitation. It is not just the mere presence or absence of the symptoms that count; rather the severity, duration and disability caused by the symptoms are more important aspects of a diagnostic process. In Dysphoric disorder, some women suffer from brief depressive episodes as a result of hormonal (estrogen, progesterone) changes in the body during the menstrual cycle. In case of usual blues (or depression as a normal mental state), symptoms are very mild and transient. People recover from usual blues without any external intervention and it neither affects the functional level nor interferes with day-to-day life in a remarkable way. In my opinion, since you are already concerned about these symptoms, seeking help from a professional is not going to harm you further.


Beauty Dissected

Q. I am 42years old and am noticing some sagging on the sides of my chin and also around my nasal area. I think it makes me look older. Can anything be done?

A. Yes of course, it is very natural for the skin to start sagging at this age as it starts to loose its elasticity. That is why we also start to develop wrinkles at this age. You need to be examined by a cosmetic surgeon to determine what kind of procedure you need. If the sagging is just starting, then a thread facelift will do. Thread facelift is a new technique where minimum intervention is required but the result is almost the same as a proper facelift. It is done under a local anaesthetic and you can see the result almost immediately. But if that is not possible than a proper facelift has to be done which is done under general anaesthesia and takes a few weeks of recovery time.

Q. I am a male aged 35.I was overweight but lost some of it and am continuing to shed weight as I am doing a lot of exercise. I have noticed that I have developed bagginess under my eyes and also my upper lids look swollen. This makes me look bad. Could you please help?

A. The bagginess around your eyes is probably due to loose skin and also deposits of fat. This can easily be removed by a procedure known as Blepharoplasty. Here the excess skin and fat is removed. Usually there is no scarring as the skin in these areas heals very well. Any well-trained cosmetic surgeon will be able to help.

Q. I am a 25year old girl. My weight is alright but I feel that my arms are fatter than the rest of my body. I can't wear short-sleeved dresses as it looks awful. Please can you help me?

A. First you need to be assessed to see what the real problem is. If your arms are disproportionately big, then simply a liposuction of the arms will help you solve your problem. Any cosmetic surgeon will be able to do that.

Q. I seem to have developed wrinkles on the sides of my eyes and these become more prominent when I smile. What can be done? I have heard about Botox but don't know how safe it is. Please can you tell me about it?

A. Botox is a neurotoxin which has been developed so that when injected under the skin, it paralyses the small muscles in that area so the wrinkling effect goes away and the skin looks much smoother. Botox injection will be a good procedure for your problem, and can be done by any cosmetic surgeon. It is a safe procedure and is used commonly world wide.


Dear Dental Wise (Dr. Khan),
If you do not feel to answer my question then stop writing in dental wise. I have sent about 9 months back and I am suffering from dental problem, do you think a reader can wait such a long time with pain?

I think I should blame editor rather you

Anyway sorry for my comments. Still I like your article.

Kabir Hossain

Dear Reader,
We are sorry that you had to suffer through your dental problem. But, a point should be noted that we do not keep our reader's mails on hold. You do hopefully realise that we have a regular cycle of columns, so not all the columns go together.
If you look at the column closer, you will see that we have Dr. Khan's website address. While we do sympathise with your problem, you could have contacted him through the website. There have also been several issues over the last 9 months where we printed his telephone number for readers' convenience. Furthermore, given the number of mails we receive for the Dental Wise column, the Doctor addresses those issues that are pressing. In case you have happened to overlook Dr. Khan's number, it is: 01819249262.

With regards,
Raffat Binte Rashid
Editor, Star Lifestyle

On A Different Note

The reason behind

First time around so venue reached much before required time. The implications are devastating because electronic verdicts gauging the next couple of hours will decide on which side of the seven seas the coming four years will be spent. Not knowing better than to expect punctuality, each ticking second is enough to burst a vein. Surprise. The hour of all importance not only comes but goes and we are still a considerable distance away from beginning the exam.

The insides are green. Green and in ruins- broken windows, grimy curtains, rusted metal. The trees are clipped with information tags and I respect the manual effort it must have taken to badge every tree on campus. We wait in a dark foyer that looks its age and after another hour has passed, hopeful expectations that the exam might in fact not take place are on the rise and jollity is widespread. It does though in due time (due being subjective) and following a series of half-sure instructions from half-sure invigilators, I am considerably amused.

One fortnight later. Another SAT exam. Another venue, this time an international, not government school.

Swift entry through the gates and we face a makeshift table where twenty efficient fingers hurriedly flip through documents and categorise us according to this exam or that. We surpass a concrete threshold and wait for a desirable amount of time- just until 7.45- exactly as has been indicated on the admission ticket. There is much to do and options vary between beholding state-of-the-art facilities reeking mechanisation from all ends and appreciating Second Grade worksheets that evenly border the centre of the passage walls. Too well-read and intricately finished.

7.45 on the dot and doors are held apart and frozen smiles are offered to any who care to look. Once inside, it looks even more perfect, startlingly without fault. Twenty or so odd tables and chairs, in a low tone of grey laid out in ruler-straight alignment. Similar displays of student accomplishment on the walls, only better, so no room to scrutinise. A simple adjustment to my neck and I can fix my hair by aide of the squeaky clean floor.

Exam begins. I am grossly alienated.

After four hundred and thirty-three words and very queer paragraphing, the point of this rambling. It took two aptitude tests at starkly contrasting exam venues to make me realise just how 'Third World' I am. Perhaps my urge to feed on the negatives is a product of being one who is only comfortable in familiar surroundings and by familiar surroundings is meant two allegedly inferior countries but if nothing else, the two exams in such quick succession promotes the 'flip side' concept. The other angle to every story and the different ways of looking at the same thing.

The two settings (too) elaborately discussed portray the difference between us and them, the difference between the First and the Third World and the thin line between (pseudo) perfection and imperfection. The government college has uncomfortable benches, graffitied desks and creaking podiums just as Bangladesh has traffic and competition and unemployment.

The latter, with sharpeners that spin themselves (I could say automatic sharpeners but that sounds less offensive) make unnecessary even the smallest forms of effort, like cutting a pencil, that can be avoided and leave for their students only that which they must absolutely do. Our students write in exercise books, they maintain copies for which they are solely responsible. We are taught to differentiate between CW and HW, made to remember which ones to bring on which days and we are forced to bear their loads. We do not only maintain one thick stack of paper from which we can pull out a sheet adequate for any assignment of any class.

We sharpen our own pencils; actually we have to have our own sharpeners, and we may not have it as easy, but that is exactly where purpose lies. Bangladesh, just like its state-run colleges, is inadequate and it is inadequacy that lies a reason to strive and a reason to move forward. We have scope for improvement, always did and maybe always will, but it is this bit of room that tells us we can and should be better; or at least try to be. Our inferiorities, alleged, have instilled in us a constant sense of something to do, something to achieve, something to fight for.

The nationality we all share shows us perpetual problems. Problems to discuss, to laugh about, to criticise and to try to eradicate. And when we see even the smallest steps towards betterment, we appreciate them. One demolished building here or one clean footpath there, and we not only notice it, but love it. We have seen both sides so when things take an up turn, we are grateful for even the slightest changes. We do not take things for granted-we have never had the luxury to do so.

Doll-house perfection (I am not condemning it), for what it’s worth, robs us of the knowledge that as human beings, we do not need to rely on this machine or that for the small things in life. We can do so much more. Doll-house perfection is cold, impersonal and lifeless, because perfection is unnatural.

This February, set aside language only and celebrate us for what we are-good and bad, because it is in imperfection that there lies life and reason to live. Bangladesh is not perfect. And thank God for it.

By Subhi Shama Reehu


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