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Wednesday, 18 May 2011

Suicide, murder turned inwards

Depressives can worsen to vegetative state or suicide within days. These are two phases of the same disease and are probably closer than mania is to depression, if hormones are important in psychiatry.  We tend to be happier with the bipolar sufferer in the depressive cycle than in the maniac phase, unfortunately for them it’s at their least functional level. It’s less disruptive to our daily life as normal population, or should I say the middle ninety percent of the population. We are looking after our own interests when we treat them. Does statistical normality override what is inherently right and wrong? Who gave the criteria of normality? My pediatrics professor once told us that intelligence, like severe retardation is only less than five percent of the population and statistically as abnormal. You only have to think about some of your heroes to identify mania features at its extreme. It does seem to be; at least just on observation that mental instability is associated with extra ordinary performance.  Winston Churchill, Adolf Hitler, van Gogh my wife just to mention a few.

Depression can also be released in the violent and murderous killing spree that we occasionally witness on television. The very reserved and quiet boy from next door is usually the culprit, wipes out nursery class or his family and then commits suicide. What is surprising is that low serotonin level is associated with higher chance of violent end point, something that most of us would have suspected anyway if you reduced depression to its chemical level. Violence and aggression has to be inversely related to the level serotonin, dopamine and adrenalin somehow. You would ask then why we don’t routinely do lumbar puncture on all depressed patients, and avoid unforeseen circumstances. I am unfortunately not going to humanize the subject at all. I am not even to consider its social impact. Epilepsy was called a psychiatric disease only a few decades ago.

Imagine being asked to do a monthly lumbar puncture on O J Simpson or Mike Tyson. The very person that you cheer across a try line today as a hero is driven by the same passion to commit murder. Who would volunteer to hold him down? Stability in life and resistance to mood swings is dependent on being in a way a rebel but within limits. If you need appreciation from the third party to survive your next day, you are a candidate for a low serotonin. If you depend on the next applause to get your next pay check, you need to be tame and it’s taxing on your true emotion. You only have to look at Michael Jackson to know that.
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