How Depression is Diagnosed

Looking at this photo and the one I posted last, both of which Leif had designated as avatars for online things he was involved in, I see clearly how sick he really was. We were worried about hims, terribly worried at that time, when he was so terribly depressed in February 2003. He was still struggling to make it back from the depth of depression when he was suicidal, but he put on a good front around us. Although we were worried, we never saw these faces. These are photos I found on his computer after his death, more of his self portraits. If you compare this unhappy man to the one in the photo at the top right of this blog, when he was glowing with happiness on Thanksgiving 2003, you can clearly see what a difference there is in a depressed and a happy man. How fervently we wish he had been able to keep that happiness and bask in it.

Leif may have considered later that he had PTSD, and whether he had that or severe depression, or even bipolar disorder, we will never know. However, given the possibility that he inherited the tendency to depression from two grandparents I think there's a strong likelihood he was severely depressed and my also have suffered from PTSD. How many times can one climb out of such a deep pit of depression? I know he did it twice. The third time was too much.

I found an excellent article about depression at this website (click the word DEPRESSION below):

DEPRESSION

If you or a loved one is suffering from undiagnosed and untreated depression, or you don't even know it's depression but aren't finding enjoyment in life, please go there and read the article.

I am going to repost a long quote from that article here, for those that won't go read all of it, and I hope that if you read this, you will reconsider.

Most people who are depressed do not seek psychiatric help and must rely on their  family doctor. Unfortunately, there are a number of obstacles associated with  this approach:

Studies suggest that although at least 10% of patients who visit a physician are suffering from major depression, most cases are unrecognized or inadequately treated. One study, in fact, reported that only 25% of family physicians accurately diagnose depression.

 Patients themselves may be unable to sense or admit to their own depression. In one study, although 21% of patients who visited their family physicians were depressed, only one percent described their problem as depression.

To compound the problem, half the physicians in one study admitted to deliberately diagnosing a different problem, such as fatigue, anxiety, insomnia, or headache, in some of their patients who had depression. Reasons for doing this included uncertainty about the diagnosis, a concern that insurers wouldn't reimburse the patient for a diagnosis of depression, or because of the stigma attached to such a diagnosis.

 Depression can be confused with other medical illnesses. Weight loss and fatigue, for example, accompany many conditions, some serious, but they can also occur with depression.

 Many people lack insurance that will cover mental health costs. Such people are also likely to have adverse socioeconomic situations that increase their risk for depression.

Although not all patients who visit their physician should be screened for depression, certain individuals, such as the following, may be at higher risk and so warrant  a screening test:

People with a family or personal history of depression.

 Patients with multiple medical problems.

 Patients with physical symptoms that have no clear medical cause.

 Patients with chronic pain.

 Individuals who visit their physician more frequently than expected.


 Screening Tests

A mental health specialist, such as a psychiatrist, social worker, or psychologist, is the best source for a diagnosis of depression. Such health professionals may administer a screening test, such as the Beck Depression Inventory or the Hamilton Rating Scale, which consists of about 20 questions that assess the individual  for depression. Studies are finding that even computerized phone interviews are valuable as screening tools for depression. It is important to note, however, that these tests are limited, and mental health professionals generally diagnose depression based on symptoms and other criteria.

I tried asking Leif about depression, tried sending him online self screening depression tests, but he would not admit that he was depressed. I ask you, though, when you look at these photos, when you look at the top right photo of him happy in 2003 and his birthday photo in 2008, his last birthday, can't you see the difference? See the hollow smile in 2008, the eyes that don't smile?

I'm sure that there are times each of us is unhappy and has a sad countenance, but when it becomes frequent, pervasive, it's time to look for help.

The Difficulties of Diagnosing PTSD and What to Do About It

Leif took more photos of himself than he did of anything else. I sometimes wonder about this. He took few pictures of his friends. He photographed his wife and some of the women he dated, but not all of them. He took pictures of his vehicles, but not much else, after he grew up. As a teen he photographed cool cars and our cat, and architecture he liked, but as an adult, his photos were overwhelmingly of him. I always photographed my sons a lot, so it wasn't that no one else was taking pictures of him. So why all the self-portraits? Was he trying to see himself, to define himself in some way?

This photo was one of a series he took when he shaved off his beard a mustache (that look didn't last long) and was dressed up to go to a job fair. He chose this one from the series as an "avatar" to use somewhere online, but wasn't using it to my knowledge at the time of his death.

In this series of photos, you can see the depressed and haunted young man that he was at that time. They are sad photos. They came to mind when I read a long and interesting article about the history of the diagnosis of PTSD and what treatment versus disability benefits might mean. If you're interested, please click HERE for "PTSD's Diagnostic Trap."

A quote from the article seems to describe Leif very well:

They called it "Post-Vietnam Syndrome," a disorder marked by "growing apathy, cynicism, alienation, depression, mistrust, and expectation of betrayal as well as an inability to concentrate, insomnia, nightmares, restlessness, uprootedness, and impatience with almost any job or course of study."

Leif was never diagnosed with PTSD, though he told at least one friend he thought he might have it. It was clear that he suffered from all of these symptoms but one . . . he had no trouble concentrating, but often concentrated on things that didn't help his welfare.

Not diagnosed (I don't think he ever brought it up to his VA doctor), and not treated, Leif also did not receive any disability benefits for it, though he did for his increasingly problematic asthma. He could hold down a job, but became disillusioned and unhappy with every one he had. He once said to me that he wished he could just get a "job that didn't suck."

We hoped Leif would climb out of his depression, but he didn't. The point this article makes about the importance of treatment is paramount. I don't know what would have helped him, but I wish he'd given something a chance. Yes, he had a long series of unhappy events and tragedies in his life, but we always hoped he could overcome them.

If you know someone, military veteran or not, who suffers from these symptoms, urge them to get help.

Leif and a Gecko on his Hand - Tampa - October 7, 2007

Leif took this photo just about two years ago, on October 7, 2007. He's wearing his motorcycle glove and a cute little lizard is just sitting there on it, a very unusual circumstance, since these little guys are extremely fast and also can jump amazingly far and fast. I don't know whether he caught it or it jumped onto him, but he managed to get out his iPhone and take a photo of it.

Leif always liked reptiles, particularly snakes and lizards. He was fascinated with them and with cats in particular. He had pet snakes but I don't think he ever had a pet lizard, though he would have liked to own an iguana.

He had a lot of compassion for animals, and maintained that he had more compassion for them than for people, since he felt people were often cruel and destructive. However, he was far more compassionate about people than he allowed to show in his bravado persona.

This was taken the day after we returned from our three-week trip to China. He had picked us up at the airport and taken us home. It was then that we found out about the sad end to his life with Donna, and although he feigned bravado about that, too, it was clearly hard for him to come to terms with that, as he sank into depression that fall and a month after this photo was taken is when he sent me the email saying that he felt he had no purpose in life and that it held far more pain and misery for him than it did happiness or meaning.

And yet, he was interested enough to photograph a gecko, and rescue a turtle from traffic just days before he died in the spring.