― Jonathan Safran Foer, Everything Is Illuminated
“there are two types of people in the world: those who prefer to be sad among others, and those who prefer to be sad alone.”
― Nicole Krauss, The History of Love
The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status examination. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 20 and 30 years, with a later peak between 30 and 40 years.
Typically, patients are treated with antidepressant medication and, in many cases, also receive psychotherapy or counseling, although the effectiveness of medication for mild or moderate cases is questionable. Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT). The course of the disorder varies widely, from one episode lasting weeks to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses and suicide. It is unclear whether or not medications affect the risk of suicide. Current and former patients may be stigmatized.
The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and has left many aspects of depression as the subject of discussion and research. Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors. Long-term substance abuse may cause or worsen depressive symptoms. Psychological treatments are based on theories of personality, interpersonal communication, and learning. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine and dopamine, which are naturally present in the brain and assist communication between nerve cells.
When the Good Lord was creating mothers, He was into His sixth day of "overtime" when the angel appeared and said. "You're doing a lot of fiddling around on this one."
And God said, "Have you read the specs on this order?" She has to be completely washable, but not plastic. Have 180 moveable parts...all replaceable. Run on black coffee and leftovers. Have a lap that disappears when she stands up. A kiss that can cure anything from a broken leg to a disappointed love affair. And six pairs of hands."
The angel shook her head slowly and said. "Six pairs of hands.... no way."
It's not the hands that are causing me problems," God remarked, "it's the three pairs of eyes that mothers have to have."
That's on the standard model?" asked the angel. God nodded.
One pair that sees through closed doors when she asks, 'What are you kids doing in there?' when she already knows. Another here in the back of her head that sees what she shouldn't but what she has to know, and of course the ones here in front that can look at a child when he goofs up and say. 'I understand and I love you' without so much as uttering a word."
God," said the angel touching his sleeve gently, "Get some rest tomorrow...."
I can't," said God, "I'm so close to creating something so close to myself. Already I have one who heals herself when she is sick...can feed a family of six on one pound of hamburger...and can get a nine year old to stand under a shower."
The angel circled the model of a mother very slowly. "It's too soft," she sighed.
But tough!" said God excitedly. "You can imagine what this mother can do or endure."
Can it think?"
Not only can it think, but it can reason and compromise," said the Creator.
Finally, the angel bent over and ran her finger across the cheek.
There's a leak," she pronounced. "I told You that You were trying to put too much into this model."
It's not a leak," said the Lord, "It's a tear."
What's it for?"
It's for joy, sadness, disappointment, pain, loneliness, and pride."
You are a genius, " said the angel.
Somberly, God said, "I didn't put it there.”
― Erma Bombeck, When God Created Mothers