Posts tagged: ennui

Anhedonia

Dr. Holzmacher's Business LogoSome words are not replaceable.  There is no one word that can be used as a substitute.  One such word is anhedonia.  It is rarely used in casual conversation.  It is even rarely used by psychologists.   As the word was typed, the online dictionary underlined the word in red, indicating that it is not in their database.

The meaning is related to its Greek roots indicating a lack of happiness, yet this could be confused as sadness or a numb feeling.  Used in a clinical context, the word means a near inability to derive pleasure from activities once found enjoyable.  For example, a person who avidly collects stamps finds their books going unfilled, and a movie buff can’t recollect the last time they went to the cinema.  If the person went on to other activities they found rewarding, then the dropping of old interests would not be considered anhedonic.  The term is meant to describe a loss of enjoyment that has not found another outlet for expression.  This symptom is highly indicative of a depressive disorder, and may be the least understood of the many depressive complaints.

Patients usually associate sadness with depression, and to a lesser extent, sleep and appetite disturbances.  It is rare that depressive people have insight into how the disorder affects their daily activities.  Typically close others observe the alteration of behavior, and the patient often voices non-depressive rationalizations for the change.  The subjective experience of sadness is generally more figural than a change in behavior.  Said another way, people are generally more aware of changes in feeling than behavior.  This becomes important when someone suffers with a depressive disorder, and they lack a subjective sense of sadness.  They may feel angry or numb, but the lack of subjective sadness prevents the person from identifying the problem as Major Depression.

It is not uncommon for a person to be labeled by their family and physician as depressed, and yet have no insight into what others see as obvious.  It is common for the person to have an “ah-ha” moment when a microscope is placed on their behavior.  For example, a middle-aged man complained that his family and doctors continually labeling him as depressed, yet he didn’t feel particularly sad-let alone suicidal.  We discussed his daily activities and how they may have changed over the past year.  Subsequently, the man identified a significant loss of interest in professional sports and cooking.  He became aware of his loss of interest in activities that had given him the greatest enjoyment.  Within six months of accepting treatment, the man was again enjoying sports and cooking.  The symptom of anhedonia often serves as an excellent marker of clinical progress.

Anhedonia is a very important symptom of depression because it has little overlap with other psychological disorders.  The depressive phase of Bipolar Disorder and Schizophrenia are two areas of overlap.  Since the anhedonia only occurs during the depressive phase of Bipolar Disorder, it is still valuable in ruling out other diagnoses.  Anhedonia is not a prominent symptom of schizophrenia, and could easily be thought of as a reaction to the auditory and visual hallucinations.  Not so much a direct reaction as a depressive reaction to the effect of the delusions and hallucinations on social relationships.  It is likely that anhedonia has a much greater overlap with medical conditions, since many physical illnesses can impair a person to the point it is difficult or impossible to engage in “normal” activities.

Anhedonia is not just a nifty word to impress others at a cocktail party.  It is a word that often correctly classifies people as depressed who are suffering without insight.  It is a symptom that has little overlap with other psychological disorders, such that it is a significant help in making a correct diagnosis.  A prospective patient needs to rule out medical conditions that lead to chronic fatigue and low motivation.  If this person is deemed physically healthy, yet continues to suffer with a global loss of interest, a trip to the psychologist will help rule out a Mood Disorder.

Depression-Existential

Joseph Holzmacher's Business Logo for Orlandopsych.comIt is a dark day when our lives lose meaning and purpose.  Most people do not realize that their lives are predicated on implicit assumptions.  Most people take these axioms of their life for granted.  If one lives a relatively trouble free life, these implicit assumptions may never be shaken.  It is rare to find someone that can hang labels on their reasons to live; that have insight into the meaning of their existence.  We all hope our life will sail along so calmly that one’s assumptions about the nature of water will never be called into question.  Unfortunately, calm seas and favorable winds are not the norm, such that we are often unrealistic navigators of our own life.

When people tell me that their life has lost meaning and/or purpose, I typically ask what had been the guiding meaning of their lives.  Without exception, people do not have a ready answer.  They know when it is gone, but are vague about its essence when present.  A common purpose of life is to raise children to be successful adults.  Most adults, especially older adults, readily agree that raising children was the central purpose of their lives.  Roughly half of my adult patients find their work to be meaningful.  It is rare for someone to voice an implicit meaning to their lives without naming one or the other, work and/or children.  It is rare for people to name an intimate partner as the primary reason to live, or activities outside of work as giving meaning and purpose to one’s life.  Exceptions to this rule often occur in childless couples and people who have talent in the arts, but the key word here is exception.

Is there an overriding meaning to life?  Can one climb the mountain and obtain an epiphany of the true transcendent meaning of life?  I do not think so.  Meaning and purpose are unique to the individual, yet there are similarities between individuals.  Meaning is congruent with one’s upbringing and experiences, and so the flavor will be change from person-to-person.  For example, the purpose of raising children for many people is to send them to college, for others to marry and have grandchildren, and yet others want someone to shield them from the ravages of aging.  While all three world views center about the meaning of children in their lives, the purpose and goals of each is different.  If one’s vocation fills them with meaning and purpose, is it because of the assistance they render to others, the money they make, or the competitors they crush?  Here again we find one meaning and three divergent forms of purpose.

The first step in discovering one’s new meaning in life, the new purpose of one’s existence, is to analyze the nature of the old meaning.  It is natural to assume some aspect of the past was a golden age in one’s life, but thorough examination always reveals troubles that had to be surmounted.  Know that there is no one grand overriding meaning, but whatever meanings and purposes are congruent with your particular beliefs and values.  By way of example, I became close to an older adult patient while training for my degree(s).  He was a very loving husband and father.  His family held him in the highest regard.  They were understandably shocked by his first Major Depression occurring at over seventy years of age.  Even before my awareness of these existential issues, it was evident that he no longer felt useful in life.  He was satisfied by his performance as a parent, having met the goals he set for himself as a father.  The patient became increasingly aware of the satisfaction he experienced mentoring younger business people.  He truly enjoyed mentoring others, and more importantly, it became central to his self-image and purpose in life.  After discharge, the patient became involved in consulting to small businesses.  Until the time of his death, many years later, the patient was not only free of depression, but contented with his retirement as well.  Please leave comments regarding this post in the space provided below.

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