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Feel guilty, anxious and sleep poorly. Feel that my mother could have recovered from melancholic depression.

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Psychiatrist
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I am very worried about myself. I am overwhelmed by guilt over my mom never getting help for melancholic depression and I've only realized after she died that she could have had a good recovery. I think I'm never going to get over this. I am consumed with guilt, anxious, and sleep poorly. My wife is at her wits end with me.
Posted Mon, 16 Apr 2012 in Mental Health
 
 
Answered by Dr. Abhijeet Deshmukh, 1 hour later
Hello.

Thank you for posting your query here. I hope we can discuss your query and arrive at a way out.

From your description, it seems you are carrying a feeling of guilt, and the predominant thought behind this feeling appears to be "I could not help my mother to get appropriate help for her depression". This is my hypothesis about what is going on in your mind. But it would be helpful if you can describe your thoughts yourself. I would like if you can describe those thoughts as answers to the following questions I have written.

1) Were you aware of the fact that there is treatment available for melancholic depression and that your mother was not getting one?

2) What thoughts come to your mind when you feel disturbed about your mother's untreated condition? Please write those thoughts unedited.

3) Do you consider yourself responsible for her death? Do you also consider yourself responsible for her not getting timely help for her depression? What are the thoughts in your mind about this?

4) If the answer to Question 3 is "yes", what meanings does your mind draw about 'you as a son' .... or 'you as a human being'?

I would appreciate if you can write back to me with more thoughts.

As far as the current situation is concerned, apart from the poor sleep, what other physical symptoms can you identify?

Excessive Guilt is an unhealthy negative emotion. It's unhealthy, because it affects day to day living, and negative because it doesn't help you achieve your goals. It is important that you can identify the thoughts that are behind the guilt. We need to check if those thoughts are the main problem. Thoughts can be wrong inferences about a situation, with often unrealistic expectations from the self.

It may be true that your mother might have recovered from her depression with prompt medical help. However, this does not necessarily mean that you are responsible for her not getting the help. In addition, even with prompt treatment, there is no assurance that she might have recovered. We will be able to discuss more accurately once you can write back with the replies to those questions.

Meanwhile, I would suggest a short article for your reading while we carry on our interaction here. Please copy and paste this link in your web browser -

WWW.WWWW.WW
Awaiting your answers to give more specific suggestions.

Good luck.

Abhijeet Deshmukh, MD
Psychiatrist and Psychotherapist

Above answer was peer-reviewed by
 
Follow-up: Feel guilty, anxious and sleep poorly. Feel that my mother could have recovered from melancholic depression. 2 hours later
1) Were you aware of the fact that there is treatment available for melancholic depression and that your mother was not getting one?

I thought there were only medications available. She didn't want to take any as an outpatient so I thought she didn't want help and I got frustrated. It never occurred to me at the time to get her help or to take her to a hospital. She kept saying she didn't want to go so I accepted this no knowing she was probably too ill to make this decision.

2) What thoughts come to your mind when you feel disturbed about your mother's untreated condition? Please write those thoughts unedited.

Guilt and then high anxiety. And more anxiety because it was treatable since it was an endogenous biologic depression.

3) Do you consider yourself responsible for her death? Do you also consider yourself responsible for her not getting timely help for her depression? What are the thoughts in your mind about this?

Yes. She neglected medical conditions because of the depression and I thought at the time this was her being stubborn. But looking back she was clearly depressed and got no treatment. I can't beleieve I missed serious cues that she was sick. She was sad all the time. Her thinking was not clear. She couldn't work anymore. She took poor care of her self. I did take her to a psychiatrist and was told that she would be like this for the rest of her life. I took her to the family doctor and he saw her alone and didn't talk to me and then gave her prescription for an antidepressant which she didn't take and then she didn't want to go back and I didn't take her back since I didn't know what else to do at that point.

4) If the answer to Question 3 is "yes", what meanings does your mind draw about 'you as a son' .... or 'you as a human being'?

I am a horrible son and a selfish human being. I saw living at home with her for 5 years while this went on and then lived away from home for 13 and I thought while I was away maybe she was getting better. But she never went back to the way she was before she got sick. At night the thoughts of this are very strong and make me very anxious.

I realize there is no guarantee that she would have been better. But I woul dbe OK with that if we tried everything -- but we didn't. She had very limited treatment. But from what I have read about melancholic depression people have a high response to ECT or drugs. I feel horrible that I didn't push harder and that she suffered all those years.

She had very classic signs of melancholic depression and I never clued in. I stopped thinking about it after a while. I forgot that she was ever well and I don't think I can ever forgive myself for this. I am an only child as well.

This situation is now affecting my wife and family and kids. My wife is very stressed out and not happy with me.
 
 
Answered by Dr. Abhijeet Deshmukh, 11 hours later
Hello.

Thank you for writing back.

1) You were not aware of the various medical treatments available for her at that time. If you were, you would have helped her with those. Most probably, you were also not aware of ECT being useful in extreme depression.

2) Unless you are a trained mental health professional, it is OK to have missed cues about her illness. Even mental health professionals with all their training miss important signs at times. And if you missed some cues, it is not your fault. And it certainly does not mean you have done something wrong.

Also, the doctor who saw her alone could have educated you about her illness and the various treatment modalities available for the same. But he didn't.

These two points actually suggest that -

1) While you could have certainly been able to do more for her if you were aware of the option, it still wasn't your fault that she did not receive adequate care and management.

2) You are disturbing yourself here by thinking you did something horrible by failing to identify her symptoms. And you are also labelling yourself as a horrible son and a selfish human being.

There is a chain of thoughts underlying this thinking. It probably goes like - 'I failed to perform my duties as a son' --> 'this means I am a horrible son and a selfish human being'. But this conclusion that your mind is drawing is not logical. Even a perfectly good son can fail in his duties towards parents. And your disturbance is arising out of an inner demand from yourself. The demand is most probably something like "I must never fail as a son". And this "must" is often so strong that if things don't happen that way, you tend to perceive it as a failure. You may need to give it more thought and check if this applies to you.

The most important aspect of this situation is that you are disturbing yourself by drawing self-downing conclusions and labelling yourself as horrible. This is certainly not helping you move ahead. And the good thing is that you can change the way you think about what happened. This process can happen with a course of Psychotherapy from a trained professional. I would suggest you consult a trained therapist for Rational Emotive Behaviour Therapy.

You can write back to me here if you would like to talk more about it. I am sure you have more queries about what we have discussed so far. Please feel free to write to me here.

Wish you good luck.

Abhijeet Deshmukh, MD
Above answer was peer-reviewed by
 
Follow-up: Feel guilty, anxious and sleep poorly. Feel that my mother could have recovered from melancholic depression. 3 hours later
Thank you for your detailed response. It was very helpful.

I will always remain regretful that I didn't clue in with respect to my mother's illness, but the point you make about now my thoughts are illogical and disturbing myself is a strong one.

I do have a family and wife to consider so that should remain my focus and not things that could have happened long ago in the past.

Many people around me have suggested I see a psychiatrist/psychotherapist. I am looking into it.

Thank you very much for your attention.
 
 
Answered by Dr. Abhijeet Deshmukh, 6 hours later
Hello.

I wish you good luck. It always helps to acknowledge that such a situation is there in your life and accept it that way. Only after this will it be easier to deal with the emotional disturbances. And what also helps in a big way is to check if the current pattern of thinking is helping you reach your goals or not. IF it isn't, this is the time to modify it.


I am glad to have been of help. Please write again if you need more help.

Please accept my answer if you do not have any more concerns.

Wish you good health.

Abhijeet Deshmukh, MD
Above answer was peer-reviewed by
 
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