Tuesday, December 30, 2008

Subjectivity and Objectivity of Symptoms

I explained the types of side effects I was having today, with special concern about my mouth movements and memory. O asked Dr X to watch my mouth and give me some feedback. Dr X. asked me if I wanted to do a memory test. I did. I love things like that...curious minds want to KNOW.

The first test he did was a test for attention. It was made up of all 26 letters of the alphabet and corresponding #'s (A1, B2C3 etc.). The letters and numbers were dispersed willy nilly on the page. The task was to start with A, draw a line to 1, then a line to B, then a line to 2, c then 3 and so on until you finished.

Subjectively I felt really self conscious. I felt like I was going agonizingly slow. I was praying he would let me stop, because I felt stupid. I seemed unable to find letters, then I would scour and scour the page again for the corresponding # and I just felt like I couldn't find any of them. I felt very frustrated. However Dr. X said I seemed really engaged and I was within the norm for attention.

He said he also watched my mouth as I did it and my mouth was not moving outside the norm. That should feel good, knowing he saw nothing, but subjectively I still feel like my lips are pursing tighter and tighter throughout the day, and my tongue is moving like mad. I do feel a bit relieved that others aren't seeing the movements.

Then he gave me a list of 10 words to write down and try to remember. After that, to distract me a bit he asked me to say as many words as I could that started with the letter "F". I thought of a reasonable # of words. He said I was within the norm.

Then he asked me to tell him the ten words I was to have remembered. I could think of only two. I think after prompting and hints I got 1 more...but I really could not visualize the words. It was like they were gone. Which is the problem I have been having with memory...word finding difficulties, remembering things I have just thought of or learned and recalling memories.

These "tests" for different cognitive difficulties makes me wonder how much the subjective experience of depression jives with a psychiatrists objective experience of a person who has depression. I remember a few years ago believing that it was impossible to be more depressed than I was, but Dr. X told me there are people whose depression is more severe. He said this in a caring context, but I was still confused.

To me my depression, when bad, is barely survivable. I can see how maybe people who attempt, or commit suicide, must have a depression that has a darker and deeper hold on them, but it still is difficult to imagine feeling more depressed than some of the times I have experienced over the past 7 years.

Perhaps the mind protects the body and your person, by telling us that this is the worst it could ever be. If this is the worst and we make it through alive, then we know we can make it through this depression. It makes me wonder if my subjective experience of my depression is accurate, or if objectively I am not as depressed as I feel. That is a difficult thing to really understand given I sense I am what I feel, and I don't feel good.


Anonymous said...

The tests seem to measure impaired memory and concentration, both cognitive functions. Your test score therefore only provides you an objective measure of your level of functioning in this dimension. Of course depression affects other dimensions as well, that factor in a person's subjective experience of the illness.


Aqua said...

Hi E,
I know you are right, but I really am not sure how I feel anymore. I don't feel the intense depression as much as I felt before. It has changed into a feeling of nothingness and emptiness. Flatness, Fatigue, Zero Motivation. A feeling of being so hopeless that I feel like I can't fight anymore. Intense Ennui, but a major fear of trying to do anything to change my fate.

Anonymous said...

Hi Aqua,
Aside from cognitive tests, there are tests also designed to measure affect (mood), motivaton, feelings of hopelessness. What you describe as emptiness or nothingness is known as flat affect. For example, speaking in monotone might be one objective measure of flat affect.

To get a full picture, you would have to be tested from these dimensions at regular intervals. and then compare the results over time to see how you are doing.

This would you better picture of your experience of depression, using several objective measures that only cognitive tests can not.