Oh doctor, I know for sure that I'm cursed
For eternity, because the soul never dies
Even death will not set me free
Because the soul remains, and so I am damned
That's the reason I'm in this condition
Where is this idea coming from?
Sorry?
Where did you get this notion?
It came suddenly...suddenly everything became clear
I understood why I was damned
It's because my gluttony and my sloth, which I have taken to the extreme
I fill myself with tasty things without thinking about the thousands of people dying from hunger
Is there something else?
Sloth...
if there is any small task that needs to be done...
I always find a way to get out of it, so that I don’t have to make even the smallest effort
that's how I am
how long have you felt this way?
[sighs] it's hard to say, doctor
I have a really bad memory...
It's been at least a month
Has it ever happened before?
no
this is the first time?
That I am feeling damned? Yes, the first time
So, how do you see the future?
Something horrible awaits me
at night, when I wake up, I immediately think:
this is not a nightmare, this is reality
How do you wake up? / It is horrible [crosstalk]
could you repeat that doctor?
You awaken at night?
yes
At what time?
Always around 4
4 in the night you are waking up?
yes
is that when you feel at your worst?
yes
and what is waking you up?
it must be...
the damnation
and what are you thinking about at that hour?
still about my damnation
Is that so?
and about my daughter, I have a daughter
..yes
but it's like I don't have one anymore, since I am damned
because I was only living for her, through her
and that also has come to an end
What happened to your daughter?
Nothing
Did something happen that you blame yourself for?
I don’t think so, no, i don't think so
And what do you do during the day?
That's the thing, you see I don’t do anything any more
I don’t have the will to do anything
What would you like to do?
all day, I just think
I ruminate
I deserve to be punished
but I am...
how would you describe your overall condition?
I could have never imagined this, doctor
so before recently, you'd never felt this way before?
no
and now don’t do anything, you can’t keep yourself busy with everyday tasks?
Oh no...But I used to knit in the past
I used to knit a lot, knit cushions.
and now?
they were very beautiful
I'd make them for anyone that liked them
as far as good deeds go, that is perhaps the only good thing that I have ever done
but have you ever really wronged anyone to deserve this?
No, that's not it...it is because of my two flaws: laziness and gluttony
which are in essence just two facets of my selfishness. That is my third flaw
but who is judging you?
Who will damn you?
I am judging myself
yourself?
Yes
or is it a higher power?
Yes
Who? Are you a believer?
Yes I believe, yes
And it is God who is judging me
but it could also be Satan, because I am his prey, I am absolutely Satan’s prey
that's what is horrible about it
have you ever...
you have to believe me, it is horrible
and have you thought about a way out of this.
..perhaps through death?
how?
Have you thought about ending your life as a way out?
But doctor, I've told you...even death will not set me free
because the spirit is immortal
it is not physically that I...that I suffer
so you have never thought about dying?
no, because it will not free me
But if it could...then yes, I would ask for death
[sighs]
What are you thinking about?
about everything that I've just told you, doctor
you see I have told you everything...yet nothing
is there something even worse that you haven't mentioned?
No...isn't this bad enough?
Well, thank you Madam
I am sorry doctor
for not being able to tell you more
(Depressive Symptoms, Melancholia) Simple Form: 62 year old patient experiencing a bout of melancholy during a psychotic episode that began with mania
...are you having a problem with your legs?
My legs are sore
I see
I've asked you to come in so you could tell me more about your depression and what you are feeling
What I am feeling? There is nothing special about it
I am struggling. I go to the market for example, but I have to force myself
I force myself to go shopping
I force myself to wash the dishes
I do it all, but I have to force myself, I don't really want to do any of it
What would you be doing if you didn't have to do these things?
If you didn't HAVE to go to the market? How would your days look?
I don't know, I don't know how to answer that
Would you stay in bed?
No, it's not that bad
But when I wake up, all I think about is that I will have to spend another day being unhappy like this
I feel so unhappy
I have no desire to do anything. You helped me before, and I was happy. I was laughing even...that doesn't happen anymore
I am despondent
Where do these unhappy feeling come from?
I don't know
it comes from my heart
It's like a kind of anxiety
That is what I feel
Do you have dark thoughts?
No, not really. I am bored
And I am envious, when I see other people laughing. I feel like I will never laugh again
never
Are you able to stay focused on what is happening around you?
For example the news?
Yes, a little bit, I read the newspaper every day
Can you do that without much trouble?
Yes, reading the newspaper is easy, but not a book, or even magazine, I don't have the energy for that
but the newspaper, well yes, I'll flip through
Are you happier when you go to bed at night?
Yes. But then I start to think about the next morning
I am better in the evening, when we watch TV for example
yes
Then I feel ok
And the next morning, what happens then?
The next morning I am in pain because it all starts again...with life
and I am forced to do things I don't want to
When I am cleaning my windows for example, I only clean them where I can reach them
But for the third upper panel, where I would need a stepladder, I don't have the will to do it
it is the same with my chandeliers. I know they are dirty, but I don't want to clean them
I can't force myself to do it
What about in the past, when you felt better?
When I was ok, I was ok
And you would do these things without trouble?
Yes. That time that you helped me - there would be no hesitation. I was happy then
Now my home is not a very happy home. It's just the two of us
My husband is very nice. He does everything for me
Did this relapse correspond to some event in your life?
No
What can you remember about when it started?
I remember that about 15 days ago I wasn't feeling very well
And all of a sudden - it happened.
I saw you on Saturday and I told you I wasn't feeling well
I was back on Tofranil at this point [medication]. And it happened suddenly.
It felt like a veil being drawn over my head, and I was in the dark
In the dark?
In the dark
I have anxiety, I feel constricted
And I feel like an idiot compared to others
It feels like everyone watches me, and knows how stupid I am
Does this bother you when you go out, for example to do shopping?
Not really
But still, I have to force myself to go
Do you make small talk with shop assistants?
Yes, a bit. The butcher always asks how I am. He asks for news and I tell him: I am so and so..
I am really sorry. You helped me get back on track. Why did it have to happen again?