Depression
We all experience changes in our mood from time to time. Many people with Alzheimer’s disease and other dementias, however, experience specific mood changes. They may become depressed, withdrawn, and lose interest in activities they used to enjoy. Sometimes, they may lose the ability to control their emotions.
It is important to remember that even in the later stages of the disease, the person with Alzheimer’s disease is still able to experience a variety of emotions such as joy, love, fear, and sadness. Monitor her mood to ensure she is able to enjoy each day as fully as possible.
What is depression?
Depression is a condition in which people feel sad, hopeless or irritable most of the time. People with depression also experience anxiety and feelings of isolation. The number of people with depression rises over the age of 65.
Up to 40 to 50 per cent of people with dementia experience depression at some point. Depression can make the symptoms of dementias worse. For example, depression can cause increased forgetfulness, confusion, and anxiety.
It is important to diagnose depression in people with dementia because depression may respond to treatment.
The symptoms of depression can be similar to symptoms of dementia. Therefore, it is often difficult to identify depression in people with dementia. There are some common signs of depression to be aware of:
- Loss of interest in previously enjoyed activities
- Lack of energy
- Problems sleeping
- Increased confusion
- Loss of appetite and weight
If you are concerned about depression, speak to the person’s doctor.
Possible causes of depression
- In the early stages of dementia, the person may experience depression after hearing his diagnosis.
- Social isolation may also cause depression in some people with dementia.
- Fatigue is associated with depressive symptoms.
- Depression can be a side effect of certain medications. Ask the person’s doctor to review the drugs he is currently taking.
Coping with depression
- Encourage pleasant activities that she can still enjoy, such as short walks or outings.
- Set realistic expectations. If you expect too much from her, she may feel frustrated and discouraged.
- Establish a consistent daily routine. This will help reassure her as well as reduce confusion.
- Counselling, cognitive behavioural therapy, and group therapy may be helpful.
- Antidepressant medications may help. Talk to the person’s doctor about the options.
If you are worried about any of these symptoms, talk to your family doctor.
Dementia is an overall term for diseases and conditions characterized by a decline in memory, language, problem-solving and other thinking skills that affect a person’s ability to perform everyday activities. Memory loss is an example. Alzheimer’s is the most common cause of dementia.
About dementia
Dementia is not a single disease; it’s an overall term — like heart disease — that covers a wide range of specific medical conditions, including Alzheimer’s disease. Disorders grouped under the general term “dementia” are caused by abnormal brain changes. These changes trigger a decline in thinking skills, also known as cognitive abilities, severe enough to impair daily life and independent function. They also affect behavior, feelings and relationships.
Alzheimer’s disease accounts for 60-80% of cases. Vascular dementia which occurs because of microscopic bleeding and blood vessel blockage in the brain, is the second most common cause of dementia. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.
Dementia is often incorrectly referred to as “senility” or “senile dementia,” which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging.
Memory loss and other symptoms of dementia
Symptoms of dementia can vary greatly. Examples include:
- Problems with short-term memory.
- Keeping track of a purse or wallet.
- Paying bills.
- Planning and preparing meals.
- Remembering appointments.
- Traveling out of the neighborhood.
Many dementias are progressive, meaning symptoms start out slowly and gradually get worse. If you or someone you know is experiencing memory difficulties or other changes in thinking skills, don’t ignore them. See doctor soon to determine the cause. Professional evaluation may detect a treatable condition. And even if symptoms suggest dementia, early diagnosis allows a person to get the maximum benefit from available treatments and provides an opportunity to volunteer for clinical study . It also provides time to plan for the future.
Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior and feelings can be affected.
The brain has many distinct regions, each of which is responsible for different functions (for example, memory, judgment and movement). When cells in a particular region are damaged, that region cannot carry out its functions normally.
Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. For example, in Alzheimer’s disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That’s why memory loss is often one of the earliest symptoms of Alzheimer’s.While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed:
Diagnosis of dementia
There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer’s and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type. Doctors can determine that a person has dementia with a high level of certainty. But it’s harder to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap. In some cases, a doctor may diagnose “dementia” and not specify a type. If this occurs it may be necessary to see a specialist such as a neurologist or gero-psychologist.
Treatment of dementia depends on its cause. In the case of most progressive dementias, including Alzheimer’s disease, there is no cure and no treatment that slows or stops its progression. But there are drug treatments that may temporarily improve symptoms. The same medications used to treat alzheimer’s are among the drugs sometimes prescribed to help with symptoms of other types of dementia .Non drug therapy can also alleviate some symptoms of dementia.
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What is domestic violence and abuse?
When people think of domestic abuse, they often focus on domestic violence. But domestic abuse includes any attempt by one person in an intimate relationship or marriage to dominate and control the other. Domestic violence and abuse are used for one purpose and one purpose only: to gain and maintain total control over you. An abuser doesn’t “play fair.” An abuser uses fear, guilt, shame, and intimidation to wear you down and keep you under their thumb.
Domestic violence and abuse can happen to anyone; it does not discriminate. Abuse happens within heterosexual relationships and in same-sex partnerships. It occurs within all age ranges, ethnic backgrounds, and economic levels. And while women are more often victimized, men also men experience abuse also,especially verbal and emotional. The bottom line is that abusive behavior is never acceptable, whether from a man, woman, teenager, or an older adult. You deserve to feel valued, respected, and safe.
Domestic abuse often escalates from threats and verbal assault to violence. And while physical injury may pose the most obvious danger, the emotional and psychological consequences of domestic abuse are also severe. Emotionally abusive relationships can destroy your self-worth, lead to anxiety and depression, and make you feel helpless and alone. No one should have to endure this kind of pain—and your first step to breaking free is recognizing that your relationship is abusive.
Signs of an abusive relationship
There are many signs of an abusive relationship, and a fear of your partner is the most telling. If you feel like you have to walk on eggshells around them—constantly watching what you say and do in order to avoid a blow-up—chances are your relationship is unhealthy and abusive. Other signs include a partner who belittles you or tries to control you, and feelings of self-loathing, helplessness, and desperation.
To determine whether your relationship is abusive, answer the questions below. The more “yes” answers, the more likely it is that you’re in an abusive relationship.
| Are you in an abusive relationship? |
| Your inner thoughts and feelings |
Do you:
|
| Your partner’s belittling behavior |
Does your partner:
|
| Your partner’s violent behavior or threats |
Does your partner:
|
| Your partner’s controlling behavior |
Does your partner:
|
Physical and sexual abuse
Physical abuse occurs when physical force is used against you in a way that injures or endangers you. Physical assault or battering is a crime, whether it occurs inside or outside of a family. The police have the power and authority to protect you from a physical attack.
Any situation in which you are forced to participate in unwanted, unsafe, or degrading sexual activity is sexual abuses. Forced sex, even by a spouse or intimate partner with whom you also have consensual sex, is an act of aggression and domestic violence. Furthermore, people whose partners abuse them physically and sexually are at a higher risk of being seriously injured or killed.
It is still domestic abuse if…
The incidents of physical abuse seem minor when compared to those you have read about, seen on television, or heard other people talk about. There isn’t a “better” or “worse” form of physical abuse; severe injuries can result from being pushed, for example.
The incidents of physical abuse have only occurred one or two times in the relationship. Studies indicate that if your spouse/partner has injured you once, it is likely that the person will continue to physically assault you.
The physical assaults stopped when you became passive and gave up your right to express yourself as you desire, to move about freely and see others, and to make decisions. It is not a victory if you have to give up your rights as a person and a partner in exchange for ending the assault!
Physical violence has not occurred. Many people are emotionally and verbally assaulted. This can be just as frightening and is often more confusing to try to understand.
Source: Breaking the Silence Handbook
Emotional abuse: It’s a bigger problem than you think
Not all abusive relationships involve physical violence. Just because you’re not battered and bruised doesn’t mean you’re not being abused. Many men and women suffer from emotional abuse, which is no less destructive. Unfortunately, emotional abuse is often minimized or overlooked—even by the person experiencing it.
The aim of emotional abuse is to chip away at your feelings of self-worth and independence—leaving you feeling that there’s no way out of the relationship, or that without your abusive partner, you have nothing.
Emotional abuse includes verbal abuse such as yelling, name-calling, blaming, and shaming. Isolation, intimidation, and controlling behavior are also forms of emotional abuse.
Abusers who use emotional or psychological abuse often throw in threats of physical violence or other repercussions if you don’t do as they want.
The scars of emotional abuse are very real and they run deep. You may think that physical abuse is far worse than emotional abuse, since physical violence can send you to the hospital and leave you with physical wounds. But emotional abuse can be just as damaging—sometimes even more so.
Economic or financial abuse: A subtle form of emotional abuse
Remember, an abuser’s goal is to control you, and they will frequently use money to do so. Economic or financial abuse includes:
- Rigidly controlling your finances
- Withholding money or credit cards
- Making you account for every penny you spend
- Withholding basic necessities (food, clothes, medications, shelter)
- Restricting you to an allowance
- Preventing you from working or choosing your own career
- Sabotaging your job (making you miss work, calling constantly)
- Stealing from you or taking your money
Abusive behavior is a choice
Despite what many people believe, domestic violence and abuse does not take place because of an abuser loses control over their behavior. In fact, abusive behavior and violence is a deliberate choice to gain control. Perpetrators use a variety of tactics to manipulate you and exert their power, including:
Dominance – Abusive individuals need to feel in charge of the relationship. They may make decisions for you and the family, tell you what to do, and expect you to obey without question. Your abuser may treat you like a servant, child, or even as their possession.
Humiliation – An abuser will do everything they can to lower your self-esteem or make you feel defective in some way. After all, if you believe you’re worthless and that no one else will want you, you’re less likely to leave. Insults, name-calling, shaming, and public put-downs are all weapons of abuse designed to erode your self-worth and make you feel powerless.
Isolation – In order to increase your dependence on them, an abusive partner will cut you off from the outside world. They may keep you from seeing family or friends, or even prevent you from going to work or school. You may have to ask permission to do anything, go anywhere, or see anyone.
Threats – Abusers commonly use threats to keep their partners from leaving or scare them into dropping charges. Your abuser may threaten to hurt or kill you, your children, other family members, or even pets. They may also threaten to commit suicide, file false charges against you, or report you to child services.
Intimidation – Your abuser may use a variety of intimidation tactics designed to scare you into submission. Such tactics include making threatening looks or gestures, smashing things in front of you, destroying property, hurting your pets, or putting weapons on display. The message behind these actions is that violent violent consequences will follow if you don’t obey.
Denial and blame – Abusers are adept at making excuses for the inexcusable. They may blame their abusive and violent behavior on a bad childhood, a bad day, or even on you and the kids, the victims of their abuse. They may minimize the abuse or deny that it occurred. Often, they will shift the responsibility on to you: somehow, their violent and abusive behavior is your fault.
Abusers are able to control their behavior—they do it all the time
Abusers pick and choose whom to abuse. They don’t insult, threaten, or assault everyone in their life who gives them grief. Usually, they save their abuse for the people closest to them, the ones they claim to love.
Abusers carefully choose when and where to abuse. They control themselves until no one else is around to witness their behavior. They may act like everything is fine in public, but then lash out instantly as soon as you’re alone with them.
Abusers are able to stop their abusive behavior when it benefits them. Most abusers are not out of control. In fact, they’re able to immediately stop their abusive behavior when it’s to their advantage to do so (for example, when the police show up or their boss calls).
Violent abusers usually direct their blows where they won’t show. Rather than acting out in a mindless rage, many physically violent abusers carefully aim their kicks and punches where the bruises and marks won’t show.
The cycle of violence in domestic abuse
Domestic abuse falls into a common pattern or cycle of violence:
Abuse – Your abusive partner lashes out with aggressive, belittling, or violent behavior. This treatment is a power play designed to show you “who is boss.”
Guilt – Your partner feels guilt after abusing you, but not because of their actions. They’re more worried about the possibility of being caught and facing consequences for their abusive behavior.
Excuses – Your abuser rationalizes what they have done. The person may come up with a string of excuses or blame you for provoking them—anything to avoid taking responsibility.
“Normal” behavior – Your partner does everything in their power to regain control and ensure that you’ll stay in the relationship. A perpetrator may act as if nothing has happened, or they might “turn on the charm.” This peaceful honeymoon phase may give you hope that the abuser has really changed this time.
Fantasy and planning – Your abuser begins to fantasize about repeating the abuse. They spend a lot of time thinking about what you’ve done wrong and how they’ll make you pay for it. Then they form a plan for turning the fantasy of abuse into reality.
Set-up – Your abuser sets you up and puts their plan in motion, creating a situation where they can justify abusing you.
Your abuser’s apologies and loving gestures in between the episodes of abuse can make it difficult to leave. They may cause you to believe that you are the only person who can help them, that they will change their behavior, and that they truly love you. However, the dangers of staying are very real.
The full cycle of domestic violence: An example
A man abuses his partner. After he hits her, he experiences self-directed guilt. He says, “I’m sorry for hurting you.” What he does not say is, “Because I might get caught.” He then rationalizes his behavior by accusing his partner of having an affair. He tells her, “If you weren’t such a worthless whore, I wouldn’t have to hit you.” He then acts contrite, reassuring her that it will not happen again. But later he fantasizes and reflects on past abuse and decides to hurt her again. He plans on sending her to the grocery store, purposely choosing a busy time. She is then held up in traffic and returns a few minutes later than expected. In his mind, he justifies assaulting her by blaming her for having an affair with the store clerk. He has just set her up.
Recognizing the warning signs of abuse
It’s impossible to know with certainty what goes on behind closed doors, but there are some telltale signs of emotional abuse and domestic violence. If you witness these warning signs of abuse in a friend, family member, or co-worker, take them very seriously.
People who are being abused may:
- Seem afraid or anxious to please their partner
- Go along with everything their partner says and does
- Check in often with their partner to report where they are and what they’re doing
- Receive frequent, harassing phone calls from their partner
- Talk about their partner’s temper, jealousy, or possessiveness
Warning signs of physical violence. People who are being physically abused may:
- Have frequent injuries, with the excuse of “accidents”
- Frequently miss work, school, or social occasions, without explanation
- Dress in clothing designed to hide bruises or scars (e.g. wearing long sleeves in the summer or sunglasses indoors)
Warning signs of isolation. People who are being isolated by their abuser may:
- Be restricted from seeing family and friends
- Rarely go out in public without their partner
- Have limited access to money, credit cards, or the car
The psychological warning signs of abuse. People who are being abused may:
- Have very low self-esteem, even if they used to be confident
- Show major personality changes (e.g. an outgoing person becomes withdrawn)
- Be depressed, anxious, or suicidal
Speak up if you suspect domestic violence or abuse
If you suspect that someone you know is being abused, speak up! If you’re hesitating—telling yourself that it’s none of your business, you might be wrong, or that the person might not want to talk about it—keep in mind that expressing your concern will let the person know that you care and may even save their life.
Talk to the person in private and let them know that you’re concerned. Point out the signs you’ve noticed that worry you. Tell the person that you’re there for them, whenever they feel ready to talk. Reassure them that you’ll keep whatever is said between the two of you, and let them know that you’ll help in any way you can.
Remember, abusers are very good at controlling and manipulating their victims. People who have been emotionally or physically abused are often depressed, drained, scared, ashamed, and confused. They need help getting out of the situation, yet their partner has often isolated them from their family and friends. By picking up on the warning signs and offering support, you can help them escape an abusive situation and begin healing.
Overseas we execute the rapist if it was by force and non consensual.