I am interested in the work Moriarty et al are doing to predict and prevent relapse of depression in primary care in the current BJGP.1 It makes me think about all the years I worked as a GP and the difficulty I had with making the diagnosis of depression as a specific disease entity in individual patients with all their own unique stories and experience of low mood, low self-esteem, self-worthlessness, and who struggle with suicidal thoughts.
In my old age I now volunteer at a suicide prevention charity, Maytree in North London. We offer people struggling with suicidal thinking, with or without acts of attempted suicide and or self-harm, an opportunity to talk about, share, and try to understand their distress during a 5-day residence. The atmosphere is one of calm safety with non-judgemental listening.
People come with a variety of diagnoses and treatments, which are acknowledged but largely put aside during their stay so that they can be encouraged to be themselves and tell their stories in their own words. In this way there is a sense of people reconstructing their own identity and regaining their self-belief.
They leave with strategies to avoid actual suicide in the future and with the hope of making constructive, fresh use of ongoing sources of help, therapy, and support.
For me now as a retired clinician I am released from having to make diagnostic decisions and concentrate on listening to people with their own special, unique stories with a view to offering hope to escape from the prison of recurrent depressive thinking and the ultimate solution of suicide.
Suicidal thoughts are always associated with the classic symptoms of depression one way or another and their exploration with those who are struggling is surely a way forward towards resolving them in the longer run. The aim of Maytree is to prevent actual suicide and, in the context of the BJGP leader, to build the hope that relapse of depressive episodes can be predicted and prevented in the longer run by increased self-awareness, self-care, and self-belief.
- © British Journal of General Practice 2020
