This has happened so many times over so many years. I don't even have to ask, "So how ya' doin' today?" with certain patients. I can look across the waiting room and I know how they're doing. If not painted brightly, then not feeling brightly, back in the black hole.
So interesting, isn't it? And we wonder why artists need that certain something to produce. That certain something is serotonin. The best paintings are produced when the artist is feeling best. Literally painting faces is the same.
Sure, the DSM mentions hygiene. We know that if a person is uncharacteristically dirty for an extended period of time that it is withdrawal. That individual is unaware of the situation, can't remember or care to bathe, can't feel the oil on the skin, can't smell that offensive smell that others notice right away. Such withdrawal is characteristic of psychosis, and the most disabling depression is psychotic. The patient does not know or care beyond the limits of his or her thoughts, feelings.
Does one who is not psychotic, however, not wear make-up to deliberately communicate to everyone else, perhaps especially a doctor, that she's not doing well? Or is it the depression talking, period. What we're looking at here is whether or not the behavior, putting on a little lipstick, is functional and can be controlled.
The answer, I think, is that sometimes it can be controlled, but the will isn't always there. The patient doesn't have much energy and conserves what she has. Putting on make-up is just another job, and getting out of bed is hard enough, frankly.
Why bother preening indeed, when a person thinks: I'd rather no one pay attention to me. I haven't the emotional energy to carry on conversations. I feel ugly and useless. What's the point of drawing positive attention to me, especially since it takes me out of my comfort zone? I'd rather be mindless, thank you.
So different from someone in sales who is on all of the time, even under depression. The personality is all smiles, the hair still in place. This is not always the case, of course, when the depression really gets bad, but when it's middle range, certainly it is.
A person who is hard-wired to perform will perform socially as a default, and look the part, then will crash harder when the performance is over. Performance artists and sales people under that depressed influence are at risk for self-medicating with drugs and alchohol as soon as the down-time permits. Even before the down-time permits.
Not unlike the evening martini, except there are three or more.
You know, of course, that we call one or two drinks a night moderate drinking for a reason. It's not always dysfunctional. Some people do this to regulate their moods and it doesn't ruin their nights or days. I would suggest they're not self-actualizing, however. And the reason I rail against this and am always on you about it is because the drinks get stronger, taller. Pretty soon what you're telling me is a drink is not a drink, it's a vessel that could water a rubber tree plant.
But back to make-up. Younger people don't need it, honestly. So this little diagnostic tip is really more applicable to those of us who are aging, who really notice the lines and lack of color. No? Okay, no. Perhaps we should generalize, however, and say,
If a person is ordinarily concerned about how they look, no matter what the age, and all of a sudden is not concerned, then you should consider ruling out depression.
I forgot! It's that season to be jolly!
Even more pressure, right, to feel good!? Act happy? Dress it up?
We'll talk about it again soon. I'm not finished.
To be continued.
Copyright 2oo7, therapydoc