DOCTOR AT SEA : Black dogs and Englishmen

I have just finished reading an interesting novel which included Winston Churchill as a significant character and, perhaps inevitably, included reference to his imaginary black dog that sat on his shoulder when he was depressed. The black dog image probably helped him to rationalise these unpleasant downturns and give them a more domestic feel rather than the untamed mood swings which controlled him at times. Depression was less easily treated in his day and the picture is helpful if not to be taken literally but the final effect is the same – the formidably positive and undaunted personality of Churchill was cut down by depression.

I had a seafarer in recently who wanted to share about the death of a close relative who took his own life earlier this year. The depression which was so deep in this deceased family member now weighs to some extent on those left behind who are trying to cope. People involved in this type of unhappy story can display a spectrum of depression produced by the combined effect of life stresses and particular personality features that may or may not go on to clinical depression. Technically this is the basis of reactive mental illness and, by definition, we can all be affected! Soft centres cave in more easily than hard nuts but eventually something gives if the pressures/tragedies/disappointments/frustrations/anxieties are bad enough for a particular individual – the most resilient have their limit, although sadly, in the course of life´s rich pageant, most people do experience the edge of their limit and sometimes succumb.

Some of you will have realised that the title for this month is a play on Noel Coward´s 1931 song “Mad Dogs and Englishmen go out in the mid-day sun” which is a witty number on the English abroad in the days of Empire. They “detest a siesta” or are “quite impervious to heat” – hm! Perhaps, when he watched eccentric English behaviour in the heat of the Far East, he had some understanding of inappropriate behaviour in unfamiliar cultural circumstances.

This (almost!) leads on seamlessly to the effect of the “bright sunlit uplands” (Churchill again) of the yachting industry and the excesses of behaviour which can lead to sadness….and depression. We all are aware of the temptations to excess whether it be, for example, alcohol, drugs, or promiscuity. This column could usefully look again at these less healthy aspects of living the dream. For instance, Dr Joh plans a series on sexually-transmitted diseases for next year because this is such a common area of concern amongst yachties. Fortunately most of these conditions can be treated although some become dormant with occasional eruptions for years afterwards. However, as well as these physical problems there is also the emotional fall-out from labile, unreliable or unfaithful relationships and this emotional damage can be more prolonged by the time unhappy folk turn up later at the practice with their story and…their depression.

My experience of medicine in the yachting industry has been hugely refreshing because depression is so much less prevalent compared with the general UK population with whom I worked before coming to Mallorca in 2007. In those days, the amount of depression whether overt (eg needing a script for antidepressant medication or just simply feeling depressed) or covert (eg red herring physical symptoms with major unspoken psychosocial burdens) added up to a big chunk of each day´s work. On the other hand, the yachting industry attracts the adventurous, the positive and the talented self-motivated….and also the physically attractive. The potential is huge and the world is literally at your feet, as long as the sea is nearby – but there are pitfalls. These pitfalls are easy to see when one tries to imagine finding a stable life partner in an unstable shifting industry and then having an exclusive relationship as a formula for the future, even for life beyond yachting (!!!) if one can think outside that box!

My experience of depression in the industry is that it is generally down to relationship issues, usually within the fairly small confines of a yacht crew, or work stress either at a junior or senior level. Sometimes it has been due to wider problems involving family or friends further afield affected by bereavement, serious illness or family rift. In general, any of these circumstances may drive some folk down so far that they become depressed but depression, whilst it is unwelcome and unpleasant, is amenable to treatment and the healing effect of time. It is the ones who come for help who are making the best move before they implode.

The stigma of depression can prevent some from coming for help and also there is the fear of job security with worries about ENG1 certification. The stigma is slowly easing and will be hard to eliminate in such an image-conscious industry, but successful treatment of depression with well tolerated medication is compatible with an unrestricted ENG1 fitness certificate. There is much to be said for antidepressant medication to turn around the metabolic negativity of depression by increasing the (happy) neurotransmitter amines in the brain. Improvement can take a week or two to start and then needs about six months of feeling well before medication can safely be reduced – this can seem such a long time that it may be construed as dependency/addiction but it is the right amount of time to see a real and lasting result and steady withdrawal is generally without mishap afterwards.

The black dog comes to heel.



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