Almost always, diabetes is accompanied by the formation of more or less pronounced emotional and mental disorders in the patient. The totality of such disorders was described back in 1935 as a “diabetic personality type” with its inherent emotional lability, a sense of insecurity, a weakening of the ability to make independent decisions, irritability, and conflict …
However, one should not assume that such manifestations are equally characteristic of all patients with diabetes. Much depends on the initial personal qualities of a person, the person’s situation, the ability to objectively assess real circumstances and opportunities, dedication, creative and general performance. In this regard, there are two main variants of psychological and behavioral reactions to the prospects of “life with diabetes”.
First option
In the first option (let’s conditionally call it “reasonable-adaptive”), the patient realizes the reality of the forthcoming set of various medical and other problems that will inevitably complicate his personal life and professional activities. Nevertheless, he does not perceive such inevitability as a catastrophe that completely breaks the prospects of the usual way of life.
Proceeding from this, he seeks to avoid psychological and behavioral withdrawal “into illness”, establishes a reasonable treatment-and-prophylactic regime that meets medical recommendations, performs self-checks, achieves, if not stable compensation, then an acceptable level of control of the disease and continues to actively engage in his work, social and family and household affairs. Quite often such a completely acceptable way of life “with diabetes” lasts for decades, sometimes to a ripe old age.
Second option
The second variant of the reaction to the disease — “anxious-neurotic”, is accompanied by “withdrawal into illness”, persistent psychological depression. The patient is oppressed by the incessant agony and thoughts about a “broken life”, the collapse of plans (most often — exaggerated) for personal happiness, a normal family life, he does not see the opportunity to realize his knowledge and abilities. Of course, this requires a lot of work of a psychologist in order to change such a person’s mood in a positive direction.
Hand in hand
Diabetes and depression go, as they say, hand in hand, mutually acting negatively on a person: diabetes mellitus facilitates the onset of depression, depression increases the risk of occurrence and severe course of diabetes. And, importantly, people suffering from both diseases have to bear more significant costs for their treatment.
In the United States, for example, the average annual “cost” of a combination of diabetes and depression is approximately $ 3,300, which is double that of diabetes without depression. The total costs associated with depression are estimated at $ 47.5 billion annually (including the cost of inpatient care, medications, additional research costs, etc.). By comparison, spending on cardiovascular and pulmonary diseases is $ 43 billion and $ 18 billion a year, respectively.
In the United States the average annual “cost” of a combination of diabetes and depression is approximately $ 3,300, which is double that of diabetes without depression.
For many years, depression in diabetic patients was perceived as a complication of the underlying disease. Recent research is changing this point of view. They show that in some cases, depression precedes the onset of diabetes mellitus, being one of the causes of its occurrence.
As early as 1936, the term “psychogenic debut of diabetes” appeared, drawing attention to the significant influence of the patient’s psychological response to the disease. The causes of depression are manifold. Here is an incomplete list of them: the death of a loved one, a serious somatic illness, the loss of the opportunity to continue their professional activities, the realization of their lack of demand for others, the loss of contacts with colleagues, acquaintances, relatives, family conflicts, serious social and domestic or financial problems …
Long-term clinical observations have established that prolonged neuro-emotional stress is one of the risk factors for diabetes. However, acute stress can also become such a risk factor. Here is a vivid example of this.
I happened to observe a young healthy man who lived in the countryside — a dump truck driver. Lying on his back under the bottom of a locked car, he was doing repairs. Suddenly, the locking block was displaced from its place, and the truck began to move slowly, threatening imminent, possibly fatal injury to the driver lying underneath. Thanks to a happy accident, the car stopped its movement, and the protrusion at its bottom that threatened to hit the driver’s head remained literally a few millimeters from it. This episode turned out to be extremely stressful, the driver’s hair turned gray, and a few days after the incident, he developed the classic picture of the onset of acute diabetes.