Coming to terms with the diagnosis is the process by which participants calibrated their
expectations over time, in response to changes in their health status. Participants exemplified the distinctive and personal nature of depression, as they sought to adapt through the sub-strategies of Accepting the diagnosis and Taking personal responsibility. For some, these processes were straightforward; for others, they were more challenging.
However, all demonstrated their efforts to be flexible as they navigated the unfolding experience of depression.
I was able to look at myself and say, “Ah, it’s time for you to come to grips with
this, Mister … you do have an emotional problem.” (Sean, 74 years)
Accepting the diagnosis
Through the process of Acceptingthe diagnosis, participants reflected on how they felt at receiving a formal diagnosis of depression and their subsequent self-perceptions. A formal diagnosis of depression often confirmed participants’ assumptions, particularly those who had lived with undiagnosed depression for an extended time.
I was actually quite relieved, because I knew there was something not quite right, because I’ve always been a very happy-go-lucky person. I knew there was
something not right. (Laura, 72 years)
I'm a fairly intense character, so I've probably been stressed out a lot which, in
turn, has turned a little bit sour. And so, I have had it [depression] for a long
time, I think. I just accepted it [the diagnosis] because I thought it was depression
all along. (James, 71 years)
Trying to understand the cause of depression was a core strategy in this process. Using cause-and-effect inferences to make sense of the diagnosis, most located the cause(s) of their depression along a continuum of biography or biology (Karp, 2017).162 Vernon, for example, referred to several major life changes as the cause of his depression, while Sandra regarded her depression as a medical condition.
My career wasn’t going quite as well as I had hoped, and my father died at the
same time. I think those were the main things that led to it. (Vernon, 76 years)
The psychiatrist said, “Well, there’s an imbalance in your brain”. So, I’ve got a
chemical imbalance in my head and I need to take medication. (Sandra, 67 years)
Several felt that their depression was the result of their childhood experiences.
Somebody should have told me a long time ago that Dad's violent temper and verbal abuse was going to have a long-term effect on me … I remember many
unhappy times. (Stephanie, 71 years)
162 The nature/nurture debate reflects longstanding recognition that genes and environments contribute to the etiology of depression (Dunne, 2011).
Although most had come to understand the symptoms, manifestation and treatment of depression as a mental health issue, others had to overcome a sense of failure before they could accept the diagnosis.
I guess I felt like I was a bit of a failure, because all your plans and dreams are shattered. One minute you’re going that way, then all of a sudden, you’re going
the other way. (Mia, 66 years)
For several, making comparisons between their own predicaments and those of others they considered to be at a greater disadvantage reinforced their efforts to accept their diagnosis.
It’s annoying, being depressed, and it’s annoying having mental problems. But
I’m okay, and I’m better than a lot of other people. (Sue, 68 years)
Taking personal responsibility
Taking personal responsibility typically occurred as a result of Challenging assumptions
about age and depression and Seeking answers. In line with their individual
circumstances and resources, participants demonstrated their commitment to taking the first step towards optimising their well-being.
I guess, if you’ve got depression, it’s up to you. I make a bigger effort perhaps
to get out more and don’t sit at home feeling sorry for myself. (Rhonda, 77 years)
I don’t want a miserable life. I want to do the best I can. So, if you’re going to
look after your health, you might as well, really, do it the best you can. (Sue, 68
years)
Given the focus of the current study on self-management, it was not unexpected that participants would identify Taking personal responsibility as a foundation for optimising well-being. From this perspective, they explained how they sought to eliminate blame and not make excuses for themselves.
Forget about who’s to blame; let’s just simply say, “What’s the problem?” Let’s identify it, let’s see how we can approach it, what are our strategies to overcome
it, put that in place. (Sean, 74 years)
Taking personal responsibility reflected participants’ commitment to managing their
apply their knowledge and access resources in a way that gave them choice and control. Through an ongoing adjustment process, participants could maintain a sense of control over their individual circumstances, as they took responsibility for establishing and achieving new goals that aligned with their mental and physical health, resources and preferences. In so doing, participants demonstrated their willingness to be flexible as they navigated the unfolding experience of depression. In conceptualising the process of ageing well with depression, participants incorporated a responsibility for their well- being into their conversations about the future. This motivated them to harness support and empower themselves to self-manage their depression.
8.4
Summary
The category of Taking Stock is an abstraction that draws together the internal processes and external influences by which participants evaluate and accommodate their current circumstances. Taking Stock reflects the personal process by which participants gauged how they felt about their age and the experience of depression. This process is influenced by a complex interplay of social, demographic, biological and psychological factors, as well as life experiences. Evaluating their well-being and overall quality of life involved participants actively Challenging assumptions about age and depression and Seeking
answers. It was through Evaluating well-being that participants could self-monitor,
counter negative thinking, engage in problem-solving and adopt positive behaviour patterns. These strategies, in turn, formed a framework for participants to start Coming to
terms with the diagnosis, through Accepting the diagnosis and Taking personal
responsibility. By accepting that depression was not a normal or inevitable part of ageing,
participants were motivated to explore, identify, initiate and implement action to optimise their well-being and overall quality of life.