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On the last track, we discussed we discussed three motives for and manifestations of denial in women who are beginning menopause. These three denial motives and manifestations included: disbelief; appearing weak; and youth obsessed culture.
On this track, we will examine three concepts of malaise in menopausal women. These three concepts of malaise in menopausal women include: malaise vs. depression; transitory grief; and comorbid risks.
3 Concepts of Malaise
#1 Malaise vs. Depression
Many clinicians liken it to the same hormonal changes found in pubescent adolescents who often experience the same sporadic and drastic emotional shifts. However, this malaise does not fit the DSM criteria for clinical depression as the symptoms are not quite as strong as those with diagnosed clinical depression. Generally, menopausal women feel what they describe as "the blues" or "the blahs." They may feel lethargic, but not incapacitated; sad, but not hopeless.
However, although these malaise clients’ symptoms may not be as severe as those diagnosed with clinical depression, they still report their symptoms affecting their lives in a negative way. Jean, age 51, suffered from general malaise which she said interfered with her work. She stated, "Sometimes, when I’m on the phone with a client, I’ll start to feel extremely weepy. I try to control myself, but that doesn’t work. I tell myself to get a grip, but then I just feel like I’m being too hard on myself. In the end, I try to end the conversation as quickly as possible so that they don’t hear my voice cracking."
Although Jean’s symptoms may not be as strong as clients with clinical depression, her own feelings of malaise impacted her life to such an extent that she had to adjust her work habits to cope. Think of your Jean. Is she suffering from general malaise similar to dysthimia? Is this negatively impacting her life?
#2 Transitory Grief
Much of this transitory grief stems from the client’s conceptions of their own sexual identity and the destruction of it by the new changes in body chemistry. This loss of sexual identity can ultimately affect a client’s self-image and also their sense of worth. Caroline, age 47, was grieving the loss of her ability to bear children. Up until that point, Caroline had had five children.
She stated, "I was raised to believe that having children was the ultimate reward for a woman. Being a mother and having the ability to be a mother is the greatest gift I can give the world, and now that gift is gone. I feel like a worthless shell. My husband may still love me, but what does that matter if I can’t love myself? I feel so alone and unhappy." I stated to Caroline, "Do you feel that the only way to be a mother is to produce children, or are there other ways to act motherly without getting pregnant and birthing children?"
She stated, "Well, yea, there’s more to it than bringing a child into the world." I asked Caroline to consider going home and writing a list of activities she could partake in to fulfill her motherly needs and re-establish her identity as a woman. The next week, Caroline brought in a list that included the following:
Technique: Say Goodbye and Say Hello
Caroline read me the following section from her letter:
#3 Comorbid Risks
If a client is close to menopause, I feel that it is important to prepare her for the possibility of feeling these symptoms of malaise. I have often found that clients who suffered from PMS during their reproductive years are more likely to experience malaise in their menopausal stage, partly due to the fact that their bodies are already sensitive to hormonal fluctuations. Ramona, age 49, was suffering from schizophrenia. Although she had balanced out with the help of medications, she still required therapy when she began to have paranoid tendencies.
Because she was on the verge of menopause, I asked Ramona if she had ever had severe PMS. She stated, "Well yea, I have actually. I used to get really anxious right before my period, and it would make my hallucinations worse." Because her disorder often responded to fluctuations in hormones, I asked Ramona to be on the lookout for menopausal malaise, which could cause her to feel depressed when there was no reason to be. Because of her proclivity to paranoia, I decided to have Ramona monitor her moods from day to day in order to give me a better idea about her emotional fluctuations.
Think of your Ramona. Does she have a comorbid disorder that could be affected by malaise?
On this track, we discussed three concepts of malaise in menopausal women. These three concepts of malaise in menopausal women include: malaise vs. depression; transitory grief; and comorbid risks.
On the next track, we will examine three effects of fear of a decrease in sexual drive due to menopause include: low self-esteem; loss of sexual identity; and actual loss of sexual desire.
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