Depression itself is a mechanism of defence in a person whose quality of life is severely affected by Crohn's colitis. The more the patient interacts with people, deals with his/her job, enjoys - or tries to enjoy - social life, the more he/she gets frustrated and suffers, as routine daily activities are prevented by anal soiling, frequent diarrhoea or abdominal pain.. Therefore, depression, i.e. refusal to participate actively in life, introversion and self-confinement to a comfortable jail represented by his/her own dark bedroom, may represent an apparent provisional solution to "feel safe" and to avoid further conflicts, at least with the external environment.
This is especially true for patients classified as "very poor" or grade 4 in Helzer's and coworkers' grading scale of Crohn's activity index . Instead of being criticised for clearly manifesting fear of people and work, the patient prefers to create a personal, inviolable safe shell, i.e. to be depressed. After all, depression represents a more quiet and respectable state than spending a day outside desperately looking for public toilets in which to change dirty sanitary pads when observed by unknown healthy people.
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