Posted by Dr. Vollmer on October 28, 2015
What does it mean to be depressed? Eating habits change? Sleeping habits change? Suicidal thoughts emerge? Fatigue sets in? For how long? When are these behaviors manipulative, or unconsciously intended to embrace the sick role? When is intervention necessary and for how long? Should that consist of psychotherapy and/or medication? Who makes the diagnosis, and after what kind of exploration? Where does family history fall into this assessment? Whose point of view should we consider? The patient, the significant other, or another professional? Then, we move on to the severity indication. Is it mild, moderate or severe? Says who? Does this relate to impairment of functioning or does this relate to the depth of despair?
I confess that after over a quarter of a century in this field, the issue of mood baffles me deeply. Moods are interesting to identify, are worthy of psychological exploration, and sometimes psychotropic medication, but the defining issue resides with the patient, not the physician. The physician is a concerned observer while the patient expresses concern over his mental outlook. There is no timetable for treatment, as Joe Biden described there is no timetable for grief either. There is only a nonlinear journey of psychological pain. As humans, this pain is alleviated by human contact which comprises curiosity and openness to hearing the internal world. Joining together in pain is helpful, at least as a beginning to treatment. Understanding that a journey lies ahead in which there will be a “pal,” a concerned professional, minimizes the suffering of feeling painfully alone and scared. From there, decisions can be made about further treatment including medication and neuromodulation. Placing constraints on the intervention defeats the purpose. It is the open-ended approach which provides security. The philosophy that “I do not know where we are going or how long it will take to get there, but I am happy to accompany you,” is, and should be the major tenet of psychotherapy. I repeat this notion because manual-based psychotherapies take this point away. In other words, by their very nature, they are not therapeutic for those who are frightened about how they feel. The rant continues.