Can Depression Be Taught?
Posted by Dr. Vollmer on December 10, 2015
Depression Class: check! I just had a wonderful and stimulating time teaching depression at the psychoanalytic institute and yet I am left feeling that this is a class which should not be taught. The word is simply meaningless. Psychic pain is my replacement. Pain is a symptom. Depression is a diagnosis. We need to be clear about the distinction. Symptoms trigger deep inquiry into the origin, the pathophysiology and the underlying issue. A diagnosis closes the discussion, as if there is nothing more to be said. “He is depressed,” the physician says, as if the next step is clear, when in fact, so much more needs to be done to investigate what that means. So, maybe I do need to teach this class to convey this point of view, spread the word, as they say. Yet, I am left feeling part of the problem and not part of the solution. I will lobby to rename this class “Psychic Pain” because this gets at the issue of how people suffer, and as with all of psychiatry, there are more differences than similarities between patients, making this the most interesting field in medicine from my point of view. Pattern recognition, the job of a good internist, to determine how symptoms present the clue to disease processes, gets old and routine, whereas the individuality of psychiatry, the unique stories of the patient, create an atmosphere of intense curiosity and openness to new perspectives. Looking at suffering as the end-product of years of life experience helps the patient understand how the past influences the present. It is not that the patient is “depressed,” but rather that the patient has hit a time in his life, both because of current and historical issues, along with their biology, making the patient lose the joy, the happiness, the fulfillment, in his life. There are contributing factors, but never a “good explanation” for why the patient is suffering. The quest of understanding is infinite and hence digging into suffering is a deep and moving experience. “Thank you for making me think about something I did not want to think about,” my patient expressed today, causing me to laugh and feel her gratitude, at the same time. That is what I want to teach. The way in which suffering has a language, which, when shared, creates an intimacy, a healing feeling, which cannot be quantified or predicted, and yet, is very meaningful when it happens. Psychic pain, that is what I am going to propose. That sounds right.