There isn’t a week that goes by when a public figure (the most recent being Naomi Osaka) doesn’t reveal their battle with depression. Given the prevalence of sad feelings, the frequency of these revelations should come as no surprise.So, why is depression portrayed as a conundrum? One approach to resolving this issue is to tell the stories of six randomly selected patients (who have been completely de-identified) whom I have treated in my psychiatric practise, some with the assistance of colleagues.Kate* approached me for assistance in overcoming writer’s block; her PhD thesis was overdue.
Her boyfriend’s constant admonishing her for “not getting on with it” added to her intense distress. was asked to evaluate Amy, who was having difficulty bonding with her first child three weeks after birth.
Her sense of floundering as a mother had become an unending source of agony.Jennie, a widow in her seventies, had lost so much weight that her doctor suspected cancer. A battery of tests, however, revealed that there was no physical condition at all. She was mostly silent, but she occasionally murmured that she deserved to die after committing “so many sins.”Abdi, 18, was heartbroken after learning of the deaths of many fellow asylum seekers who had drowned after their rickety boat capsized. He couldn’t come to terms with his “failure” to save even one person because he was burdened with unbearable guilt.
Finally, a middle-aged professional who had just returned from an overseas conference was unable to overcome intractable jetlag and lassitude, which was exacerbated by severe bronchitis. He was completely defeated and helpless.It was clear that all six patients’ moods had plummeted.
They were afflicted with “depression,” to use a colloquial term. But let me show you how fundamentally they differed in terms of the treatment they required. A one-size-fits-all approach was clearly inappropriate. Returning to Kate and her writer’s block.
Having gained an understanding of her predicament, I suggested we investigate what might be impeding her in a safe location. It soon became clear that she had never received affection from her father, for whom material success was the only thing that mattered in life.
He was raised in a poor family and rose to become a wealthy businessman through sheer determination. Kate quickly realised that her ambitious academic pursuit was not only an ill-conceived, futile endeavour, but also did not align with what her “authentic” self valued – a loving family in which her hoped-for children would thrive.
Jane’s feigned grief was understandable within minutes of our first meeting. She had indeed suffered a setback. Her brother Edward, to whom she had always been close, had died at the age of ten from leukaemia after four years of suffering. Jane’s parents and two siblings had avoided their bereavement for more than a decade. Jane had felt profoundly alone as a teenager, and she was resentful that the family had, in her opinion, erased Edward’s name from their history. She and the family (reluctantly) agreed to meet with me to figure out how “everyone could help in the situation.” Five sessions were enough for them to openly share their grief and reclaim their original warmth and closeness.
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