"I just want to be happy," Julia said. She looked at me expectantly
She wasn't a patient with clinical depression--but someone with unreasonable expectations of life, or at least of medicine. There isn't an ICD-9 code for that.
Some patients think doctors can give them a pill or treatment that will makes them feel as exuberant as the perfect-looking people in advertsements for antidepressants. As an art form, advertising is beautiful. As a tool for manipulating viewers' wills, it's toxic and invidious. It has made a mess of people's psyches by promising the impossible--especially happiness.
"What do you mean, you want to be happy?" I asked.
"I don't know," she said. "Happy...you know. I don't want to be sad."
"But sadness might be the right feeling for you, these days," I suggested.
"What?" she raised her eyebrows. "Sad isn't good. I don't want my kids to see me like this."
In the ensuing conversation I found out that Julia was in the middle of a divorce, and had lost her mother six months ago, and her grandfather two months before that. She couldn't find a job, she was having trouble losing weight, and her teenage daughter hated her. They fought all the time.
"Something would be wrong with you, if you were happy right now," I told her. "Sadness is the appropriate feeling for what's happening to you. Your life is sad."
"What can you do about it," she asked.
"There isn't anything to do about your sadness except feel it. You have to wait for it to wear itself out."
"You mean, I have to keep feeling like this?"
"That would be the best thing," I said. "Just let yourself be sad."
"I can't belive you're telling me that," she answered. "What about Zoloft? My sister got that from her doctor. Can you prescribe it? Would it work for me?"
"Does your sister feel better on it?"
"Not really."
I suggested that Julia visit with me every week for a few weeks, so I could monitor her. Perhaps I was missing something. Or, maybe there were things she could do in her life to keep from sinking under the weight of sadness. She agreed, and even seemed cheered by the suggestion.
Then I remembered that her insurance, Medicaid, had passed a new rule saying that patients aren't allowed more than two doctor visits a month, no matter what. I don't believe this rule will cut costs in the long run, but I'm not the governor of Florida. I'd have to see Julia at no cost.
It's Thursday night, 10 pm, and I'm almost finished with the day's charting. After this week's 120 patients, I feel sad, too. The weight of people's suffering is a mantle of sadness doctors carry. It's not like being at a fashion show, or the mall--but more like a house of mirrors, where everyone's troubles seem like everyone else's and like my own. We aren't so different, when it comes to pain.
Sadness is part of the human condition, an equalizer. Sharing and normalizing it are the reasons group therapy works. There's never been a panacea for unhappiness, and there never will be. But if Julia comes to see me every week, and we talk together, her sadness will probably begin to feel okay. Then, since this is how the world works, it will begin to give way to something else.
She wasn't a patient with clinical depression--but someone with unreasonable expectations of life, or at least of medicine. There isn't an ICD-9 code for that.
Some patients think doctors can give them a pill or treatment that will makes them feel as exuberant as the perfect-looking people in advertsements for antidepressants. As an art form, advertising is beautiful. As a tool for manipulating viewers' wills, it's toxic and invidious. It has made a mess of people's psyches by promising the impossible--especially happiness.
"What do you mean, you want to be happy?" I asked.
"I don't know," she said. "Happy...you know. I don't want to be sad."
"But sadness might be the right feeling for you, these days," I suggested.
"What?" she raised her eyebrows. "Sad isn't good. I don't want my kids to see me like this."
In the ensuing conversation I found out that Julia was in the middle of a divorce, and had lost her mother six months ago, and her grandfather two months before that. She couldn't find a job, she was having trouble losing weight, and her teenage daughter hated her. They fought all the time.
"Something would be wrong with you, if you were happy right now," I told her. "Sadness is the appropriate feeling for what's happening to you. Your life is sad."
"What can you do about it," she asked.
"There isn't anything to do about your sadness except feel it. You have to wait for it to wear itself out."
"You mean, I have to keep feeling like this?"
"That would be the best thing," I said. "Just let yourself be sad."
"I can't belive you're telling me that," she answered. "What about Zoloft? My sister got that from her doctor. Can you prescribe it? Would it work for me?"
"Does your sister feel better on it?"
"Not really."
I suggested that Julia visit with me every week for a few weeks, so I could monitor her. Perhaps I was missing something. Or, maybe there were things she could do in her life to keep from sinking under the weight of sadness. She agreed, and even seemed cheered by the suggestion.
Then I remembered that her insurance, Medicaid, had passed a new rule saying that patients aren't allowed more than two doctor visits a month, no matter what. I don't believe this rule will cut costs in the long run, but I'm not the governor of Florida. I'd have to see Julia at no cost.
It's Thursday night, 10 pm, and I'm almost finished with the day's charting. After this week's 120 patients, I feel sad, too. The weight of people's suffering is a mantle of sadness doctors carry. It's not like being at a fashion show, or the mall--but more like a house of mirrors, where everyone's troubles seem like everyone else's and like my own. We aren't so different, when it comes to pain.
Sadness is part of the human condition, an equalizer. Sharing and normalizing it are the reasons group therapy works. There's never been a panacea for unhappiness, and there never will be. But if Julia comes to see me every week, and we talk together, her sadness will probably begin to feel okay. Then, since this is how the world works, it will begin to give way to something else.
Some men think a different woman will make them happy, and some women think a different man will make them happy. Meaning we are all human, and at times will be sad, nice to see you can be empathetic as a Doctor, yet we also need to be empathetic in our own persona...just something to contemplate...
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