My patient Jim, as I'll call him, fears that he's about to lose his job, though he actually hates his job and dreads keeping it almost as much as losing it. Thirty five years old with a pregnant wife and two year old son at home, Jim feels anxious, sleeps poorly, suffers from stomach pains and frequent headaches. Plus, his two-year old is an obstinate terror and Jim had not been nearly as eager as his wife to have another child. Jim comes to my office not so much to discuss these problems but to ask me whether I can prescribe something to calm him down.
Michaela arrives in my office later that same day. A curly haired, petite 21 year old woman who had graduated from college just two weeks earlier, Michaela finds herself lost and sad, living at home with no job. She misses her roommates, misses the comfortable structure of college life, misses her identity as a college student. She's taking an antidepressant which I'd prescribed a year earlier when Michaela, who has a strong family history of depression, suddenly lost all interest in her studies and friends and couldn't stop crying. Michaela wonders if now her medication dose needs to be adjusted.
Two days later I see Bernice, a tough and practical 85 year old woman who had been living alone in an apartment in the city until a month ago when she moved in with her daughter and her husband in the suburbs. She loves her daughter and son-in-law, and they couldn't be kinder to her, but she just doesn't feel like herself "out there." No longer able to drive, she feels trapped and dependent. Bernice wonders if some lab work might reveal why she feels so tired.
I am not a psychiatrist, though, like most internists, I see patients with psychiatric problems and recognize that even "purely" physical conditions always have an emotional component - since, as a colleague of mine once put it, most bodies are attached to people. I am a great believer in psychiatric medications. But sometimes when I see patients like Jim, Michaela, and Bernice who are going through major transitions or life stresses, I wonder whether blunting unhappiness or discomfort is always beneficial.Pain, after all, is often a necessary part of growth.
I don't adjust Jim's or Michaela's medication and I don't draw Bernice's blood, though I am tempted to. I advise Jim to go back with his wife to a family therapist they have seen before , and also to return to the exercise program that made him feel so much better in the past. I tell Michaela what her mom and dad and all her friends have already told her, that transitioning from college to the "real world" is hard and disorienting and that it will get better. Of course I arrange to see both Jim and Michaela again soon to make sure they're feeling better. Bernice passes on a return visit. "Don't worry about me, honey," she reassures me at the end of our visit. "I've been through a lot of changes in my life and I'll get through this one, too."
