I'm ending the year with a trip abroad, so this posting is likely my last for 2008. I've considered different topics - antidepressants and bone fragility, transcranial magnetic stimulation - but I thought finally that it would be best to leave with some thoughts about the story of the moment, the economic crisis. In particular, I want to say how it looks from the consulting room.Psychiatry is a countercyclical industry. When things go badly, people want help. But my patients' outlook is not uniformly negative. In fact, what has struck me is how solid my patients seem, on the whole, in the face of financial threats.
For some, the recession offers justification. In their business, they were the ones who counseled prudence. More broadly, financial setbacks accord with the melancholic worldview. For decades, some patients have been braced against the next Great Depression, and here it is, perhaps. Yet another way to put the matter is that what's happening outside accords with what they feel within. A black mood that when it disagreed with circumstance induced a sense of dislocation now, when reflects everyone's external reality, provides a sense of connection and inclusion. Pained satisfaction can take on moral and political overtones: the country is being cleansed. This perspective has a quasi-religious aspect. Two or three times this past week while listening to patients I thought of that line from a Thanksgiving hymn: "He hastens and chastens His will to make known..." There is a pleasure to be had in the prospect of universal chastisement, which is why people sing about it. I have to say that I find this attitude reassuring; it normalizes what otherwise seems like very strange and disturbing economic news.
