Depression

What’s an ordinary life problem?

Pathology, problems, and psychiatry

Posted March 3, 2010

What's an ordinary life problem?

I asked myself this question as I read a recent New Yorker article by Louis Menand, entitled "Head Case." Menand is asking if psychiatry can be a science, and if so, why there is so much dissonance in the field. If there are clear answers to the problems of the mind, why aren't we applying the same answers at every possible opportunity?

Menand's first paragraph tells a fictionalized account of one person's response to being laid off:

"At first, your family is brave and supportive, and although you're in shock, you convince yourself that you were ready for something new. Then you start waking up at 3 a.m., apparently in order to stare at the ceiling. You can't stop picturing the face of the employee who was deputized to give you the bad news....You react defensively when friends advise you to let go and move on. After a week, you have a hard time getting out of bed in the morning. After two weeks, you have a hard time getting out of the house."

Menand is talking about depression, and he's asking if a response to an "ordinary life problem," like being laid off, can constitute a clinical depression. If so, what is the appropriate treatment?

Though I genuinely loved Menand's article and will probably write more about it in future posts, I can't help but keep getting stuck at the first question - what's an ordinary life problem?

Because, it seems that the way we define that idea will influence how we define an appropriate response, if we pathologize/diagnose, and if we allow insurance providers to compensate us for getting help.

In the United States of Disorder, we must have a diagnosis to get insurance to pay for treatment. So, it literally pays to have a problem. But, what would be the appropriate response to an abusive boss who makes every day at work a waking nightmare? Or losing your life savings on your 65th birthday? Or, well, getting laid off?

What's the role of a clinician in diagnosing and treating any of the above ordinary life problems? I can imagine any of the problems I named above might make a person contemplate suicide, even if just for an instant and never again. I can also imagine that any of these problems could make someone contemplate suicide very seriously. Is medication ever the appropriate response to these problems, inorganic in nature, at least to tide someone over and out of suicidal risk?

I was moved by an account I read in a New York Times article this week that I found particularly timely having just read Menand's piece. Said psychiatrist Andy Thomson:

"I remember one patient who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I'll never forget. ‘Yes, they're working great,' she told me. ‘I feel so much better. But I'm still married to the same [jerk]. It's just now he's tolerable."

Our current system seems to require pathologizing - sometimes defining ordinary life as a "problem" - in order to get help. But, once we are getting help, what is our responsibility to define the parameters, the beginning and the end, of that help? Can we say, as the woman quoted above, yes, this treatment is working, but I think it's treating the wrong problem?