THE LAST WORD
Looking Beyond Diagnostic Criteria
The power of family medicine is seeing patients as more than just signs and symptoms.
Fam Pract Manag. 2020 Mar-Apr;27(2):36.
Author disclosure: no relevant financial affiliations disclosed.
My grandmother always said I was a “feeler.” She said I was like her in that regard and empathetic beyond my years. Ms. Graham, the elementary school librarian, told my parents I had a future in the theater thanks to my emotive reading. And in high school, I won a regional award for a poem the local newspaper described as “tortured.”
Being a “feeler” was an asset, until I reached high school. That's when it became a heavy burden. Activity and achievement became analgesics to the pain of emptiness I felt. I worked to suppress the nagging feelings of worthlessness by making myself indispensable to any club or team that would take me. Surely I could rid myself of the sense that I wasn't good enough if I was at the top of my class, right? My drug of choice was knowing who I was better than.
When I finally broached the subject of my melancholy with my pediatrician, he told me “kids don't get depression,” so I never brought it up to him again.
In college, things got worse. It wasn't unusual for me to stay in bed for days at a time or to suppress my feelings with an unholy mix of alcohol, Netflix, and carbohydrates. When I could no longer muster empathy, and I could barely muster the energy to bathe, I decided to see a psychiatrist. After a brief interview, he declared I didn't have depression because I had no suicidal ideation (SI), was performing well in school, and had recently gotten married. I only fit four of the DSM-5 criteria for major depressive disorder, not the five required to assign an ICD-10 code and bill my insurance.
My wife refused to accept this and made a next-day appointment for me to see her family physician. In him, I found an advocate and a liberator. After I explained my symptoms, this family physician told me the truth: “That really sucks.” In my later work as a hospital chaplain, I found that these are perhaps the most powerful words in bedside care — no sanctimonious explanations needed.
These days, my depression is well-controlled,
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