Feeling better is hard work

The consult started with a box of tissues.

There was a lot going on. She struggled with mood issues on and off for a few years. But was in a good place until end of last year. She witnessed her father’s suicide when she was a little girl. Didn’t think about it much. Now her children were growing up and asking questions, and she started to think more about what happened. There were some ongoing family feuds amongst the siblings, and no one was talking to each other directly. Her husband was sub-fertile after chemotherapy for his severe autoimmune disease. They had been trying for another child for a few years, including several unsuccessful attempts at IVF. She felt like a failure.

For awhile now she was sad and teary all the time, but kept herself busy with work and home life. She was dubbed “cheery” at work because she tried hard to make sure no one knew how she was feeling. Not even her husband.

“Can’t you give me something for that? I just want to feel better.”

We talked a bit about goals and options. Discussed medications, what that involves, and the evidence of non-pharmacological versus pharmacological management. She tried the clinic psychologist a year ago and liked her. But stopped because she didn’t like having to talk about her problems. Or think about them. I thought about my own sadnesses, hmm (and hmm, should I be at work). I don’t have a view either way about antidepressants but it struck me then – the expectation that complex life problems can somehow disappear, go away, when you visit the doctor. I hesitated.

“I’m sorry to say this… but feeling better is hard work.” I said, gently offering the option of exploring her issues further, medications or not. I’m not passionate about consumer partnership. Even less so after editing some painful journal article on “co-creation” last year. But suddenly this idea that her life issues is something we treat, independent of her participation, became very odd to me.

The blurry line between medical and life issues (kid doesn’t like school, kid has preference for junk food, man has been cheating on wife, woman feels the need to clear her throat when she is nervous etc.) bothers me. The expectation of listening with a strong and perverse financial incentive to not listen bothers me too. Sometimes I wonder whether this line of work is for me, but I suppose it will have to do for now.

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