Josh was 21 years old and he was suffering, crying uncontrollably for days on end, feeling utterly lost. “Give me some meds, Doc, please; I can’t take this anymore.” But Josh’s depression, in my mind, was not biologically based. I told him to forget about meds, that the hard work of psychotherapy and spiritual connection would help him much better in the long run. “Give me some meds, Doc, please”, he pleaded. I then told Josh that Abraham Lincoln went through intense depressions, even to the point of being suicidal, and came out a stronger person because of his internal work. And Lincoln didn’t take even one pill of Prozac! “Please, Doc, I need meds; meds!” I looked Josh straight in the eye and explained that many people these days just want quick relief in everything, medications included. “It’s the curse of your generation, and Josh, you’re beyond all that.” But Josh did not accept this. He said he wanted to join with the cursed of his generation. He said that Abe Lincoln was a great man, but times have changed. “Why are you depriving me? Why?” I paused. Josh was desperate. I tried telling him that life is filled with pain and challenges and that‘s how we grow. And now is his chance to look at his real self….. And with that, Josh fell silent. And looked away. In the medical profession we are instructed to listen closely to our patients. And then we need to use our judgment for what we think is best….. …….the next morning, I wrote Josh a script for Prozac. I didn’t mention a word about Lincoln or spirituality or life being difficult. Josh thanked me profusely and then, wouldn’t you know it, in a couple weeks he started getting better. Slowly, steadily he climbed out of the pit of his darkness. Was it the Prozac? Would Josh’s improvement have happened anyway, simply with the march of time? Or was it because he searched inside himself? Trying to figure this all out is why being a psychiatrist is so damn hard and wonderful.
All POSTS
"Ramblings on the Psych Ward"
“We are not physical beings having a spiritual experience; we are spiritual beings having a physical experience.”
(Pierre Teilhard de Chardin)
Overeating ”Overeating regularly eventually leads to underliving.” (Mokokoma Mokhonoana) When 38 year old Bruce walked into my office and announced that he was an overeater, I had to admit that I felt out of my league - and I told him as much. “Eating disorders are not my area of expertise,” I bluntly declared. Still, Bruce persisted. He had been to dozens of diet doctors and tried all sorts of pills and programs and figured it was now high time to see a psychiatrist. His wife and teenage kids insisted on it. And so we started the journey together. Like most of us, Bruce loved cookies and ice cream and once he started, his self control went out the window. Sugar controlled him and his weight had soared to 350 pounds. What should I tell him? “No flour!”, I proclaimed, “not until we meet next week”, and, sure enough, Bruce returned a week later singing songs of success. “Another week!”, I encouraged, feeling now on a roll, “and no sugar, either!”. But, of course, my directives, my inexperience, were destined to failure. Bruce returned the following week, sheepishly saying that not one minute could go by without dreaming about chocolate chip cookies and coffee ice cream. And so, giving in to temptation, he started secretly eating both of those delights, unseen by his wife and kids, now more than ever before….. _ _ _ _ _ _ _ _ …..I think the biggest challenge of life is to achieve self control, to take responsibility for all that we do, speak, and even think. Certainly, there are certain mental conditions that are out of one’s control, like schizophrenia, bipolar, severe depression, dementia and intellectual disability. Beyond this, however, the sages say that we do have the capacity to orient our thoughts, speech, and actions toward goodness, and that we can reject unhealthy temptations that come our way. Difficult, yes! Absolutely difficult, yes. But incredibly empowering. As for Bruce, I suggested that he imagine his wife and kids there in the room with him just as he’s about to chomp down those cookies and ice cream. And that he should practice and practice this mental approach. Were my efforts successful?? Absolutely not. It turned out that Bruce really wanted a stimulant medication, like Adderall, which he hoped would curb his appetite. But I told him I was concerned about the potential cardiac effects from a stimulant. With all this, I wasn’t too surprised when Bruce didn’t show up for his next appointment. Concerned, I called him and he kept insisting on Adderall. I told him again that it all starts with internal work, not swallowing a pill, that his mouth and stomach should not be substitutes for the yearnings of his soul. And that we could talk about this some more. Bruce then thanked me and asked if I knew the name of another psychiatrist.