Friday, July 1, 2011

Dear Always Depressed Amanda:

She's a "help-rejecting complainer," in the words of Irv Yalom MD.

Today "Amanda" called me. I didn't call her back right away b/c I dread talking to her.

She calls every year or so to complain about her psychiatrist, Dr B, who's a very good one, and to tell me her depression never goes away.

"I'm ready to end it all," she always says.

Although I listen intently, I show very little sympathy. I won't play into her possible unconscious desires to remain sick. Or her conscious desires to be as stubborn as possible.

She wanted the name of a new psychiatrist. She gets frustrated with Dr B.

Dr B just put her on Latuda, which is an indication that Dr B is up on the latest treatments. I'd never heard of the drug before, a new antipsychotic.

Dr B, like most psychiatrists, pushes pills. I wonder if Dr B ever pushes "lifestyle changes" on her patients.

I gave Amanda the name of two psychiatrists in her Main Line neighborhood, culled from our Top Doc list.

Do you ever leave home? I asked.

Yes, she said, today I went to a bar/restaurant for lunch. I sat next to a man who has 7 children. He and his wife are leaving for Nantucket tomorrow for the Fourth of July weekend.

Isn't that terrible, she exclaimed, having 7 children? I don't know what I'd do with myself.

I was shocked to hear her judgmental attitude of the man.

"Dyou suppose he thinks it's terrible?" I asked her.

"I don't know," she said.

Here's what I think, I told her. I think he and his wife are ecstatic that they have such a wonderful family.

She didn't seem to know what I was talking about.

Then I began questioning Amanda to see if I might help her.

- When was the last time you felt well? Never.

- Ever had shock treatments? Yes, but they stopped working an hour later.

- Dyou really want to get well? Maybe you like being sick. She assured me she wants to be healthy, that's she's sick and tired of being depressed.

- Dyou have any friends? Not really.

- What are your hobbies? None.

- Dyou go on the Internet? Never.

My pronouncement: You need more than meds to get out of your depression. You need a whole lifestyle change.

Are you saying, It's my attitude? she asked.

Yes, I said, you have a bad attitude. Very negative.

You've got to try new things other than meds. Be around people. Join a book discussion club, a nature center.

Get involved with the world, not just Amanda.

At age 40 or 50, she still lives at home with her parents. Every evening her mom sits with her and they watch a TV show.

Amanda sits there "like a lump"and says nothing.

Try this, I suggested. Make a few comments about the movie. You know, small talk.

Small talk, she repeated.

Yes, I said. Just simple things like Gee, she has a nice pocketbook, or That guy looks creepy.

She listened but her mind was not on what I was saying. She had tuned out. Totally. I had lost her, just as I always do each time she calls me over the 20 years I've known her. She came to New Directions long ago and I have no recollection of what she looks like.

But I always recognize her firm, self-assured yet defeated, angry voice on the other end of the phone.

It's pills or nothing for Amanda.

And there ain't nothin' I can do about it.

1 comment:

  1. Oh dear. It makes you want to grab somebody like that by the shoulders and just shake them hard. It makes you wonder which came first-chicken or egg. I doubt it was the depression that made her unable to see the benefits of a positive attitude or any other ways of helping herself. She was most likely a negative person long before that set in. Hope somehow she sees the light. Yes, people like that are hard to take, even if you are highly compassionate and whether you are dealing with them as a professional or in your private life.