Monday, October 6, 2008

Embracing the Dark Side: The medical view of depression: good for patients, or just for doctors?

By Jenna Baddeley in Embracing the Dark Side

It is popular these days to explain depression as a medical problem caused by chemistry: an imbalance of serotonin and other neurotransmitters. Many mental health care providers favor this explanation of depression's causes, supposedly because it destigmatizes the illness and shifts blame away from the patient. The problem is, it may benefit providers more than patients.

When depressed people seek treatment, they want relief from their psychological pain, but they also want their experience, their concerns, to be acknowledged. In other words, what they are looking for is to be empathized with, not just not to be blamed. Unfortunately, there is good evidence that doctors aren't very good at responding empathically to their patients' concerns. A recent study reported in the popular press found that the physicians responded empathically to only 10% of patients' concerns. They frequently discussed biological processes and medical treatment options in lieu of empathizing.

The truth is, one of the most difficult parts of a healthcare provider's job is having to listen to patients reveal heart-wrenching problems and the strong negative emotions that accompany them. Psychiatrists are alone among medical doctors in that hearing and treating emotional problems is precisely their line of work. They sometimes deflect the difficulty by asking canned diagnostic questions, explaining biological causes, and prescribing medications. In such encounters, it is hard to imagine that the depressed patients -- who typically feel alienated and vulnerable to begin with -- are being listened to as if their human experience mattered. And that is troubling. As mental health treatment providers, we are privileged to receive confidences that our clients might not give even to some of their closest friends. When we retreat to a view of our clients as clusters of symptoms to be differentially diagnosed or neurotransmitter systems to be rebalanced, we dishonor our clients' personhood and we miss an opportunity to provide care in the fullest sense of the word.

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