Letters to a Young Therapist by Mary Pipher

Author:Mary Pipher
Language: eng
Format: epub
ISBN: 9780465098958
Publisher: Basic Books

12

MEDICATION

May 15

Dear Laura,

I have been fighting the blues all week. It’s hard to know what causes this. Sometimes it feels like sorrow over work struggles or a friend’s sad news. Other times it seems as if I suffer from a kind of biological sludge that seeps into my good life and covers it with mud.

Did you know that spring is the season of suicides? No one knows why. It may be something biochemical, or it may be that if people are still unhappy with all this loveliness around, their depression feels inescapable.

It’s not surprising that last week we disagreed about whether your client Marlene needed antidepressants. Some of our differences were theoretical and some felt more generational. I went to school in an era before there were good psychiatric medications and I was trained to see solutions in terms of the therapeutic relationships, not prescriptions. You are more of a biological determinist than I am. Mostly we discussed Marlene’s case philosophically: Is she just sad because her boyfriend dumped her? When is medication appropriate? I laughed at your concluding remark, “Biology isn’t destiny but it isn’t chopped liver either.”

If five therapists saw Marlene we would have six different theories about the cause of her sadness. Our field has always had competing notions about why humans act the way they do. Many earlier theories are stale now, but a thousand others, some very old, still flourish. Our theories range from biochemical, genetic, and environmental to spiritual and existential. We believe people can have trouble because they have certain kinds of brains or inborn temperaments, or because they are victims of childhood abuse, or members of an oppressed minority, or because of their birth order. We suggest misery is related to maladaptive behavior patterns, poor communication skills, irrational thinking, and a lack of meaning in life.

There is no doubt that some depression is biologically based, entrenched and relatively unrelated to the environment. I’ve seen clients who reminded me of Richard Corey. He was the healthy, loved, and successful man who killed himself in Edwin Arlington Robinson’s well-known poem. One of my clients was so prone to despair that even good luck caused her dismay. She once opened a fortune cookie that read, “Money will fall from the sky for you.” She shouted, “My god, I will be killed when it hits me on the head.”

Much of what we call depression is simply sadness brought on by events. I think of Erin who had a dull, uncaring husband, a lousy job, and very little in her life that was fun or rewarding. I think of Amin who ran the gift shop at my hotel in Toronto. He had been a psychiatrist in his native country, but was unable to secure his license to practice in Canada. He told me proudly that he had once presented a paper at an international conference in the Azores. Now he spends his days selling breath mints and bottled water.

To quote old-time country singer Sam Morrow, “We need to be able to tell the difference between ‘that’s life’ and ‘that’s nuts.

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