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inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #176 of 178: Linda Castellani (castle) Tue 12 Oct 10 23:36
    

I had to scribble.  Forgot that I was in a publicly-viewable
conference.
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #177 of 178: Mark McDonough (mcdee) Wed 13 Oct 10 04:39
    
Well at least those of us who read before you scribbled finally know
what happened to Judge Crater!
  
inkwell.vue.378 : Gary Greenberg, Manufacturing Depression
permalink #178 of 178: Gary Greenberg (gberg) Wed 13 Oct 10 07:38
    
And even when they do recommend or insist on therapy, psychiatrists
can be awfully naive about the effects of their prescriptions. 

Case in point: 60-year-old man, retired successful businessman,
getting divorced, divorce rancor at about a 6 or 7 on a scale of 1-10,
worst feature being that he and wife are still living together (house
is big enough to accommodate). He's listless and fatigued, an little
bored and restless, not going out much, napping a lot, avoiding friends
and other pleasurable activities, melancholy although not tearful--in
short, a textbook case of depression. Psychiatrist decides to put him
on Ritalin, because the thing he talks the most about is his malaise.
Stuff perks him right up, he starts going out, is less morose, more
engaged, etc. 

It's a good outcome in many ways, although important to remember that
Benzedrine was once the drug of choice for depression, and stimulants
have a way of losing effectiveness on mood. But he avoided the side
effects of antidepressants, got immediate results, and won't have to
worry about antidepressant withdrawal.

But she told him that the reason she gave him the Ritalin is that he
has adult ADHD. As proof, she gave him one of those 15-item scales
they're so fond of. Now, I've seen this guy on and off for a long time,
and it never crossed my mind that he had ADHD. He's been steadily
employed, built a successful business, but not the kind that relies on
quick hits and fast sales--a slow and steady buildup in a business that
requires long-term client relationships and lots of concentrated
work--been faithful in his marriage, etc., etc. He's got a lot of
interests, and many irons in the fire, which is probably why he tested
the way he did, but the guy just doesn't fit the profile. 

Being the drug libertarian that I am, I have no objection to the
prescription. But that doesn't mean the prescription is not a
problem--or, to be more precise that the diagnosis is not a problem,
and perhaps a worse problem than "masking his symptoms" or whatever.
His  diagnosis now has him thinking that he's got ADHD, and that this
is why he was suffering. This diagnosis will change his experience of
his life, the way he understands himself, and how he approaches
therapy. The most underrated side effect of all.
  



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