A middle aged woman in late 50’s, employed in a eminent organization, brought up in a wealthy family, influential Parents with good social standing and a Father who was a Civil Rights Lawyer. Living alone now, been on multiple different medicines for depression and anxiety. Had a history of being in Therapy with various Counselors, Psychotherapists and Psychiatrists over a period of 40 years since age 19. History of Suicidal attempts and Emergency hospitalizations in her early 20’s.
Consultation: Individual wanted repeat prescription of her current medicines. She wanted no detailed assessment or discussion of her Life; she hoped ‘No Change‘. Doctor did not probe much. He respected her Privacy and Secrecy and the Right to remain Guarded. Basic and Routine information, essential for Psychiatrist to prescribe Medicines was collected.
Treatment:
Medicines prescribed. Follow up appointments every 6 weeks in Outpatient Clinic. Individual stayed well, had good composure and impeccable sense of clothes and dressing. After few appointments, she once came complaining about Anxiety triggered by change in her Cabin / Work desk at Workplace. Minor adjustment in medicine dose resolved the issue. After few more appointments, she reported feelings of chronic depression and loneliness.
Doctor remarked, “You don’t appear depressed or anxious. All these months you seem to be cheerful, normal having good conversation skills and a pleasant sense of humor.” Patient responded,” I can Camouflage my feelings and interactions with people; with you, at work or in social situations. Even when I am Dating Men, they can’t see through the front that I put on. And I back away from or end all potential Relations when I develop feelings of Intimacy.”
Doctor asked, Can i understand more about your Life, your Past ? Patient reacted with Anxiety and said, “I feel vulnerable. Can you do Therapy ? Are you Trained as Therapist ? Doctor explained and clarified, “Yes, But I operate with a different Mind-Frame, when I practice Psychiatry and another Mind-frame when I employ Therapy. Therapies are of different types and which type or form of Therapy will benefit you, depends on the Assessment and Evaluation of your Psyche and Persona.” Patient asked, ” Can we start with CBT ?” Doc responded. “We can start with CBT approach but this may need Revision based on better understanding of the Cause and Effects of your problems.!
Patient: Will you take away the Medications? Doc: The Medicines will stay as it is now. It will be modified only according to external symptoms. Psychiatry is not a Science of the Mind anymore.! Since I am familiar and a trained Doctor, I am qualified to manage your Medical needs as well.
Read next: Part 2 of Abuse – A Case Story
See also: Cognitive Behavioral Therapy (CBT) ; Depression ; Psychiatry ; Anxiety
