Saturday, October 15, 2005

Mental health and medicine

I was looking at a blog entry over on Bloggernacle Times about cognitive-enhancing drugs. You can read my comment about it.

It got me to thinking about a physician's role to discern disease state. Although less-progressive folks might still question whether things like depression or ADHD qualify as disease states, I think that most people would agree that they do. The question is whether or not an individual actually has the disease or not. And this is where a lot of criticism has been leveled at doctors who aren't careful in making that determination.

Critics point to the "bad doctor" who is prescribing Prozac and Ritalin to every other patient who comes through his office. "How can it be," they say, "that so many people are depressed?" This is why I try to always be careful when I hand out mental-health diagnoses of one sort or another. There are published guidelines regarding what symptoms a person must have in order to be given some diagnosis. (Whether or not those guidelines are valid is a question for another day.)

But even after a diagnosis is made, the question of treatment still remains. How does one treat depression? Why do anti-depressants work? Why is it insufficient to simply do psychotherapy of some sort? Does this patient even need treatment at all? I ask myself these questions. And there is no single answer to any of them. So I go carefully along, and try to avoid getting stuck in routines of treatment that ignore the variation in individual needs.

Thursday, October 13, 2005

An Evening in Paris

So we're long back from Paris, which was wonderful and stressful and expensive and stimulating--and I very much got out of the habit of writing, once home. I wrote a little bit while we were there, and this is one of those jotted-down entries in my much-loved Moleskine notebook:

Sept. 19, 2005
In a Chinese cafe tonight, a man sat alone, reading the paper and eating his dinner. He was seated a few tables away from us in the almost empty restaurant. He was perhaps 40, with thinning brown hair and a hunched kind of attitude, deeply absorbed in his article.

Having just passed so many merry parties gathered around sidewalk tables, or laughing over glasses of wine in restaurants, the solitude of this man caught my attention. I watched him for a few moments while Blain had a French conversation with the proprietor. In his quietness, I saw him as an outsider and I felt a kinship with him. And as I looked out the windows at the fascinating river of people walking past, I wondered: who are these people having their social, beautiful, enviable time? Are they typical Parisians? Are they tourists or visitors? Who was this lone man? Is Paris the same Paris if you don't have anyone to eat dinner with?