She was 20 and bedeviled by episodic bouts of depression, anxiety, and irritability. I saw her for an initial visit with an excellent fourth-year psychiatry resident. She asked to be joined by her 21-year-old live-in boyfriend to hear our impressions and recommendations.
After a thorough and comprehensive evaluation, the resident explained that the patient was wrestling with a host of developmental issues: establishing independence from her parents, confronting her mother’s mental illness and its meaning for her, choosing a job and career, working out a meaningful relationship with her boyfriend (if, in fact, that’s what she wanted). He recommended psychotherapy. She belittled therapy. (“If I want to talk, I can just call a friend.”) And she balked at the time and money it would cost. No go.
The boyfriend also had no use for talk therapy. He wanted her to be more energetic and available to him at the end of her work day, to be less irritable. He wanted her medicated. We were willing to consider an SSRI, but she balked at meds.
She wanted to be happy. He wanted her to be the girlfriend and roommate he felt he deserved. The resident and I described the scope, nature, and limits of modern psychiatric interventions—for that matter, all medical treatments. That line of reasoning went nowhere. I asked each what he/she hoped to come away with. We were back (slowly) to square one.
Two unhappy “customers” left our facility. It’s too bad. But we have our limits.