Psychiatry is a medical specialty. Appropriately, we tend to focus on pathology: symptoms, dysfunction. But before I complete an assessment of a patient, I try to remember to elicit what the person is about, what makes him or her “tick.” What are the assets, the passions? Should I neglect to elicit those “positives,” even if I prescribe an ideal treatment, the patient may not follow my advice—because we would not have “connected.”
Similarly, clinicians routinely inquire about what is demoralizing, what makes a person consider suicide. The “flip side” too is important. What is re-moralizing? What keeps the person grounded, attached to life?
I’ve run into several patients lately who turn to mental-health professionals for passports to meaning and happiness, for antidotes to ennui. I was struck by how these folks had reached adulthood without learning those things that make life meaningful, fun, worthwhile, things that make us happy to awake in the morning. Those things seem pretty elementary: passions; contributing to causes outside ourselves; play with others, a sense of mastery and productivity; feelings of goodness and efficacy; attachments to people we care about; and love. When I meet someone like that in a clinical encounter, I do share those observations. But typically the patient is disappointed. It seems life has yet again brought them to a god with feet of clay.
- Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry