Archive for health

Up and Down

An article from a week ago in NYTimes Magazine on the evolutionary purpose of depression:

Depression’s Upside

“…For Darwin, depression was a clarifying force, focusing the mind on its most essential problems. In his autobiography, he speculated on the purpose of such misery; his evolutionary theory was shadowed by his own life story. “Pain or suffering of any kind,” he wrote, “if long continued, causes depression and lessens the power of action, yet it is well adapted to make a creature guard itself against any great or sudden evil.” And so sorrow was explained away, because pleasure was not enough. Sometimes, Darwin wrote, it is the sadness that informs as it “leads an animal to pursue that course of action which is most beneficial.” The darkness was a kind of light…”

“…If depression didn’t exist — if we didn’t react to stress and trauma with endless ruminations — then we would be less likely to solve our predicaments. Wisdom isn’t cheap, and we pay for it with pain…”

“…The challenge, of course, is persuading people to accept their misery, to embrace the tonic of despair. To say that depression has a purpose or that sadness makes us smarter says nothing about its awfulness. A fever, after all, might have benefits, but we still take pills to make it go away. This is the paradox of evolution: even if our pain is useful, the urge to escape from the pain remains the most powerful instinct of all.”

Maybe we’re all just neurotic. Maybe this is a way of finding optimism among pessimism. I think it makes total sense that challenges and failures teach us lessons for the better; but how are we supposed to find and navigate the line between making worry and distress productive, and just letting it get you down?

Upon My Honor

I feel naive for not knowing that there’s such a thing called the Physician’s Oath, which was created by the World Medical Association as part of the Declaration of Geneva. The following is a quote, followed by the oath, courtesy of Grey’s:

The biggest influences in your life are sitting around you, right now.

It changes you, this work. Your patients, your colleagues, you change each other. You don’t ever think you’ll lose your way, but what happens in this hospital…just remember why you came here. You said it the day you graduated from med school. You took the physician’s oath. Remember it. Tape it to your locker, to your bathroom mirror. Cause it is too easy to lose your way.

“I solemnly pledge to consecrate my life to the service of humanity. I will give to my teachers the respect and gratitude that is their due. I will practice my profession with conscience and dignity. The health of my patients will be my number one consideration. I will respect the secrets that are confided in me, even after my patient has died. I will maintain by all the means in my power, the honor and the noble traditions of the medical profession. My colleagues will be my Sisters and Brothers. I will not permit considerations of age, disease, or disability, creed, ethnic origin, gender, race, political affiliation, nationality, sexual orientation, social standing, or any other factor, to intervene between my duty and my patient. I will maintain the utmost respect for human life. I will not use my medical knowledge to violate human rights and civil liberties, even under threat. I make these promises solemnly, freely and upon my honor.”

Good Grief

A recent read from The New Yorker on issues related to grief: how it can be considered clinically, it’s forms in private life and public ritual, why we experience it, and what we hope to get from it as human beings.  Article here.

In “Mourning and Melancholia” (1917), Freud suggested that mourners had to reclaim energy that they had invested in the deceased loved one. Relationships take up energy; letting go of them, psychiatrists theorize, entails mental work. When you lose someone you were close to, you have to reassess your picture of the world and your place in it. The more your identity was wrapped up with the deceased, the more difficult the loss.

Care for the Caregiver

An article in the NYTimes blog, “The New Old Age,” about doctors providing support for family caregivers who take full-time care of fragile and elderly loved ones. Features Harvard’s Arthur Kleinman:

http://www.nytimes.com/2010/01/22/health/21chen.html

Later outside the exam room, the son pulled me aside. I noticed the dark circles around his eyes. “You’re tired, aren’t you?” I asked him.

The man’s dark eyes began to fill with tears. I immediately, reflexively almost, started apologizing for not being able to do more for his father. But he stopped me.

“No, no,” he said, wiping the tears away with the back of his hand. “It’s not that. It’s not that at all.” He paused and looked toward his father, still lying on the table in the room and smiling at the lights. “It’s just that no doctor has ever asked me if I was tired.”