Back in the day, not so long ago, when I was supervising therapists at a local community mental health clinic, I was often called upon to lend an ear and some insight into cases that seemed to be going nowhere. In response to the seeming lack of progress, my supervisees would often question whether they were being of any help to the client and whether medication might be a more useful intervention. As one who long ago came to understand that there are rarely quick fixes in life and that there is greater value to treating people with patience than as patients, I would sometimes respond to my supervisees’ concerns by recounting the following anecdote, borrowed from an episode of the television series, The West Wing:

This guy’s walking down the street when he falls in a hole. The walls are so steep he can’t get out. A doctor passes by and the guy shouts up, “Hey, can you help me out?” The doctor writes him a prescription, throws it down the hole, and moves on. Then a priest comes along and the guy shouts up, “Father, I’m down in this hole–can you help me out?” The priest writes out a prayer, throws it down in the hole, and moves on. Then a friend walks by. “Hey Joe, it’s me–can you help me out?” And the friend jumps in the hole. Our guy says, “Are you stupid? Now we’re both down here!” And the friend says, “Yeah, but I’ve been down here before, and I know the way out.” [link]

When people fall into a metaphorical hole, as happens periodically in life, and they encounter difficulty in extricating themselves, sometimes what they need is not a quick rescue (or a prescription or a prayer) but the time and the patient support to work their way out at their own pace. There is value to sitting with people as they go through such struggles. There is value to easing their loneliness and confusion and despair with empathy and understanding and occasional guidance. There is value to therapy.

Unfortunately, far too many psychiatrists and health insurers do not respect this hole truth, preferring the anodyne of medication—even when such may be premature or unnecessary. They do not respect the fact that suffering is part of the human condition and offers great opportunities for personal growth and examination. They do not respect the hyphen that separates natural dis–ease from unnatural disease. As a result, there is a growing tendency to unduly pathologize and medicalize normal—albeit painful and unpleasant—human experiences. That is not healthy.

The following story by Shankar Vedantam in the Washington Post would seem to support my point of view:

Criteria for Depression Are Too Broad, Researchers Say

Up to 25 percent of people in whom psychiatrists would currently diagnose depression may only be reacting normally to stressful events such as a divorce or losing a job, according to a new analysis that reexamined how the standard diagnostic criteria are used.

The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugs.

Diagnoses are currently made on the basis of a constellation of symptoms that include sadness, fatigue, insomnia and suicidal thoughts. The diagnostic manual used by doctors says that anyone who has at least five such symptoms for as little as two weeks may be clinically depressed. Only in the case of someone grieving over the death of a loved one is it normal for symptoms to last as long as two months, the manual says.

The new study, however, found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness.

The study also suggested that drug treatment may often be inappropriate for people who are experiencing painful — but normal — responses to life’s stresses. Supportive therapy, on the other hand, may be useful — and may keep someone who has been through a divorce or has lost a job from going on to develop full-blown depression. [full text]