Shrink rap

Meet the panel

The abusive coworker  |  The procrastinator
The loner  |  The commitment phobe
The rejected gay son  |  The cutter
The crime victim  |  The serial dater
The fast and the furious  |  The coaster

{Dilemma 10}

The coaster
I’m a 30-year-old man who was cruising along: I had a decent job, a steady relationship and even a rent-controlled apartment! About three months ago, though, I started feeling kind of down all the time. I feel tired a lot and have trouble sleeping. It’s bizarre. I can’t think of any reason I feel so bad—I even cancelled a vacation because I didn’t feel up to it. What’s going on with me?

Charles F. Ehrhardt: Thirty-year birthdays seem to give many people fits; a flulike depression-anxiety seems to envelop them in a fog of self-doubt, guilt about what they have failed to accomplish, why they’re not married with three kids by now, or at least have a substantial relationship, a better apartment, etc., by then. What stands out in this case is the language, which is hardly the language of emotion: “cruising along,” “decent job,” “steady relationship.” These words demonstrate little that would imply he is at all happy, but instead that he’s merely content and that’s fading now. What may be useful is insight therapy to talk about how he is feeling along with fantasies and disappointments. A low-dosage antidepressant might be a way to jump-start him, but this case would best be served by a therapist with skills at coaxing out unseen emotions.

Allison Conner: This person is most likely experiencing an episode of depression. He may also be lacking in self awareness, at least in this area. In most instances of depression, the reason(s) for depressive symptoms become clear in therapy, following some exploration of current-life circumstances, personal history and underlying issues. However, if psychosocial factors are unable to be identified, the depression may have a biological cause. In that case, medication may be needed. Most likely, however, even if a biological component exists, a psychological and/or situational trigger is associated, which would be uncovered. In treating depression, I would help the patient to identify, challenge and correct maladaptive negative thinking patterns that are maintaining his current state. Also, behavioral choices and coping strategies would be examined to see what changes may be needed in those areas to enhance recovery. If a biological component is present but the patient is reluctant to take medication, therapy alone may be sufficient treatment.