What's in a name.
Since 1935, when Dupont adopted the slogan "Better Living Through Chemistry," we have been a culture pummeled by polymers and overly impressed by the new and shiny. Their advertising not only changed how we thought about the rush of chemicals being delivered to us (through medicine, in our water, in our foods), but reflected a new age of humanity in which biochemistry became a cruel and indifferent king. No longer were people thought of as "heartbroken." They were thought of as chemically imbalanced.
Most people don't know that diagnoses vary and move along social currents. Because of the authority with which words like "clinical depression" or "bipolar" are used in modern conversation, they are given the impression that those words have a permanence and solidity they do not actually have.
For instance, what we now commonly call PTSD has only been recognized as a formal disorder since 1980. During the American Civil War, soldiers returning from battle with inexplicable symptoms were said to have "Soldier's Heart." In World War I it was referred to as "War Malaise" or "Shell Shock," in World War II, "Combat Fatigue," in Korea "Gross Stress Reaction" and after Vietnam, it was cleverly called "Post-Vietnam Syndrome."
Does it matter what we call it?
Some think it matters a great deal because names often determine approach or treatment. It makes sense. If someone is called "Your Highness" we are sure to approach him or her quite differently than if he or she were called "dear." Similarly, if we call a state of mind a chemical imbalance, than we are very likely to approach (or treat) that state with chemicals, often many. If, on the other hand, we call it a broken heart or loneliness or arrogance or self-pity, we take a rather different tack.
This comes up because of something a patient said to me the other day. She also recently moved east from New Mexico when her husband was made a corporate offer he couldn't refuse. She came from an old family in Santa Fe with a history that went back almost 400 years to the Spanish Conquest. She had grown up with open vistas, nearly eternally clear skies and a community in which everyone knew one another. To say hers was a shocking uprooting would be an understatement.
She came in complaining of inexplicable and free-floating anxiety, lethargy, a tendency to weepiness over trifles, an inability to sleep through the night because of dreams and restlessness. Her first question after she elaborated on her symptom picture was: "Do you think I'm depressed?" The as yet unspoken question underneath was: Did she need medication?
Instead of answering either of those questions, I asked her about her dreams, when these symptoms started, what she'd been doing since she moved here and how well (or poorly) she was getting acclimated to a new environment and culture.
As it turned out, her symptoms began about a month after arriving, shortly after the last box had been unpacked and recycled. Suddenly, there was nothing to do. Her husband was going to his new job. Her two young children were in school. She was at home, sans friends, sans work, sans family. In New Mexico, she had not only been working, she had an extended family that occupied a great deal of her time with social engagements and care-taking of elderly members. People stopped into one another's homes fairly regularly. She had a church she loved. Here, she was alone. Worse, she was lonely.
Could someone call that depression? I imagine they could find support for it in the diagnostics and standards manual. But I'd rather call it homesickness. Not only because it is more precise, but because it gives her a way out.
Of course she misses her home. Of course she feels lonely. Of course she's bored and restless. Of course she longs for friends and relatives. Who wouldn't in her situation? There's no pathology in that.
What needed to be changed were not those feelings, but what she was doing all day with them. First prescription: volunteer. Second prescription: find a church with her husband. Third prescription: join a club (in her case, she agreed to a yoga class).
It took about a month for her symptoms to abate. While she still missed friends and family (and bright, endless blue skies), she was no longer as lonely, bored or restless. She slept better because her energy was redirected and expended during the day. She began to make new friends and feel a part of something bigger than her own heartbeat in a large, empty house.
The more I think about her case, the more I am inclined to think of PTSD as "soldier's heart." I think it more clearly sums up what we are looking at: A wound of war that breaks a heart, not a chemistry problem.
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