I thought you might enjoy the outline of a lecture I’m giving Tomorrow to CUSM (California University School of Medicine) 3rd year medical students. It’s one lecture intended to cover mood spectrum and anxiety spectrum disorders.
Here’s the outline:
- **Psychiatry as a Type 2 Error Problem:**
In psychiatry, assume people are much worse than they look until proven otherwise. Unlike other medical fields where you prove the existence of an illness, in psychiatry, you want to rule out disorders, not rule them in.
- **Monitoring and Recognizing Depression in Yourself:** Monitor our own selves for subtle signs of depression. Depression often manifests in small changes like sleep disturbances or increased irritability. It’s essential to catch it early, as depression can have profound physiological effects, akin to a bear chasing the body constantly.
- **Depression as a Physiological Issue:** Depression is not merely a result of stress or external factors—it’s primarily a physiological issue. Treating mild depression proactively is crucial, as it not only impacts the individual but can also affect the entire family due to its viral nature.
- **Seeing People as Brains, Not Just Individuals:** Shift the perspective from viewing patients as individuals with stories to understanding them as brains in need of healing. By focusing on the brain’s physiological state, it becomes possible to reduce suffering more effectively.
- **Combining Physiology and Coping Skills:** Physiological aspects, address them first and then integrating coping skills. Changing habits takes time, but when combined with improved physiology, it becomes a potent approach for reducing the impact of depression.
- **Environmental Influence:** The temporal impact of environment but stress that the viral influence of depression can be severe. Living with someone experiencing depression can affect the entire family, emphasizing the need for proactive and aggressive treatment.
- **Genetics and Heritability:** Genetic loading and heritability, understanding family history and genetics is crucial in psychiatric assessment.
I want to give each of these students four years of psychiatry residency, just so they can grasp some of this. I don’t know how to get it to the community. Depression is biological. Physiological. It is dramatically under diagnosed. It is largely responsible for treatment nonadherence in any area of medicine. And it destroys our own lives.
I remember when I was a Psychiatry graduate of 6 years, when the word sounded through our community. Dr. Schultz’s, our beloved residency director, the one who had joked around with me, who had worked so hard to eliminate my imposter syndrome and who gave me a sense of being among my people, he shot himself. In our clinic’s corner bathroom, between seeing patients, he used his own gun.
I am still grieving him. He was a mentor. He was a friend.
But more than his impact on my life, he was a father of a preteen son, and was survived by many beloved family.
I’m sure you, readers, have your own stories. Maybe even against your own person. Please share them here. We need your story. Somehow, our community, our practitioners, our own medical graduates, don’t understand. Depression ruins us. And treatment can heal.