This story puts in a nutshell why we doctors spend far too much time worrying about how to diagnose and treat mental health problems. Given the chance, our patients have much more interesting and useful ideas than we do, about how to find their way out of difficult circumstances and improve their lives.
Jenny comes to see me in my surgery in Liverpool one morning. She tells me she feels dreary, denigrated. She says she has no self esteem. She is thirty seven, and has realized - like Lucy Jordan - that she’ll never ride through Paris in a sports car with the warm wind in her hair. ‘By the time you’re 40’ she tells me, ‘what is inside you comes out to the surface. I look in the mirror and see an old, ugly, hard bitch’.
She can find no value in her relationship with her partner. Recently he went five days without washing himself. ‘Just attention-seeking’ she reckons, ‘but it didn’t work’. He has warned her that if she ever tries to throw him out of her home he will kill himself - and their eight year old son. Jenny doesn’t really believe him but she is not quite sure. She might risk it when her son is older - thirteen, maybe seventeen – and can look after himself.
I ask Jenny what she would do in an ideal world, if she had all the choices available to her, if she could do anything she might possibly want. ‘Not money or fame,’ she replies. She sits and thinks for a while. ‘Respect from others would be good… and being able to write’.
How would she like to get there, I wonder? We talk about antidepressants – they might be an option, maybe sertraline which she she’s tried before. Alternatively, I suggest she might like to take part in a Positive Thoughts Course, one of the group psycho-education programmes that my wife Sue runs.
Then suddenly, unexpectedly, a whole set of other possibilities emerge from our conversation.
Jenny tells me she’s been thinking about signing up for a creative writing course. She’s also been wondering about taking up meditation or yoga, and exploring Buddhism. Or she might join the anti-cuts movement (our conversation takes place in the weeks after the first Coalition budget).
‘Or maybe’ she says, ‘maybe I should fall in love’.