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CHAPTER 6 A Depression Worse than the Disease We have seen how, in the initial consultation, the doctor spoke in powerful scientific language that split his patient into two parts, objective and subjective, and declared the objective part the sole domain of medical interest. Yet for the patient, the affective component of the medical encounter was fundamentalto the lived experience of her illness. For her the emotional repercussions of the doctor's interventions came to be more serious—and debilitating—than the bodily ills that had brought her to him in the first place. This chapter tells the painful story of how the doctor 's discourses of biomedicine, filtered through the patient's psychology of gender, precipitated yet another disease—depression—which manifested itself both mentally and physically. The chapter begins by describinghow, from the patient's point of view, the doctor effectively produced her depression by diagnosing five chronic diseases, including a second major condition, and giving her a prognosis of worsening pain and deformity. Although her physical condition had not yet changed, the mere idea that she had a second serious lifelong illness eroded her sense of pride in her body and shattered her image of a happy future, producing feelings of sadness and diminished selfesteem . S.could not directlycontest the diagnosis and prognosis, because the language of science had defined the doctor as the expert on her body. She tried to place her depression on the medical agenda, but the doctor rebuffed her efforts. He refused to acknowledge that depression might be a by-product of his practice and told her to accept as "cathartic" his dark view of her future. As if to rub salt into her psychological wounds, he talked of disability and death, implying that these were in store for her soon. Faced with a bleak diagnosis and prognosis, and with pointed reminders of her impending death, S. fell into a deep depression that, try as she might, she could not shake. The next section traces how the doctor's diagnosis of fibromyalgia became a self-fulfilling prophecy, giving S. a complex of new symptoms that she had not had before. Interpreting these as manifestations of his spe176 A Depression Worse Than the Disease / 177 cialty disease, the doctor instituted a treatment program of close monitoring and restriction of the patient's activities. Whereas the diagnosis and prognosis had produced only the fear of loss, the doctor's ban on her favorite activity led to a real loss of a major part of her life. Her depression deepened, becoming a pervasive melancholy that gnawed at her, sapping her energy and will to persevere. The final section documents S.'s descent into despair as she sought out the biomedical literature to find comforting news, only to discover that her newly diagnosed condition would last fifteen years or more. Despite the energies she poured into the task, she was unable to vanquish the monster. By mid-June, when S. left the West Coast to spend five months back east, she was barely managing to hold everything together. While the doctor's biomedical discourses and practices fostered feelings of loss and low self-esteem, the psychological makeup that S. bore as the mark of her femininity left her particularly vulnerable to "biomedical depression." As we have seen, S.'s relational reasoning led her to silence her critical inner self and to create a falsely agreeable social self to maintain the intimate relationship on which her care and safety depended. But this relationship-first approach to care exacerbated her feelings of loss, for she had voided her true feelings so that she could get help. S.'s relational strategy also eroded her self-esteem, for she had betrayed her self to please another. S. felt the pain of self-betrayal all the more keenly, for she had given up her feminist values—those of standing up for herself and speaking her anger—and embraced feminine routines of sweet compliance and silent rebellion that, on an intellectual level, she deeply deplored. And finally, all the energy S.expended to silence her concerns and suppress her rage depleted her stores of physical and psychological strength. This loss of stamina no doubt contributed to the physical symptoms of depression that emerged in the spring and grew markedly worse in the summer and fall: apathy, insomnia, and loss of appetite and weight. Trying to get help the only way she knew how, S. ended up deepening her psychic and physical wounds. S...


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