Presenting Symptoms

In a few weeks I’ll start seeing a new psychiatrist. My old doctor just wasn’t cutting it. On top of this, my therapist of the last thirteen years is retiring in December. Talk about a transitional phase.

And so I simultaneously begin anew and continue where I left off. There’ll be introductions and medical histories. How do you summarize the last twenty years of your life in thirty minutes?

I have maintained a narrative of my life, as we all do. It’s undergone many revisions. Some details seem more important now, some thoughts I’ve conditioned myself to forget. But my illness from the beginning has colored my perspective. It makes me a trickster, a manipulator, my own unreliable narrator.

But I also understand a great deal about my condition. I like psychology and have learned some of the lingo. Doctors and therapists might appreciate my insight.

Lately I’ve been reading The Depths: The Evolutionary Origins of the Depression Epidemic by Jonathan Rottenberg. In chapter five Rottenberg discusses three factors that contribute to low mood, which can turn into a full-fledged depression: events, temperament, and routines.

People who experience traumatic events are prone to low mood. I’ll share with my new doctor the circumstances surrounding my past traumas. Temperament is crucial in the development of low mood. I was born with an “anxious gene”; remove my most troubling experiences and I’d still be depressed. Of course, how I live day-to-day also plays an important role. If I’m slow to get going in the morning and don’t take care of myself, I’ve laid the groundwork for a difficult day.

I relate all of this because these factors shape the stories I express in therapy. How did significant life events forever change me? What in my genetic makeup leaves me vulnerable to distress? How might an unhealthy lifestyle worsen my symptoms?

It’s up to my new caregivers to paint their own picture of me. But I provide the backdrop, I set the scene. How I present my story matters as much as my willingness to share it.