My colleague on the Fox Medical A Team, Dr. Marc Siegel, has written a crucial book called The Inner Pulse that explores why some patients summon the will to live and defeat illnesses that might otherwise have been terminal.
He has borne witness repeatedly to the way that a patient’s intuition and spirit fuels that person’s recovery and he has refined ways to tap that “inner pulse” in service to extraordinary healing.
Tapping the inner pulse of patients is no less important when treating psychiatric illnesses, particularly depression. As I have practiced psychiatry over the last 20 years, it has become increasingly apparent to me that using medications to relieve depression is often tremendously helpful. Exploring the psychological roots fueling the illness is essential. But so too is reaching to the core of patients—to their inner pulse—to speak to and fan that eternal flame inside them that still sees an arduous journey to recovery as one worth taking and sees life as worth living.
It is very common for patients struggling with depression to ask me, for instance, whether they will “get better.” Since the data is so encouraging, I could tell them in a monotone that over 90 percent of people with major depression do indeed make a full recovery. But I never deliver the message that way, because I see our work together as being joined in battle against an adversary, and because that more energized vision of defeating depression can kindle a patient’s inner pulse.
Instead, I say what I feel about our work together, which is truly this: “I don’t accept defeat when I work with someone to overcome depression. If you don’t believe to the core of your being that we’re going to win at this, and win so completely that you are fully restored to health, then you should pick another doctor. Because I’m going to ask you to reach very deep inside and use every bit of energy you have to wrestle this depression to the ground, just the way I will.”
Indeed, the inner pulse of a patient will respond to the inner pulse of a physician—whether that physician be an internist or a psychiatrist. Such is the inexplicable, immeasurable synergy between doctor and patient.
Even if a psychiatrist were brilliant at ferreting out the psychological dynamics that made her patient vulnerable to depression in the first place, even if she were a brilliant psychopharmacologist, her being less than a gladiator in the arena of health versus illness would invite catastrophe. Patient and doctor must join life forces, not just share time, space and knowledge.
In psychiatry, the inner pulse is important not only in defeating depression, but in overcoming addiction, eating disorders and even obsessive compulsive disorder. What does it take, after all, to say no to heroin or alcohol, when psychological suffering will at least temporarily be the result?
What does it take to resist making oneself purge food when doing so would temporarily relieve emotional pain? What does it take to force an obsessive concern out of one’s mind? It takes, among other things, raw determination. It takes the extreme fighter inside the patient and the extreme fighter inside the psychiatrist. It takes the inner pulse of each, bound together in a struggle that each understands at a fundamental, elemental, spiritual level must not, and shall not, be lost.