George On hopelessness

Categories: Case Notes

Sometimes life presents us with a double dose of challenge. George was a 65 year-old divorced male who was struggling to overcome the recent loss of his mother, who had maintained a close and supportive relationship with him throughout his life. As I read through his medical record, I took note – this was more than the usual grief reaction. George had been losing ground for months, and it was impacting every area of his life. It was several months since his loss, yet instead of showing the very slow but steady improvement that is typical of healthy grief, his mood had been tumbling downhill. And there was something more. A couple of red numbers highlighted in his recent blood work results. It looked as though his sugars were high along with other indicators that went with type II diabetes.

When he arrived for his session I was struck by how terribly sad George was. His eyes were red from crying. He was beyond miserable, and couldn’t hide it. As I gently probed for some background about his current life and work, I was also struck by how negative he was about his life. Every comment was punctuated with self-criticism or hopelessness. I bit my tongue. As a clinician I knew better than to start reassuring him at this point. He needed to get some things off his chest first. As I gathered his history, I confirmed that along with his grief he had many symptoms typical of uncontrolled diabetes. I hear about these signs all the time working alongside physicians as part of a primary care health team. People come in complaining that they feel tired all the time. Just getting out of bed is a struggle. It is an effort to do anything. Usually they can’t slake their thirst, yet are peeing away the fluid as fast as they take it in.

There was no sense that George was aware of his recent test results, but he had some pretty strong suspicions that something was wrong with his sugars. He wasn’t surprised when I agreed with him, but I was in a fix, since as a psychologist I am not the right person to be giving medical advice. He had a lot of questions. More importantly, he wanted to know what he could do. I set him up with an immediate follow up appointment with his doctor so that he could get the advice he needed and hopefully get started on some medication and meet with a diabetes educator. I told him what to expect. I explored his stage of change – he seemed ready and willing to get to work, and part of my job is reinforcing this to improve the chances that he would go home and act on his good intentions. So we reviewed what his doctor and the diabetes nurse were likely to tell him about the importance of good diet and regular exercise, and I suggested that any changes he could make in this regard would help his mood as much as therapy or an antidepressant might.

Believe it or not, that is the truth. Someone with diabetes is twice as likely as a healthy person to get depressed, and if sugars remain uncontrolled they play havoc with a person’s mood.

I reviewed the research evidence on the role that diabetes often played in worsening or even causing symptoms of depression, and could see some hope return to his eyes. It was a bit of a gamble, but it paid off. The next time I saw George was just a month later, but already he had lost weight and was starting to feel a bit better. Now we could get to work on the other things contributing to his depressed mood and have a better chance of getting results.