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Meet Madison: Part I

Years ago I met an unforgettable gentleman named Madison. His initial reason for seeking therapy was depression. He had set a late afternoon appointment to satisfy his schedule due to sleep disturbance. He arrived promptly for his appointment at 4 p.m. Physically, he was an imposing specimen of a man. He was 6-feet, 3-inches and 230 pounds. His gait was steady. He sat down and let out a powerful breath of air. “Well, I made it.” His voice was clear.

When someone says he (she) is depressed, I explore by observation, then inquiries, the physical, mental, emotional and spiritual symptoms related to mood, behavior, poise, eye contact, body language and voice inflection, to name a few symptoms. If I could freeze time, Madison gave no immediate sign of depression. Thankful for not over-focusing on initial observation, I asked Madison to describe the depression he referenced when calling for an appointment.

“Marshall, about a year ago, my health was a mess. I weighed 340 pounds. My knees, ankles and legs ached like hell. I barely got around. I had a diagnosis of Type 1 diabetes. I was on insulin medicine. My cholesterol was sky high and I took medicine for that too. I’m not done yet. I had hypothyroidism and, you guessed it, I was on medicine for that. Luckily, I was near retirement in my job. I had taken time off for medical appointments and plain ‘ole fatigue. My blood pressure was high and I had terrible headaches. I gradually lost basic functioning. I had to depend on my wife to get anywhere. Her time from work limited freedom to drive me to appointments. My primary care physician placed me on an anti-depressant. I slept a lot, ate a lot and was losing focus. My thinking became foggy. My creative juices stopped flowing. To top it off, I took my pills in a futile attempt to end my life. My wife, Mabel, well, she stood by my side and continues to do so. She’s working as we speak. If it’s all right, I want her to come next time with me. I took a taxi today.”

With an abundance of information to process, I gazed upon a man whose outward appearance belied his lengthy narrative. So, Madison, what brings you here today?

“Marshall, my health painted me into a corner. I felt worthless and destined for an early grave. I’m 62 years old. My primary care physician has asked me to consider some health-related choices. I tried some fancy diets but to no success. My habits were so ingrained. Finally, I opted for a bariatric surgical procedure. My primary care physician set it up for me. I completed all the required conditions. Months had gone by. I tried a diet that the hospital suggested. My wife, bless her heart, changed our entire household diet. I still felt like a slug. I resisted my doctor’s call for counseling until now. I got accepted for the surgery, went through the procedure without complications and a year later, here I am. I’ve lost over 100 pounds. I’ve been able to walk comfortably. My legs and feet still ache. I think it’s mostly muscle ache from exercise. My blood pressure is in normal range. My cholesterol is also in normal range. Guess what? My diabetes is under control. I take oral medicine. My doctor says that may end soon. My thyroid is in therapeutic range and I’m not feeling suicidal. My doc still wants me, however, to take the anti-depressant. I can drive myself anywhere for any needs. My sleep is improved.”

That is an amazing story, Madison. With all your recovery from physical-medical matters, how do you think therapy can be helpful? “Well, Marshall, something, I believe, needs my attention. Yes, I amaze myself that I’ve achieved a life-changing miracle of sorts. I think that the process of my change needed work on my emotional state. Can you help me?” Yes, Madison, let’s set up another appointment to explore this area. We were to meet in a week along with Mabel to satisfy schedules.

Let there be peace on earth and let it begin with me.

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