pyschosocial = root of all evil

developmental psychology, personality disorders, post-traumatic stress disorder - it is amazing what clues you can dig up from the dim dark past that seems to shed light on someone's present condition, if only you know where to look and persist long enough. maternal depression leads to dysfunctional attachment, rolling into separation anxiety, becoming oppositional defiant disorder, developing into conduct disorder, culminating in antisocial personality disorder, an entire catalogue of forensic histories, domestic violence and abuse. the vicious cycle continues. faced with a patient across the desk, at the tender age of twenty-something, against the backdrop of all of the above, the overwhelming psychosocial burden would seem to snuff out any hope of change before it can flicker. our arsenal of management options suddenly feels like a box of useless toys. what can medication, psychotherapy or social agencies hope to achieve against such a formidable fortress of human tragedy and maladaptive coping? years of psychodynamics therapy will merely peel away layers after layers of misery, anger and guilt, only to uncover more failed developmental tasks. it seems futile.

a patient presenting with any medical condition can be approached in a similar way. a middle-aged man presenting with angina - a seemingly typical problem to be managed in a matter-of-fact manner, working through the modifiable risk factors, shopping for the latest pharmaceutical miracles. but in addition to the bad genes, ailing heart, and a whole vascular system choked with atheroma, there might be a person, stressed from the demands of work; coming to terms with his own developmental tasks; coping with the responsibilities and fading dreams of young adulthood. around this person, a partner, children, relatives, friends, and a whole society revolves. how much can a doctor know and do? it can never be enough.

we had dinner with dr greenberg and his wife yvonne tonight at soulmama. the food and the restaurant was very decent; the mood from the table reflective and hopeful, looking to the past and the future. i glimpsed the bay outside and couldn't help but wonder at the mass of humanity that the bay had witnessed passing by its shores: all the dreams, emotions and lives that were, are and will be. we are all children; wonderful, ridiculous, oblivious children. the bay does well to laugh at us, at our silliness. it will still be there when we are gone.

the trouble with human beings is we can grasp the idea of eternity and a sense of our mortality at the same time. it is our gift, and our curse.