"What a lovely home you have here," I say as I walk in the front door.
"Thanks. People always say that when they come here." He seems like any other suburban middle-aged man. We sit in the living room.
"So, what's happening today?" I ask as I open his lock box and arrange his morning and evening medications.
"I don't know. Maybe I'll make some calls. Maybe I won't. I don't have a car right now so I don't know what to do today."
"Well, it's a beautiful day out there. Would you consider getting some sun, checking out the flowers and the trees, and getting some fresh air? I see on your care plan that you're supposed to try to go outside every day."
"Yeah, I could do that, I guess. I hadn't thought of that. I'm pretty lonely, too. I've been depressed."
"I think I know what you mean," I reply. (What I want to say is that I've been very depressed myself, but "therapeutic use of self" does not seem appropriate in this situation. There are times like these when I want to explain how depression also frequently has its grip on me, and reaching out---both to people and to Nature---is often my greatest survival strategy.)
"How about this?" I begin. "Make some calls to at least one friend and one member of your family this morning. Then make sure you get outside for a walk once this morning and once this afternoon. Getting out of the house can be really helpful, even if only for a few minutes. The sun feels so good."
"OK. I can do that. Thanks for the suggestion. Should I take these meds now?" He seems confused.
"Yeah. Take these now and take the evening meds with dinner. And I'll leave your meds for Sunday on the table since there won't be a nurse coming tomorrow."
"Oh, that's right," he replies. "Sundays are hard because nobody comes over. It can seem like a long day, especially when I don't have a car and it's so far to town."
"Well, remember we talked about making those calls today? Maybe there's someone who can come see you tomorrow, especially if they know your car is broken down."
"Hey, that's right. Why didn't I think of that? I'll make those calls as soon as you leave." A smile passes across his face, then disappears. By the time we reach the door, he's smiling again.
"Thanks so much for the visit," he says, shaking my hand warmly. "I feel a little better now."
"So, you'll do some good things for yourself today?" I ask in parting.
"Oh, yes. Absolutely. You can bet on it."
I get in the car and put the key in the ignition. Looking in the rear-view mirror, I see that he has walked over to the garden and is leaning on the fence, looking out towards the hills. The sun is bright and there are a few horses in the fields beyond his house.
My prescription for him was no different than what I tell myself, and in the face of depression and the sense of isolation that often accompanies it, there's no telling how effective those interventions will be. When it comes to the mystery of our minds and the solitude we each experience within our minds, no one can offer an explanation that will wholly satisfy us.
Some of us are blessed with an inner equanimity free of depression and isolation from others. Some of us---myself included---struggle with the demons of depression and other mental afflictions that bog us down and cloud our thinking. Depression can short-circuit decision-making and cause us to pull away from those we love just when we need them most.
And what about my admonition to my patient to call friends and family and get outside in the sun? It was like I was talking to myself.