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At the heart of general practice since 1960

A diagnosis from the archives

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‘Help me doctor, I feel tired all the time,’ was his eye-rolling opening gambit.

Over the years he’d been diagnosed with neurotic depression, dysthymia and dysfunctional personality disorder. And that was just the things starting with ‘D’. The profession had kicked around alphabetically for a label and had run, as far as I could work out, every test under the sun.

When I decided to flick back through his paper records to see if they’d shed any light, I came across a smorgasbord of antidepressants and, tucked away, was a small handwritten letter penned in the late 1970s by his psychiatrist. The profession could write more honestly back then and the correspondence relied more on prose and context than on results and investigations. It revealed a moral zeitgeist that was completely different to ours.

‘I reviewed this dismal lad again in my rooms,’ the GP wrote. ‘He’s unhappy rather than depressed and spreads his unhappiness like a common cold. I suggest he gets a wife and some hobbies.’

I slowly swung back to face him and made a conscious effort to bite my tongue. If I put that prescription to him, 30 years after it was written, I’d be hauled in front of the GMC. But why? The content of the psychiatrist’s letter said so much more than the comfortable euphemisms used today, euphemisms that speak volumes precisely because they say so little.

We all know and use terms like dysthymia and are happy to trade them because their facelessness shortcuts a deeper meaning. Why confront or pretend to understand the misery of our fellow creatures when we can comfortably hide behind the smooth, bunkered walls of language?

Like a thoroughly modern doctor, with one eye on the contract and one eye on the time, I arranged PHQ-9s and thyroid function tests and reeled off his prescription for happy pills. As he left I was no nearer to helping him, and a voice from the past rang in my ears.

‘What a miserable sod, he really could use a wife and some hobbies.’

Dr Kevin Hinkley is a GP in Aberdeen, Scotland

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