I was a young doctor in 1990 when I met a patient with rheumatoid
arthritis. Mrs. P told me quietly but in no uncertain terms that she
ticked all the boxes for a diagnosis of co-occurring depression.
When I reported this to the senior physician in charge of her case, he
said: "Well, you would too, wouldn't you?" and changed the subject. He
meant that her mood was obviously a reasonable reflection on her current
state of disability and a future of inexorably deteriorating health
and mobility. Mrs. P was "understandably" depressed because she was
thinking about, and ruminating on, what it meant to have an inflammatory
disorder. And so there was nothing we physicians could do about it. It
was a matter of the mind, not of the body—the province of psychiatry.




