She was forty-eight, ran a regional team for a financial services company, and had been seeing a psychiatrist for eighteen months for what had been diagnosed as anxiety disorder with mild depression. She was on an SSRI. It was helping, somewhat, but she still described a quality of mental life that she found alien to herself — difficulty concentrating, a flatness of motivation, an inability to retrieve words and ideas […]

I hear this at least twice a week. A woman in her mid-to-late 40s, sometimes 50, sits across from me and says some version of the same thing: “I haven’t changed what I eat. I haven’t changed my exercise. And my body is completely different.” She’s not imagining it. The distribution of weight has shifted. There is more fat around the abdomen than before. The arms look different. The legs […]

I have a photograph on my computer — two images, side by side, of the same patient, three years apart. The later photograph was taken when she came back to see me after a period she described as “the most stressful three years of her life.” Divorce, business difficulties, terrible sleep. She was 53. The difference between the two photographs is not just lines or volume. It is the quality […]