Case Study

Seth, an accountant and father of two, presented to his family physician at the urging of his wife. He complained of fatigue, difficulty concentrating, and anhedonia. His symptoms began the day of his son's 8th birthday party. He recalled inexplicably feeling a sense of dread and was near tears that day, despite having a good relationship with his son and looking forward to the party. His physician discovered that Seth's mother had died from a heart attack when Seth was 8 years old. Seth and his mother had been close; he remembered that she called him her "perfect little angel." After her death, Seth's family coped by telling him that he was too young to understand. His family avoided all conversations about his mother. He never fully mourned her. He maintained his attachment to his mother by his ambitious achievements and his perfectionism. His son's 8th birthday party reawakened Seth's unresolved maternal grief, sadness, and new symptoms of depression.

Typically, a patient in crisis such as Seth cannot explain what is upsetting him, although he is certainly aware that something is wrong. Seth's family physician asked, "Why now, at this point in time, are you depressed and feeling in crisis?" When asked, Seth felt distressed and confused. As he began to talk about his son and the birthday party, he realized that he was the same age as his son when his own mother died. He began to cry with the unresolved grief and the pride he imagined that she would have for him and her grandson.

Frequently, people in the crisis do not seek help by themselves and instead are brought in by concerned family members, lovers, friends, or perhaps the police or an ambulance. In these cases, it may take hours for the "Why now?" causes to be identified. Patients typically are not able to identify the specific cause of their crisis. Physician questioning and asking patients to retell their experience is typically how the "Why now?" of the crisis emerges. "Why now?" questioning is the first step in treating a crisis.

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