In the initial diagnostic stage of treatment, the disease perspective alerts the clinician to exhaust empirical medical data provided by the presenting problem and gathered in the patient’s history. A recent physical examination is necessary for any disorder that may have somatic roots.
Dr. M.’s knowledge of Sally’s behavior was grounded in a careful history taking, which indicated that a major mental illness had afflicted the patient’s mother. While certainly the illness could have affected the mother-daughter relationship in many ways (e.g., making the mother less emotionally available), Sally’s bipolar disorder might also have genetic components.
The disease perspective correspondingly alerts the clinician not to rush prematurely to establish an etiology rooted in a “meaningful explanation” of the problem. For example, it would be facile to attribute Sally’s behavior to some fault in the marriage or to personality factors such as inappropriate dependence on male approval. Indeed, almost all depressed individuals attribute their depression to life situations, in an understandable attempt to develop a rationale for the way they feel. It is much easier to say “I am depressed because of the way my life has gone recently” than to say “While things have not been perfect, all in all everything has been going as it usually does. It is just that my depressed mood has a life of its own. My neurotransmitters must not be working properly.”
The former is an attempt at a meaningful explanation (to be examined in the life story perspective, while the latter is a (rarely heard) appreciation of the depression from the disease perspective.
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