Cogs And Gears

William was rather brutish.  Although his large beefy hands rested quietly at his side for the moment, they danced around the room when he began to talk.  At first look, one could mistake him for slow, an oaf.  But this was miles from the truth.  A skilled engineer, he made a living building complex machinery.

William understood cogs and gears.  He understood the complex interrelationship between moving parts.  So to talk with him about the pathophysiology of diabetes or the mechanics of a heart valve was natural.  It took months, however, to breach the issue of depression.  After a prolonged divorce and layoff, his mood was slumping.  Yet only recently was I able to convince him to start an antidepressant.

A few weeks later, his spirits were gently rising.  The cloud around his humongous cranium had started to part, and the rains had contracted to an infinitesimal pitter patter.  The visit started on a high note, but quickly became contentious.  When I mentioned the referral to a therapist, I felt like William chewed on my words and spit them out on the side of his chair. 

Doc, I solve problems with my hands, not my mouth!

Of course, I knew that this was not true.  His profession required on the spot thinking and innovation every day.  But William didn't feel these things came from his mind.  It was as if his limbs had their own master control center and worked independently from the rest of his body.  I thought for a moment before speaking. 

Depression is like being stuck in a hole twenty feet below the ground.

William's eyes narrowed but I caught a sparkle of recognition.  I could see that my analogy resonated.  He shifted in his seat and waited for me to continue.  I paused for effect.

Antidepressant medication is like having someone lower a ladder down to you.

Again I watched and waited for him to react.  His chest moved up and down but the rest of his body was still.  He was soaking in my words and allowing them to wash over him.  I wasn't sure yet whether he was buying my pitch, but I wasn't going to stop now.

You see the ladder and feel a burst of hope, but your not sure if you can make it all the way up.

I stopped.  I wanted to make sure I finished the analogy correctly.  I figured I had one shot to convince William.  There would be no second or third chances.

Therapy teaches you how to climb the ladder.

Without it,

your still a man stuck in a hole.