psychopathology imagined is very distant from how illnesses present in real people. the reason for this, i think, is that when we think of a depressed person, we think only about how they're depressed, and not at all about how they're a person, and after sitting and actually talking to someone with depression for 3 hours, you habituate to the sadness and the pain, and what emerges is just a core like anyone else would have. diagnosis is hard -- not just because of the therapist's humanity, but also because people contradict themselves, or misrepresent themselves, or just flat out lie

and of course there are the very human traps of wanting to diagnose people with the cool thing rather than the obvious thing (too much house!), or asking leading questions, or asking the wrong questions, and put that all together -- i guess what i'm trying to say is that what i'm doing now is hard, and hard in a different way from the academic work, because it's to do with people, who are messy, and because i often feel like i don't really know what i'm doing, and because we don't get any answers once our patients get sent away back to their primary therapists. so what you have instead is that those with high self-esteem pat themselves on the backs, and the ones with low self-esteem keep second-guessing themselves even after the report has been turned in and the patient gone forever.

i think i'm somewhere in the middle, reared on ten-year series where you get to go to the back of the book for the answers, far enough along in the process to realize the blatant stupidity of that. unlearning the lessons of childhood is a long journey; fortunately, it's one i've been given the chance to make.