"DON'T BE SO SURE IT'S PUMP HEAD " >Page 1,
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Zen and the art of diagnosing depression
Even before "pump head" pried its way into public consciousness, cardiologists and cardiac surgeons were notoriously poor at recognizing depression in their patients. This failure is not because they are uncaring, cavalier, or ignorant. The problem is deeper than that – it goes to their nature.
If the Zen masters had contemplated physicians’ inherent natures, they would have identified at least two opposite aspects. (This is no trick. Zen masters always identify two opposite aspects of everything.) And cardiologists and psychiatrists embody these opposite natures.
The cardiologist’s nature is to embrace the concrete, the mechanistic, the object that can be analyzed, broken down to parts and assemblies, and held in the hand and examined, component by component. The heart, being essentially a sophisticated pump, is thus inherently attractive to the cardiologist, an object worthy of one’s entire career.
The psychiatrist’s nature is just the opposite – it is to embrace the unsubstantial, the ethereal, the abstract. They dedicate their lives to the study of behavior, a topic viscerally incomprehensible to cardiologists. And the psychiatrist's organ – the brain – just sits there, for goodness sake.
Depression is a condition inalterably within the realm of psychiatrists, and to expect most cardiologists to notice states of depression less severe than near-catatonia is to expect Bill Clinton to eschew impropriety. In other words, cardiologists are not trying to cause harm when they fail to diagnose depression – they just don’t see it. They are focused – by their natures – on a completely different aspect of reality.
How will pump head complicate this picture?
The new-found popularity of "pump head" will pose a further problem to many of the cardiac patients suffering from depression. Many of the symptoms of pump head and depression are the same – the memory difficulties, the mental sluggishness, the often subtle personality changes – and it seems clear that these conditions are likely to be confused.
But pump head, as it is now conceived, is fundamentally different from depression. Pump head represents an organic brain problem – possibly caused by a showering of the brain with tiny particles (microemboli) arising from the heart-lung bypass pump used in open heart surgery. Actual physical brain damage is present, according to this explanation. As such, pump head is not directly treatable. The good news (if there is any) is that pump head has not been associated with increased mortality.
Depression, on the other hand, is behavioral. And while there is a physiologic cause for it in many cases, that cause is most likely a chemical imbalance in the brain, rather than anatomic brain damage. Depression can usually be treated effectively, often by using drugs that restore a more proper chemical balance. And if untreated in the cardiac patient, depression substantially increases the risk of future cardiac events and of death.
Therefore, when a patient is suffering from symptoms compatible with either of these two conditions, it is important to decide which condition is causing them. More accurately, it is important to rule out depression – the more dangerous and the more treatable of the two.
Unfortunately, considering how poor cardiologists already are at diagnosing depression, the confirmed existence of – and the growing popularity of – pump head will make the accurate diagnosis of depression even more unlikely.
Consider:
- With all the recent publicity, people with symptoms compatible with pump head will be more or less expecting to be told they have pump head.
- For the same reason, the diagnosis of pump head will also be at the forefront of the doctor’s mind, and is likely to be the first thing they think of.
- Pump head, being an anatomic problem as opposed to a psychological one, will be inherently more understandable to cardiologists than depression, and therefore inherently a more attractive diagnosis.
- Since there’s no treatment for pump head, once the doctor make the diagnosis he/she is pretty much done.
- In contrast, when diagnosing depression the doctor may be letting him/herself in for hard-to-understand psychological testing, trial-and-error treatment regimens, longitudinal follow-up, and (horrors) possibly a referral to a psychiatrist.
- Since patients often mistakenly believe that clinical depression is a sign of personal weakness, some might rather accept a diagnosis of pump head (which is, after all, an act of God over which they have no control) instead of a diagnosis of depression.
All in all, diagnosing pump head just seems much easier. It is the course of least resistance. Depression, a condition already grossly underdiagnosed in cardiac patients, is likely to fall even further off the radar screen.
For anyone who actually has depression, this failure can constitute a disaster.
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