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How Ya Doin'?


Modern medicine has come a long way in treating diseases that at one time were considered fatal. But science may be lagging when it comes to measuring a person’s wellbeing especially when it comes to treating depression. KUNC commentator Dr. Marc Ringel has more.

Over the last century or so modern medicine has drawn an ever more detailed map of depression, its psychodynamics and its neurochemistry.  Much of the miracle of medical science, including in the field of psychiatry, has come from maintaining a narrow objective focus on pathology, too often at the expense of considering patients’ own experience of their health and illness.

Today we treat depressed people with counseling, psychotherapy, medication, and electroshock, continuing until, hopefully, they’re not depressed any more.  With these therapies, we tend to shoot for a normal that is defined as the absence of symptoms of depression.  Is there a more ambitious target?  Happiness maybe?

It’s estimated that about one in ten American adults is depressed.  And the incidence of depression is way higher in people who suffer with a host of chronic diseases.

We also know that depression is not only the result of many medical problems but also a risk factor in their cause.  Coronary artery disease, stroke, diabetes, chronic pain and Alzheimer’s are but a few of the illnesses that can be both causes and effects of depression.

Research has demonstrated, in a multitude of ways besides the obvious that striving to live without signs of depression is well worth it.  But isn’t happiness even better?

Doctors are just beginning to look at treatment goals for depression that are above and beyond absence of depressive symptoms.  We now have a new tool to measure the emotional wellbeing of patients who suffer with depression.  It’s called the Remission Evaluation and Mood Inventory Tool, REMIT for short.

REMIT is a set of five simple questions that amplify and focus the picture generated by the usual depression questionnaire.  Standard tools have focused on negative feelings and symptoms like hopelessness, sleep and appetite disturbance, and suicidal thoughts.  Remission of a mood disorder is judged by absence of these adverse characteristics.

REMIT asks if, in the last two weeks, on a scale of one to four, the respondent has felt happy, content, in control of his emotions, and resilient.  The one negative question is whether the future has seemed dark.

When REMIT is paired with the PHQ, a standard depression questionnaire that focuses on symptoms, the combined 13-question test has been found to be over 70% on-target in its estimate of patients’ own sense of recovery from depression.  The scale also correlates well with level of function at home, work and leisure.  Considering how complicated a disease depression is and how brief and simple the questionnaire is, this is a very good result.

Let REMIT be, to all who work in health care, a reminder of why we have chosen our profession.  Sure, we battle disease.  But ultimately, we’d like to help people be not only healthy and functional, but happy too.

One place to start regaining some of the high ground from our habitual preoccupation with pathology is to take seriously the question of how to measure wellbeing.

Inquiring if a person is happy, content, in emotional control, and resilient may seem like an awfully obvious way to assess how someone’s doing.  But modern medical science is just now figuring out the utility of posing, in a more formal and structured way, a question that the folks of the Jersey Shore have been asking since about when the white folks arrived.  “How ya doin’?”

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