In addition to lecture and reading assignments, the following case can be used for discussion or written assignments.
Case Study 2
Mrs. Kamala Chary is a 65-year-old woman who lived in India for most of her life and moved to the United States two years ago to spend her final years with her son. She came into the doctor’s office with a complaint of generalized tiredness. She states “I have no energy and fell tired all the time”.
Further questioning reveals that she has problems sleeping. She admits that she is home bound and does not have any friends. Rest of the history and physical is negative. She is not anemic. Recent labs are all within normal limits. She is not taking any medications. You suspect depression and you ask her “Are you depressed?” and she immediately gets upset vehemently and denies depression. She then stops engaging with you for the rest of the visit and asks her son to take her home.
What could the clinician do to help her?
Discussion
Since there is stigma about mental illness, most Asian Indian older adults will present their psychological problems with physical complaints. This patient is most likely depressed. However, the cultural taboo and stigma associated with mental illness may cause fear and thus prevent the patient from freely expressing her feelings. It is also to be noted that not all depressed patients have self-awareness about the depression. A gentle and sensitive approach to build trust and will likely facilitate an open and frank dialog. and information should be obtained sensitively and addressed carefully.
