Wells: And is your work essentially the same as it was in pre-corona world? Or are you kind of doing or experiencing something different now?
Rapke: That’s a hard question. My answer is always: It depends, as a psychologist. The content is technically the same, our role in the hospital is still the same, but our method of doing that is very different right now. Normally, I’m physically in the hospital five days a week, so virtual is all new for us. And we’re also really only seeing people when they absolutely have to be here, so the cases we’re seeing are a little bit more severe.
James Hamblin: When we talk about depression, often the medical system has the job of distinguishing: Is this a context-dependent situation where it’s going to go away? And at what point it becomes a pathology.
I understand it is a spectrum, but you as a clinician, you have to decide whether or not someone gets that diagnosis in their chart or doesn’t. There’s kind of a black line that has to be drawn because of the way the system is arranged, at least. And I’m wondering if that line has changed for you at all in the current situation.
Rapke: I see it on a continuum. All of us have varying levels of depression at different points in our life. All of us have varying levels of mood swings at points in our lives. When does it get to the point where, as a profession, we draw this line? The DSM is the main way we do that, where you have to meet certain numbers of criteria, but I never want a family to feel like that discounts their experience. So I don’t in any way want people to misunderstand that just because we don’t say that it gets this code doesn’t mean that that discounts their experience.
Just to go back, it has changed a little bit. At what point would we just talk to a friend? It’s very similar to medical triage, but it’s sort of developing what those levels are. Can I call a friend and feel better, and that sort of changes things? Or have I called all the friends, baked all the cookies, and I still can’t seem to get out of this funk? That’s sort of the first level. If getting up and going for a walk, doing things that would normally help me feel better, talking to somebody that always helps me—if that doesn’t do anything, now we’re to the next point of: How long have I been feeling this way? Has it been just today? Or has it been lasting several days, where I really can’t seem to get myself out of this state?
At that point, you really need to reach out to somebody, whether you have a pastor or a good friend that has a little bit of experience or knowledge. It’s at that point that maybe you need to reach out and do a little bit of screening, maybe even go online to some of the screeners online, some of the reliable ones through your local hospital.
And then I think at that point, if that screener comes up, if your friend who normally can snap you out of it thinks this is more than your normal funk, then it’s time. You definitely have to reach out to somebody, whether it’s a hotline, your pediatrician, a counselor you’ve talked to in the past.