The patient was the only child of hard-working immigrant parents, and his identity revolved around his career. His brief but regular visits with the physician allowed him to express his anger and sadness about his disability. Eventually, the patient was able to channel his anger and his drive to work into a successful woodworking business. Clearly, validation of the patient's feelings by the physician assisted in the restoration of self-esteem. The visits were useful in identifying the central issue and maintaining the patient's self-esteem.
Some patients have feelings of depression as a result of learned helplessness.
7 Learned helplessness is most often accompanied by feelings of powerlessness and frustration. However, feelings of anger, resentment, shame, guilt, fear and anxiety can also be prominent. These patients are frequently refractory to conventional antidepressant drug therapy or psychotherapy. The aggression or frustration identified in the affect is mobilized and rechannelled into self-fulfilling ways of being. The question concerning what is most troubling about a patient's situation often evokes responses that trace the pain of these patients to their early memories of trauma.