She said goodbye to me for a long time, but her smile still stayed in front of my eyes, leaving me with a cold to the bone.

She was introduced by a colleague of mine. Colleagues said that this 20-year-old girl, studying at a prestigious university in Beijing, has excellent grades and is sunny, but only her mother knows that she is depressed, lonely and eccentric. The mother comforted her, encouraged her, and blamed her, but it was useless, and the mother-daughter relationship became ossified.

This summer, the mother noticed that the child occasionally overeats, vomits, and cries for several hours before realizing that something is wrong. My colleague found out about the situation and found me.

I asked, "How long has she been like this?" ”

My colleague replied, "It's been like this since middle school, about three or four years." ”

I felt sorry in my heart and said, "It's been too long! Let her come to me, don't delay, the sooner the better! ”

Yesterday afternoon, she walked into my office.

Her first impression to me was a bright smile, generous and decent. Round face, big eyes, shiny, youthful. In short, a very likable girl.

I sat her down, and after a few pleasantries, she said, "You don't look like anything is wrong, you smile so beautifully." Is your smile from the bottom of your heart? ”

As soon as she finished speaking, her eyes darkened, and her eyes turned red; Then I saw her tears rolling down.

She said: "For many years, my face is smiling, my heart is crying, my heart is cold. ”

Here's what she had to say:

"I've been introverted since I was a kid, I'm not happy, I don't like to be busy, I always like to be alone. Later, I left my hometown to go to middle school in another place, and I became even more lonely. In my junior year of high school, I was nervous and stressed, I couldn't stand it anymore, and I felt like I was going to collapse. I couldn't lift my spirits for anything, and I held on until the college entrance examination. I always thought that when I went to college, my studies would be less hard, and the environment would change, and I would get better. ”

"Who knows, going to college is getting more and more uncomfortable. University is different from middle school, no one cares, and the homeroom teacher doesn't see each other a few times a year. My classmates also took care of each other, and no one paid attention to me. My dormitory mates knew me a little better, but they didn't. They said that my family conditions are good, I have everything, and I am not happy, which is hypocrisy. ”

"I know I'm not normal. But I don't want others to see it, so I have to work hard. I was the head of the Liaison Department of the Student Union, and I pushed myself to do a good job. As soon as I relaxed, I was very tired and tired. In the morning, when there are no classes, I will lie in bed for a long, long time. ”

What follows is my Q&A with her:

"What you were interested in in the past, are you still interested in now?"

"I didn't have anything to be interested in since I was a kid. Growing up, everything I did was because I felt like I should do it. ”

"So you don't have any happiness in your day now?"

"Occasionally, when I've done something difficult, I'll breathe a sigh of relief and feel happy."

"It's not really joy, it's just relaxation after tension and stress. True happiness comes from the bottom of my heart. ”

"Yes."

"Is there anything you like to eat?"

"No, I just think I should eat."

"Do you have a boyfriend?"

"Nope. I see that many of my classmates have boyfriends, and I think I should have them too. I tried, but I couldn't really get started. ”

"Are you hesitant to do things?"

"Very hesitant. It's a little thing to think about. ”

"Do you have low self-esteem and self-reproach?"

"Yes, since I was a child, I have had good grades, and everyone praises me. But I don't know why, I feel inferior in my heart, and I think everyone is better than me. ”

"Do you have a situation of self-blame?"

"Yes, when I encounter something bad, I will blame myself, regret it, and suffer."

"How are you interacting with people now? Are you afraid of dealing with people? ”

"I don't want to deal with people at all. I'm scared to call. Ever since I was a child, I was afraid to make phone calls, and I didn't call if I could. ”

"Then how can you be the head of the Student Union's Outreach Department?"

"I forced myself to do it. I want to be recognized. ”

"Isn't it tiring to force yourself like this?"

"Yes."

"Do you have any friends in Beijing?"

"There are a few classmates."

"Do you see noodles?"

"Not often. They're in town. The thought of going that far scares me. ”

"What's the matter with your overeating?"

"Once, I was so irritable that I felt like I was going to collapse, so I ate so hard that I couldn't eat anymore and threw up, and then I felt better. It was often like this in the future. "How often?"

"Once every two or three days."

"What to eat?"

"Whatever. Mostly buying a bunch of bread at the school's small supermarket. ”

"Don't pick your favorite food?"

"I don't have the concept of liking at all, I just stuff it in my mouth."

"Eat the same thing?"

"It's all the same."

"Isn't it painful to vomit?"

"After vomiting, I feel a little better."

"How long will it last?"

"Not long after. So I will come once every two or three days. ”

"So you're actually anesthetizing one kind of pain to another? And the anesthesia period is also very short? ”

"Yes."

I almost burst into tears.

I pondered for a while and asked bluntly, "Have you ever thought about dying?" ”

She smiled again and replied, "I thought that death is a beautiful thing. But I didn't really want to die in the past. I still want to live. ”

I said, "Yes, we're going to live." Let's figure it out together. We've got a way. ”

And then I said, "You know what? Your situation is not unique at all, it is typical depression, and there is a specific term for 'smiling depression'. ”

I opened my phone and found one and showed it to her:

“…… Smiling depression falls into the category of depression and is a symptom of a small percentage of people with depression. The patient seems to have a veil of a smile on the surface of the depressed state of mind. What they have in common is their unwillingness to confide and give up their 'dignity', thus entering a vicious circle......"

“…… People with smiling depression are smiling as if they were smiling, despite feeling extreme pain, depression, sorrow, and sadness deep downward. This kind of 'smile' is not a real feeling from the bottom of the heart, but out of the 'need of work', 'the need for face', 'the need for etiquette', 'the need for dignity and responsibility', and 'the need for personal future'. ”

She nodded slightly.

I said, "You're not mentally ill, you're sick." Do you refuse to go to the hospital? ”

She said, "No." ”

I further asked, "Do you refuse to go to a psychiatric hospital?" ”

She replied, "No." As long as I can get better, I'm willing to do anything. ”

My tears finally flowed.

I said to her, "In the future, if someone says that you are not strong, don't listen, don't believe it!" You're strong! It's not easy for you to stay alone in the dark for 5 years. No one is stronger than you. ”

In an instant, tears welled up in her eyes, gathering on her jaw like a thread rolling down.

No more need to say anything. I stood up and told her, "Okay, good boy, next Monday, I'll take you to the doctor." As long as you strictly follow the doctor's instructions, are not afraid of hardship, and add a little luck, after two or three months, you will be refreshed. ”

"I can endure any hardship, as long as I can get better. I've always dreamed of getting better. She said.

Take her to the doctor next Monday. I'll talk about it later.

continue

I took this girl to see a doctor today, and the doctor diagnosed her as bipolar.

I was puzzled. According to the child's account, she has never experienced mania or hypomania in the five years she has been ill.

The doctor explained to me: 1. There is a family history of bipolar, 2. Adolescents under the age of 20 have bipolar disease, 3. Overeating, which is an eating disorder, and most of them are bipolar symptoms, suggesting bipolar.

The drugs are prescribed as follows: lorazepam, debajin, lithium carbonate, prozac, aripiprazole, trihexyphenidyl diphenyxyphenidyl.

Among them, Laura is an anxiolytic; Debajin and lithium carbonate are mood stabilizers; Prozac is an established antidepressant; Aripiprazole is mainly used for the treatment of schizophrenia and has a manic effect; Trihexyphenidyl, also known as antan, selectively blocks the cholinergic nerve pathway of the striatum to alleviate the tremor side effects that may be caused by the aforementioned drugs.

Why is it so medicated? I had doubts at first. Because Prozac is a selective serotonin reuptake inhibitor, the drug has good efficacy, but has a strong irritation effect. Why choose it?

Later, the doctor explained to me that the most important symptom of this girl now is an eating disorder, and she has a bipolar comorbidity. The top priority is to curb overeating. While overeating is compulsive, Prozac is the drug of choice for treating compulsions. Therefore, although Prozac has an irritability effect, it can only be used at risk; In order to deal with irritability, it is balanced with two mood stabilizers, Debajin and lithium carbonate. To be on the safe side, the anti-schizophrenia drug aripiprazole is finally used to suppress possible mania. - This is a complete medication logic.

Depression can be traced back to human childhood. When our ancestors evolved from a hunting civilization to an agricultural civilization, some hunters who did not adapt to this change and could not master farming techniques became the earliest victims of depression.