A Narrative-Based Approach to Teaching Diagnostic Criteria

Appendix

Sample Narrative Passage and Scoring Rubric

More than four years ago—on May 26, 1998, to be exact—I awakened during another restless, dreadful night. The clock read 4:15 a.m., so I closed my eyes and tried to be calm. It didn’t work. I got out of bed. “This must end, today,” I thought. “I can’t sleep. I can’t eat. I can’t teach. I can’t even read or write.”

After taking a walk around our farm, I brewed coffee for my wife, Diane, and me, and then helped get our 16-year-old daughter, Alexa, off to high school. Diane asked if she should cancel her appointment to go horseback riding. “No,” I said. “I’m a little less depressed, and you can’t just sit around here all day after and take care of me like I’m a baby. By the time I get a haircut, you’ll be back.”

As soon as she had driven away, I put all the antidepressants and sleeping pills I had into a small satchel, added a full quart bottle of vodka, and headed my car toward Highway 95. I didn’t know where I was going, but it certainly was not to the barber. As I crossed the bridge into Pennsylvania, I vaguely remember seeing the sign for Highway 32, and I exited. The sun was shimmering on the Delaware River, which only made keeping my eyes on the road more difficult. I saw a sign for New Hope (or was it No Hope?) and drove into town. I wandered up one street and down another until I saw a sign for the Wedgewood Inn. I had never been there before, but I was too agitated to look further. The Wedgewood it would be.

The proprietress looked askance at the luggage I carried but showed me to a small room anyway. “This will be fine,” I think I said and closed the door. I sat down on the double bed with its chenille spread and put the pills and the vodka on the bedside table. Slowly, almost ritually, I took one or two pills at a time, washed down with a generous swig of vodka. By the time all the pills and more than half the vodka were gone, I started to feel less wired—even quiet. As I lay down and sank toward what I believed would be death, I found myself thinking of a relative who had committed suicide this way some years earlier. Perhaps I connected with him because my jumbled brain thought he, and only he, might comprehend what I was doing.

• Rosenberg, L.E., Brainsick: A Physician’s Journey to the Brink. Cerebrum, The Dana Forum on Brain Science, 4(4), 2002. Available online at https://www.dana.org/Cerebrum/2002/Brainsick__A_Physician’s_Journey_to_the_Brink/. Note: this passage is reproduced with the express permission of Cerebrum and The Dana Foundation.

What symptoms of a Major Depressive Episode is this individual exhibiting?

• 1 point for poor mood

• 1 point for decreased sleep

• 1 point for difficulty concentrating

• 1 point for poor appetite

• 1 point for + suicidal ideation

What other data would you need to determine if this person meets the criteria for major depressive disorder?

• 1 point for duration ≥ 2 weeks

• 1 point for r/o other mental health dx

• 1 point for r/o physical health dx

• 1 point for r/o substance-induced mood disorder