A single case can be illuminating, especially when it is statistically banal—in other words, not at all exceptional. Yesterday, for example, a 21-year-old woman consulted me, claiming to be depressed. She had swallowed an overdose of her antidepressants and then called an ambulance.

There is something to be said here about the word "depression," which has almost entirely eliminated the word and even the concept of unhappiness from modern life. Of the thousands of patients I have seen, only two or three have ever claimed to be unhappy: all the rest have said that they were depressed. This semantic shift is deeply significant, for it implies that dissatisfaction with life is itself pathological, a medical condition, which it is the responsibility of the doctor to alleviate by medical means. Everyone has a right to health; depression is unhealthy; therefore everyone has a right to be happy (the opposite of being depressed). This idea in turn implies that one's state of mind, or one's mood, is or should be independent of the way that one lives one's life, a belief that must deprive human existence of all meaning, radically disconnecting reward from conduct.

A ridiculous pas de deux between doctor and patient ensues: the patient pretends to be ill, and the doctor pretends to cure him. In the process, the patient is willfully blinded to the conduct that inevitably causes his misery in the first place. I have therefore come to see that one of the most important tasks of the doctor today is the disavowal of his own power and responsibility. The patient's notion that he is ill stands in the way of his understanding of the situation, without which moral change cannot take place. The doctor who pretends to treat is an obstacle to this change, blinding rather than enlightening.

UPDATE: On the other hand, this fisking by Tim Blair of a D.C. columnist wandering in bewilderment through Red-State America and hearing the impossibly sensible warm tales of life in the land of responsibility—and concluding, of course, that such a thing can only exist in association with intense racism and bigotry—is worth reading too. I sure hope that this reassurance that the journalist musingly gives himself makes his city life seem less, well, unhappy.