During our first visit, Sara seemed distracted. She was a pleasant, middleaged woman who had never sought care from a psychiatrist. Several months earlier she had begun to feel tired and irritable; she thought she had the flu. When her 25- year-old son called to say that he was getting a divorce, she began to cry. “I worried I had done something to break up his marriage,” she told me, dabbing at her eyes. “I felt so guilty.” Over the following months she became depressed and so preoccupied that she often forgot to pay bills. She couldn’t sleep, cried several times a day, and ultimately broke down,.
