Case 2, Episode 2: Constructing a Life Timeline – More Than a Psychiatric History
“I don’t even remember when it started.
Maybe it’s always been there.
Like a dull hum in the background of everything.”
— Marcus, 48
When a patient has lived with depression for decades, asking “when it started” may not lead to clarity. Instead, it may surface a deeper truth: the symptoms and the self have become intertwined.[1]
Marcus doesn’t just have depression.
He’s begun to identify with it.
This is where many clinicians give up—or pathologize further.
But for those of us willing to stay curious, this is where transformation begins.[2]
Why We Don’t Just Take a “Psychiatric History”
Psychiatric history often sounds like this:
First episode of depression at age 25
Second episode at 31, after divorce
Hospitalized briefly at 35 after stopping meds
Multiple med trials, therapy “on and off”
Useful—but not enough.
This kind of history tells us what happened.
But not why it mattered, what it meant, or how it shaped identity.
That’s where the Life Timeline comes in.[3]
The Life Timeline: A Clinical and Narrative Tool[4]
This isn’t just an interview technique.
It’s an act of respect.
It says: You are more than symptoms. Your life has a shape. Let’s trace it together.
What to Map:
Major life events – moves, losses, trauma, accomplishments
Relational shifts – caregiving dynamics, breakups, betrayals, absence
Identity chapters – “Who were you becoming then?”
Emotional signatures – what feelings defined each era?
Internal narratives – “What did you start to believe about yourself?”
Let’s apply this to Marcus.
Marcus’s Life, Unfolded
Childhood (0–12):
Raised by a single mother who worked two jobs
Describes her as “strong, but not available”
Father left when Marcus was six—“just stopped calling”
“I learned not to need anything from anyone.”
Adolescence (13–18):
High achiever in school, but socially withdrawn
Experienced bullying, minimized it
First major depressive episode at 16: “Didn’t tell anyone. Just kept going.”
Graduated early, left home at 18
Early Adulthood (19–29):
First love at 20, ended suddenly when partner moved abroad
“I never really recovered from that. I just shut it down.”
First therapy attempt at 25—left after 3 sessions: “It didn’t do anything.”
Adulthood (30–48):
Several long-term jobs, consistent but unfulfilling
Multiple romantic relationships, none lasting
Long periods of emotional numbing
Describes himself as “a ghost who works and sleeps”
Last therapy ended after therapist moved—“didn’t see the point of starting over”
What the Timeline Reveals
Loss and disconnection are central themes
Attachment wounds likely shape his reluctance to trust help
Emotional suppression has been adaptive—but costly
A core belief has formed: “My needs either go unmet, or make things worse”
His depression may not just be biochemical—it may be an identity scaffold
Clinical Implications: Moving from Timeline to Insight
With this deeper story in view, we can reframe Marcus’s depression:
Not just a mood disorder, but a life-long strategy of emotional self-erasure
Not just a “failure to respond to treatment,” but a system of beliefs that protect against disappointment
This doesn’t mean we abandon biological interventions. It means we treat the meaning, not just the mechanism. And we invite the person to come forward—not just the patient.
Coming Up Next: Episode 3 – Diagnostic Deep Dive
Next, we’ll look again at Marcus’s diagnosis.
Is it really just “recurrent major depressive disorder”?
Or have we missed:
Persistent depressive disorder (dysthymia)?
PTSD or complex trauma?
Subtle personality structure patterns?
Existential despair mislabeled as clinical depression?
We’ll explore the difference between labeling and understanding—and why it matters more in chronic cases than ever.
Reflective Prompt for You
How do you structure your assessments with long-term patients?
Have you ever discovered a turning point—or unspoken trauma—simply by asking, “Can we walk through your life, chapter by chapter?”
You might be surprised what emerges when you make room for the full story.
References
[1]Neimeyer, Robert A. Meaning Reconstruction and the Experience of Loss. American Psychological Association, 2001.
[2] Murray, Joanna, et al. "Primary care professionals’ perceptions of depression in older people: a qualitative study." Social science & medicine 63.5 (2006): 1363-1373.
[3] Palm, Joanna. "Time-geographic life chart versus medical chart: Do we get more information by using a time geographical life chart?." (2025).
[4] Sunnqvist, Charlotta, Margareta Rämgård, and Karin Örmon. "Time geography, a method in psychiatric nursing care." Issues in Mental Health Nursing 41.11 (2020): 1004-1010.