Trapped at the End of the Second Act

In the standard movie formula, the end of the second act is when the main character appears to have lost everything. All efforts have failed. Love is beyond reach. The future is bleak. The end is near. Then comes the third act bringing resolution and relief.


Richard J. Metzner, M.D.

Clinical Professor

Semel Institute for Neuroscience and Human Behavior at UCLA


To the extent that we are all living inside our own movies, our scripts (or “narratives,” as some call them) often follow a similar pattern. We go through life seeking what we seek until we reach a point where it appears that our youthful “first-act” dreams aren’t going to come true. Goals are either unattained or less rewarding than expected. Harsh realities ultimately turn all dreams into something less.

Those of us who are resourceful or blessed, may still end up with a satisfying third act. We transcend the obstacles at the end of our second acts through combinations of good fortune, personal effort, outside help and some attitude adjustment.

Unfortunately, the third act never seems to arrive for some people. I’m not just talking about the satisfying ending. I’m talking about not being able to escape the bleakness at the end of the second act to the day where hope reemerges. In my forty years as a practicing psychiatrist, I’ve come to recognize this second act syndrome as the inner state of people suffering from clinical depression.

Depression steals away hope and the possibility of pleasure. In its throes, there is no joy in the present and no way out. There can be no third act because the story is frozen at its heart. Love is not enough for these people because the chemistry of love requires ingredients that have gone missing. The third act cannot begin without those ingredients, which also fuel the courage and determination to overcome formidable obstacles. How can people with this paralyzing condition ever get their lives started again?

This is where the story takes different turns, depending on who collaborates in the “re-write.”  The treatment of depression for many adult patients is about finding ways to get the third act moving. Those who know about chemistry (doctors and psychiatrists), typically get the story going by writing their script notes on a prescription pad. Others (psychotherapists) are better at dialogue. Some, fortunately, understand the value of both. They are the ones who can collaborate most effectively with the person whose story needs to resume again towards a revitalized ending.





Copyright 2012, Scaled Psychiatric Systems, Inc. All rights reserved.