My first several patients were what you might call textbook. As they shared their histories, I had no trouble making connections between their grievances and their upbringings. But soon I met a patient I’ll call Lizzie. Imagine a bright, attractive 20-something woman with strong friendships, a close family, and a deep sense of emptiness. She had come in, she told me, because she was “just not happy.” And what was so upsetting, she continued, was that she felt she had nothing to be unhappy about. She reported that she had “awesome” parents, two fabulous siblings, supportive friends, an excellent education, a cool job, good health, and a nice apartment. She had no family history of depression or anxiety. So why did she have trouble sleeping at night? Why was she so indecisive, afraid of making a mistake, unable to trust her instincts and stick to her choices? Why did she feel “less amazing” than her parents had always told her she was? Why did she feel “like there’s this hole inside” her? Why did she describe herself as feeling “adrift”?