Insanity is a state of profound self absorption.
-Siri Husvedt, A Summer Without Men
The background is this. I started my fourth year in Medicine a month ago, and my first placement has been in Psychiatry. Psychiatrists are doctors who specialise in mental health… this is different to psychologists who have learned the theory of mind and behaviour, but do not have a medical degree. (That wasn’t intended to be patronising, many people don’t know the difference and it just makes sense to put it out there first). I must admit that before starting, I knew very little about this field… and even now I have hardly scratched the surface of it. But being on this placement has had a more profound effect on my worldview than any other placement I have experienced so far, so I figured I could share a few thoughts. Here it is ladies and gents, medics and… normal people with better life choices, what I have learnt so far from my Psychiatry posting.
1. Mental Illness is not an abstract thing.
With 1 in 4 people experiencing a mental health condition in the UK, it still astounds me the way in which people think that mental illness isn’t a real disease. Let me tell you now that a placement in Psychiatry will cure that. Mental illness is a very very real thing. Just as much as a broken arm or a viral infection. Ultimately we, as humans, are massive organisms and our thoughts, feelings and ideas are strung together by chemicals in our brains called neurotransmitters.
In the same way that an imbalance in insulin in your body can cause you to develop Diabetes…an imbalance in brain chemicals can cause you to develop a mental health problem.
The factors that influence Diabetes can be genetic and environmental- same with mental illness.
How is Diabetes treated? Well, if it isn’t all that severe- the first thing your GP will do is say ‘Let’s look at your lifestyle. Have you thought about your diet?’, and try and get you to take active steps to change your eating habits to help cure your physical illness. What if your Depression or Anxiety is mild and is in early stages of treatment? Your GP may refer you to Psychotherapy or Cognitive Behavioural Therapy in order to try and change your thinking habits to help cure your mental illness.
What if your Diabetes is more advanced and needs more than lifestyle changes to help you get out of it? You will be prescribed drugs, such as Metformin to stabilise your blood sugar levels. What if your mental illness is more advanced? You are prescribed antipsychotics or antidepressants to help stabilise your mood.
Same shit, different part of the body. If there is any one thing you will take away from this post… let it be that mental illness is a disease just as much as physical illness.
2. Insanity is a state of profound self absorption.
I wish this was my own quote but it’s actually from my favourite book of all time (‘A Summer Without Men’), and it is said by a woman who has just undergone a bout of Reactive Psychosis after her husband left her. Last week, I saw an elderly gentleman with Schizophrenia, who was entirely convinced that he was being stalked by a drug gang. His belief in this was completely unshakeable. Imagine being that absorbed in your own delusions. Imagine living in a world where you can’t let other people in because you are in a constant state of paranoia. And imagine not realising that, not being in control of that, and all that happening to you because you are ill. This is not only a lesson for Psych but a lesson for life. I always remember this quote when I find myself being a bit too self absorbed. It reminds me to let other people in, because that is the only thing on earth that will, quite literally, keep me sane.
3. Every branch of Medicine should strive to see the whole person.
The thing about mental illness is that it doesn’t just affect your stomach, lungs or bowels. It affects your entire being. And thus, Psychiatrists, by default, are forced to view people, not just as body parts with diseases but as people. I went into Medicine for the people, and most days all I have seen in front of me are diseases. Textbook cases. ‘Go see the patient in Bed 2 because he has classic signs of Myasthenia Gravis’. Patient in Bed 2 also has a wife, 2 kids, a job, a worldview, and a personality. I can’t stress enough how important a lesson this is for medical students, doctors, nurses… and anyone in the healthcare profession. If you strive to see the whole person as well as the disease, you will deliver the most kind, compassionate and genuine care. This will set you apart from all the other doctors, nurses and medical students on that ward. I hope I keep this in mind for the rest of my life.
4. Psychiatrists are the nicest doctors I have met to date.
And no… it isn’t because they are the touchy-feely-lovey-dovey-‘let’s have a chat about how you feel’ type. This is an overgeneralisation, but out of all the doctors I have met so far, Psychiatrists seem to be the best communicators. They’ve given the most varied and interesting lectures- not because of the lecture material but because they’re pretty captivating. They listen. They take an interest in you. They also have seriously tough shells because the kind of thing they see in day to day life is not for the faint hearted. God bless the (good) Psychiatrists of the world.
5. Some people have had genuinely terrible lives.
Due to the person that I am, I sometimes get crazy urges to hug people when I’m all full of love or sympathy. I spoke to a 65 year old gentleman the other day (The guy in Bed 5 with really good liver signs) who has had a history of Alcohol Abuse ever since his separation from his wife. He’s the guy who you pass on the street and avoid because his beard is overgrown and he smells a bit. We are not placed upon this world to judge people’s life choices because we don’t know what the hell they have been through. Despite his beard and smell… I wanted to hug the life out of this man because I wanted to make him better (thankfully I did not act upon said urge because I don’t want to be chased with a Fitness to Practise form from the GMC). When you face these people every day, you give thanks that your life is less tragic than theirs. Let us all take it upon ourselves to be compassionate human beings all the time because what do we know about people really?
Well, there you have it.
Three rants and a host of intense opinions later, I wonder what this placement has done to me. I’ve learnt about Depression, Schizophrenia, the difference between Delusions and Hallucinations, the side effects of typical and atypical antipsychotics and how to do a Mental State Examination. I’ve also learnt a bunch of things about life and the practice of Medicine. I hope I’ve articulated myself well here and I hope nothing I have said has been of offence. Like I said… I have merely scratched the surface of this specialty and I know nothing. These are just my thoughts.
A career in Psychiatry? Hmmmm…. I haven’t totally ruled it out!
Take care folks, and stay sane,