I’m officially done with my psychiatry rotation! Being at Brookdale Hospital I was able to see and learn SO much and I’m definitely grateful for that. There’s so much value to being exposed to so many different areas of medicine not only to figure out what I like, but also to gain insight into how I might identify problems within patients I might not routinely see later on when I’m practicing on my own. This may be the only time I work in psychiatry, but psychiatric problems and principles are important in every area of medicine- because we’re all people, and we all think and feel.
Before working in a psychiatric unit I commonly heard people talking about patients who were “crazy.” In fact, the word “crazy” is pretty commonplace amongst much of our vocabulary when referring to psychiatric disease. Dealing with “crazy” people. Or perhaps being “crazy” ourselves. This brings me to lesson number one from psychiatry: I don’t believe that any patients were actually crazy.
Let me explain.
Almost 80% of the patients admitted to the floor had Schizophrenia (or some kind of alternative like Schizoaffective disorder, depression with psychotic features, bipolar with psychotic features). Many patients heard voices talking to them about themselves, about others, about day to day tasks. Patients also had delusions that led them to into dangerous situations.
We have this tendency to just label: crazy. But after talking to these patients, you realize that if you’d been through what they had….you’d probably be crazy too. Their childhoods were tarnished by sexual and physical abuse, abandonment, and neglect. They’re living in shelters, have no money, no job. One of the doctors I worked with would always tell patients they were NOT crazy. He explained it as follows: the patients are just under a lot of stress. When the stress becomes severe it can work in ways that alter brain chemistry and cause their minds to start playing tricks on them. Whether it’s in the form of voices, mania, depression, or anxiety, there is a common ground: stress. So it’s not that people are crazy; it’s that they’ve become a product of their circumstances which can deteriorate quickly especially in the face of genetic predisposition to psychiatric illness.
Lesson Number Two: Psychiatric illness can be absurdly debilitating.
I spent the first two years of medical school reading about medicine. The textbooks talk about 33% of patients with X disease doing poorly and 10% of patients with Y disease making full recovery. And as strange as this sounds, I just never really thought about that. Like, thought about what is really means to have a debilitating illness. I was working in a hospital where patients were continuously readmitted, and where many of them had little chance of getting much better. One very frustrating aspect of psychiatry which is unlike most other areas of medicine is how frequently patients lack insight into their illness. That is, they don’t believe they are sick. They don’t believe they need medicine. But they do very deeply believe their delusions despite evidence proving them wrong. The voices they hear are real to them. And many times, it becomes even more difficult to treat these patients in part because they don’t think they have a problem- so why take these meds that have all kinds of adverse effects from sedation to severe muscle stiffness. Would you want to take a medicine that made you feel so uncomfortable? Thus we run into the problem of patients who are unable to care for themselves or put themselves in danger.
The upshot is that the really severe patients are very difficult to treat. And they can’t care for themselves, hold jobs, or function in society. We are so limited in this area of medicine and have a long way to go towards understanding what more we can do to help.
(Caveat: most of the patients I was seeing were from a poor area and severely decompensated- there are many people who have very good insight into their illness and do quite well with therapy and medications)
Lesson Number Three: Don’t forget who your patients are.
It’s one thing to read about a disease in a textbook and know everything about it; it’s quite another to stand in front of a patient who has that very disease and talk to him or her. There were days when the only things I’d talk to a patient about were their own lives; what they enjoyed, who they lived with, what their ambitions were. And then it was no longer about the disease, it was about the person. It was about really knowing that patient- not as “the one with Bipolar Mania” but the one who told me all about her fashion design company and styling commercials and making millions (even if none of it was true…). Psychiatry is all about relating to people and building trust. Then again, a lot of medicine is too.
All in all, psychiatry was a great experience. Next I’m on to surgery for 10 weeks! Definitely scared of how many hours I’ll be working each week and how to keep up a workout schedule But more on that to come!