I’ve been on psychiatry for 2 weeks now, with another month left to go. It’s been pretty interesting so far – you see everything from severe depression to psychosis to borderline personality disorder. And of course the scarier stuff like overdoses, suicide attempts, and withdrawal.
I certainly didn’t expect it to be as chill as it is. On the wards, at least, most people have been there a while and are most of the way to getting better. It’s not a lockdown ward where I work, so we don’t see much in the way of (I hesitate to use the word) “dangerous” presentations. As in, we don’t have any wanderers or overtly violent people, just a group of people most of the way to getting well.
But I have noticed a pattern, especially amongst those with chronic depression and suicidality. For lots of them, the reason they come to us is a severe drop in mood precipitated by relationship troubles, often divorce. You see it with patients who have schizophrenia, too, but there are fewer of them to begin with so it’s harder to tell. I may be painting with awfully broad strokes, here, but I think it speaks to a deeper sickness within society.
(Note: this next bit isn’t a personal affront to you – not trying to be obnoxious, just trying to provoke thought.)
Think of your typical patient that you might see in a family doctor’s office. Maybe they have high blood pressure, maybe asthma, maybe uncontrolled diabetes. Now go through each one of those in turn and decide, if you were in a relationship with them, would this make or break it?
I may be putting words in your mouth, but I’m guessing the answer is no.
But those are pretty benign, right? What about the bigger stuff like paraplegia? Cancer? Loss of limb? That makes things a bit more complicated, but I’ll bet my bottom dollar that you feel pressured to think you shouldn’t care. Because there are wonderful, beautiful people with those problems, and many of them find love.
Now think about some mental disorders you’ve heard of. Depression, schizophrenia, generalized anxiety disorder… how do you feel about those? Could you start a family with someone with uncontrolled bipolar disorder? They’re just as sick as someone with uncontrolled diabetes, but… at least for me, there’s a hesitation there. Because I’ve seen families hurt by bipolar disorder. And depression. And nearly every other mental disorder.
(Of course, you may find that you could confidently answer “yes.” Or maybe you’re currently living in a family that includes mental illness. In that case, bravo to you. Because it’s certainly something I struggle with.)
Personal opinion aside, there’s no doubt that there’s a massive double standard when it comes to mental illness. It’s socially acceptable to be hospitalized for a broken hip, but certainly not for psychosis. You automatically assume the status of “crazy.” Because that’s where crazies go – the psych ward. Movies like One Flew Over the Cuckoo’s Nest and A Beautiful Mind, while excellent portrayals of the experience of mental illness, speak rather disparagingly of the medical system and the treatments we offer. (Don’t even get me started on ECT – it saves lives every day.) Problem being, to some degree, they only emphasize the differences between the psych unit and the rest of the hospital.
Perhaps it’s because mental illness changes behaviour, and sometimes that behaviour is incongruent with what society deems acceptable. We think that it’s somehow inseparable from their core being – that their depression or anxiety is some unchangeable part of their psyche. Whereas diabetes is only related to the pancreas or COPD only to the lungs, mental illness alters the mind and the observable part of personality.
But here’s what I argue – why not consider them similar, if not the same? Illness of the nerves, of the heart, of the skin, of the mind… what difference does it make? On the psych ward, we often talk about “really sick patients” or those who are “getting better,” not the “really crazy patients” or those who are “getting less crazy.” It’s the same language that’s used all over the hospital. These are patients who are unwell. Full stop. And we always send them home healthier than when they came in. Of course, there are unique challenges to psychiatry, just as in any other specialty. Taking a history from floridly psychotic patients in the ER can be difficult, but then so can treating highly unstable patients from bad motor vehicle accidents.
I can’t pretend that I’m perfect and carry no bias. But I’m hoping that over the next month, I can try to challenge what bias remains and be a better, more open-minded doctor for it.
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