Psychiatry has always been one of those rotations that I had dreaded because of the heavy subject matter. At the same time, I have looked forward to going through this because I was hoping to finally be able to reduce some of my own prejudice and stigma around mental illness (we all have some of it, let's be honest). I had come into this rotation with certain ideas based on my own anecdotal encounters with family members who suffered from mental illness, as well as my own experience with caring for my mental health in this rigorous program. I would like to share with you some of the thoughts, feelings, and lessons that I have experienced over the last three weeks.
1. Psychosis is anxiety on steroids
Psychosis is effectively a loss of one's connection to external reality; it can manifest with features such as paranoia, hallucinations, etc. Contrary to what I had previously believed, psychosis is a response in some people to overwhelming anxiety. When emotions become too overwhelming for a person to handle sometimes their brain will create these psychoses as a way of alleviating that anxiety. We have all experienced anxiety and seeing psychosis as an extension of that for me has helped me better relate to these patients.
2. Psychosis is on a spectrum
Again from anecdotal experience with people I know, as well as input from the media, I had always thought that psychosis was like an "all or nothing principle" and that one day people "snap". One of the greatest revelations I have had in this rotation is that psychosis is on a spectrum and many people who are psychotic have good insight into their condition. I have had numerous patients tell me that despite taking their medication they are still hearing voices in their head that tell them to hurt themselves and others. They know these voices aren't real and are in their head. They try very hard to ignore them but sometimes it can be very difficult. They have calmly and eloquently explained this to me, stating that they think they need a higher dose of their medication which is supposed to stop these voices.
3. Personality is fluid
Prior to psychiatry, I had always confused temperment with personality. Temperment is more of an animalistic state of being, i.e. are you a calm person vs someone who is more volatile at baseline. Personality is a combination of a person's temperment, opinions, personal characteristics and emotional responses. Growing up as a somewhat anxious person I had always felt that there was no hope in changing something that was so ingrained in me. However, through various psychotherapies we can change our emotional responses and various facets of our personality. These changes are a slow and require a lot of work. But the way a small simple stream of water can erode a boulder, we all have the ability to change ourselves. Even looking back on the last three years I have noticed changes in my personality - I have become more positive, more patient, and more spontaneous based on the experiences I've had and my own personal commitment to self growth.
4. I have much admiration and respect for the patients I have met in the ER
I know that seems like an odd thing to say - that I admire patients coming to the ER for psychiatric care but I promise it will make sense so please hear me out. These people have often been through so many traumas and overcome so much in life, I can't even begin to imagine what they must have gone through. Many of them have such strength in the face of adversity. They come to the ER because they have insight into how they are feeling and have recognized that they have exceeded their capacity to cope on their own. I think we can all remember a time where we were overwhelmed and were maybe too afraid to ask for help. It takes tremendous strength to reach out to others for help, and even more to open up about pain and suffering to a stranger.
5. People with psychiatric issues are good people who need help
The majority of people I have met were contributing members of society, highly intelligent and caring people that grew up in environments where they were never able to learn proper coping mechanisms to deal with the difficult situations that they were living. I will never forget one man whom I met in the emergency room. He had presented for suicidal thoughts after many months of loss; first his job, then his family under tragic circumstances. When I came to see him, he was sitting and listening to another patient who was crying in a corner. At the start of our interview, I had asked what they were talking about and he said the following: " We are all kind of in the same boat here in the ER, but that doesn't mean we can't be there for each other. I had nothing else to do and if I could sit and listen to someone and have them truly feel heard why shouldn't I? Is that not what being human is all about?" My inner clinical instincts recognize that this is partially a coping mechanism on his part. That aside, throughout the interview this patient strongly valued being kind to your fellow man - something we can use more of in world of violence and unsightly comb-overs.
Over the past three weeks, I have seen more random acts of kindness in the psychiatry emergency than I have for months walking around the streets. I hope that reading this blog has helped you to have a greater appreciation for the people behind the labels of psychiatric illness.
1. Psychosis is anxiety on steroids
Psychosis is effectively a loss of one's connection to external reality; it can manifest with features such as paranoia, hallucinations, etc. Contrary to what I had previously believed, psychosis is a response in some people to overwhelming anxiety. When emotions become too overwhelming for a person to handle sometimes their brain will create these psychoses as a way of alleviating that anxiety. We have all experienced anxiety and seeing psychosis as an extension of that for me has helped me better relate to these patients.
2. Psychosis is on a spectrum
Again from anecdotal experience with people I know, as well as input from the media, I had always thought that psychosis was like an "all or nothing principle" and that one day people "snap". One of the greatest revelations I have had in this rotation is that psychosis is on a spectrum and many people who are psychotic have good insight into their condition. I have had numerous patients tell me that despite taking their medication they are still hearing voices in their head that tell them to hurt themselves and others. They know these voices aren't real and are in their head. They try very hard to ignore them but sometimes it can be very difficult. They have calmly and eloquently explained this to me, stating that they think they need a higher dose of their medication which is supposed to stop these voices.
3. Personality is fluid
Prior to psychiatry, I had always confused temperment with personality. Temperment is more of an animalistic state of being, i.e. are you a calm person vs someone who is more volatile at baseline. Personality is a combination of a person's temperment, opinions, personal characteristics and emotional responses. Growing up as a somewhat anxious person I had always felt that there was no hope in changing something that was so ingrained in me. However, through various psychotherapies we can change our emotional responses and various facets of our personality. These changes are a slow and require a lot of work. But the way a small simple stream of water can erode a boulder, we all have the ability to change ourselves. Even looking back on the last three years I have noticed changes in my personality - I have become more positive, more patient, and more spontaneous based on the experiences I've had and my own personal commitment to self growth.
4. I have much admiration and respect for the patients I have met in the ER
I know that seems like an odd thing to say - that I admire patients coming to the ER for psychiatric care but I promise it will make sense so please hear me out. These people have often been through so many traumas and overcome so much in life, I can't even begin to imagine what they must have gone through. Many of them have such strength in the face of adversity. They come to the ER because they have insight into how they are feeling and have recognized that they have exceeded their capacity to cope on their own. I think we can all remember a time where we were overwhelmed and were maybe too afraid to ask for help. It takes tremendous strength to reach out to others for help, and even more to open up about pain and suffering to a stranger.
5. People with psychiatric issues are good people who need help
The majority of people I have met were contributing members of society, highly intelligent and caring people that grew up in environments where they were never able to learn proper coping mechanisms to deal with the difficult situations that they were living. I will never forget one man whom I met in the emergency room. He had presented for suicidal thoughts after many months of loss; first his job, then his family under tragic circumstances. When I came to see him, he was sitting and listening to another patient who was crying in a corner. At the start of our interview, I had asked what they were talking about and he said the following: " We are all kind of in the same boat here in the ER, but that doesn't mean we can't be there for each other. I had nothing else to do and if I could sit and listen to someone and have them truly feel heard why shouldn't I? Is that not what being human is all about?" My inner clinical instincts recognize that this is partially a coping mechanism on his part. That aside, throughout the interview this patient strongly valued being kind to your fellow man - something we can use more of in world of violence and unsightly comb-overs.
Over the past three weeks, I have seen more random acts of kindness in the psychiatry emergency than I have for months walking around the streets. I hope that reading this blog has helped you to have a greater appreciation for the people behind the labels of psychiatric illness.
