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Today's Psychiatrist

People think that if you are a psychiatrist it means you push medications on people. Nothing could be further from the truth. Sure some bad apples do. And yes we do prescribe but most of us don't unless we really need to.

"Oh so not a real doctor then, how do you like being a psychologist?"

I imagine how much pleasure my medical school friends would get a kick out of that statement.

How is it with mental health dominating the political agenda when I tell people I am a psychiatrist I get a blank if somewhat scared stare back? Is it still that clouded in mystery?

"So you can read my mind? That's so scary!" She says to me.

"Errr no that's a psychic." If I had a penny...

It's a very regular occurrence that people either don't really understand what a psychiatrist is or what we actually do. And that surprises me in 2015 especially when the major political parties are banging each other over the head (no pun intended) explaining how they would make mental health a priority.

When I start to talk about treating people with schizophrenia and bipolar affective disorder I get looked at as if I work as an SAS paratrooper in Afghanistan.

"Wow that must be sooo dangerous!"

Patients when unwell do get agitated but I have worked as the head of a PICU (psychiatric intensive care unit) in London and as a junior doctor in the ER in America and it's a myth that people with mental illness are much more violent than the general population.

Give me a patient with psychosis over someone who's been binge drinking all night and is strolling around A&E on a Friday night anytime.

So why do some of us doctors go into psychiatry?

A lot of my colleagues went into particular areas of medicine because they were moved by a kindly inspiring GP or their family was affected by a particular illness. For me it was no different.

I definitely had anxiety growing up. It got very bad when I moved schools as a child. I looked around and I realised I was totally alone in my new environment. I was lucky enough that a new classmate, Jonathan, whom I am still friends with to this day took me under his wing and made life bearable.

It was probably then that the seeds were fertilising in my mind of a desire to learn about mental health and I began thinking how I could help other people when I got older. But how to get there?

I went to medical school for 5 years. I learned everything from cardiology to neurology and really enjoyed my psychiatry rotation. It was the only rotation I saw where the doctors would sit and spend some time chatting with the patients building trust with them at St Clements Hospital in East London.

The psychiatrist I shadowed was bona fide cool. Outside of ward rounds he would sit in the smoking room, light up a smoke and sit there chatting away with his patients! Hard to believe today I know.

He used his communication skills. The doctors were not just scientists but they were often analytical and thoughtful. Some used their psychodynamic training, others didn't, but the debates were fascinating.

I was hooked.

What separates us from other doctors is that we can't order a test and definitely say the patient has this or that. We consult with our teams, we debate, we think.

It reminded me of my English lessons at school where we dissected what an author or poet was trying to say in their work. What do our patient's symptoms tell us? In that respect I suppose things have not changed since the days of the pioneers of psychiatry such as Kraepelin and Bleuler, Jung and Freud.

My training then meant moving on to work with children some who needed slow and sensitive care after being through some horrific and traumatic childhoods. Being a big kid myself it was easy to try and build rapport over a game of Monopoly.

So this is work? I loved it. I filled my book case with literature and kept going.

Image: Blogger's own

I extended my rotation at Edgware Hospital in London from 6 months to 1 year.

We work with families, we hear secrets that patients have kept to themselves for years and I myself have held some people's hands when minutes earlier they had taken a razor to their wrists.

Nurses, OTs, psychologists we all work together to show people that we can hopefully help them live to fight their demons another day. We don't give up on getting someone through a crisis.

People think that if you are a psychiatrist it means you push medications on people. Nothing could be further from the truth. Sure some bad apples do. And yes we do prescribe but most of us don't unless we really need to.

One Flew Over the Cuckoo's Nest may in fact represent asylums of the past but I am pleased to say those days are long gone.

We know that mental illness can affect any of us or our nearest and dearest.

I remember when my sister came down with post-natal depression and I was quick to send her to a colleague and with the recommended treatment of medication and care she was well again within a few weeks. And I was proud of how far we have come and how effective our treatments are.

The question I get asked most often is "don't you take it all home with you?"

And if I am honest the answer is yes of course I do. I couldn't be a good doctor if I didn't.

So the next time you tell your psychiatrist that they don't understand what you are going through and they don't care - you might just be wrong.

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