One's Inner Being

"Mental Illness is NOT contagious; you cannot catch it by being kind."-Hope Warriors

It was a hot day; and as some unspoken rule would have it, the conference room in which I sat with eleven other classmates awaiting the arrival of the Chief Psychiatrist, was cranked up to the highest notch. My expectations and tolerance for the cold became seemingly overwhelming.

Social media and society has done a great job at stigmatizing mental disorders and those who are mentally ill, to the point where I unconsciously had a fear of being in a room with a Psychiatric patient participating in a Psychiatric interview.

Our rotation was 8 weeks long and unbeknownst to me at the inception, an interest in Psychiatry and a hunger for advocacy was soon sparked. I'm not sure where you are currently located in the world and the sort of views you or society may have towards the mentally ill, but here in The Bahamas Psychiatric and Geriatric patients are two populations of my society that are often victim to stigma, prejudices, neglect, ill-treatment and disrespect in healthcare.

The following are a few tips I picked up to help avoid counter-transference and to ensure adequate care is offered to this population of patients.

Psychiatry is a specialty of medicine that requires patience, empathy, compassion, attention to details, active listening skills and most importantly respect.

2 Months In Psychiatry Taught Me This

1. Mental Illness Is NOT Contagious

It goes without saying that one cannot 'catch' a mental disorder by touching a person with a mental disorder. Despite knowing this, Psychiatric patients are often treated as if their condition is contagious.

They are scorned by some medical professionals and thanks to the entertainment industry, they are viewed as violent and harmful. There are some instances in which patients are aggressive and may become hostile; in these instances you must ensure the safety of other patients as well as yourself that goes without saying, however, simply because one has a history or diagnosis of a mental disorder should not dictate the level of service or care you offer as a medical student or healthcare professional.

After all the Hippocratic oath and our societal contract expects us to provide adequate and appropriate care to ALL regardless of creed or race.

"I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice."

2.  Taking a Psychiatric History Requires Patience & Practice

With every specialty, there will be some variance when taking a history from a patient or guardian of a patient. In Psychiatry there are certain things such as the patient's childhood development and interpersonal relationships that are vital. These are personal questions that may be difficult to ask, but are important to finding out why your patient is demonstrating certain behaviors.

Be sure to practice this skill and to take advantage of opportunities that may present themselves to practice. This may be during ward rounds or clinic. Take note of how the Consultants are addressing patients; look out for the tone of voice they use with persons who may be bipolar or depressed or in a highly expressed state and always ensure that you are accompanied by either a superior or orderly when having to interview a patient outside of ward rounds.

3. Read

The Diagnostic and Statistical Manual of Mental Disorders -5 was my go to resource for this rotation. It provides definitions for mental disorders as well as the symptoms, clinical presentations and their management and treatment. 

Bare in mind however, that patients rarely present with the textbook descriptions, or fit a mold so deriving a diagnosis will be based on your observations of the patient from the moment they enter the room to the time they exit, attentiveness to the patients answers and your ability to ask appropriate questions. Collectively, you would be able to find pertinent positives and negatives for each of your differential diagnosis which would further lead you to a diagnosis.

By actively reading, you would be able to participate in class discussion, have queries clarified and be able to learn more during the rotation. 

4. Bedside Manner-IT MATTERS!

Believe it or not, your bedside manner is affected when you view a patient as a particular condition rather than a patient. 

What does this mean? It's simple, the moment you approach a patient after having read their notes or previous case files and you get a glimpse of that diagnosis of 'Schizophrenia' for instance, you automatically start trying to stuff them into this mold of the disorder based either on what you've read in the DSM-5, First Aid for Psychiatry or your Kaplan and Sadock. By doing this you unconsciously ignore the person and once this happens, the patient ends up suffering-even if it is just marginally, the family questions your ability and you may sad to say it, miss properly identifying, diagnosing and managing their disorder. 

Give this a try; (this is based on a conversation I've had with my friend who's a Clinical Psychologist, who was very kind as to shed some light on things that would be beneficial to future Physicians) you can try this during a clinic day or during ward rounds. Try treating your last patient as if they were the first person you were seeing for the day; you know when you're all excited for the day to begin and looking forward to being on the wards. Take record of whether or not your bedside manner at the start of your day was superb, when it started to deteriorate, what factors of your day influenced your patient interaction and if you allowed counter-transference to dictate your level of care. 

5. Not EVERY treatment Works

We've seen it before if not heard it before, treatments do not work for everyone in the same manner. The same is true for treatment of mental disorders. Once we accept this as medical students and soon to be practicing Physicians, we will be less frustrated with the patient and better clinicians. 

By understanding the intricacies of the pathophysiology of mental disorders, it's safe to acknowledge that medicine doesn't have any answers as far as proper management and care. It may provide dampening effects for certain disorders and allow a patient to be functional, however it's not the case for everyone and that's alright. When you accept this fact upfront and relay this information to your patients and their families and caretakers, you will find that the disorder becomes better managed because you're not setting unrealistic high expectations based on clinical trials that failed to take your patient population into consideration. 

Feel free to share in the comments below your thoughts and experiences. 

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