On Psychiatry

During the first two years of medical school we were taught to ask everyone we interviewed about a history of physical or sexual abuse. I’ve fortunately never been abused, and erroneously believed that the prevalence was low so I would often skip over the question. I told myself it was because I didn’t want to make the patient feel uncomfortable, but to be honest I was afraid that the answer would be yes and I’d say the wrong thing. There was nothing I could do at that point as a medical student to help and I thought it’d be worse to bring up a terrible memory for the person.

To my shock, about 80% of the patients I’ve talked to over the last six weeks on Psychiatry have said yes to the abuse question. That’s not to say that people that have been abused exclusively go on to develop Psychiatric illnesses or that all Psychiatric patients have been abused, but the prevalence was striking. It likely would be just as high in other medical specialties because Psychiatric patients have comorbid diseases like heart disease, diabetes, osteoarthritis, etc, but this was the first time in 12 weeks of rotations that I’ve actually asked. I’m sure I’ve seen patients that have been abused on Family Medicine or Internal Medicine, but at the time I assumed that they would volunteer the information if they wanted help. Looking back on it now, that was a big mistake.

I was surprised when I realized over the last 6 weeks that I could actually help people that said they’d been abused. Talking about it, while painful, offered a cathartic release for many of the patients. We gave them medication to help with their flashbacks and concurrent depression or anxiety, and offered supportive therapy for them to deal with the consequences of their abuse. It was the first time since being on rotations that my job was to worry exclusively about someone’s mental wellbeing instead of viewing distorted cognition as a roadblock to treating someone’s medical illnesses. I love hearing people’s stories and I relished in talking to people at length to find out how their life has shaped who they are. I enjoyed figuring out how to help them and to provide support. Most importantly, I learned a lot about how to approach patients–there’s way more below the surface than their chief complaints.

Before this rotation, I honestly thought Psychiatrists only treated floridly psychotic patients with out of control bipolar or schizophrenia. I thought anti-psychotics were meant to dull the mind and offered little relief than to zap someone’s consciousness so the delusions would stop. But I’ve seen medications take people from the brink of psychosis, with little hope of functioning, to relative normalcy. It’s given people that have lost control of their minds, an opportunity to regain some function and live with autonomy. Anti-depressants and anxiolytics have helped people going through really horrible life situations the support to keep going.

I’m astonished by how prevalent mental illnesses are and how little they’re being talked about. I’ve heard a lot of really heartbreaking, messed up stories in the last few weeks. Narratives that consume the lives of the ones that wrote them are kept inside. People that you encounter every day at the store, in traffic, or in the classroom. No one is immune. It’s made me think twice whenever I get angry at someone driving slowly in front of me or am wary of the cashier that’s frowning in the grocery store. Instead of a knee jerk reaction to judge someone, I think about their story and how it’s shaped who they are today. There’s a reason for everyone’s behavior. No one’s an asshole for no reason, and understanding that has given me more peace and empathy.

I likely won’t go into Psychiatry, but it’s opened up a new world to me in regards to patient care. I won’t be afraid to ask patients the hard questions about things like abuse because mental health needs the attention it deserves.

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