When you walk into a psychiatric hospital on the first day of your M3 psychiatry clerkship, you don’t know what to expect. It’s terrifying and anxiety-provoking for many. On the one hand, you worry about the psychotic patient that hears voices telling them to hurt other people who can be angered by something as seemingly simple as talking about the weather in the hallway. On the other, you worry about being bored to tears as psychiatrists do medicine checks all day long as most of the actual therapy of psychiatric illness is delegated to therapists. It is a great mystery that no one can prepare you for.
Most of us are influenced by a pervasive social stigma that all the people in psych hospitals are “crazy,” dangerous, or emotionally weak and unable to handle the normal stressors of life. Society has taught us to fear psychiatric patients. If a person is labeled with a psychiatric illness or spends some time recovering in a psychiatric hospital, they are forevermore considered unstable. If someone confesses that they are hearing voices, those around them automatically become uncomfortable. If someone goes to their family members and divulges their longstanding depression and suicidal thoughts, they are told to suck it up and learn to be happy. Society prefers that these people be locked away or pushed into a corner because we are all uncomfortable with facing the reality of mental illness.
When I started on inpatient psych and sat down with one of my first patients, the attending asked her, “If you could say one thing to educate a future medical student about psychiatric illness, what would you say?” She looked at me sadly and said, “Just because we have a mental illness, that doesn’t mean we are going to hurt you. We are normal people.” Having just met me, it took a lot of courage for her to tell me this as she sat wringing her hands, obviously anxious. She has severe agoraphobia, or fear of open, public spaces, and becomes incredibly nervous when around a lot of people. Those words and her solemn demeanor struck me, and made me incredibly sad.
If you sit down and really talk to most patients with severe mental illness—and I mean really talk to them—nine times out of ten, you will uncover an astounding number of biological, psychological, and social stressors both in their past and present that contributed to their mental state. Many have histories of severe psychological and physical trauma. This can be as obvious as abuse, but can also be as subtle as emotional neglect as a child. An example of emotional neglect that I have seen with many patients is patients who were raised by a depressed parent. These parents never acknowledge their children’s emotions and express to them that it is okay to feel and display those emotions. Instead, they expect the child to take care of their own adult problems and acknowledge and support their own adult emotions. There is a role reversal, and in many ways the child effectively loses their parent at a young age and has to deal with issues that they are not prepared to address. This can create a void that may lead to a variety of conditions including borderline personality disorder or substance abuse as the patient tries to find something to fill that void or cover it up. Of course, genetic predisposition can be influential, but many patients develop pathological defense mechanisms in childhood that quickly become overcome by everyday stressors leading to anxiety, depression, psychosis, etc. You won’t uncover these past traumas without digging and prodding, because many have blocked the memories. However, what doctor has the time to sit with each patient for an hour to discuss their life story?
With all that said, always consider your own safety when consulting any medical patient. Use good judgement, read body language, and don’t get yourself stuck in a bad situation with an agitated patient. But realize that mental illnesses are biological diseases. These people cannot just cheer up or pull it together, and this is not their fault. They need therapy and emotional validation, but instead most are knocked down and made to feel guilty by people claiming they are weak even though they don’t understand what these patients have and are going through. For people with low self-esteem, this can seriously set back their recovery.
Slowly, society’s view of mental illness is changing, but many of the fears and judgments are hardwired into us. It will take time, but it needs to happen. They need support and acceptance from society to help them get better, not judgment. With a better understanding of this field of medicine at a community level, there will be a push to create more resources for mentally ill patients that are currently severely lacking in the healthcare system. Education will decrease some of the stigma of mental illness and make patients who are afraid of the “mentally ill” label finally come forward to receive help. We as a community need to advocate for these patients, not beat them down or make them afraid to seek treatment.
I am from North Augusta, South Carolina, and I am a born and bred Carolina girl. When it came time for college, I happily made my way to Columbia to attend the University of South Carolina (USC). I started college in Biomedical Engineering because I figured it would be an acceptable fall back plan. The only problem was, I forgot just how dismally boring the combination of calculus and physics could become. Also, all of my medical volunteering and biology classes made me realize that medicine was actually the best match for me. I loved it. So, I made one of the more difficult decisions I’ve had to make in life and switched to biology, committing myself to a medical track. Graduating from USC with a major in biology and minor in chemistry was a big moment for me, because I was among only two or three people in my uncommonly large extended family to receive a college degree. And, I was the first to be going on to further my education. I am very excited to be starting my medical education here at USC School of Medicine Greenville on behalf of my family and myself. It is going to be an adventure and it will be difficult, but my experience here so far has made me feel that I definitely made the right choice.
Copyright 2014 USC School of Medicine Greenville