Friday, November 21, 2008

a week in psychiatry

to be honest, i was of the impression that psychiatric illnesses are all psychological or social in aetiology, with no biological origin at all. i didn't like that doctors used drugs that mess with the nervous system instead of psychotherapy to correct symptoms of depression, anxiety, psychosis. after all, every mental illness could be traced to some element in a person's past, right? some kind of traumatic experience? or unfair pressure placed on someone? once you bring it all out and use cognitive behavioural therapy, things should all go back to normal, no?

i was initially pretty mad when one of my lecturers told me that 70% of psychiatric disorders can be cured with the right medication. that's not a cure, i thought to myself, that's merely controlling symptoms so that patients can resume a somewhat, but not completely, normal life. what i didn't realise at the time was that that was precisely what the goal of psychiatric medicine is.

it's been a week since i started my psychiatry posting and it's taken that long for me to finally accept that most conditions have a biological basis, whether it be an imbalance of neurotransmitters or a genetic predisposition, and hence could be treated medically just like any other illness. the drugs don't act to ignore the possible underlying psychological factors contributing to the disease, they enable patients to lead less distressing lives and allow their loved ones some relief from the stress, pressure and sometimes fear of caring for them.

but it all got me thinking about how unfair it is for some people to be more susceptible to mental illness than others. i personally feel that it's more difficult to deal with someone who has a sickness that is usually not manifested physically, a problem that no one can see. since humans are social beings that place emphasis on being socially acceptable, a psychiatric patient has to face social stigma and, if surrounded by people who don't make any attempt to understand their conditions, will possibly never be able to function normally again.

i was particularly upset yesterday when i saw a teenage girl who possibly has asperger's disorder. her brother's known to have some mental retardation, as does her mother. no one's noticed that she has a problem of her own, probably because the attention has always been on her brother. as a result of that, she is ostracized in school, she gets in trouble with the teachers for her lack of tact, and worse of all, she doesn't even know that the things she says are not politically correct and she doesn't understand why her behaviour is socially unacceptable.

it's hard enough being a teenager...but to be a teenager with undiagnosed asperger's disorder? i'm sure she never asked to be born that way.

it's a good thing that her father, who seems to be unaffected, is patient and has always been supportive of her brother. that probably means that if she does eventually become diagnosed with a mental disorder, he'll be supportive of her too. still, it made me wonder why some are spared from that kind of anguish while others have to go through life misunderstood.

anyway, just thinking out loud. i still need to remind myself to liken mental illness to other medical conditions. i need to tell myself that "cure" means something broader in psychiatry, that medication is necessary sometimes, that psychotherapy still has a role to play and, God willing, some patients do eventually recover enough and not require therapy any longer.

sigh. i'm not sure if i wanna be a psychiatrist anymore, not even for the extra 2 weeks' leave. it really is an emotionally taxing profession. i have nothing but utmost respect for psychiatrists who manage to keep their faith in God and in humankind after practicing for many years.


*note: i watched a movie a couple of years ago about a love story between two people with asperger's syndrome. the movie is called "mozart and the whale", starring josh hartnett. do watch it if you have the chance.

lishun at 12:00 AM