My interest in psychiatry had been growing during my first year slowly although it was something I never put much thought to when I first entered medical school. My first year was tough and I had been through enough treatment of my own by that point to realize several things about psychiatric treatment. #1- It worked. A patient really could be happy after years of depression and sadness. #2- It was not just witchcraft. There was serious scientific data to back up the treatments used and with neuroimaging a growing science, data showing changes in the brain function and structure in mental illness was becoming quite prominent. #3- People did not have to suffer, so why should they? The treatments available were growing rapidly, bringing the promise of much better qualities of lives for patients who received the right care. I wanted to be a part of that.
Psychiatrists do not talk about their personal lives as they are not there to burden their patients with their issues or bias them in any way. Truth be told, though, a large percentage of them have struggled with mental illness at some point or dealt with it in family members. This is part of what drives them into the field. They know how it feels to hurt. They know how it feels to be told "just get over it" or "you just need to pray more, you're a bad Christian" or "you're weak" and so on. They understand the pain their patients feel when they hear that, and how much harder it makes recovery from illness become. So they know how to listen to their patients and empathize with what they are feeling.
I am no different having struggled with depression on and off for years and finally found myself in the hands of a competent psychiatrist who helped me lock the pain away and move on. The world became a different place, more beautiful, less angry. One that I could more easily separate myself from the negative parts and enjoy what I had. Does that mean that I do not worry about the wars in Africa? Or the unspeakable acts of cruelty that occur in Darfur and the Congo and ask why did I deserve such happiness and why to those women suffer so? No, I still ask that, I still give money to Doctors Without Borders, and hope someday I can take a sabbatical to work with them. But it does not rule my life. I can enjoy the things I have and consider myself blessed.
So I had found I field that I felt called to but was still unsure as I knew that most of my patients were not going to be depressed medical students. I applied for and was accepted to an internship in a program in my city that placed interns in sites that helped underserved populations. I had requested and was placed at a facility that provided housing for homeless mentally ill people. This is one of the finest facilities providing for the homeless that I have ever seen. More than a shelter, they provided permanent housing to persons who were far too ill to be able to tolerate more structured settings and ensured that they were safe, warm and fed. They did monitor their medications although they tolerated medication refusal to some degree. Many of these patients without this facility were wandering the streets, living in boxes, sleeping on grates for heat in the winter. They were leaving themselves open to assault, rape, the elements, and starvation. These were the sickest of the sick patients out there.
I spent the summer helping out with various activities, monitoring the front desk, helping residents out with tasks, but much of the experience was to introduce me to the services available to the needy in the city. I learned a lot there. Like the Antichrist is really a pretty nice guy who will always offer to buy you a pop. Like schizophrenic patients often tell you about having past careers in fields they did not have to fill the void of their empty past. That a patient who is catatonic looks scary, but is pretty much harmless. That mentally ill women who have gone homeless have often been raped, assaulted, mistreated in terrible ways adding PTSD to their already disabling list of diagnoses. That a homeless women without legs who has her wheelchair stolen may get no help from her "sane" neighbors, but that a mentally ill friend may go to the to ends of the Earth to make sure her friend gets a new wheelchair. That just because a patient is mentally ill does not mean they are just crazy and do not deserve respect.
That was when I was certain that I wanted to pursue psychiatry. That was my dream.
To be continued.
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