It was my first night of my psychiatric residency and I was assigned to the emergency room. I was feeling quite disoriented altogether as I had just moved to Pittsburgh a few days before with my wife and four month old son. Everything felt strange, and so, for reasons I didn’t understand, I started freaking out, I started panicking : is this the right work for me? What if I can’t handle this? Is psychiatry for me? So I went to a back room and in my troubled state I called my wife. She immediately comforted me, gave me support, and advised that I simply focus on the specific patient, “the human being”!, that I was to evaluate. “Don’t get global or think of the long run, my sweet husband”, she said to me. “There’s a person there who wants to be heard; you can do this, I know you can.” And so I met with my first psychiatric patient. She was nice and gentle, it turned out, but filled with anxiety. She told me she grew up in Indiana and went to college at California University. I then asked what brought her to western Pennsylvania and she responded that she’s always been in western Pennsylvania and why am I asking her that question…… Aha!!, I thought to myself - she’s not just anxious. She’s delusional! Indiana and California are thousands of miles away! I quickly arrived at my diagnosis: Delusional Disorder, or probable Schizophrenia. Thinking I had this nailed down, I proudly reported my findings to Dr. S, the attending psychiatrist. After listening to my enthusiastic assessment, Dr. S hesitated, looked at me, welcomed me to Pittsburgh, and kindly informed me that there is a city in Pennsylvania called Indiana (where the famous actor Jimmy Stewart is from) which is about 60 miles from Pittsburgh - AND that there is a university in Pennsylvania named ‘California’, located about 40 miles from Pittsburgh. “Nice work, Dr. Guterson!” Dr. S smiled at me, “maybe you should go back and talk with her some more.” So - the patient was correct, absolutely correct - and not delusional - and so in one big swoop I was delighted that she did not have Schizophrenia, delighted to learn something about western Pennsylvania geography, and absolutely delighted to go home the next day and laugh about all this with my dear wife.
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"Ramblings on the Psych Ward"
Dear Dr. Guterson: I have a cousin who has a seizure almost every week. I don’t want to sound unkind, but I think he’s faking it. How do I know for sure?
A: Your question is one that we psychiatrists are challenged with all the time - and not only with regard to seizures. Are our patients telling us the truth?
We do have a name for seizures that are not real: psychogenic nonepileptic seizures (PNES). In short, patients with PNES often exhibit certain symptoms - like screaming or crying, side-to-side movements of the head, and closed eyes - that do not generally occur in those with real seizures. Also, those with PNES will usually ‘wake up’ quickly after the event whereas those with real seizures can be quite confused for many minutes to hours.
To help these patients, it is important to be nonjudgmental and to show understanding. In psychiatry, we see patients all the time who may make things up or who intensify their problems. Recognize that this person is in pain, probably a type of pain that is vastly different from what they are saying or exhibiting, oftentimes a deep, psychological, traumatic pain.
By listening with kindness, you will see that amazing gates of sharing will soon open up.
Dear Dr. Guterson: I’m interested in becoming a psychiatrist. Could you please tell me how?
A: Your question reminds me of what my mother said to me when I was about 15 years old: “John, you should become a psychologist; or, better yet, go to medical school and become a psychiatrist.”
I had no idea what she was talking about.
To become a psychiatrist is a long and winding road, but in my mind, it’s sure worth it.
First, you do need to go to medical school. And to get into medical school one needs (1) a college degree which includes at least one year each of biology, general chemistry, organic chemistry, physics, and math. In my mind and experience, these courses are not easy but they are also the study of G-d’s physical creation, and therefore fascinating; and (2) to take the medical school admissions test.
I will be honest: (1) and (2) above are rigorous and many people lose their momentum and ultimately get ‘weeded out’ in the process. And getting into medical school is competitive. But if you are dedicated and willing to put in the time, and keep your eye on the goal, it can certainly be done.
Medical School itself is not a piece of cake. But the coursework is certainly intriguing as one is learning and experiencing the wonders of the human body. Medical School is a four year process - I will leave the details of these four years to another time, but suffice it to say, upon graduating medical school, one then can choose the specialty one desires: internal medicine, pediatrics, obstetrics/gynecology, radiology, ophthalmology, etc.,or PSYCHIATRY!!
Psychiatry is, yes, different than most fields of medicine. It is the ultimate integration of science and art. It is the exquisite journey of the human mind and soul. And there are a huge range of possibilities that are open to a psychiatrist: hospital psychiatry; private office practice; research; forensic psychiatry; child/adolescent psychiatry; geriatric psychiatry; writing; psychoanalysis; and many more.
As medical professionals, psychiatrists have the option to prescribe medications as well as doing psychotherapy. In contrast, psychologists do psychotherapy alone.
Perhaps that is why my mother said “better yet,… become a psychiatrist.” She saw more opportunities for a psychiatrist. Who knows?
I certainly didn’t know when I was 15 years old, an age when we all know way more than our mothers.
(Postscript to my readers: please don’t misconstrue my words. I think
the world of good psychologists, who are generally much more gifted at
psychotherapy than we psychiatrists.)
- Dr. John Yaakov Guterson