Thursday, May 26, 2011

On Psychiatry

The psychiatry ward is one of the most interesting places in the hospital. What makes it interesting are the patients, I was so intrigued that I began to reflect on it.

Among them was a gentleman who would stroll along the patio singing and smiling, if you spent three minutes observing him from afar you would catch him carelessly dancing and spreading his arms imitating a bird. He was fond of purple sweaters and could spend hours staring blindly at the sky as if he was urgently waiting for rain. He was docile, meek, ridiculous and stupid. This gentleman was happy-- so much that i'll admit-- he smiled and laughed more in one day than I typically smile in one week. Each day I'd spend thirty minutes charting trying to justify medical necessity, which oddly enough, became a novel habit of mine to pathologize behavior. There is little doubt in my mind he was genuinely happy. I'm slightly embarrased to admit that for a brief moment I envied it...this of course irritated me-- that someone so delusional and cognitively impaired could be so happy. 

A question has lingered since leaving the psych ward -- would I rather live a hopelessly happy and non-functional life oblivious to society’s expectations or carry-on a high functioning existence tormented with inner demons but mitigated by self-control?

During those five weeks I was taught to observe and ascribe terms to abnormal behavior and present these findings to my preceptors to demonstrate clinical skill. Initially this kind of work was interesting… but after a few short weeks I was compelled to consider some inconvenient truths. 1) psychiatry is very subjective 2) The DSM has helped to standardize and legitimize the profession, but it begs the question, who the **** sets these standards dictating normal vs abnormal behavior, anyways?

In addition to this happy, free-flying, purple-loving gentleman, there was another man who I was assigned to shadow. This man was cunningly smart and perhaps too eccentric for society's comfort.  During those five weeks on the psych wards he showed me how to synthesize methamphetamine and even clarified some of Nietche's views on absurdism and nihilism. I was equally amused by his intellect and his buffoonery. He could predict precisely what I was writing on the chart and would sometimes remind me with a smile, "don't forget to write down my new 'delusion of grandeur". He walked the wards with a swager, smiling unpretentiously and effortlessly winning the hearts and admiration of others. Even the nurses would flirt with the guy. But it all became clear to me during the last day of rotation when he cleverly stated how he was going to be discharged soon with disability insurance, how he was working the system... stickin' it up to ******
Many questions still linger. First, what causes mental illnes? Secondly, can we really say that all mental illness is organic in nature?


o.O said...

i love the question you asked yourself? who wouldn't want to be oblivious and carefree? sometimes i do.

The nerd said...

Psychiatry is definitely an interesting field, and as not concrete as medicine is, psychiatry seems worse. I glad to be following your blog! :)