A unique branch of medicine
.
In a very basic way, doctors working in mental health use much
the same skills as those working in other areas. Medical school
always felt like a challenge in which you cram your head with as
much information as you can and hope to hold onto enough of it for
long enough to get through your exams. When I started working, I
realised that for 5 years they had been teaching me a system or a
strategy for managing sick people in a (largely) foolproof way.
When you leave medical school you have a highly systematic method
for quickly assessing the patient, rapidly identifying which one of
the thousands of things you have learnt about is going wrong in
front of you, focusing on the dangers associated with that
particular problem and quickly devising an efficient plan to deal
with what you’re seeing.
It may not always be as obvious,
but a structured approach and absolute precision are as important
in mental health as in any other specialty. The difference lies in
the knowledge base that we work from. Neurobiology and the
pathophysiology of mental illness is an important part of this
knowledge base. The same principles apply here as in any other area
of medicine. There are, however, a number of differences. The first
is that our understanding of the pathophysiology of mental illness
is more limited than in many other areas of medicine. The second
difference is that neurobiology is only one of a number of
different ways that we have come to conceptualise mental illness.
We also recognise that the mental wellbeing or otherwise of the
individual is linked to their life experiences. Their development
and experiences through childhood and beyond can be a significant
factor in the development of mental illness. More current
circumstances and life events can also contribute to the
development of mental illness. The theories and knowledge base that
underpin this aspect of our understanding are as complex and
important as the neurobiology of mental illness. The treatment of
these kinds of problems is also much less straightforward than
writing a prescription.
Treating the whole patient
The biological, psychological and
social aspects of each individual case need to be carefully
considered and attended to in thinking about management. This is a
considerable challenge and the reality is that you could happily
devote your whole career to fully understanding just one aspect of
the model. It is no simple task to develop a full and workable
model to guide your practice. Our capacity to utilise these models
to understand the people that we work with is technically
important. It is also often the case that the sense of being
understood is one of the most powerful interventions that we can
offer to the people with whom we work. In psychiatry, our
relationship with our patients is often as important as any
technical intervention that we can provide. Mental illnesses are
often considered to be less “serious” than physical illnesses. The
reality is that the morbidity associated with mental illness tops
most charts comparing the specialties. Mortality is not
insignificant and never inconsequential. Death by suicide is always
tragic and has massive implications for friends and
family.
Psychiatry is complex, challenging and
absorbing
Working in psychiatry you still use
the core skills that you develop as a medical student and a doctor.
It is complex, challenging and absorbing. The big draw of
psychiatry is that you have the freedom to make what you want of
it. You can choose to specialise in any of numerous subspecialties.
Within your specialty, you can choose to work in a way that bests
suits your personality and how you think about psychiatry. It is
this variety, flexibility and freedom that make it such an
interesting area to work. I have always enjoyed my work and found
it extremely satisfying. It’s also true that time spent with the
patients is often much more fun than work really ought to
be.