This I Believe

(Dr.) Elizabeth - Clayton, Ohio
Entered on February 14, 2007

I carry a scar on the palm of my right hand from a10-year-old injury. Furious at me for recommending hospitalization, a patient hurled a Coke can at my head; I blocked it with my hand. After long days treating the severely mentally ill, I look at the scar and wonder why I stay at my job.

After all, I have options. The daughter of pre-managed care physicians, I grew up with privilege and opportunity. My summers were filled with tennis and trips abroad; I attended private schools, graduated from an Ivy League college, and completed medical school with negligible debt. I finished my residency around the time that managed care was getting started.

I never fancied myself a Dorothea Dix type, nobly toiling for the mentally ill. After giving birth twice during residency, I was too tired to advocate for anything but a good night’s sleep. I chose to work with the severely mentally ill for reasons not at all noble: I couldn’t handle a growing family and full time psychiatry practice complete with the headaches of justifying to my patients’ HMOs why they needed the medications I prescribed to them, why they couldn’t be cured in 2-5 sessions. All I wanted was a salaried job and the local mental health center had one to offer.

The first years of my public mental health career were rocky. I almost quit after the near collision between Coke can and skull; I did quit after my third child was born. Then I was offered a position at a clinic treating the sickest of the sick: patients referred to this clinic because they had “failed” every other form of outpatient treatment.

Initially, I hated it and believed that the patients hated me. They would enter my office practically spitting phrases like: “Don’t ask me anymore damn questions,” or “Quit abusing me.”

After working in this clinic for almost two years, I have seen patients go from mean, confused (and sometimes scary) to polite, lucid (and often timid) after staying on their medications. And I have seen them stop taking their medicines over and over because they don’t want to accept that they are sick (who would) or because they believe their illness is a result of bad choices (that they can change on their own) or irrevocable defects (from which they can never recover).

Whether they accept it or not, my patients ARE sick; their illness is characterized by brain chemical imbalances (that we are only starting to understand) of neurotransmitters like Dopamine and Serotonin. These imbalances trigger horrifying hallucinations, delusions of persecution or paranoia, and the more insidious symptoms of apathy, impaired concentration, and lack of forethought. Though my patients’ actions may appear aggressive or bizarre, they are the understandable result of these symptoms. Still, the worst thing about untreated schizophrenia must be an inability to discern what is real and living in constant fear as a result. Recovering from schizophrenia is possible as many newer medications do not leave patients “drugged” but instead preserve cognition, giving them the ability to question their delusions and make choices that are not based on fear or faulty information.

I have learned from my patients who, after nearly two years of seeing me regularly, are only now beginning to trust me. They have taught me to be thankful for opportunities I have been given and for things I took for granted such as the fact that the only voice interrupting me when I type is that of my preschooler. They have taught me not to judge them based on first impressions but to give them a chance to respond to the care they receive.

I believe that we can learn about ourselves when we remain open to what others, even the most severely ill, can teach us. And I believe that we should do whatever we can to care for the sickest members of our society who have not chosen the illnesses that ravage them.