On the palm of my right hand, I carry a 10-year-old scar. I blocked a Coke can hurled at my head by a patient furious at me for recommending hospitalization. Sometimes, after long days treating the severely mentally ill, I see the scar and wonder why I stay at my job.
I have options. The daughter of pre-managed care physicians, I grew up with privilege and opportunity. My summers featured tennis and trips abroad; I graduated from an Ivy League university and completed medical school with negligible debt.
I never fancied myself a suburban Dorothea Dix, 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 in public mental health for reasons not at all noble: I couldn’t handle a growing family and full-time psychiatry practice complete with the headaches of billing insurance. All I wanted was a salaried job and the 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 state clinic treating the severely mentally ill.
Initially, I hated it. I thought my patients hated me. They would enter my office practically spitting phrases like: “No more stupid questions!” or “Quit abusing me!”
Now, after two years, I have seen patients go from mean, confused and sometimes scary to polite, lucid, even timid, after continuing their medications. And over and over, I have seen them stop taking medications because they don’t want to believe they are really sick. Or, they accept the popular misconceptions that mental illnesses are due to bad choices, poor willpower, or irreversible personal flaws.
In truth, severe mental illnesses like schizophrenia are the result of imbalances of brain chemical messengers such as Dopamine and Serotonin. We are just starting to understand these illnesses.
Schizophrenics experience horrifying hallucinations and paranoid delusions along with more subtle symptoms like apathy, impaired concentration, and lack of forethought. Their actions may appear aggressive or bizarre, but are the unfortunate result of these symptoms. Surely, the worst aspect of untreated schizophrenia must be the inability to discern reality, snaring the victim in a web of perpetual fear.
But recovery is possible, thanks to new medications that don’t leave patients “drugged.” With improved cognition, patients can finally question their delusions and make choices apart from fear or faulty information. And sometimes, they can rise above the “system” to become productive citizens.
After two years, my patients are just beginning to trust me, but I have learned much from them. 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 now is that of my preschooler). They have taught me to be less judgmental and more patient as I wait for them to respond to the care they receive.
I believe we can learn about ourselves by remaining open to what others, even the most severely ill, can teach us. And I believe that we should do whatever possible to care for these sickest members of our society who have not chosen the illnesses that ravage them.
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