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   Psychiatry

Medical Student.

What Can You Expect?

Psychiatry is a fascinating discipline that captures and integrates much of why students choose to enter the medical profession.  It requires an understanding and knowledge of the physical aspects of health but also demands a sophisticated understanding of the psychological aspects of people's lives and the social circumstances in which people live.

Psychiatric disorders can be understood at many levels corresponding with this complex mixture of the individual, their society and their physical make up and developing good psychiatric management plans with individual patients is an art that is both intellectually challenging and endlessly rewarding.

Psychiatry as a career offers a huge range of potential careers in a wide range of settings across the age range. 

Reality!

"Psychiatry is a discipline that is often met with concern and stigma.  Throughout the ages, mental illness has been a historical and public curiosity.  Commonly ascribed to either divine or daemonic possession, the behaviours witnessed in those suffering from psychiatric disorders were often overlooked by healthcare until the last few centuries, seen as incurable or punishable.  Culture often falls behind science and the new understanding that it provides.  A misunderstanding or ignorance of the unknown, or indeed its mechanism, often can promote fear and superstition on both personal and societal levels.  This is a forgivably human response, gained from the early reptiles and manifested anatomically in our limbic system, and shown psychologically as fear and distrust of the unfamiliar. Just look at two year old, terrified of everything new.  Psychiatric disorders, especially those resulting in psychotic symptoms (defined here as experiences or beliefs existing in direct disregard to rational thought and proof within societal norms), often illicit this primary response. This response exists on both and individual and societal level.

So, with this societal expectation lodged firmly in my memory banks, I approached my Psychiatry placement with an air of trepidation.  Given my previous experience with dealing with mental disorders (as they are commonly labelled) within close contacts, contrasted with the overtly negative media portrayal of psychiatric illness, I found myself entering the attachment wondering if the societal expectation of these disorders would be justified.  I wondered if the myriad film biopics of famous men and women such as Howard Hughes and John Nash, portraying dramatically the emotional turmoil of mental disorders, were accurate accounts or embellished for entertainment at the patients expense.  My experience of psychiatry was a mixture of the fulfilment of society expectation, and a harsher and simpler reality.

Mental disorders are not as simple or dramatic as portrayed in the media, but the essence of each specific subtype of disorder is remarkably well captured.  A simple example would be schizophrenia, which is characterised by persistent psychotic auditory hallucinations and persecutory delusions, mixed with stereotyped behaviours.  The classic media portrayal of a schizophrenic patient is someone who believes they are being hunted, watched or controlled by an external agent or agencies, with ambiguous messages meant only for them found on television, radio, books and other media.  They also often hear voices chronicling their actions, usually with a critical judgement.  The prime example of this behaviour would be ‘John Nash’s character played by Russell Crowe in ‘A beautiful mind’.  A character who becomes gradually more convinced that he is being pursued first by the communists, then the American government.  That he is able to decode secret messages in newspapers, which if decoded would prevent nuclear war.  Although these ideas are convincing to him, those outside of his sphere, including his colleagues, watched helplessly as John sunk deeper into his fractured reality.

My first schizophrenic patient was a young man who believed that he was being watched, that an external agent was sending animals to spy on him.  He did not trust being outside, and believed that the DJ on the radio was playing songs specifically for him.  He also believed that a house further down the road was lair to his pursuers.  He often heard voices talking about him. His demeanour was of the classical type, blunted and odd, a look you would recognise given the training.  What struck me about him was the incredible conviction in which he believed his delusions, and how these beliefs changed on medication.  He was two separate people.  Very much like John Nash.  The experience of working with this patient caused me to reflect on my initial assumptions.  Like all people, regardless of my intention or ambition, the thought processes and stereotypes we build are hard to shake and my initial reaction to the patient was one of wonder and speculation.  But as I talked to him, I realised just how much like me he was, and how he experienced his thoughts, beliefs and emotions at symptoms.  He was not his disease, he simply carried it.  In my experience of medicine, people often define themselves by their conditions, and I believe this is incredibly prevalent in mental health.  This fellow defined himself as having a disease, not being the disease itself.  This realisation allowed me to connect with him on a personal level, and he often requested me back to help him. 

This theme of self-recognition seemed to prevail in those who were better treated.  It could be argued that this recognition is akin to insight, which is the psychiatric term given to realisation of reality or the false nature of delusion within a patient.  It is my belief that the self-recognition expressed in my discussion is a deeper that regardless of the reality or delusion suffered by the patient, that the sobered and treated recognition of their beliefs as symptoms of a disease process, as opposed to their own nature, is a powerful tool in management of such a condition.  The key to cultivating such a belief, from a healthcare point of view, is patience and acceptance of the patient as who they are, not based on your expectation, and working with them on a journey that they are experiencing.

My Psychiatry placement was eye opening, with its penchant to present several realities to me at once, showing the same painting drawn by multiple artists.  Regardless of medication, cognitive behavioural therapy or the pure science of the subject, the most rudimentary and best form of treatment is simply patience, understanding and acceptance of the patient, the person underneath the disease.  So my advice to new medical students entering their Psychiatry placement is very simple, go in with an accepting mind, patience and the knowledge that only true understanding of the person underneath the disease will help you form the connection necessary to help them."

Benjamin Janaway, 5th Year Medical Student
South Yorkshire

 

"Little to no exposure at all in Medical School up until the semester prior to starting Psychiatry.  Steep learning curve but very good lectures.  However, they seem almost too concise and oversimplify Psychiatry and the approach it requires.  Would have liked more about the psychological perspective of health and disease.

Appeal: Very enthusiastic Clinicians manage to generate genuine interest in a field that is unfortunately still looked down upon by other Specialties.
Senior Support: Good learning framework and support through small group teaching and ad hoc bedside teaching on placement.  Sometimes wards feel overcrowded with Students though.

Placements: Was on Maple Ward at Longley Centre.  Excellent organisation and planning of our time there.  We had the opportunity to explore some Psychiatry Sub Specialties e.g. Old Age and Community.  Would have liked more of Emergency/Liaison Psychiatry.

Reality: Very laid back placements and relaxed Ward Rounds.  Good learning environment but also a lot of down time."

Anonymous, Medical Student
South Yorkshire

 

"I was at the Longley Centre based in the Academic Unit which was great as each day we were place in different Wards around the Longley Centre as well as attending outpatients clinics.  So we got to see a variety of patients e.g. intensive treatment suite, elderly Psychiatry etc.  The staff at the Academic Centre went out of their way to teach us and we were also able to go and see ECT - which was very different to how it is described in the media!

Although I enjoyed my Psychiatry placement, it did not actually jump out at me as a strong future career option until my Paediatric placement in Grimsby.  There were so many teenagers admitted onto the ward with Psychiatric problems and it was good to see the Medical and CAMHS team working together to give the young patients the best care they could.  These patients were not under just Psychiatry but also remained under Medicine for some time as tests were performed to rule out any physical pathological causes."

Gemma Chatterton, 5th Year Medical Student
South Yorkshire

 

"I have to say that my placement here was the best organised placement I ever had.  The support staff in the education centre were astonishingly helpful and friendly.  On our first day we were provided with a lengthy induction, given a tour of the unit, given a timetable for the full six week placement, and introduced to the module lead and our personal tutors (we were each assigned to a Consultant who we met with periodically throughout the placement who we could practise long cases with and discuss things we'd seen on the attachment or ask any questions).
All teaching we received during the placement happened on time and was of good quality.  On the rare occasion that a facilitator for a teaching session did not show up, the support staff were promptly on hand in order to bleep them etc.  The amount of teaching was substantial - in addition to the ILAs, we had 2-3 extra tutorials per week on relevant topics not covered by ILAs/lectures. We also had the opportunity to attend patient consultations with Crisis Team, which was a good learning experience.  Staff who were very helpful and good at teaching during the attachment were Dr Das, Dr Taylor and Dr Ackroyd."

Cara Evans, Medical Student
South Yorkshire

 

"I had a Psychiatry placement at Chesterfield in the Summer, and it was absolutely fantastic.  We were inducted well at the beginning, had multiple Consultants who we could go to with problems and for feedback, and there was teaching every week."

Emily Alsworth, Medical Student
South Yorkshire


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