Posted on November 17, 2017
By Dr. Mim Fatmi
November brings a somber reminder that the days will get shorter, that the craze of pumpkin-flavoured everything is over and that most folks will retreat indoors under layers of blankets as the world outside gets blanketed in snow. Winter is often a time when people keep to themselves, preoccupied with getting through the work day and looking forward to cozy nights at home with their loved ones.
When I started residency in psychiatry, I don’t think I truly appreciated what I was getting into. To me psychiatry was a medical specialty like any other where I would learn about diseases of the brain, learn appropriate medications and stay up to date with the research. What I found instead—rather, in addition—is that psychiatry is a specialty of human connection above all else. And when done right, this kind of understanding has the potential to allow someone to see everyone around them as a complex summary of their past and present experiences, to hear someone’s story non-judgmentally, to speak to them compassionately.
Unlike the rest of medicine where an abdominal exam is an abdominal exam, the signs of meningitis are unanimous and nearly every physical exam maneuver should be conducted in the order of Inspection-Percussion-Palpation-Auscultation, I’ve learned that the psychiatric assessment is more of an art. Sometimes I strike gold and get a patient who can articulate every one of his or her symptoms, but more often than not, I am dealing with barriers of paranoia, lack of trust, irritability, emotional dysregulation, or a simple refusal to engage with any health care professional. In these cases, for me to spend an hour building rapport can sometimes be more useful in the long run than doing a psychiatric screen. When one year ago I would have been just as disgruntled with an uncooperative patient as they were to be talking to me, I’m grateful to say that I’m learning to have a more nuanced understanding of why patients react the way they do. Is it really helpful for me to declare a patient too irritable to interview and cut the session short, or would both I and the patient benefit more if I tried to understand what’s causing her irritability? Maybe with a bit of coaxing and compassion, I would get to hear her story of having just been assaulted by her ex-boyfriend, being sabotaged by his family, having her catering business uprooted, losing everything she worked for, now accepting life on the streets… and maybe I would understand that irritability because goodness knows if that happened to me, I’d be irritable too.
Psychiatry, when it comes down to it, is a study of human behaviour. What I didn’t expect when starting this residency program was how much I would learn about myself. Realising my own biases, coming to terms with my own emotions, recognizing that my strong reactions to certain patients have a lot more to do with me than with them… it’s all making me see that the fancy terminology we use like “transference” and “countertransference” are just euphemisms for asking, “how do I connect with this person?”
People are the way they are for a reason and everyone has a story. Put all the stories together and you get to see human connection in action—all we have to do is offer to listen. I challenge you all during this cold winter season to fight the urge to stay huddled up alone and reach a hand out from under your metaphorical covers to someone else, whether it be a colleague, a family member or a patient. Make an attempt at the human connection that is innate in us all, even if it’s simply sharing a hot cup of tea and you’ll be surprised at what you find out about yourself when you offer a listening ear to someone else.
Dr. Mim Fatmi is a PGY 2 in Psychiatry at the University of Calgary.