| Abstract|| |
Background: The uniqueness of mindset of an individual makes psychiatric practice interesting, sensitive, and at times subjective. The practice in setup of an organization makes the situation more complex in view of administrative regulations, existing work culture, and issues like confidentiality, etc., Dilemmas are often faced while balancing loyalty between an organization and the patients, values of the therapist and the patient, and different dimension of justice coming from different cultural backgrounds of the patients and the treating doctors. A lot of mental work needs to be put in by the practitioner to consistently adhere to medical ethics and professional approach for taking key decisions despite of contradictory external forces from within and without.
Aims: I thought of sharing my experiences especially in setup of an organization with my colleagues so that the decision-taking process becomes somewhat easy and balancing for them.
Settings and Design: I have to try to interpret my clinical experiences gathered while working with my patients from the Department of Atomic Energy as well as from my private practice.
Conclusion: The need of psycho education to self and others from time to time never ceases simply to make the practice more objective, justified, and graceful.
Keywords: Grace, introspection, psycho education, psychiatric practice
|How to cite this article:|
Patkar SV. Add grace to psychiatric practice. Indian J Psychiatry 2013;55:197-9
| Introduction|| |
Mind is not an anatomical organ, but simply a treasured perception of an individual. Precisely for this reason mental health professionals come across ample opportunities for conscious as well as conscientious learning to understand the inner and outer core of each and every unique psyche, and this process of learning becomes possible only with great will and effort on the part of the therapists.
In my professional journey, I have learnt a lot through introspection, discussion with colleagues, and asking for guidance from within.
I thought of sharing my experiences to enrich therapists who travel on the same path.
Add grace to psychiatric practice
Achievement of the post-graduate degree in psychiatry endowed upon me the license to peek into the patient's psyche for guidance and care. I thought then that I was fully equipped to do so with the adequate knowledge of psychodynamics, psychopathology, and psychopharmacology. Little then I knew that my own psyche would play a vital role in my practice and would need to be examined and cared for from time to time as well.
Initially, I used to be quite satisfied by calming a violent patient, lifting the mood of a depressive case, and allay the fears of anxiety-driven clients. I was all the more happy when I witnessed the cases of marital discord leaving my room happily holding each other's hands, and when alcoholics started remaining dry for longer periods.
My confidence was boosted when a medical student under my treatment completed his graduation and a female patient suffering from manic-depressive psychosis was stabilized with lithium therapy to the extent that that she did not even shed a tear after losing her 8-year-old son in an accident.
Then to my surprise, the daughter of the same manic-depressive psychosis case entered my room angrily and requested to stop her mother's treatment. She felt that drugs were making her insensitive, indifferent, and even unable to share grief with the family.
Now I had to revive and revise my skills of psychotherapy. My task was to enable the daughter to choose between coping with her mother's unpredictable moods or to withstand mother's self-soothing insensitivity. The different dimensions of psychiatric treatment had started coming forth. I realized the importance of education and participation of the family members in choosing the line of treatment. Thus, my own psycho education began here.
One day a patient opened the door of my clinic half way and despite my kind requests refused to either enter the clinic or go back to the waiting room. I got irritated all the more with his dumb face and requested the staff to physically take him away.
Later, after examination he was found to be suffering from schizophrenia. Suddenly, my brain signaled me that his behavior of noncompliance and presentation of dumb face were simply expressions of thought block and blunting of emotions. It occurred to me then that knowing signs and symptoms of disorders and understanding a human being were two different things. Promptly, I imparted this lesson to my colleagues as well as to my staff in the waiting room.
In course of time we started receiving referrals from other medical units. We felt that the importance of psychological factors in patient's illness was being realized by other colleagues. We welcomed the added work only to deal with greater enthusiasm and energy.
Gradually, we started noting that cases were actually pushed to us with intention of passing the buck rather than dealing with psychological roots of the problems. To take it further, the patients suffering from primary psychiatric disorders with comorbid medical illnesses were dealt with great resistance and sometimes even denial from medical community.
My ego - though angry had to lift up my spirit and driven by the ultimate goal of patient welfare my superego had to take me ahead. I started initiating one-to-one dialogue with low but firm profile with each and every medical officer who referred the cases to us. I had to convince them as to how our coordinated expertise and exercise would complement each other's treatment. I also emphasized that this approach would safeguard patient welfare as well as our legal security in matters of fitness, allotment of jobs, and issues alike. These efforts of psycho education were spreading the wings all over the hospital and beyond.
The availability of psychosocial services widened our scope of work and cases of absenteeism and non productivity at work started crowding our OPD. No doubt these employees needed our intervention, but all the same we also expected cooperation from people at the workplace. Our requests for job replacement, job transfer, or change in shift duty with due respect to work culture and administrative regulations were met with great apprehension and somewhat negative attitude.
The thoughtful analysis of this situation made us see our role from employer's and colleague's point of view only to conclude that as a psychiatrist we were expected to change the person in terms of his attitude, tolerance, and potential as well. The working community did not feel the necessity of participation for achievement of these goals at all. We smilingly wondered at their innocence/ignorance only to work on the new chapter in psycho education.
Yet we had to face one more strange phenomenon. A male employee was referred to our unit for spells of awkward behavior with female employees. Otherwise he was quite descent and adequately productive. We needed more time for investigations, expert's opinion, and study the response pattern. During this period queries from all corners of the department bombarded upon us, more out of curiosity than out of concern. We had to be extremely careful while responding to their questions in view of keeping the confidentiality over the issue concerned and maintaining the dignity of our patients.
As an extreme approach people wanted us to make the patient unfit immediately. In fact, they wondered as to why we were wasting so much time on such an indecent person. In their opinion, the dignity of women and the organization should have been our prime concern. We as decision makers were supposed to set the right precedence and not only think of our mentally abnormal patients all the time.
Our loyalty towards our organization was being tested here. However, our basic medical ethics did not permit us to opt for any impulsive decision without executing professional action plan.
Despite of all these efforts for care and rehabilitation his temporal lobe epilepsy was not controlled fully. Finally, the medical board was set in to assess medical fitness. The expert members collectively decided to make him unfit and the scenario changed.
The same people who thought of dignity of the workplace, women, and the right precedence now felt genuine sympathy for the same patient. They kindly advised him to opt for reexamination by another board or approach the union.
Now it was our turn to learn lessons in mass psychology.
Meanwhile, the so-called dry alcoholics and happily resolved martial discord cases started rereporting with problems of greater magnitude. After reviewing the cases, I realized that same blame game was being played over and over again between the couple or among the family members. When questioned about following our advice - they simply said that they already knew what we had advised earlier, and yet they were sitting there right in front of us for further advice.
My ego and superego both agreed on one point that clients though appeared irresponsible and noncompliant were actually much smarter than what we had thought of them. Then my ego shouted saying, "why one should entertain such people who do not value our instructions and suggestions." However, my superego softly murmured that basically our job is to modify the beliefs and concepts of the clients, and then maybe at this point we needed to reexamine our approach towards such cases.
Ha! I got quite perplexed. I questioned to myself. Was my knowledge in psychodynamics and psychotherapy not adequate to deal with these patients? Are we here to expand boundaries of our profession or follow the standard treatment and leave the rest to the patient's fate? If relapse is the rule, then are we not going to face burn out soon?
Finally, I shared my thoughts with the senior colleagues who relieved my stress by sharing their experiences. We then concluded the following dimensions of our practice.
The foundation of psychodynamics and psychopharmacology as well as psychotherapy qualifies us to practice in the field of mental health. By virtue of our profession we are blessed with a special privilege to peek into the psyche of others. However, every patient's psyche is unique and so should be our approach. We need to evolve all the time by keeping our minds open and flexible enough to deal with the ever-changing norms and culture of the community around. This approach makes our practice in fact more interesting than any other discipline in medicine and does not leave any chance to face burn out ever. In essence, a psychiatrist's will to grow with every patient makes the practice absolutely graceful.
Finally, I want to emphasize that although we are here to relieve the distressed minds, we need to de-stress our minds also. After all we are human beings and should enjoy fruits from our gardens.
Shobha V Patkar
Pitruvandana, 11 - Kalanagar, Bandra (East), Mumbai - 400 051
Source of Support: None, Conflict of Interest: None