David Goldbloom - How Can I Help? A Week in My Life as a Psychiatrist

KSENIJA HOTIC

DAVID GOLDBLOOM, M.D ., is senior medical advisor at the Centre for Addiction and Mental Health and professor of psychiatry at the University of Toronto. His career has spanned clinical care, education, research, administration, and advocacy; he remains active as a clinician and teacher. He is a graduate of Harvard University, the University of Oxford (Rhodes Scholar), and McGill University. In 2007, he was appointed vice-chair of the Board of the Mental Health Commission of Canada, and served as chair from 2012 to 2015. He is an Officer of the Order of Canada.

KSENIJA HOTIC

PIER BRYDEN, M.D ., is a psychiatrist, clinical teacher, and educator in the Department of Psychiatry at The Hospital for Sick Children, and is the pre-clerkship director of Undergraduate Education and an associate professor at the University of Toronto. She graduated from the University of Toronto, the University of Oxford, and McMaster University. She is a committee chair at the Medical Council of Canada and an editor at Ars Medica .

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Significant issues of trust arise for physicians who write books that include their patients. Neither of us can forget the criticism thrown at the late neurologist and author Oliver Sacks by Tom Shakespeare, a geneticist and disability activist offended by Sacks portrayals of neurologically impaired individuals. Shakespeare characterized Sacks harshly as the man who mistook his patients for a literary career. The ethics of physicians writing about patients have been written about in many forums, testifying to the unease that both physicians and patients experience when the extraordinary access offered to physicians in the course of their work is used for a literary purpose.

Arguably the ethical risks are greatest for psychiatrists and our patients, given the vulnerability and stigma associated with those who experience mental illness. We have identified real patients only with explicit permission. All others are fictitiously described, most representing composites we have created from our shared experiences of meeting thousands of patients over several decades.

We greatly respect our working environments and have also identified real colleagues only with their agreement. We are grateful to those who provided feedback on their experiences and perspectives. All others are fictitious, again drawn compositely from our experience.

Someone who has lived through a psychiatric disorder and its treatment whether the person directly affected by it or a family member or intimate brings an essential understanding and point of view to the public discourse. On the other hand, our years of caring for patients, often during their most acute periods of illness, and of working within a mental health system that can only be characterized as fragmented and difficult to access, has given us a particular perspective. We have seen not only the barriers to receiving treatment faced by patients both within and outside the mental health system, but also the larger societal barriers that prevent desperately needed mental health research and treatments from receiving the funding and attention they require.

While we have attempted to write about psychiatry as a medical specialty that is international in scope, our experience as physicians working in Canada has inevitably shaped our descriptions. It is also true that in an attempt to avoid a book that extends to six volumes, we have left out fascinating chunks of psychiatric history and scientific discovery, and provided limited accounts of the sociological and philosophical critiques of how societies approach mental illness. We have therefore included a section on further reading for those who wish to know more about the subjects that we have only touched upon.

We should also note that we have compressed particular patient events that in fact took place over several months into a one-week period although the variety of professional activities that occurs in one of Davids weeks is realistic. We did so in the interest of meeting our publishers requirement of not putting readers to sleep, as well as to emphasize the intersect between Davids clinical and personal lives.

Of course, all mistakes, inaccuracies, and inevitable omissions are our own, as are passages where we have been inadvertently insensitive, cavalier, or simplistic. For these we apologize.

We want to offer our thanks to those without whom this book would never have come about. First, Malcolm Lester, who provided input and encouragement on a much different conception of a book, which nonetheless was the seed from which this book was born. Next, to colleagues Drs. Vivian Rakoff, Shitij Kapur, and Patricia Cavanagh, who patiently allowed themselves to be interviewed on their careers and ideas about psychiatry, again for a version that anticipated but was not included in this book. Michael Levine, our literary agent, tirelessly advocated for us with publishers that this was a book that mattered, and insisted that despite the gravity of its content, a book that would find an audience.

To Kevin Hanson, Alison Clarke, Phyllis Bruce, Patricia Ocampo, and the team at Simon & Schuster, thank you for believing we could learn to write a book and for treating us gently when we delivered our first draft.

To Jennifer Glossop, our literary editor, who patiently, kindly, and rigorously taught us how to write a readable book without her eagle eye, insistence on clear, nontechnical language, and extraordinary understanding of what makes a book engaging, we would not have been able to deliver a manuscript.

Thank you to Judith Kwok for her invaluable assistance researching bibliographic resources on psychiatric history and science.

Pier wishes in addition to thank her colleagues in the Department of Psychiatry at the Hospital for Sick Children, who supported her in a part-time sabbatical to write the book, and who covered her on-call duties during that time. She thanks too her colleagues at the University of Toronto Undergraduate Medical Program, who supported her to reduce her workload there during the same time period. And David is grateful for all the opportunities that the Centre for Addiction and Mental Health has provided him to be a clinician, a teacher, a researcher, and a writer.

We both thank our families, who put up with our endless phone calls, weekend meetings, papers strewn over tables, and general abdication from much of family life while the book was being written.

Thank you, Nancy, Daniel, and Will.

Thank you, Micheil, Diana, Callum, and Euan.

Finally, we thank our colleagues and patients, both those who agreed to be in the book and those who inspired different parts of our composites of patients, residents, and colleagues. Our colleagues share the work and challenge of trying to do their best for patients with resources that are often limited and imperfect. Our medical students and residents come to psychiatry with fresh eyes and ask us why we cant do more for our patients, demanding that we respond to their questions with real solutions and with hope, rather than becoming jaded or resigned to the status quo.