Christine Montross - Falling Into the Fire: A Psychiatrists Encounters with the Mind in Crisis

Bedlam

Canst thou not minister to a mind diseased?

Shakespeare, Macbeth

I n early January, Charles Harold Wrigley, a twenty-two-year-old gas engineer, was brought by his family to the psychiatric hospital. The patient is extremely depressed, the evaluating physician wrote. He sat with his hand on his forehead as if in pain during my interview. He says everything he does is wrong and that he is very miserable. A second doctors note adds, I am informed... that the patient has suicidal tendencies and since he has been [at] this hospital has attempted to strangle himself. Notes like these are familiar to me. As a psychiatrist, I have seen countless patients in emergency rooms, inpatient units, and outpatient offices whom I might have described in nearly identical terms. This patients symptoms are not striking; however, the familiarity of the description is, considering that Charles Harold Wrigley was evaluated and treated at Englands Bethlem Royal Hospital in 1890.

Before I became a doctor, I had more faith in medicine. I thought that medical school and residency would teach me the bodys intricacies, its capacities to heal and to falter, and all of our various methods of intervening. Once I mastered these, I thought, I would really know something. That has turned out to be partially true. I know many more things about the bodyits wonders and its failingsthan I could ever have imagined. But as a doctor, I have emerged from my training with a shaken faith. If I hold my trust in medicine up to the light, I see that it is full of cracks and seams. In some places it is luminous. In others it is opaque. And yet I practice.

At times this doubt is disillusioning. More often, however, Ive come to view the questions that arise as a vital component of the work of medicine. My faith in medical knowledge has shifted into a faith that the effortthe practiceof medicine is worthwhile. I cannot always say with certainty whether the course of treatment I prescribe will heal; I cannot always locate with precision the source of my patients symptoms and suffering. Still, I believe that tryingto heal my patients and to dwell amid the many questions that their illnesses generateis a worthwhile pursuit.

I have found that one of the gifts of medicine is that it allows those who practice it to participate in the purest and most vulnerable moments of human life. As doctors we share in the utter joy of birth, the irrepressible relief of a normal scan or a benign biopsy. We deliver earth-shattering diagnoses. We accompany people to their deaths. In these moments there is not much room for the protective or insulating layers that peopleall of usput upon ourselves in our daily lives. Joy is joy, and grief is grief, and fear is fear; and in the context of medicine, those emotions are often at their most primitive and raw. As an inpatient psychiatrist, I treat people who are in moments of profound crisis. The majority of them are hospitalized because they might not be safe otherwise. I do not lose sight of the fact that my patients come to me in these precarious states.

I am a few years into my psychiatric practice. Relatively speaking, I am new to the job. Every day that I go to work on the inpatient psychiatry wards, I encounter people who are despondent, or terrified, or raving mad. I see people whose lives have been ruined by addiction. I hear unfathomable things that people have done to others, from familial betrayals to brutal attacks. I talk with people who, more than they have ever wanted anything, want to die. It is not a dull job.