A fresh look at pseudoseizures…
Robin Berlin M.D., in collaboration with James Griffith M.D., is studying
the association of pseudoseizures with other mental illnesses. They
are collecting measures of dissociation, depression, and anxiety in
patients diagnosed with pseudoseizures. Stay tuned for insights about
these fascinating and sometimes perplexing patients.
Doctors as advocates…
The barriers to recovery from mental illness extend beyond the brain
and the psychiatrist's office. A patient is faced with numerous complex
life challenges upon stepping out your door.
Suena Huang M.D., in collaboration with James Griffith, M.D. and Lynne
Gaby, M.D., is exploring ways in which patient advocacy in psychiatric
care can be incorporated into resident education. You can learn more
about this in a workshop at the 2006 American Psychiatric Association
meeting.
When I was asked to write this article I was not sure
what to say. What was my personal journey as an African-American woman
into the field of Psychiatry? I grew up with a Jamaican mother and German
father, the youngest of six. Two of my sisters are Caucasian, one sister
half Chinese, one brother half Indian, and the other brother Jamaican.
Although I look and identify myself as African-American I always knew
there was more than what was reflected on the surface. Growing up, people
always expressed a curiosity regarding my background- some kind, some
cruel. I recall a moment in 8th grade where I was teased incessantly
after we read To Kill A Mockingbird. There was a portion in the book
that stated that mixed children grew up to be 'all mixed up'. The black
and white children in my class teased me equally. This was a continued
theme in my life; at different times, being pushed out by both communities
and not knowing quite where to fit in.
There have been times during medical school and residency
that patients have expressed shock and surprise that I was their doctor.
There have also been many times that people have said to me how proud
and happy they are that I am a woman of color caring for them. Entering
the field of medicine I had no questions about where I would fit in.
My background had prepared me for the variety of responses I would elicit.
Going into Psychiatry has allowed me to be open to understand people's
reactions, feelings, and motivations. As I move forward I hope to broaden
my own and others beliefs about where a woman of color fits into Psychiatry.
"It is not the person who has too little, but the
person who always craves more, that is poor."
-Ancient Chinese Proverb
Without
peace of mind, happiness cannot exist. I have always tried to do what
I felt was best for me, as well as those around me. My choosing Psychiatry
as a career is no exception. I chose psychiatry because it is one of
the only fields of medicine that delves into the more intangible elements
of disease-the mental health disorders, which have always fascinated
me.
I credit
part of my early interest in mental health disorders to my grandmother
who is the Director of one of the largest community mental health facilities
in Chicago, Illinois, where I was born and raised. I attribute the remainder
of my early interest in mental health disorders to my surroundings while
growing up in Chicago. Due to my surroundings, I recognized the symptoms
of depression long before I could put a name to it. I regularly found
myself daydreaming about what I could do to help those around me even
as a child and throughout my teenage years. You can imagine my further
frustration when I discovered the stigmatism associated with mental
illness in my community. Amongst African Americans, and in the United
States as a whole, there seemed to be a negative view of people who
have mental illnesses. Somehow their chronic illnesses were different
from the other more commonly talked about chronic medical illnesses
such as hypertension or diabetes mellitus. Yet despite this overbearing
negative public opinion, my interest in helping those who are mentally
ill only continued to grow. By the time I reached medical school I had
no doubt I was going to be a Psychiatrist.
Admittedly,
I wavered at times, due to the various pessimistic attitudes and comments
of my peers, and at times, my mentors towards the profession. Also,
during my Inpatient Psychiatry rotation in my third year of medical
school, I encountered my first in depth experience in the field of Psychiatry.
I went in to the rotation with dreams of Freudian Psychoanalysis sessions;
I left with a reality check that shook me to my core. I quickly learned
that the managed care industry, large randomized controlled pharmaceutical
trials, and the need for faster modes of therapy had long ago replaced
the eclectic treatment form I had dreamed of. What I saw were patients
who were severely psychotic, suicidal, homicidal, or a combination of
the former. Most of them stayed in the inpatient unit until they were
stabilized and then discharged-usually 3 days. Although a much needed
service, it was not what I had in mind for my career choice or myself.
As
a result, I looked into the other fields of medicine, including Internal
Medicine. Internal Medicine appealed to me because it gave me the opportunity
to use most of the medical knowledge I was learning in medical school,
including Psychiatry. There was a strange comfort in the well-defined
diagnostic methods and treatments that I routinely encountered in my
rotations, yet I found myself inquiring about patients' moods and dispositions
even when it may not have been essential to the case. For example, after
hearing how gastric esophageal reflux disease forced a severely obese
patient to change their diet, I began to inquire about symptoms of depression
in addition to the commonly asked questions in the review of systems.
In time, I realized that I was "hard wired" for Psychiatry.
I had no desire to "shake" my love of mental disorders-organic
or otherwise, however I walked away from the other specialties appreciating
the importance of maintaining one's general knowledge of medicine no
matter what their specialty may be.
At
the beginning of my last year of medical school I was accepted to the
Asklepios International Telemedicine Consortium Fellowship in Germany.
During my matriculation there I spent time working with Psychiatrists
and Trauma Surgeons, and helping with the Telemedical research and testing
of a new Global Positioning System based Emergency Medical Response
technology for Southern Germany. The new response system allowed the
paramedics to enter medical data and have it transferred real-time to
the Emergency Physicians- who travel to the scene of the emergency and
to the hospital. The software was also programmed to translate between
English and German as an incentive for the United States Army to purchase
the technology. While there, I discovered that Psychiatry was practiced
in the same way overseas as it is in the United States, except equal
emphasis was given to pharmaceutical and to non-pharmaceutical adjunctive
therapies. Areas of therapy such as psychotherapy, art and music therapy
were regularly used with all of the chronic patients. It was a welcome
change to what my mind had begun to accept about the practice of Psychiatry.
I came
to several realizations during my time there. I realized the importance
of language proficiency in the practice of medicine both in the United
States and abroad. I also became truly conscious of the importance research
plays in the advancement of medicine, whether that research is clinical
or technological. Most importantly, I revitalized my faith in Psychiatry
and re-realized the important role it plays in the healing process.
These realizations were the basis of my decision not to enter the National
Residency Match Program in 2004. Instead, I decided to spend the year
conducting research. I have had the opportunity to work on research
in HIV/AIDS in minority women in Washington, D.C. The results of the
research were presented at the July 2004 AIDS Conference in Bangkok,
Thailand and published in the annals of the conference.
In
early 2005 after "The Match", I spent time in Puerto de la
Cruz, Tenerife, Canary Islands Spain in for Spanish language proficiency
training, and to experience another facet of medicine abroad. My stay
in was only for 2 months, as I had already had the opportunity to study
Spanish in high school and undergraduate college. The nine weeks of
linguistic-cultural immersion was adequate to push my Spanish-speaking
ability to a medically functional level. I plan to continue my study
of Spanish with a focus on medical Spanish to implement it during my
Psychiatric career.
So
how have research and traveling abroad play into my career in Psychiatry?
I would ultimately like to work with the World Psychiatric Organization
in some capacity in the future. Politics has always interested me; its
role in the advancement of medicine has already been established worldwide.
My other areas of interest include Disaster and HIV/AIDS Psychiatry.
Eventually, I would like to participate in collaborative international
research initiatives dealing with the acute treatment of Post Traumatic
Stress Disorder, especially in war torn countries.
Then
again, one does not have to travel to a foreign country; you can find
a "war torn" atmosphere in almost any inner-city community
in the United States. Eventually I would like to start multiple multi-service,
multi-ethnic community based clinics in major cities around the United
States. My aim is to have the clinics funded by federal and private
grants and investments as well as by the other revenue they bring in.
My goal is to provide the surrounding communities, especially those
of underserved populations, with mental health care, primary care, complimentary
and alternative medicine and social services. I had the opportunity
to work in a clinic that was very much like what I have envisioned myself
creating in the future. Yet, the clinic was founded to serve a very
specific population and thus was limited in its spectrum of care.
I have
undeniably cast my net of future goals very wide. However, I am already
on my way to fulfilling my goals and dreams. I am currently a Post Graduate
Year One resident at in the George Washington University Medical Center
Psychiatry Department. While the busy work schedule of Intern year has
not allowed much time for dream fulfillment, I have had the chance to
start attending the Hospital Emergency Preparedness meetings. I truly
view this opportunity as an honor because I am one of the few residents
who attend these meetings. The prospect of jointly working on a Masters
of Science degree in Public Health during my residency also represents
another possible "stepping stone" along my path of goal fulfillment.
Regardless of how my career development unfolds, over the years, I know
I will significantly impact the vast morbidity that mental health disorders
represent in the world today-in our country and abroad.
