“Why psychiatry?” is a burning question I frequently get asked by people from all walks of life. The people who have asked this question include but are not limited to: family members, close friends, acquaintances, people who happen to read my hospital badge in the elevator, colleagues whose children are thinking about a career in medicine, patients, and sometimes even people in the grocery store who happen to strike up a conversation while standing behind me in line.  

And I usually get one of two reactions from people when I tell them I’m a psychiatrist. 

  1. “Oh!” accompanied by a scrunchy face with a look of disdain and disbelief. “You don’t look like a psychiatrist.” And the conversation awkwardly and abruptly changes to something much less personal like the weather, and the person I am talking to suddenly has absolutely no interest in continuing the interaction and looks for any possible excuse to escape. To which I immediately wonder… what exactly is it that you think a psychiatrist looks like? And am I really that scary?
  2. “Oh my goodness, I could definitely use one of you” usually followed by “I have a family member with…” or “I have struggled with” or “I know someone who has had a really hard time with…” This response is the one that makes me hopeful about reducing mental health stigma in the future. It reminds me that mental health diagnoses do not discriminate when it comes to age, race, country of origin, socioeconomic status, or gender. It also makes me wonder how many people I’ve talked to who have ridiculed the profession as a whole but have themselves struggled with their own mental health diagnoses and have never seen a psychiatrist. 

When I was in medical school psychiatry was the only clinical specialty that came naturally to me. There was an art in the way I watched my attendings practicing. Each psychiatrist had their own style, their own flow, and although there were great differences in the way each practiced, there was a common thread that tied them all together. There was a very strong instinctual component each of them possessed that went far beyond traditional lab tests and imaging. There was a certain intuition, a strong attention to detail, the ability rely on all of the innate human senses to truly elucidate the inner workings of another human being. And I remember thinking to myself in my third and fourth year clerkships “I want to learn how to do that.” It was that moment when I decided that psychiatry was the only specialty for me.  

As a resident psychiatric assessments take place multiple times a day, every day, and each assessment is uniquely fascinating because the process involves a mix of analytical interpretation, subjective deductions, and the ability to rely on our primitive human senses. This organic, difficult, complicated process makes each evaluation different and exciting. In the same way that no two people in the world have the exact same set of finger prints, no two psychiatric evaluations are ever identical. 

When I complete a psychiatric evaluation I am forced to pay incredibly close attention to even the most subtle of observations. What do I see when I look at someone? Are they well groomed, do they gesture with their hands a great deal, are they speaking with loud animated words, are they using profanity, is there any slurring noted, are their pupils dilated, is their breathing rapid, are they looking around the room checking for exits, do they look comfortable or scared? Do they appear restless or agitated? And then I focus on my senses, and that I feel when I interview someone. Does my heart beat faster when someone raises their voice, does their presence and body language make me nervous, does the hair on the back of my neck stand up when they provide me with an intense and suspicious stare, is my posture straight and rigid in an attempt to appear unintimidated, or am I slightly slouched with my legs crossed to project a sense of warmth and calm? What do I hear when I interview someone? Are they tapping their foot on the floor because they are nervous, are they picking at their fingernails because they are uncomfortable or bored, does their voice become more tense when they describe a traumatic event, do they whisper to themselves to try and keep calm? Do the questions I ask make someone more forthcoming, or do they express feelings of irritation or defensiveness, do they get angry when asked certain questions or become tearful with others? 

The give and take between two people speaking to each other is what makes the psychiatric interview more of an art than a science. There is a step wise beauty of the dance that takes place during an interview that I still find incredibly fascinating, exciting, but also meaningful. When interviewed people have a choice as to how much of themselves they want to share. And sometimes people tell us things they haven’t had the strength or ability to tell anyone else in the world. There is a sense of honor and privilege in that. People tell us their darkest thoughts, their deepest secrets, their most heartbreaking trials and tribulations, and trust us with them. Patients trust us to keep their secrets safe, and when that sacred connection is made between psychiatrist and patient, there is an incredible opportunity for lasting change.  

Psychiatry is important because it is one of the few fields left that still places an intense focus on the holistic understanding of how physical, mental, biological, and social aspects of a person’s life can come together and affect the presentation, expression, and thus treatment of illness. We see people who are often in very difficult places in their lives. And to have an opportunity to help them recover, watch them get better, and move forward with their lives is truly incredible. There is so much joy, meaning, and satisfaction in playing a role in the patient’s success. 

It is also important to recognize that the science of psychiatry is continually evolving. The mind is incredibly complex, and we live in a very exciting time where neuroscience is furthering our understanding of the brain and it’s inner workings. This research is so important because it is pushing the limits of understanding what makes us human. The knowledge obtained from further study of the brain will pave the way for new treatment modalities which can help transform people’s lives.

The brain is arguably the most complex and vital organ system in the body. The inner workings of why people think, behave, and react the way they do to different stimuli and circumstances is extraordinarily complicated. And we have barely scratched the surface when it comes to unlocking and understanding all that the brain does. Psychiatry and mental health is not a field to be mocked. It is not a pseudoscience, it is not magic, it is a work in progress and should humble us because despite how long scientists have researched the brain we still know very little about it. Thus psychiatry and related fields should be fields we look at with awe, and is a specialty to be proud of. Because the hope is that one day we can stamp out mental illness so people afflicted with a mental health condition or conditions never have to suffer in silence again.

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