liquid's Blog

If God is watching us, the least we can do is be entertaining.
APRIL 28, 2012 8:17AM

Psychiatric Ponderings

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I have borderline personality disorder.

Or at least that’s what I thought when I first studied psychiatry in my first year of medical school. In reality, all I had was medical student syndrome: the tendency of medial students to imagine that they have the disease they’re currently studying. Indeed, one of my buddies thinks he has tuberculosis and no amount of testing will convince him he doesn’t. Psychiatric conditions, particularly personality disorders, are the easiest one to imagine that you have since the diagnostic conditions leave some room for interpretation and cannot be ruled out by lab tests or imaging studies. 

Let’s take the example of borderline personality disorder: we have all had moments of impulsivity and instability (key features of a borderline personality), and it’s easy to remember those moment while reading the diagnostic criteria and fear that you’re borderline. It took me time to realize that there are degrees to instability and impulsivity. Just because I impulsively buy a chewing gum in the check in line and get upset when my girlfriend cancels a date doesn’t make my personality a borderline personality. Thereafter, I have this protip for you: do NOT try to diagnose yourself with psychiatric disorders on webMD. 

At the moment, I am doing my psychiatry rotation in a state mental hospital where I have the privilege of serving people who are so mentally ill that they simply cannot function outside the hospital. Both pharmaceutical and non-pharmaceutical approaches are used to treat our patients.  I used to be a bit skeptical of psychiatric medicines, but even in the short amount of time I’ve been there, I’ve seen some incredible transformations in the mental status of individuals which can be attributed substantially to the medicines they’re being given. In addition, exercise, kindness, and all sorts of interesting group activities play an important role in mental rehabilitation as well. One of the interesting studies I came across showed that exercise was as effective as antidepressant medicines in helping people with a major depressive disorder feel better. Moreover, those who recovered were less likely to relapse into depression. Tal-Ben Sharar, a psychologist at Harvard, offers us a caveat: do not think of exercise as an anti-depressant, think of the lack of exercise as a depressant. 

Despite the progress we make with many of our patients, we do hit an unyielding wall with some of them. These poor patients end up staying in the hospital for years and years because they pose a danger to themselves and others if left unsupervised in society. Frequently, when I speak with them, I feel the same helplessness doctors of yore must have felt without effective drugs in their arsenal. As a society, we need to invest more energy into finding treatments for mental health issues because we lose a lot of lives and talent to these conditions. Indeed, some of the most creative people in our midst have mental disorders. For instance, my beloved Stephen Fry has bipolar affective disorder and has come close to taking his own life at least once, a common end for those with this diagnosis. Had he done so in 1995, we’d have missed out on 17 years of gentle intellectuality and refined humour. 

Anyway, the point of this essay was to say that studying psychiatry in this mental institution has given me a better understanding of psychiatric disorders and forced me to consider my own motivations and reactions a fair bit. Do I still think I have a borderline personality disorder? No.

Do I think I am a messed up human being? Yes.

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Comments

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We are all damaged and fragile when the surface bluster is wiped away a bit. Nicely done without patronizing.
To be human is to be messed up. (At least at some time in our life.)
I love hearing about your latest adventures in medicine. I think your compassion and sensitivity are what make you the best kind of doctor.
Good to see you, Pranay. ~r
"One of the interesting studies I came across showed that exercise was as effective as antidepressant medicines in helping people with a major depressive disorder feel better."
really? that hasn't been my experience. Do you have a link to the study?
We're all messed up in one way or another, but being cognizant of that puts you a notch above those who think that they are perfectly normal. I hope you don't "lose" that perspective as you go through your academic and practical training to become a doctor.
Rita-- Thank you, you're very sweet.

Joan-- messed up ergo sum?

Julie-- I am not sure it applies to everyone. Genetic differences, degree of depression, and a dozen miscellaneous factors determine responses. Here's your study: http://www.psychosomaticmedicine.org/content/62/5/633.full.pdf+html

Gotham Chick-- Thanks for reading, I'll do my best to remember.
Thanks for the link! It is interesting to note that Sertraline was the only drug tested and the population was limited to 50 and over, who were not on medication for their depression currently (they also could not be suicidal).
It does look interesting though... that was awhile ago. I wonder if they've done broader studies since then?