Psychiatry and psychiatrist are powerful words. They stop conversations, and create awkward gaps. I try not to say I am a psychiatrist in social settings, sometimes muttering something about being a doctor, and usually wriggling out of anything further. Conversely, in a clinical setting, I always tell patients that I am a psychiatrist, probably because it would feel quite wrong not to; and, given that I work in a chronic pain clinic, people are not always expecting to see a psychiatrist. Explaining it upfront works better, but difficulties can still be caused by expectations, both theirs and mine.
When I think about the word psychiatry, I think of a big grey building. It has a vaguely menacing feel, and it is quite male in nature. I guess this is fairly easily explained by my first experience as a patient, admitted to hospital, seen by male psychiatrists, confused and unhappy, with no notion of if and how I might get better. I felt small, ignorant and infantilised, and in hardly any control of my destiny. I knew that psychiatry was a branch of medicine, that it involved assessing and treating people with mental and emotional illnesses, but it was, to me, overwhelming. I had previously been a medical student in this hospital, where I had been failed in my attachment by male psychiatrists, and made to feel like a rather silly and immature girl. Well, I was that, but not all of me.
The psychiatrists that I saw at the start were all men, something which has certainly changed. But back then, I saw them, suited, dark, walking to places, knowing things that I could never know. I hated them, and at the same time was desperate for them to fix me. They were what I wanted to be myself, but they were different and “other”, and their masculinity made this even less likely. Since then, I have been lucky in that I have seen a couple of them consistently for years, even throughout my own training as a psychiatrist. Like the building, they have softened, and no longer seem omnipotent and mysterious. I have been able to see them in some sort of context which made them real, and even if this is loosened when I am ill, it rights itself afterwards. But the relationship with a psychiatrist (especially when you are also a psychiatrist in the same hospital) will always be awkward. They have knowledge of you, and potential power over you, and that is always in the space of any conversation.
My own training, seized later despite the obstacles, has unfurled many of the mysteries inherent in psychiatry. I find it fascinating in so many ways, and I hope that I am never a frightening representation of psychiatry to any of my patients. If I ever am, I hope that can change. But there is no doubt that psychiatry can appear powerful and formidable to some of its most vulnerable patients. I may see myself as small, gentle, feminine, but all psychiatrists have the power of the Mental Health Act – we can stop patients leaving, detain them in stark, and often grim, surroundings. Because what are surroundings when you are kept against your will?
In fact I am fortunate that I rarely have to use the Mental Health Act in my specialty of addiction psychiatry, but it strikes fear into me, even now, even as the detainer. Maybe that’s how it should be – it should certainly never be something that is done easily.
My fear of psychiatry has undoubtedly lessened with repeated exposure. Every morning I cross a car park to go to work, the same car park that I crossed as a student, and looked out onto as a patient. That building there was my own personal Tower of London, the one where I waited without much hope. I know this sounds melodramatic, but I don’t know how else to convey the fear and helplessness I experienced then. Now it is very different, like seeing a modern photo superimposed over an old picture – I don’t really think of the old times that much, but sometimes a glimpse comes through.
I wonder how other people see the word psychiatry. The fact that it’s difficult to spell is vaguely annoying, but actually also quite unhelpful. Some people, with less education, or with cognitive problems, will struggle with this word right from the start, creating barriers and imbalances. Being a patient is hard enough at the best of times, and we should be asking people what it means to them, what the word itself invokes. Perhaps for some it will be very positive, with a feeling of being cared for, if this is what they have experienced. But for many, especially first-time patients, there are all sorts of ideas and myths, born in families and communities, that give form to their ideas. Families and friend will also have their own views, which will inevitably touch and influence the patient. My family were not hot on belief in mental illness, which certainly fed my fears and feelings of culpability.
I’m not too sure what other doctors think of psychiatry and psychiatrists. My interactions have mostly been very positive – I work closely with anaesthetists, and communicate a lot with hepatologists, and I think we respect each other. I have no impression that they see psychiatry as a specialty for the oddities or less gifted, as has sometimes been postulated. I did, however, have one interesting conversation with a friend who is very high up in medical management, which made me wonder. I had just had an extra piercing or two done in one of my ears – she said, “well, it’s all right for a psychiatrist but would never do for someone in my position”! I’m not sure she was right, but it may confirm what some think of psychiatrists. My own view is that a little eccentricity will do no-one any harm; it is the perception of what psychiatry is, and the power balance that we should consider. Our own view of psychiatry may be very far from that of our patients.