Changing minds

Why do we change our minds, and what does this actually mean? Every day we do things, and then decide not to – ‘I’ve changed my mind, I’m not going to come with you to the shops.’ It implies free will as well as a mind to change, neither of which are concepts that are easy to prove or disprove. But in the world of psychiatry and mental illness, there may be other sides to this.

As psychiatrists, we are certainly guilty of trying to change our patients’ minds, albeit with the best intentions (I hope). For example, if my patient has beliefs that seem paranoid, and without reasonable basis, I may try to persuade them to take antipsychotic medication, as it has been shown that this will improve symptoms for many people. My patient may not be very convinced by this, firstly because they don’t agree with me, and secondly because antipsychotics have horrible side effects for many. There is a degree of external pressure on me to act, though. My role as a psychiatrist is to make diagnoses where I can, and to attempt to treat them. The problem is that I can never be 100% sure either that I’m right, or that the medication will work, and that can be a problem when trying to change my patient’s mind. There is also the fear that mentally ill people will harm themselves or others, and that we need to do something to reduce that harm. Medication will do that for some, but not all, and psychiatrists worry about losing a patient, which is devastating, and then perhaps also being blamed, as well as blaming themselves.

I’ve also been my patient. I’ve had long conversations with psychiatrists who have usually been trying to get me to take, or continue, medication. I think it’s very rare that they make me change my mind about this, but I have ultimately agreed to do what they want. Usually this has been to get away from the situation, or because I am afraid of being seen as uncompliant. For me, as a doctor, the murky threat of the General Medical Council is always there, although it has never been used to persuade me. But I am aware of those who have, and I feel I’m on thin ice at times. There is a degree of subjectivity about who gets reported to them as some doctors have a lower threshold, and I’ve been lucky – or maybe just compliant.

The General Medical Council isn’t an issue for many, however, but the Mental Health Act is. Prior to becoming ill, the idea of being detained had an aura of almost gothic nightmare; the very first time I was admitted to a psychiatric hospital it was mentioned, and I think I would have agreed to anything rather than have that happen to me. Perhaps irrationally, all I could think was that my career as a doctor would end, never mind the chance of becoming a psychiatrist; it would be something that I would always have to declare, and would reduce the possibility of going places in future, and of getting life insurance. My mind was changed pretty quickly, I can tell you, and I never did manage to get life insurance. 

But compulsory treatment and changing peoples’ minds about it are not at all the same thing. You can make someone do something without making them believe in it, the problem is that neither party feels good about this. But sometimes, when people are ill, it is the duty of the psychiatrist to treat them, with or without consent, and this can be very difficult, especially for younger doctors in training, and those of us who have been on the other side – or have had relatives on the other side. 

As a patient, I don’t know how to change my mind. I know my psychiatrist has my best interests at heart, and I don’t disagree with his treatment, but there is nothing that he can say that really makes me believe him. I am lucky, perhaps, that I am well between episodes of illness, and perhaps that helps me get away with this. He told me recently that my attitude was unusual, and this worried me. But I wonder if it really is – in many ways, it’s easy just to go along with things. I am in the odd position of being a trained psychiatrist, and I think I’ll always ask questions. Perhaps just talking about things helps, both for the mind changers and those who are supposed to change their minds.

Medication changes your mind, though, I’m in no doubt of that. It makes you tired and sedated, numb or agitated. I suppose this doesn’t actually amount to changing one’s personality, but I live in fear of this. Sometimes I worry more about the medications that don’t have side effects – for me this is lithium. It makes it easier to take, but conversely I wonder if it changes me in a way that I can’t recognise, and that does concern me. My partner has said – at different times – that lithium possibly makes me boring, and that he also prefers me on it – funny, perhaps, but not entirely.

There are plenty of unprescribed substances that can also lead to sudden mind changes. Alcohol is one, and is something in which many indulge without a second thought. It can lead to very many very bad choices that a person would never make when sober, often starting with a change of mind about that extra drink. I suppose you could argue that they changed their mind when they had the first one, and it’s true, alcohol changes the mind, but perhaps not always in the way that people hope. And the volte-face the following day can be disconcerting.

Ultimately, we may do many things with which we disagree without actually changing our minds. Sometimes that can be right, but we can’t assume that we have the power to change the minds of others when we are scarcely sure of our own.