I am a psychiatrist, and I hope that when I see my patients I am helpful, friendly even. I don’t know if I am, though. For me it’s a job, a job I like very much (mostly), but a job that ends with the end of the day. I forget some of my patients; not all, but remembering them isn’t always a good thing. There is, after all, a massive chasm between doctor and patient.
I’ve always found that rather odd, skipping between roles, and no doubt getting it wrong. But the doctors who’ve helped me the most have had firm boundaries. They might at times be able to be a colleague – that seems to work – but not a friend. It’s a very different role, that of patient. I suppose that once you’ve been discharged, there might come a time in the future when it would matter less, but I think it would take time. As a doctor, particularly, but not exclusively, as a psychiatrist, you know things about your patient that a friend doesn’t. As a patient, you are vulnerable.
I think of myself as fairly tough; but when I’m unwell, I’m not normal. I have scribblings and emails from these times which remind me, and I wouldn’t share them with a friend.
I have been more lucky than most, in that I have had a couple of psychiatrists over my long career as both psychiatrist and patient. I acquired them on my first admission. I saw others, but when I settled into training as a psychiatrist myself, the more senior of the two saw me regularly. He was very kind to me, and I must admit to surprise and devastation when he retired. I’d read about all these issues – transference, I guess – but I didn’t really recognise it then. I just felt he didn’t care. This was, of course, rubbish, as I was making him, and our relationship, something they were not. I was relieved when he suggested his younger colleague as his substitute – I knew him, he knew me, I wouldn’t have to tell him everything again.
All went well, after I adapted to the change – at least from my own narcissistic viewpoint. I have no idea how either of them felt seeing me. Did they dread it, was I a difficult patient? I didn’t know or care. But over the years, I gradually began to see things differently, and, I hope, in a more thoughtful manner. I think we got used to each other – or at least I did to him. I trusted him more, I knew what he was likely to say, most of the time. And I also knew that at some point he would leave, and sometimes I tried to think about that.
I knew it would be, for me, a wrench, a loss even. But I also knew that that this wasn’t really real, that it was a loss of what he represented to me, and that that was important. And I hoped that I would be able to see someone else, subsequently, because that mattered. That the handing over would be gentle – that mattered. And when the time came, I was grateful, surprised even, at how kind he was. I found myself wondering if I would have been as kind, had I been the psychiatrist, and all I can say is that I hope so.
I also considered both of them as people, in a way that I hadn’t done before. Mental illness is a selfish creature, and I regret that I saw them only as people to care for me. But now, with years of experience and life, I know that they are people – happy, sad, proud, regretful. I knew that that they, too, might experience illness, as well as joy and success.
It is right, in a sense, to mourn them. A good psychiatrist will be cared for by their patients. It isn’t love because it’s not a real attachment, but it’s one that can help us learn. As a psychiatrist, instead of ignoring this, we must help them to connect, to ask questions, and to separate. This isn’t psychotherapy, this is being a psychiatrist.
Of course, it’s not so easy these days, with sparse resources, and pressure to see, diagnose, prescribe and discharge. I don’t want to be that kind of psychiatrist, and I don’t want to be seen by one. I think I am lucky – there are few perks, but being a psychiatrist may have helped me to have a regular psychiatrist myself. Whatever it is, being seen, not too often, but regularly, has been very important for me.
I am very grateful that my psychiatrists have taken the trouble to hand me over to other psychiatrists. I will think of them and remember them, and if I see them, I will smile at them, person to person.
Thank you for sharing your experience. Sadly, it is not universal. Being a psychiatrist has presented a barrier, not a gateway, to confidential psychiatric care. I am lucky to see a psychiatrist in the private sector. Medical notes taken whilst I was in crisis were accessed by my former employer.
I also respectfully disagree about our relationship with our patients not being a ‘real attachment’. I think it is and there is significant evidence that this relationship can be incredibly healing. I wonder if perhaps you are more person-centred than you give yourself credit for.
Many thanks for your comments, Jackie. Perhaps better to say that the relationship between psychiatrist and patient – and vice versa – is often different from what we may initially perceive. For me, that has been important to recognise and understand, and has helped me come to terms with what has happened to me, over the years.