The question’s come up a lot, “So… why psychiatry?”
My reply was always crisp, clean, and confident: “People. I enjoy relationships and psychiatry was the best way to do that every day.”
How about the truth? I was compelled like iron filings to the magnet.
I was nearing the end of medical school, all rotations in my rearview, and in those specialties I saw no viable future on the horizon. I was lost, only three months removed from a bout with depression. I knew not what I wanted but needed something else: to find myself. A reasonable person might have taken stock here, and said, “Ya know, maybe this whole medicine thing ain’t for me.” But I was not reasonable, yet; I needed to make this medicine thing work. And… there was a small part of me—deep deep deep in there—that knew my fractured life was unsustainable and maybe, just maybe, if I could help others figure out their problems, perhaps I’d figure out mine. Perhaps.
Which specialty offered that kind of providence? You guessed it: orthopedic surgery. Just kidding. (Funnily enough, all through medical school and residency, people guessed I was an ortho resident. Nurses would actually grab me and ask about ortho patients, assuming I was the responsible resident.)
No residency is designed for residents to find themselves, but psychiatry seemed a worthy shot in the dark. When I considered life as a psychiatrist, that choice at least had life in it. Knowing the scarier choice is often the right choice, I chose psychiatry because it scared the shit out of me. Psychiatry demanded an unflinching commitment to truth, which seemed the antidote to my inauthentic medical school pursuit. In the process of becoming a therapist, treating depression and anxiety, and learning how to manage psychosis, that would have to iron out my shit. Right?
If the self-salvation motivation sounds twisted, maybe it is but I believe it’s valuable. If a patient comes to you for a solution that you don’t have but also need, wouldn’t you do anything to find it?
Here again, I think of something Voltaire wrote that I came across in medical school: “Men will always be mad, and those who think they can cure them are the maddest of all”.
Hard to argue with his take.
(Today, I curiously scrolled Voltaire’s Wikipedia page. His family wished he become a lawyer, but he, against their wishes, became a writer. That was 1715. Everyone walks the same war.)
When I applied for residency, a personal statement was required. One page in length, it was a summative articulation of why in the hell a program should gamble on me. I just reread my essay for the first time in six years. The opening line was… cryptic:
Restoring joy is my mission.
I laughed out loud. Taken with a glass of six-year hindsight, that line reads like a prescription I hoped to receive. The rest of my essay is a regurgitation of accomplishments, but at the end I added a summation:
Helping patients rediscover joy is my purpose.
My heart goes out to myself then. Damn, I was trying hard. And I really wanted psychiatry to work, both for me and my career. And after that mission I went, dedicating everything to psychiatry and patients, ultimately losing myself and becoming broken. Reading like a script from a Netflix series about a psychiatrist, I lost the distinction between me and patient, their emotions and mine, and identity and disintegration. I got lost in the sauce.
Which introduced a pivotal understanding: until you fix yourself, it’s really hard to help others, because you continue to bring yourself into the solutions.
In the end, was my self-salvation gamble on psychiatry successful? Did I achieve the mission, restoration of joy?
Back in medical school when I was trying to choose a specialty, I asked a mentor if his life had changed since becoming a shrink. Was he still, say, a normal member of his family? Was he too weird and now an outcast? He laughed and sighed simultaneously, then said, “Ya know, I think I’m a better friend and family member now because I understand people better.” At the time, that seemed the natural result of a done-right career in psychiatry. And a result I hope to own too, but for now I’ll accept what psychiatry’s gifted: just a better understanding of myself.
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In a way, I arrived at the mission’s destination. I had to become a psychiatrist to realize I didn’t need to be a psychiatrist. The absurdity of that statement demonstrates another understanding: I will always be a psychiatrist. The experience and training are a part of me, gratefully, never to be undone.
I committed to learning therapy. I worked to help my patients. I discovered I couldn’t help everyone. At a point, I broke down, lost in the amalgam of my shit and everyone else’s. I got a therapist and came to understand I could not practice medicine and be myself because I never wanted to be a physician.
And here and now, I have a chance to go be myself and go after what I want.
So, should everyone become a psychiatrist to find themselves? Please, trust Voltaire. I’m hopeful more efficient paths exist for you. The only thing I know is that we all have to take the path, our path, psychiatrist or not.
(Photo Caption: Relishing the present, afforded by medicine’s wandering, psychiatric path.)
