Learning the trade
Psychiatry is not like other medical specialties. I’m a psychiatrist, so I would say that, but it is viewed as distinct. For many doctors it is a Marmite specialty— you love it or you hate it. If your feelings are lukewarm, it probably isn’t for you.
When I was at medical school many years ago, a small number of students had their hearts set on psychiatry. I had been one of them, but then I experienced a ward placement that drained whatever limited confidence I had, so I put the idea aside. When people ask me now why I wanted to do psychiatry back then, I usually come up with something vague about how interesting I thought it was.
If I’m honest with myself, the reality may have been that I was unhappy at medical school. I felt overshadowed by my ambitious peers and, although I passed my exams, I did not excel. I was stuck, at a very young age, on a route that dismayed me, and psychiatry seemed exciting and alluring. It was about people and their thoughts and words, rather than science, criticism and brutal hierarchies. So, for me, it may have been an optout rather than an opt-in. But my goal to become a psychiatrist was always there in the background, and although I initially took an alternative route by training to become a GP, I feared that I would regret not pursuing it.
Psychiatrists have to be doctors, unlike psychologists or therapists, but the specialty requires different skills compared with other areas of medicine. Looking back, it is hard to know exactly what its appeal was to certain medical students like me. Some may have seen themselves in a patched tweed jacket, life less frenetic than a surgeon’s; others may have been passionately interested in psychoanalysis and Freud or, alternatively, fascinated by the hidden curiosities of the brain. Maybe some had encountered psychiatry first hand, either personally or by supporting relatives in treatment. Some may have already worked in some capacity in mental health. I had none of these experiences; my only time in psychiatry as a student had been awful, yet my dream persisted.
When I became ill with severe depression at the end of my GP training, and underwent the reality of psychiatry as a patient, I thought that my dream was dead—but, against all the odds, it revived. Now, as a consultant psychiatrist, I look back bemused at how I got here. The only
I try very hard to listen, but all the trauma and suffering that we see can be overwhelming
constant was wanting to pursue psychiatry, and I’m still not sure why.
Psychiatric patients and even psychiatrists were stigmatised when I was a student. This has changed, but not as much as it should have done. It was seen as a soft specialty, one that attracted oddballs and outsiders. Gifted psychiatrists might be asked, with incredulity, why they chose to waste their talents. Many of our medical colleagues barely view us as real doctors. Yet just this week I was asked to attend to an unwell passenger on a plane, something that has never happened before. I opened my mouth to say—but I’m just a psychiatrist—then thought that if they had someone else, they would have asked them. I did my bit (fortunately minimal). I sat down, trembling, and told myself, “I’m a psychiatrist and a doctor. I’m not just anything.”
However, it can be hard to remain passionate when the striving that comes with pursuing a goal dissipates on reaching it. I like my job, but it’s perhaps not what I once thought it would be. I do talk with patients, and I try very hard to listen, but the deprivation, trauma and suffering that we see can be overwhelming. Psychiatry, too, has changed, and training now is more similar to that for other specialties, full of competencies to achieve and portfolios to complete. Resources are generally scarce, and many patients are seen only in busy clinics, with limited opportunity to get to know them. It’s not the dream I once had, but the patients remain the same.
Psychiatry is different to other branches of medicine. You need to study it, but that’s not enough to succeed; you need something more. You need to read literature, see films, watch people and engage with humanity. And you will never stop needing to do so.