My mother thought I wasn’t making enough progress with therapy, since the sensation of impending doom and endless concern kept sparking in me that malicious, vicious circle of anxiety and pain. I was worried, tense, tearful and, most of all, misunderstood. She took me to a renowned psychiatrist. “Dr. S” quickly “evaluated” me and decided I was “somewhere in the bipolar spectrum.” He gave me free samples of sodium valproate and pregabalin and jotted down an appointment for the following day with his psychiatrist wife (whom I never ended up seeing). I was a fifth-year medical student who knew very well I had never in my life had a single episode of depression, let alone of mania. By then, I had accepted that my ailment was psychological—but it was also physical, emotional, and social.
Down a cardiologist, and now down a psychiatrist, I tried a second psychiatrist at the recommendation of my psychologist. “Dr. A” also believed my anxiety levels were skyrocketing, even though I kept my cheerful mood and never wavered in my performance at school. She looked at me, smiled, and said, “You are young, you are beautiful, and you are smart. But nothing I say will mean anything to you unless you understand it yourself, because you are full of a blinding anxiety. If I ever hear that another colleague diagnoses bipolar in your case, I will sue them.” With that, she hugged me and prescribed an anxiolytic, which I rarely took. The true anxiolytic was finally feeling normal.
In my third year of medicine, I had already decided I wanted to become a psychiatrist, with its constant challenges and mysteries of the body and mind. The balance between science and compassion, biology and psychology—these were a perfect combination, the right fit for me. My experiences as a patient did nothing but reinforce that passion, and I graduated from medical school and the psychiatry specialty at the top of my class.
The value of empathy
I don’t mention my rise to the top lightly. It cost me my mental health for many years. My desire to please, to give, and to help reinforced feelings of emptiness and isolation. I could barely endure the strain, and life is still a battle to undertake every morning. Nowadays, I tell my story to the patients who I feel will benefit from my suffering. I tell it to those who ask, “Doctor, can you help me?” “Doctor, have you tried any of these pills yourself?” “Doctor, am I normal?” I tell them normal is what we want normal to be. Normal is to feel well, whole, complete, safe, and understood.
I know how to titrate lamotrigine. I’m very sharp at diagnosing personality disorders. I can name all the receptors blocked by tricyclics. But that is not what makes me an effective health care professional. Like many good psychiatrists, I have empathy and concern for my patients. But in my case, I’ve quite literally walked in their shoes. I’ve danced in the hallways of the main psychiatric hospital in Buenos Aires with my dual pathology patients. I cried as I held a patient whose dog died tragically. I sang a song with a patient who thought she was a star in the opera. I’m a good psychiatrist because the patient who changed me was me.
Editor’s note: An earlier version of this article was submitted for the Psychiatric Times Writer’s Contest. The entry was not eligible because the author is not a US-based psychiatrist. Nevertheless, we publish a newer version of this article for our readers to enjoy.
Dr Giacobone is a general adult psychiatrist and a psychotherapist specializing in CBT. She is a lecturer in psychiatry at the University College Dublin, Republic of Ireland. She reports no conflicts of interest regarding the subject matter of this article.