How did you get into psychiatry?
PORTRAITS IN PSYCHIATRY
I am almost 80 years old and have decided to retire from the profession of psychiatry, which I cherished and enjoyed for several decades. My professional journey began in India on a good footing, with the deep desire to help the less privileged and make the world a better place to live. I received further training in neurology in England, with the plan to embrace this exciting medical specialty. However, later, without giving much thought to it, I moved to the mysterious field of psychiatry. I kept it a secret from my parents and siblings since it would have been shameful for them to acknowledge that I was working as a mental health doctor. When asked by a friend what I did, I answered I was practicing neuropsychiatry. Well, were not Tardive dyskinesia, parkinsonism, and akathisia all parts of neurology? I told another friend I only wrote prescriptions and did nothing else. Maybe, there was less shame attached to a psychiatrist who prescribed medications. It was humiliating to come across even well-educated folks who were confused by the difference between a psychiatrist and a psychologist.
However, my fascination with this mysterious field continued. When a psychiatry job came up in the adjacent hospital, I readily accepted, thinking of it only as a short-term plan, until the immigration papers to proceed to America came through. It turned out to be much more than that. A year later, I applied to a psychiatry residency program in the United States without much hesitation. This time, I rationalized that psychiatry would give me a head-start in the new country, due to my expertise in neurology.
It is hard to believe that it took me decades to unfold the mystery behind my decision to become a psychiatrist. When the answers finally emerged, I realized that the early seed for my unexpected adventure had taken place when I was 20 years old, in my third year of medical school. Initially, a thin veil descended on me, profoundly affecting my education. Even though I listened to the lectures, attended the lab work, and examined the patients, my mind was registering them much differently than others. I began failing exams, but surprisingly this did not bother me much. This low-grade, yet destructive spell continued for 2 years. I am certain if I was living in the southern US then, I would have been diagnosed with an attention-deficit problem and prescribed Ritalin!
Unlike the slow beginning, its end came unexpectedly at the very moment I found out I could not write the final exam with my classmates. Suddenly, it felt like an emotional dam burst, pouring out megatons of electricity. Unrelenting waves of current came down, shrouding my whole body with strange sensations. After several hours, the gushing tides subsided and were taken over by a blanket of numbness—numbness of body, thoughts, sensations, and appetite. I gulped food without taste. Slept long hours in a frozen state. Even the night dreams shied away in deep weariness. My brain found it hard to let out words, as if my basic intellect had dried up, its nourishment cut off. The mind of this ill-prepared young man was shattered into a thousand pieces.
The recovery from this spell was slow as if programmed to last a certain time and inflict maximum pain. Since then, I have wondered what made it last only 6 months. Who decided the calamity had gone on long enough and called it quits? Did the stocked-up dark brain energy simply get exhausted? Or did the brain feel sorry for the victim and retract, knowing it could come back another day, just like a rogue elephant returned to destroy the fertile fields? Finally, the relief came very slowly, without much effort on my part. The blue skies reappeared and the sun became bright again. A euphoric feeling lifted my spirits and I passed all exams in excellent shape.
The next spell occurred while in the US, returning from New Orleans after a family vacation, crossing the 23 miles long Lake Pontchartrain causeway bridge. My wife and daughters were enjoying the vast display of birds flying around in flocks, occasionally snatching a fish, and looking for the crocodiles showing up above the waters. They did not notice the internal explosion I was going through. An uneasy feeling built up within me, with my heart pumping, throat getting choked up, breathing faster, eyes foggy, mouth dry, and palms sweaty. Utter terror engulfed me. Will the steering wheel slip off my wet hands? I badly wanted to stop. The teeny-weeny stopping zones appeared regularly, I glanced at them helplessly, finding them too short for the car to stop. Also, what if I pressed my foot on the accelerator instead of the brake? That would have been an absolute disaster.
I learned how to connect the dots and tame the devil by this time. I concluded that my initial mood disorder, the major depression that followed, my phobia of water and height, and my panic attack were all interrelated. The culprit was the wonderful neurotransmitter serotonin. Prevention was my goal and the Prozac revolution that began in 1986 was the answer. This medication and similar ones that followed treated several psychiatric disorders, becoming the ‘broad-spectrum antibiotic’ of psychiatry. Still, another surprise was in the store. I felt like a new person within days. The depleted serotonin did not have to wait for the usual 3 weeks to attain enough saturation within the brain, to have its impact.
Now, with 3 distinct spells behind me and enough expertise in this field, I know without any doubt how I became a psychiatrist and what allowed me to chart out a pathway toward complete recovery. I was able to accomplish this without abandoning the noble goal of helping out the less privileged and making the world a better place to live. I realize many physicians like me got into psychiatry to better understand their mental health problems. Some may have been influenced by their family health issues. I hope all of them found the right answers like me while journeying through this interesting profession and thrived to the maximum, to help out others in need.
Dr Jos is a psychiatrist in St Louis, Missouri.