It’s been a long day!
I sit in the OPD and look with wonder and gratitude as people stream in. All ages, different personalities and so many varied cultures and backgrounds and I think about the days when people would hesitate to reach out for help. In the past twelve years, there has been a notable change in the rate at which people reach out & seek mental health intervention. And it is heartening to see people starting to look inward and realize how important their emotional well-being is.
And while I am grateful for the shift, I cannot help but feel frustrated at the common refrain that accompanies the reports of distress, despondency, panic, and hopelessness. “Doctor, please don’t prescribe any medications!!!! I just want to get better but NATURALLY!”
To be fair, I understand where they come from. And it is only the many years I’ve spent in training that have created in me the awareness, that various things, including genetics, environment, past experiences, personality factors and social circumstances, have an impact on a person's mental health. And so, all of these factor’s mould, shape, and program our minds to behave in specific ways. For most of the individuals that come to me with anxiety and depression, there are long backgrounds of unstable environments, trauma, hostility, and growth in poorly regulated emotional environments.
As professionals in the field of mental health, we are very motivated and constantly on the alert to assist those in need or are willing to refer them to the right connection for their optimal benefit. In fact, whether it is a psychiatrist, psychologist, or any other mental health professional, we each contribute in our own unique way to the holistic recovery of those who reach out to us. Why then this constant pressure on us to heal, but with binds????
As the stigma surrounding mental illness slowly clears, we now face a new set of difficulties. So many of our clients come with their own methods for addressing problems that in reality actually call for professional clinical intervention. While it is absolutely okay for clients to have questions, be curious, and want to understand the recommended line of treatment, the important message here is that the professionals are there to guide and direct treatment planning. It is truly a challenge for the professional if the client is rigid and unwilling to consider available options.
Case in point: Megan came to me after years of reaching out to therapists with panic attacks, messed up relationship patterns, and self-harm, saying that psychology is all hokum and that all therapists do is mint money. After a detailed psychiatric history, I pointed out to her that she was struggling with Severe Anxiety with Depressive symptoms with a background of borderline personality disorder and outlined to her treatment options including and necessitating medications, regular therapy, and lifestyle modifications.
Although initially reluctant, she finally agreed to give this line of treatment a chance and six months later, she is doing much better, in regular therapy and on minimal maintenance doses of medications. She exercises 2-3 days a week, avoids her earlier alcohol and weed binges and works hard at building sustained relationships with people who truly matter.
I honestly could not have achieved all this without her openness to medication because she herself realised that she was getting nowhere in therapy alone. There are limitations to what each of us professionals can do in terms of helping the client and when the concerns are at a clinical level, it is all the more important that we address it with the recommended scientifically-validated line of treatment that is available.
As a practicing psychiatrist, my role is to suggest medications where they can be helpful, insist on medications when they are absolutely needed and re-direct clients to therapy when they would be ideally benefitted by counselling support. However, when clients insist there is a huge problem and express intense distress in the OPD, but then turn around and say that they will not follow the recommended strategy, it creates for me a frustrating dilemma. One where I know that my recommendation is valid but still understand the limits my profession demands I set! That the client takes the call, no matter how damning that call may be!
This is a genuine conflict in OPD every day and this is something that I have been dealing with for years now. I often choose to give my clients the leeway to take their time, to begin the recommended treatment only when they are ready but when they do, I hope they give me adequate time to allow my treatment plan to make a difference. And I have found this to be amazingly effective! Both for me and my clients!
I dream, of course, of a day when my clients come to me and believe in my words to the extent of accepting what I say (after all their queries are addressed, of course) but in the meanwhile ill accept the conundrum they present to me in the OPD. And I will keep going at my job because that is the reason I breathe and live!
A Hopeful Psychiatrist
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