Give and Take

No one plans to be uncomfortable, ill, or emotionally and physiologically exhausted— it arrives unannounced, stealthily, much like an ambush that interrupts one’s focus elsewhere. Adding to this confusion is the fact that psychiatric symptoms may appear in someone who has been a high achiever and historically very successful in life. A man or woman who has functioned at a high level of professional responsibility, with recognition and success, will recoil in disbelief when symptoms of exhaustion appear. The unwarranted assumption is “once healthy, always healthy”. The simple mention of psychiatry often evokes images of an outdated, upholstered couch in the company of a bearded wizard. This is followed by flashbacks of imprisonment a la One Flew Over The Cuckoo’s Nest, over-medication with sedating drugs that results in an ambulatory, “embalmed” person, or use of medications with draconian behavioral, or at a minimum, unpleasant, adverse effects and possible medication interactions. In addition, the focus of medical ethics has shifted from a paternalistic guiding principle in the day when the clinician worried for the patient in a parental way. This has given way to respect for self-determination, but has placed a great burden on the patient, as well as affording him liberty and respect. The onus is now on the patient to weigh all relevant clinical information before making a treatment decision. He must calculate his own preferred risk-benefit ratio. This may be hampered by absence of information such as prevalence rates of possible side effects, ability to imagine the experience of some adverse effects, and so on. The fact that anyone seeks or accepts treatment in this environment is testimony to the degree of suffering caused by symptoms associated with significant neurophysiological changes. Neurophysiology simply means the processes of nervous system cellular functioning. The workings of the cell can be affected by many factors such as genetic, metabolic, infectious, toxic environmental, and autoimmune factors. Consequently, this book is a distilled conversation between a prospective patient and her psychiatrist, which may facilitate making an appointment, provide helpful information, and possibly lead to understanding the clinical challenge for the psychiatrist. It is not intended to be a psychiatric text or represent psychiatric knowledge in any comprehensive, or organized fashion. My patients have been my best teachers. I rarely forgetinformation shared in a personal dialogue with someone who expresses human emotion, often while suffering, and extended with trust. A patient wants to be certain that their feelings and personal information will be received with the intention to understand them and respond for the benefit of its bearer. Moreover, attending people who have struggled with life’s toll-takers, such as the neurophysiological changes of cellular exhaustion, or situational burdens has provided me an awe-inspiring example of surviving or coping with suffering.Witnessing patients triumph over existential “testing” has afforded me some measure of courage in meeting my own life challenges. Perhaps it is surprising at first glance that those who initially struggled against establishing a working partnership with me, initially resisting treatment, but later who invested themselves in treatment after re-evaluating their circumstances in light of new information, were the people with whom the most meaningful relationships were forged. In retrospect, this is not surprising. Those who are battle buddies, engaged in a challenging mission with a unity of purpose develop a uniquely enduring, lifetime relationship. My indebtedness to these courageous patient-souls with whom I have worked is only exceeded by my unlimited respect for their strength of character. A person merits respect, who is sufficiently perceptive to recognize appearance of symptoms, brave enough to face the uncertainty of the unknown, and motivated to take responsibility for solving the problem that may not only be interfering with their own optimal functioning, but also causing anxiety or burden for those around them. If only there were predominance of such qualities in my interactions outside the office...