Magazine article Clinical Psychiatry News

Fink! Still at Large: Teaching the Teacher. (Opinion)

Magazine article Clinical Psychiatry News

Fink! Still at Large: Teaching the Teacher. (Opinion)

Article excerpt

Continuing education is an integral part of any psychiatrist's professional responsibilities. But ongoing formal training isn't the only route to increased clinical knowledge--or to a deeper understanding of the profession. Sometimes, the most indelible, invaluable lessons travel not from psychiatrist to patient, but from patient to psychiatrist. Lessons learned from extraordinary patients can change the way we practice professionally and live personally.

For Discussion: Have you ever had a patient who profoundly altered your perspectives on psychiatry? What lessons--professional or personal--did you learn through such a patient? How open are most psychiatrists to insight gleaned from those they're charged with treating?

Knowing the Patient

My patients have been some of my best teachers. Those who have learned to live with severe mental disorders have taught some of the most important lessons.

One special person comes immediately to mind. I first met him in an inpatient unit when he was in the midst of a florid psychotic break. He was hearing voices telling him to kill his father and his doctors (including me). At that point, I would have never predicted that he would eventually inspire me with his fight against schizophrenia.

He was large, very muscular, and rather frightening. Yet more than 20 years later, I regard him as a role model for how to face a serious illness or other life catastrophe. His deep sense of purpose in a life that many would find bard to face is often a revelation to the medical students and residents who see him in the outpatient clinic. He is just one of many patients who have shown me that knowing the person with the illness is at least as important as knowing the illness.

Jesse H. Wright, M.D.

Louisville, Ky.

Sometimes It Works, Sometimes It Doesn't

Definition of a psychiatrist: someone who pretends not to know everything.

That is, until 24-year-old Ms. M came with episodes of hallucinations and delusions since childhood, one voice having caused a suicide attempt during her mid-teens. Although she completed school and had a life in between, there was major late adolescent drug intake in the early 1970s, and the episodes grew more severe, frequent, and disabling.

I treated her with medication and psychotherapy They were calming, but had little effect on the hallucinations and delusions. Several times I had to hospitalize her, once because there was a spirit after her that could take anybody's form and was going to kill her and once when she had gotten up at night "to witness a sacrifice."

In the hospital, she refused to give blood because she needed all of it for the sacrifice. When I discussed this with her she looked up and away listening to the voice. I asked what "he" said. She smiled and shook her head.

One day she suddenly said to me, "Dr. Peyser, Carol on this ward hears voices like I do. I asked her, 'Do you think we make these voices up, because when I stopped listening to them they went away?'"

The voices went away and never came back. I did try to guide her regarding her hallucinations, as, I have attempted to do with many others. This usually fails, and why she took the guidance and the others didn't, I'll never know. I do know that the wonderful meds and the brilliant psychodynamic interventions I'd been giving her all along didn't do it.

As Plato wrote, we are wiser than they who think they know everything. We know we don't. Or ought to.

Herbert S. Peyser, M.D.

New York

Barking Up the Wrong Tree

Each patient is a synthesis of biologic, psychological, and social issues. Treatment situations often seem to demand an emphasis in one direction or another, and sometimes I see that I've chosen the wrong emphasis. Sometimes, a patient will tell me, "You did it this way but I needed it this way" Part of therapy is how she confronts me on what she needs and how I might be inadequately addressing it. …

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