Thursday, September 21, 2023

How Can I Help? A Week in my Life as a Psychiatrist


by David Goldbloom and Pier Bryden; 2013
Book review by Peter McKenzie-Brown; September 25th, 2023.

Lately, the best reads I get have come from one of the many Little Libraries (book boxes) around town. That applies to the book I’m reporting on this month. Once I started reading, I was hooked.

The downside was that I lent it to a friend who promptly went on holiday. To show you the book today, I had to order it from the library. I knew it would be available, because it was a non-fiction bestseller across Canada.

A psychiatrist, David Goldbloom is a senior medical adviser at the Centre for Addiction and Mental Health in Toronto. He and co-author Pier Bryden, who is also a psychiatrist, seek to reduce public fear of psychiatry by showing what they really do, the conditions they treat, the resources they deploy and the settings in which they work.

Tracking Goldbloom over the course of a hypothetical week gives the reader a bird’s-eye view of what psychiatrists in a teaching hospital do, providing a textured picture of its complexity. In this book the reader observes Goldbloom diagnosing and critiquing a diagnostic interview, meeting with long-standing patients to monitor their symptoms and medication, teaching residents, administering electroconvulsive therapy, and confirming a diagnosis of Asperger's disorder by long-distance telepsychiatry to Kenora, Ontario, and admitting an involuntary schizophrenic patient to the acute care unit. Those activities all take place on a single morning.

Some of the patients profiled gave explicit permission to appear in the book as themselves; others are fictionalized composites. Whichever category they fall into, all seem equally real. Goldbloom's genuine and sensitive engagement with his patients is moving to behold. Yet a great many of the bonds he ha- with his clients are based on that recognition that are virtually no cures for what this book describes as the three major psychiatric disorders: bipolar disorder, schizophrenia, and depression. In these cases, the challenge is to restore mental health when relapses occur, extend periods between episodes by facilitating emotional, vocational, cognitive, and other strengths, bolster social supports, and offer hope.

The book explains many of the biases that exert internal pressure on him when he's trying to remain on an even clinical keel. More impressive is the way he frames his professional story with his personal life. While immersing himself in the moods, thoughts, worries and preoccupations of his patients, the same processes are pressuring him. All physicians are subject to emotional vicissitudes, but most specialists are not trying to treat these same intense fluctuations in others while trying to cope with their own. Goldbloom's extra measure of personal exposure makes it clear that psychiatrists and other physicians are not exactly exempt from human emotions.

Shouldn’t psychiatrists be able to manage their internal challenges with introspection, insight, and other techniques? Well, yes. But in one case he mentions, Goldbloom is so distraught by the news that one of his patients has committed suicide that he rallies many resources to regain emotional equilibrium, including paying a condolence call to his patient's family in which their shared grief helps all of those present to heal.

This book is beautifully written. Although there are two authors, most paragraphs are written in the first person: I did this, I saw that, I asked how, and so on. Throughout the book, the first person clearly seems to be Goldbloom. This confused me a bit, in the sense that Ms. Bryden is the co-author, yet no segment of the book seems to directly represent her own point of view. Odd though it may seem, the consistency of this approach contributes to the book’s readability.

Throughout the book, the authors refer to the literature that helped create modern psychiatry, much of it originating in the 19th Century. I’ll close with a story from that century about a young woman who had the mental condition known as anorexia nervosa, which is mostly a female syndrome, in which the patient refuses to eat. To give an example, he cites the story of Sarah Jacobs, who stopped eating normally as she entered puberty. I’ll close these comments with her story:

[Sarah] claimed to need no form of nourishment and became a tourist attraction, bringing her family money and fame. A medical team was sent to observe this apparent miracle, providing nurses to watch Sarah around the clock and ensure that she wasn’t surreptitiously given any food or water. After six days of this, Sarah was clearly failing, and the nurses appealed to the doctors on the team and to Sarah’s father to feed the girl. Mr. Jacobs refused, presumably determined that the family’s golden goose not be slaughtered, and after ten days of observation, Sarah died.

This book is powerful; I rank it a Canadian masterpiece. Every page is a source of knowledge and wisdom. It is worth savouring.

No comments: