In our psych rotation, we have the option of getting out of a weekend call by engaging in a quick book club. We read a book chosen by the clerkship director, then get together with a handful of psych interns to discuss it over pizza. I don’t know the details, but the book club was started shortly after an intern at Penn committed suicide for unknown reasons. This collective reading and discussion serves many purposes: it sheds light on mental illness, something that we as a society are painfully poor at acknowledging; it gives that illness a face, not so unlike you or me, or those we hold dear; it allows us to appreciate what we learn on the wards in a different forum, thereby deepening our understanding; it recognizes those, like the young intern, who perhaps wasn’t fortunate enough to find comfort and aid, to receive treatment, and calls for us to do better, to not let other colleagues slip through the cracks.
My cohort read Brain on Fire: My Month of Madness by Susannah Cahalan. Cahalan was in her mid-twenties, an up-and-coming reporter for the New York Post when she developed hallucinations, seizures, behavioral changes, and delusions before entering a catatonic state. She had been seen by a number of physicians in a variety of specialties, spent weeks in different inpatient units, and when she woke up, strapped to a bed, her head covered in electrodes, she had little memory of any of it. Through the use of hospital records, a journal kept by her father, and other first-hand accounts, Cahalan pieced together her story.
My colleagues were most disparaging about the last third of so of the book, which Cahalan devotes to describing her recovery. Many of her critics hold the same complaint: the puzzle had been solved, and she had been “cured”; she spent too many pages going on about her painful and frustrating recovery. I admit, it wasn’t as gripping, but in many respects I think it was the most important part for me, as a med student, to read. We’re all health twenty- or thirty-somethings. Very few of us have had to endure a long recovery, let alone one that involves your mind. The exciting part of patient care is the diagnosis and finding a treatment that works, not managing side effects and trudging through the long road that we can’t expedite. It’s important for me to be reminded that the patient’s journey is many times just starting when she’s discharged from the hospital. And Susannah was one of the lucky ones. Many don’t fully recover from this kind of brain insult, and some die, even after treatment.
By no means one of her most traumatic moment, but a time that sticks out in my head during her recovery is when she attended a wedding, several months out. It was to be her big comeback. She, Susannah, had returned to being the person she once was. She and her boyfriend would be that cool hipster couple with whom others want to talk. Sure, she was bloated and swollen from the steroids, her speech and movements weren’t fully back, or even fluid. But she bought a great new, pink I believe, dress, and got a new haircut. Only months later, looking at video and photographs, did she realize that she actually looked like a deranged robot, with her mechanical, broken movements on the dance floor.
anna in med school 
I read about this book back when it came out, and I’ve really been wanting to read it- probably more-so now that I’m taking psych. Thanks for the insight!!
Hi there! Oooo, I loved reading it on psych, especially since I had just finished neuro (the novel is very much linked to both fields). Enjoy, and thanks for checking in! Hope psych treats you well!
I will check the book out. I think its a great tool for learning some aspects of medicine that can be just a list of symptoms. This method of learning puts a face behind it.
I completely agree with you! I really hope you enjoy the book!
Being in the psych biz from the seventies until my retirement a few years ago, I’ve observed a lot of growth in the field of healing those with severe mental disorders. Philosophies have changed over the years. Watch the old film, “Snake Pit” the next time you have the chance. It actually has most of us saying, “Wow! They got that right!” even thought the book was written about when I was born, and the movie came out just a few years later. In that film, the New Treatment is talking therapy. Talk about your illness and you’ll get better.
A friend of mine remembers when chlorpromazine (Thorazine) suddenly became approved for treatment of psychoses, in the mid fifties. Thorazine’s like a blow with a seventy-five-pound hammer, compared with the feather-touch of modern neuroleptics, but it suddenly enabled thousands to live outside the mental hospital.
The revolution was on. If you have a mental illness, we’ve got the ill for you. I can’t tell you how many ed and training sessions I went to, only to find some guy trying to tell our physicians to use such-and-such to end a patient’s illness. And the nasty truth was it seldom worked anyway.
Toward the end of my tenure, the move was away from reliance of the physician for more than a light assist with some medication, while the activities and groups did all the heavy lifting.
I was at a psychiatric rehabilitationconference in which the best education, for me, was talking for some time with several consumers (folks who utilize psychiatric services are called consumers, rather than clients or patients). It was a nice informative talk, but the part that was significant to me was that these folks in very nice suits had been in inpatient care — restraints, locked wards, the whole ball of wax — and they were able to move on to a normal life. I wanted to take them with me to my friends at the facility where I was working and just let them chat with them. “Hey! See? This lady was once in five-point restraint, and now look at her! It is possible! There is real hope!”
One point they made was that recovery is an ongoing thing. you do not get cured; you simply keep keeping on, and day by day, you find ways to do things better.
Recovery begins the day the consumer realizes they have an illness, not a stigma, and that they can find ways of dealing with it. Recovery is very similar to the approach of the 12-step programs in that sense. You accept that there is something going on with you that can be incapacitating, and you start to learn what it is, what your trigger points are, what your vulnerable situations are and how to avoid them. You learn that if you neglect attention to what you need to pay attention to, you just might end up on an inpatient ward til you get stabilized. My goodness, it is so unpredictable. I’ve seen folks who just never got better for decades, and I’ve seen folks who one day just said, “F–k it, I’m sick of this. I want to get out of here.” and they really began to work on their recovery, and after a while, they came to me, making true adult-to-adult eye contact, and said they would not be coming to my shop any more since they were being discharged.
Yes, recovery is often a bit less fun for the observer than the other stuff, but that’s where the real victories are won. One day at a time.
It should have said, “If you have a mental illness, we’ve got the PILL for you.”
Thanks so much, Jim! I love this kind of dialogue. I will definitely need to watch _Snake Pit_!
I love that you’ve interacted with consumers at all stages. God–it’s still so had to think that we still overuse restraints in this country ( https://annainmedschool.com/2013/06/05/restraints/). A book you might enjoy, and I would be interested to know your thoughts, is _The Center Cannot Hold_ by Elyn Saks. I’ve been meaning to post on it–brilliant, and illuminating through the eyes of genius with schizophrenia, who is also old enough to have seen the different variations of medications (I think she might have started on thorazine).
xo