Losing It

As a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day. If I can help you put these symptoms into a framework such as a syndrome or a disease, then we can work together on trying to figure out how to treat them. Often times in mental health, the best we can do is to dampen the symptoms and make them better or more tolerable because we haven't figured out exactly how to get rid of them completely yet. Frustrating for you and for me, but at least your life can be more enjoyable and you are not plagued by intense depression, debilitating manic episodes, or maddening hallucinations.

Now, we all would usually agree that getting rid of symptoms and curing disease are two admirable goals that are well worth pursuing. Much of medical school and residency training for doctors involves diagnosing, treating, and getting rid of pain, symptoms, suffering and disease. Lord knows, when I recently went to my doctor for diagnosis and treatment of severe pain that was measurably cramping my style every day, I had every expectation and confidence that he would listen to me, examine me, diagnose something, tell me about a cure, and fix me! He pretty much did that, and though I will not be cured from this syndrome, I feel much better and can go about my life with only moderate pain and discomfort.

What about psychiatric symptoms? Does the same hold true there? Well, of course, you would say! Who wants to suffer from sad mood and shyness and inability to go out of their home and hearing voices and social isolation and decreased appetite and all these other myriad symptoms that patients tell me about every day when I ask, "What brought you in to see me today?"? You would say, emphatically, that all patients with mental illness would want to be cured and rid of all their psychiatric symptoms and all their behavioral problems and all their social faux pas. You would say that, right?

Sometimes, you would be wrong.

I have started patients on antipsychotic drugs that got rid of the hallucinations that they had been plagued with since they were teens. All the voices-gone. The scary shadows on the wall-gone. The command hallucinations telling them to kill themselves-gone. But, the pretty, soft, soothing music that played in their heads when they lay down on the couch to try to sleep at three AM? Gone too. The positive affirmations that play in their heads that tell them that maybe things will be OK after all and to hang in there-gone along with the grandmother whose voices they conjure. The lithe, thin, physical body they'd had for years-gone with the weight gain that can come with medication treatment, just at the time that they feel like getting out and wearing a swim suit in public for the first time in their lives at the beach. The desire for intimacy, emotional and physical, with another human being-gone with the "bad" symptoms when the medications they take completely shut off a wakening sex drive that gets better when their mood improves, or that cruelly causes sexual dysfunction just when desire is returning.

So you see, sometimes losing symptoms and fixing syndromes and diseases is a tricky business indeed. While we very much want to help patients get better and function in life the very best they can in spite of their mental health problems, sometimes we take away the very things that help them care, connect, and cope.

This is why medicine, in spite of all the high tech and the wonders that we possess, is still an art.

Cookbook medicine is a fallacy.

Compassionate medicine is a worthy goal.