This vignette is from an outpatient neurology month I did last year, mostly a pretty calm scene compared to the inpatient psychiatric wards - until Ms Q arrived on the scene. Forty-five minutes late for her appointment, she stumbled in on the arm of the fellow, mascara streaking down her cheeks. "She's intoxicated," the fellow murmured gently in his refined hint-of-British, hint-of-Indian accent as he steered her to a chair.
"I hate it, I hate it," she sobbed incoherently. An overpowering odor of alcohol wafted about her. She had been swigging from a bottle in the car all the way from home, over an hour away. I shuddered at the thought of the unsuspecting commuters who'd shared her road.
I was assigned to calm her down; my few months' worth of psychiatric education had won me this one. I murmured soothingly, knowing there was little useful diagnostic information to be obtained from her right now. She was a blonde beach girl, far from home; and it showed in her long yellow hair, bright pink lids and lips, pink toenails in metal-ringed sandals.
"I hate you," she raged. "I know you're trying to be empathetic, but you don't understand. Look at you - you're young, you're pretty, you have cute shoes..." She dissolved into a bathtub of drunken tears. Cute shoes... emblematic of the good life. I sighed and patted her on the back. She was in need of some perspective at the least.
But she was right, of course. I don't know what it's like to be an alcoholic. I have worked in recovery programs, and noticed that the addiction specialists with drug histories often seemed more effective than those without. Regardless of training and other forms of institutionalized expertise, in the addict's own head it is important that his therapist "understand where he's coming from." All that training is for naught if you can't even get the addict to listen to you. For people with their own drug histories, that door is already wide open.
Even a hint of personal experience is worth more to patients than a barrel of education. I haven't myself been substance-addicted or psychotic; but I've got examples of each among my family and those close to me. I tend to play those cards pretty close to the chest because I'm not sure myself how it's relevant or useful for my patients to know that. But in the very few cases when I've mentioned the fact, the response from patients has been overwhelmingly positive.
I've also had patients ask if I've tried the medication I'm recommending for them; and somehow I always cringe a bit internally when I must admit I haven't. (I did sample one commonly used antipsychotic just for purposes of personal education; but I've never been prescribed a psychotropic med and I certainly am not planning to sample the whole arsenal.) But why is there any part of me that feels as if I should have?
One wouldn't expect one's cardiologist to have his own history of heart attacks; nor ask one's internist if he's tried the antibiotic or diuretic he suggests. Yet psychiatry is somehow different, removed from the clearly delineated ethics and protocols that apply in other areas of medicine.