The journey to becoming a psychiatrist

Sharing the experience
My exposure to mental health began at the early age of five when I witnessed a sudden change in behaviour in a close relative in a remarkable way due to what we later learned was going to be his first psychotic episode.

Over time, I came to realise that my choice of becoming a psychiatrist was primarily motivated by a need to understand how such behavioural change comes about, what precipitates it, how it can be prevented, or, if this is not possible, how we can improve the mental health and life of the people affected.

The journey, however, was not easy, not only because of the high complexity involved in the profession itself but also because of the initial difficulties I had to overcome to harmonise my personal experience with the professional one.

Dealing with the patients

When one begins to work and train as a psychiatrist, there is always a process of adaptation and learning driven by exposure to dealing with patients, their disorders, and their biographical histories. Some resonate with us more, impact us more, and others less. But they all contribute to acquiring theoretical and practical knowledge and maturing our personality.

Not surprisingly, this exposure is not always easy; it often affects us, stirs us, and makes us uneasy, and we need to process all that new information that we are accessing for the first time, thanks to the postgraduate training in psychiatry that equips us in dealing with all.

Theoretical training

The second inexhaustible source of exposure and learning are books, scientific publications and congresses, training courses, etc. The study and the training activities lead to the acquisition of a theoretical corpus and explanatory models which enable the professional to work with patients’ mental health problems. But in psychiatry, an extreme diversity of models, theories, theoretical approaches, and schools coexist, almost all in apparent contradiction or open struggle. It is truly overwhelming for the doctor in training to be able to master all of them, which unfortunately often leads to desperately clinging to the one with which we are most comfortable. And this is not very good because it already limits the professional’s perspective on mental health and illness.

It is virtuous to have the humility to accept what we do not know and maintain a critical attitude towards “solutions for everything”.

This disparity of theories inevitably implies some confusion for the professional beginning to train in psychiatry. Still, once we can corroborate which theories are valid (or rather: in which cases yes and in which no), we have no choice but to maintain an ongoing interest in learning. It is virtuous to have the humility to accept what we do not know and maintain a critical attitude towards “solutions for everything”.

Mental health professionals

There is a third source of training and learning for the beginning psychiatrist. It consists of a team of psychiatrists, the teachers and mentors with whom one works during these first years of professional practice. Not only one learns from psychiatrists; many other professionals, although to a lesser extent, contribute to the training of trained doctors.

In the same way, psychiatrists in training must deal with and learn from the disparity of criteria of their mentors, which is so common in current psychiatry. We often come across such a variety of opinions among established professionals. Although on the one hand we can all learn from those diverse opinions, on the other hand they can also overwhelm and discourage us.

But it is clear that the object of study of psychiatry, the human mind, is the most complicated entity in the universe, the most complex of Creation.

One should not rush arrogantly to want to dominate it. But it is not easy not to do it, especially at the beginning, because we receive the mandate that you have to master the speciality that you are studying and at the same time accept that, in a certain way, it is unattainable.

In summary, regarding the intellectual aspects, the psychiatrist must manage uncertainty well when addressing the unknowns surrounding mental disorders, their aetiology, pathogenesis, course and treatment.

On a more personal and biographical level, it is essential to know what has led us to take a professional interest in psychiatry and to have more or less well-represented the qualities of one’s personality and the personal relationships that have shaped us.

"The human mind is the most complicated entity in the universe, the most complex of Creation"

At the beginning of this article, I outlined the biographical facts that have marked me the most in my professional choice. I have briefly added in this regard that I had to face specific difficulties at the beginning of my practice of psychiatry about how to reconcile the roles of being a “family member of patients with mental disorders” and a “psychiatrist“.

The combination of support from my wife, my supervisors in the psychiatry department, and the invaluable help of analysis (a psychotherapeutic process that lasted around two years) helped me persevere and balance both facets of my life fruitfully.

I want to highlight the support I received from the head of the Psychiatry Department where I was doing my residency. She helped me see that my own personal experience of closeness with mental disorders, well channelled, could in fact help me built better relationships with my patients and ultimately help become a better psychiatrist.

Lastly, for those that may not know it, I would like to mention that there are well-known examples of psychiatrists who, throughout history, have had cases of very close relatives with severe mental disorders, frequent hospitalisations or even suicides. Public statements by mental health professionals who state that they have some mental disorder are also increasingly common. Perhaps the most striking and paradigmatic is that of Dr Linehan, creator of the most effective treatment today for patients with borderline personality disorder and high suicidal risk (dialectical-behavioural therapy) and who has shared her experience as a patient, for example, in this New York Times article: Expert on Mental Illness Reveals Her Own Fight

In any case, whatever the vital situation that leads us to work in the field of mental health, it is essential to know, appreciates and direct great intellectual efforts and also maturation of the personality to be able to give the best of ourselves to the patients, add value to the development of the speciality and enjoy the professional practice.

I hope all readers, especially those contemplating this profession or at some point on their initial journey through it, will find this article interesting.

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© Todos los derechos reservados. Samon Psiquiatría.

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21 Feb
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