Dr Benjamin Janaway @drjanaway Psychiatrist, Writer and Science Communicator. Working on a novel. Widely published. Media enquiries via DM. RTs usually endorsements. Future Silver Fox. Sep. 20, 2019 4 min read

Mental Health thread//

Lessons from training as a psychiatrist

1) Mental health is complicated, and illness can come from a variety of experiences, genetics and biology. No two people are the same, and no two approaches should be. Person centred medicine is important.

2) Stigma is common, both in patients fearing illness and others judging them. This same stigma delays diagnosis, harms people and attacks rights. The solution is education and speaking openly of ones experience. Fear is often based on assumption, not reality.

3) Capacity and Insight are not the same. Capacity is a time specific ability to receive, understand, consider and communicate information relevant to a decision, insight is the ability to recognise the presence of delusional or hallucinatory symptoms as part of an illness.

4) Medication is not always necessary, and as psychiatrists we always attempt to reduce and stop it. Sometimes it is necessary, and for a long time. This is based on evidence, and is only done to help ameliorate suffering, risk of relapse or harm.

5) Medication has side effects. Some of these side effects can be challenging enough to cause people to stop taking them. This is well known and should be addressed as part of any treatment plan. It is the patient who is important, and we should work to support their decisions.

6) Psychology is a fundamental part of treatment and should not be separated from psychiatry. It tells us not just why we do things, but the processes by which these actions are generated, and how they can be addressed. Therapy is a lifeline, and should be respected.

7) Psychiatry is difficult. Communication can be hard when someone is distinctly unwell. Sometimes diagnosis can take a while, as disease takes time to form a recognisable pattern. We work in grey areas, and hope that the ends justify the means. Psychiatrists respect this.

8) At times people will be sectioned, either to protect them or others. This does mean detention and removal of rights. Some patients recognise why later, others will disagree. This decision will never be taken lightly, and we lose sleep over it.

9) We get things wrong. Sometimes there are mitigating factors, other times there are not. It is up to us to recognise and be honest about mistakes, take responsibility, be safe and make it right. A doctor without fear of making mistakes is dangerous.

10) Empathy is incredibly valuable. You cannot understand a persons story fully without trying to walk in their shoes. Sometimes this is not fully possible, but there is always a common thread between us. Learn to spot it, and you turn from a doctor to an advocate.

11) Sometimes Psychiatrists burn out, become cold or seem insensitive. We are human, and dealing with so much trauma can take a toll. If you feel we aren't communicating, tell us. Its important to us to recognise when we need to take a step back. We cannot help if we are lost.

12) Mental illness does not mean that you are worthless, hopeless or useless. Like any illness, it will range in severity and duration, and recovery is possible. Do not be afraid to ask for help. This is why, as part of a team, psychiatrists are here. Optimism helps recovery.

13) Illness does run in families, but that's not everything. Do not feel you cannot live a full life because of the spectre of some future event. Talking about concerns with a doctor can help you make plans to live your best life regardless. I know this one personally.

14) There is much more to be known. Psychiatry is in its relative infancy and much more evidence is awaited. We can only do our best with what we have. The science is improving, but there are holes. Compassion and understanding will fill them as much as we can.

15) Some have argued that psychiatry is a form of social control. Others that it invents illness. 100 years ago, this may have had some merit. But now we have genetic studies, patterns of symptoms, research and evidence. We are here to treat suffering, not society.

16) Psychiatrists are often brought into complex social issues due to a combination of opinion, politics and stigma. We cannot provide a moral answer better than others simply due to our training, but we can try to support the patient as a priority.

17) We do not always maintain good relationships with our patients. Sectioning someone is not a way to make friends. Sometimes advocating for someone's best interests in the long term means burning your bridge right now. We try to avoid this, but it is a reality.

18) Culture plays a huge role in mental health, both in terms of perspective and treatment. It is up to us to ask and respect it, recognise differences and account for them. This can be hard, so please educate us.

Thank you for taking the time to read. I am always happy to answer questions where and when I can. I will not engage with sustained abuse. Please #retweet and add your own lessons.

I want to be better at this work, and I need to listen to you.

#mentalhealth #psychiatry

And feel free to follow me. I try to help educate by writing articles and tweets. I will continue to do this, but the more people that engage and discuss with me, the more I can do to help.

Thanks again.


And if you want to read more about my experiences of having depression and how it changed my perspectives


You can follow @drjanaway.


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