South African Psychiatry - November 2018

PERSPECTIVE
a yellow file, with next-of-kin details, and alternative
contact numbers? I struggle to place my hurt and
heartache into the category of another’s commodity.
I STRUGGLE TO TRUST SOMEONE WHEN
I FEEL THAT MY MOST INTIMATE DETAILS
NEED TO BE HANDED OVER AS SIMPLY
PART OF A ‘JOB’. IT MAKES ME FEEL
DEFENSIVE AND GUARDED”
I realize now that on day two or three of that
admission my psychiatrist had tried to prepare me
for the dreaded conversation he wanted to have
with me the following day. He needed to know more
detail about my story in order to treat me effectively,
and he explained this to me – warning me that the
next night we were going to ‘go there’. In some ways
I felt pushed and I was angry, but more than anything
else I was terrified. Today I know with certainty that
my psychiatrist was acutely aware of my terror and
that is why he had attempted to forewarn me about
what was to come.
REFLECTING BACK NOW I HAVE TO
WONDER IF, IN A WAY, HE WAS PREPARING
HIMSELF TOO. IT IS FAIRLY OBVIOUS HOW
I FELT IN MY HOSPITAL BED DIATRIBE,
BUT AT THAT STAGE I NEVER STOPPED
TO CONSIDER HOW HE FELT. I KNOW IT
WASN’T MY JOB OR DUTY – AFTER ALL I
WAS THE PATIENT. BUT, I HAVE TO WONDER
IF THIS TYPE OF SCENARIO ISN’T PERHAPS
TOUGH FOR PSYCHIATRISTS TOO.
How tough is it to be the one who has the responsibility
to decide that a patient’s fear, instability and distress
are so acute that the best place for them to be is the
confines of a hospital bed?
My psychiatrist has watched and listened to me as
I’ve traversed every up and down along my journey.
He has seen everything from pulsating nausea and
shivers to insomnia and terror, elation, laughter,
panic, dizziness, desperation, confusion, terror and
migraines. He has witnessed it all. He has listened
to my stories of bewilderment, love, dread, elation,
travel, bikes, textbooks, graduations, mother, brother,
friends, excitement and disappointment – so the list
continues. I don’t know how he does it. When I leave
my psychiatrist’s consulting room I often wonder how,
day after day, he manages to listen, with such care
to the complex and deep intricacies of so many
people’s lives. Where does he find the reserves to
perpetually assimilate the delicate nuances of every
patient? Not all psychiatrists get this right, but what
sustains those who do?
I can’t imagine that being diagnosed with mental
illness is great for anyone. It’s not something that
comes coupled with a statement from your doctor of:
“… but don’t worry we can cure this with a strong dose
of penicillin”. I think about the fact that psychiatrists
have a duty to regularly hand over diagnoses of
these illnesses. Not only are they often incurable, but
frequently they are tricky to treat – a tedious path
of medication trial and error for both patient and
doctor. In addition, these diagnoses psychiatrists
pass over to us come loaded with societal stigma.
Caring for us seems an overwhelmingly weighty
responsibility. Does that weight ever feel too much
to carry?
Being on the receiving end of diagnoses and
psychiatric treatment is far removed from Flake ice
creams. I remember when I received my diagnosis;
on the one hand I felt relieved – relieved that there
was an explanation other than a lack of self-control
for my erratic, unreasonable thinking and behaviour.
BUT I ALSO FELT AS IF I HAD BEEN LEFT-
HOOKED IN THE SOLAR PLEXUS. IN
THOSE FIRST MOMENTS I DIDN’T FIND
MYSELF DEALING WITH THE STIGMA OF
THE OUTSIDE WORLD, BUT THAT, WHICH
LIVED INSIDE MY OWN MIND. I HAD
ALWAYS FELT A DEEP EMPATHY, OR
PERHAPS SYMPATHY, TOWARDS THOSE
WITH MENTAL ILLNESS. HOWEVER, IT WAS
SOMETHING THAT BELONGED TO ‘THEM’
NOT ME, SOMETHING WORTHY OF PITY.
I was horrified at myself. After I faced myself I did
have to deal with the reactions of the outside world.
I find it so fascinating to watch the responses of many
when I disclose my diagnosis. Even those who have
known me for extended periods make comments
such as: “No! But you’re so normal!” What pray-tell
is that meant to mean? Do they expect me to be
walking around wild-eyed and snarling? Or another
choice reaction is when it seems as if the wind
has been knocked out of them, and they scrabble
desperately for a way to change the subject. If you
let it, these reactions can make you believe that your
‘abnormality’ renders you unworthy of consideration
– renders you a failure on the most basic human
level, shameful, and useless.
Often, it has been the time spent sitting across from my
psychiatrist that has helped me regain perspective
and figure out how to navigate the hurdles of
stigma. Amidst my own doubts and uncertainty my
psychiatrist seemed to have consistent, granite belief
in me – my abilities and potential, belief beyond
what I could fathom. His belief fed my husband’s
belief, and eventually this helped me believe that I
shouldn’t give up, even when I fell. The combined,
unwavering support I have received has often
shored up my crumbling walls.
I question how often it is that psychiatrists notice lifechanging
moments that happen across from them.
Moments that in their brevity might seem little, but in
SOUTH AFRICAN PSYCHIATRY ISSUE 17 2018 * 57