The words remain etched into the soft, gray wood of a cabin door, where my best friend from summer camp once wrote them with a black, sharp-pointed pen. Melanie smiled proudly when she was done, with the mixture of conviction and rebellion that guided everything we did when we were fourteen. But even then, the words made me a little uncomfortable.
"POOF: the Psychiatrist."
In a list of summer nicknames, that was mine. Had I not loved her, I would never have tolerated the name, "Poof." Melanie meant this to refer to my flyaway curly hair, which created a woolly cloud on top of my skull. I had always longed for straight, controllable hair like Melanie's. Nevertheless, Poof I was.
Melanie and I had met the previous summer, as thirteen-year-olds. I had short hair then, and wore iridescent lip gloss and big metal earrings with my t-shirts and Bermuda shorts. She had shoulder-length straight hair and a sweet face, and her clothes were preppy. I was excited to be at camp; she had been sent against her will. But in our first walk around camp, we struck up a conversation-and didn't stop for the rest of the session. We both, it turned out, loved to psychoanalyze people. Especially, but not limited to, boys.
That first summer started us on a correspondence by mail that replaced keeping a diary throughout our first year in high school. I still have a binder of our letters, mine photocopied before I sent them, and hers as I received them, in chronological order (though our letters frequently overlapped). "I wish I knew what he was thinking," I wrote about my freshman-year crush, with whom I shared a locker. "My parents are driving me crazy," Melanie penned. When the loneliness of being at a new school got to me, I wrote Melanie from class: "I am so depressed today." For her, home was a harder place to be than school: "I almost ran away yesterday."
By the time we arrived at camp for our second summer, Melanie and I felt ourselves to be soul sisters.
I'm not sure when Melanie dubbed me "the psychiatrist" for the first time. I know she told a girl from another cabin to come to ours before lights-out, to talk to me about her boy problems. This started a trickle of visitors to my bunk bed, where girls I had never seen before poured out their worries to me. I answered with Dear-Abby-like sincerity, unsure whether they would trust a stranger, but surprisingly sure of myself. Except for a three-week tryst at a summer school the previous year, I had not yet had a boyfriend myself. But with Melanie's encouragement, I was invincible. We had the gift of understanding, Melanie and I.
In my pre-clinical years as a medical student, a mild derision permeated my classmates' collective attitude toward psychiatry. Based partially on human interaction and intuitive sense, the course didn't garner as much respect as hard sciences like pathology or pharmacology. Some students acted indignant at being taught how to interview patients. Others just avoided the class. Anything having to do with the brain that couldn't be evaluated under slides prompted more discomfort than a hot day in anatomy lab-but we were still required to learn the material and pass exams. The lectures were terrific. The material was relevant. But the conditioned response of my peers, inherited from classes of medical students before ours, was difficult to overcome.
Part of the uneasiness, of course, bloomed from the fact that in symptoms of psychiatric disease, we saw aspects of ourselves. I could empathize with depression. I could believe that paranoid behavior was sometimes normal. Obsessive-compulsive behavior? What medical student doesn't possess a few of those traits-or even the whole, stock diagnosis? I diagnosed my ex-boyfriend with narcissism: exaggerated sense of self-importance, believed the rules don't apply to him, craved excitement to ward off boredom. Bingo. Or perhaps compulsive: "a preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency." Yes! Other characteristics of these disorders didn't fit, but the beauty and danger of psychiatry was how pliable an interpretation could be.
I had thought I understood depression. I would have called it a sadness that does not go away, pervading and saturating the hours and days so they never dry enough to flap carelessly in the winds of time and change. I would have blamed it on losing a friend in a car accident, or feeling lonely, or the meanness of others. I was too sensitive as a child, and I cried frequently. By the time I started high school, after my summer at camp, I believed myself endlessly empathetic to others' troubles.
"Jenny" seemed to fill our eleventh grade classroom by herself. She would ask embarrassing questions a little too loudly ("So, Dave, I heard you got some this weekend?"), just as the hour started. She made faces that made a classmate laugh, causing Ms. Coleman accost him. When he deflected to Jenny, she giggled guiltily, but she was too cute to bust. She flirted maddeningly with the same boys I had crushes on, but won back my favor by the end of class. That was just the way she was.
The morning Jenny walked in pale and trembling, too dazed to say anything to anyone, I think most of us didn't know she was there. I had just put my bookbag down when I noticed her standing beside me, her eyes glazed and distant.
"Claire," she said softly, urgently, "I need to talk to you."
I picked my bag up and followed her outside automatically. She had nothing with her.
"I'm numb," she said when we were twenty yards away from the classroom, standing in the empty quadrangle under a sunless sky.
"What happened, Jenny?" My voice was coaxing but firm, like a parent's hand in a child's. She looked despondently sad, as though tears might leak out if she sank deep enough, but not sad like she had been injured. It felt bigger.
"I didn't think I would wake up," she complained in her little-girl voice. "And then my mom was yelling I was going to be late for school and I got sick on the way and had to throw up."
"Do you feel sick like you need to go home?"
She shook her head slowly. "I don't feel anything."
I wanted to ask what she meant, but instead I waited.
"Last night my mom and my dad were fighting and my brother was being an asshole and I just didn't want to deal with it anymore." Her voice was plaintive, dazed. "I had a headache the whole time and I decided to go to bed and I took some Tylenol and then I just thought I might as well take more and I thought I wouldn't wake up."
Suddenly a bird started fluttering wildly in my chest and I felt a surge of panic. "Jenny, how much Tylenol did you take?"
Her eyes, trained on me, still seemed uncomprehending. "I don't know. I think the bottle was almost full."
"Oh, my God." I was fumbling for my keys and starting to cry and I didn't know where to take her, but I knew it was not the school nurse.
"I'm numb, Claire," she said again. "I'm scared."
I put my arm around her and guided her out to the parking lot, murmuring reassurances and Thank-God-you're-alives, then made sure she was seat-belted before I roared out over the speed bumps and into the street, to the county hospital where my father worked. I half-dragged her out of the front seat, into the box-shaped, cream-painted building where an unimpressed nurse informed me that she could not be admitted without permission from a parent or guardian.
"She took a whole bottle of Tylenol," I repeated incredulously. "She needs help."
I could have screamed, for all the good it did.
Then I was on the phone to her house, to her mother's school, to my father. Dad strode into the waiting area with eyes wide and signed that he would take responsibility, and then Jenny was backed through swinging doors in a wheelchair, still looking at me blankly, sadly.
With my father there, and Jenny gone, I crumpled. Dad walked me out to the car.
"She's going to be fine, physically at least," he reassured me. "You did the right thing."
I blubbered a string of nonsense and questions. "I just can't believe she did that…Is she really okay?… What are they going to do?…Should I not have told her mom?…Why didn't they know?…Maybe I should stay…"
"Honey, it's going to be okay. Jenny's going to need some professional psychiatric help," Dad said. "But you did everything you could do."
I slumped tearfully against the side of the car.
"You should go back to school."
I stared in disbelief.
"I'll be here. I'll keep checking on her. Didn't you say her mom was coming, too?"
I nodded slowly. I had failed Jenny. Friends were the first line, I thought. By the time parents have to get involved, a problem has started to tear at the seams and erupt out into broad daylight where people who don't really understand try to trim it back, hacking at the tendrils of a tree whose roots go deeper than anyone remembers.
I did go back to school. I ghosted through my classes with my heart buried deep, shame sealing my lips for days to come. I had known Jenny was prone to feeling moody, but not this. I had not seen this coming.
Clinical depression is not sadness. It's not the normal response to loss, grieving giving way to denial, anger, bargaining, acceptance. It isn't a cloudy day making you move more slowly, a little bit of fog slipped through a crack in the window and muting feelings for a day or two.
Real depression lingers. Two weeks is the cut-off, the DSM (Diagnostic Statistical Manual, which defines and classifies psychiatric disorders) criterion by which depression is diagnosed. Two weeks of persistent depressed mood, maybe tearfulness or loss of interest in activities. Sleep loss or sleeping too much. Change in appetite. Loss of energy. Withdrawal, cognitive impairment, pessimism or shame or guilt. Many people ruminate on death, or suicide. Less typically, there may be anxiety, or hallucinations of voices criticizing, cajoling, commanding.
Was Jenny depressed? In retrospect, I still don't know. Her weight changed often but she only rarely seemed sad. She didn't sleep overly much or too little. Her energy, whenever she was surrounded by her friends, was high. But voices? I don't know whether she heard voices.
The first time a patient described the voice in his head, I felt my arm hairs stand on end. Nineteen years old, he heard a man's voice telling him how "lame" he was. Sometimes it told him he should kill himself. When he was brought in to the hospital, he had been preparing to do that: with gasoline, and a match.
It wasn't the first time I heard about voices-but this time I understood that psychosis is a very bad thing.
My ex-boyfriend Sean did not have the protected childhood I knew. Son of a woman who was clinically depressed and a man whose best defense was avoidance, Sean was neglected for years. There were reasons for him to be sad, explanations I could make up for his episodic moodiness.
Late one night, after we had argued bitterly about his mistrust of my friendship with another man, our conversation softened and we lay together on the bed, still talking.
"You have no idea what it's like," Sean said, "to have voices inside your head telling you to just end it all, telling you, 'You're stupid, you're worthless. You might as well just get it over with.' Over and over, like a tape recorder you can't shut off."
I could feel the weight of what he was telling me, but I didn't know what to say. Who can't remember feeling insecure as an adolescent? I had spent a few years convinced I was ugly and untouchable. I starved myself to be more attractive. I hid behind make-up. I changed schools. If my family had been so fragmented, maybe I would still, in my early twenties, feel the same way. I reached my arms around Sean and rocked him through a long winter night while he apologized for his rage, talked to me about his stepfather, cried about feeling hopeless.
"I don't know. I'm sorry I get depressed sometimes. I can't really help it. I know it's hard, and we fight over stupid stuff. I really don't want it to be that way. Sometimes I think I should go ahead and do it, just make the voices go away."
My voice came out thin, like white breath in cold air. "Do you really think you might try to kill yourself?" These last words were punctuated by my heart knocking at my chest. How on earth could I stop him?
"I don't know," he said again. "I've thought about it. Just get a gun and-" He made a soft explosion noise. "-then I can sleep."
"Oh, Sean," I gasped. He still wasn't looking at me, just out the window at the clear night sky. I tightened my embrace. "But think of all the reasons to be alive."
He was quiet.
I reached out to all the reasons I loved life in the mountains, loved life in general, and I offered them to him one at a time, like feeding quarters to a slot machine: each one was a chance to hit the jackpot and break him free from despondency. But each fell with an empty, echoing clank.
"You're the only thing that matters to me," he said. The intensity of the moment anchored me there, my leg twined around his, chest pressed up against him, tucked under his arm like I belonged there. I felt tiny beside his depression, but my heart swelled with surety that love would heal him. My love. My energy, the joie du vivre he needed to be whole.
It would be months before I learned that that wasn't enough.
Snorkeling with Sean during a six-week vacation in Central America, I felt out of my element. He had grown up near the ocean, and now, as our guide brought the small motorboat sputtering to a stop near Caye Caulker, Belize, where the clear Caribbean Ocean was too deep to see the bottom, Sean readied himself to dive in eagerly. Sharks, our guide promised. Rays. My boyfriend took a deep breath through his snorkel, and plunged. What could I do but follow?
The first time, I came up spluttering. Gradually I learned how to hold my breath, and clear the snorkel when I came up. I kept Sean always at the corner of my vision. His long limbs waved with the ebb and flow of the ocean as he cruised fearlessly around the underwater world. Even with practice I could not go as deep, or stay down as long. I choked on the brine water. He didn't notice.
Away from home, we were all each other had. My mood became complexly reliant on his, even as he veered from contentment into the darker crevices of his mind. Coaxing a smile from him was like dragging through miles of sand and not being sure of the way. But it was better than sinking. I'm strong enough to do this, I told myself. We'll make it back. But sometimes it felt like I was the one drowning in depression. The boundaries blurred. I began to believe we were meant to be together, my emotions a continuation of his, our pathetic symbiosis the greatest achievement of six weeks of travel. The rare good days seemed blissful.
When my parents picked us up from the airport, Sean barely spoke. I chatted garrulously, to distract them from his brooding silence. Having witnesses to our interactions was like walking out of the water with him on my back: I felt the full weight all at once, and it was staggering.
It took months for me to realize that Sean's depression, and whether or not he acted on the voices in his head, had nothing to do with me. Even two and a half years after we broke up, when I could first diagnose his mental disorder and knew it as an organic, brain-chemistry-related phenomenon, I felt very real sorrow for having left him. I had loved Sean, and been loved by him, and part of me-naïve, hopeful, but painfully earnest in the desire to heal him-was irretrievably lost with him.
As a third-year student, I spent six weeks in a required clinical psychiatry rotation. The best description I can offer of that purgatory is having the constant sense that I was reckoning with ghosts-my ghosts-and that if I lost, they would bear my filthy, pathetic soul away to the land of the ostracized, psychologically unfit. Empathy was no help to me. In fact, it was potentially my greatest weakness, the link that might drag me into the world of Them, not Us.
As is true for depression, there are diagnostic criteria established for every psychiatric malady: schizophrenia, personality disorders, bipolar disease, autism. Normal grieving has a time limit. Mood has parameters. A charming woman with a tragic history of loss and betrayal turned out to be a manipulative patient with borderline personality disorder-and I thought we had just had a constructive heart-to-heart. An exuberant young man, filled with elation about the wonders of love, turned out to be in the manic phase of bipolar disease. As with my ex-boyfriend, the boundaries of normalcy wavered dangerously, and I felt disoriented.
What I never realized as a pre-clinical student, ever confident that psychiatry was an intuitive field, is that you have to dissociate yourself from a patient to do him any good. You have to work at becoming immune to charm as well as insult, objective in the face of strong emotion, removed when you are asked to be most involved.
I sucked at it.
Mr. Edwards limped into my borrowed office on a scarred wooden cane, his atrophied legs barely filling the stone-washed Levi's he belted with purple nylon. He wore a lopsided, black beret over grizzled gray hair, and his blue eyes stared at me as we greeted one another. A plain silver earring adorned his left ear. Seating himself delicately in the only available chair, he waited for me to speak.
"Before we start," I offered, feeling uncomfortably like a made-for-TV psychiatrist with my three-days' experience in that role, "I just want to make sure you understand this program. I am a medical student, and I will meet with you over the next four weeks to learn why you are here and how we might best help you. I will share this information with Dr. Shimaya, whom you met on the way in, and she will continue to see you after I am gone. We will make any treatment decisions together."
I had learned that setting forth clear boundaries and expectations would make a therapeutic alliance more productive.
Mr. Edwards nodded, and in a drawling British accent said, "Yes. Yes, that's fine."
I smiled politely and leaned forward a little bit in an attentive and interested pose. "So," I asked, "what brings you here today?"
He tilted his head curiously, and I almost expected him to call my bluff. Instead, he said, "Well, it all started when my mother abandoned me. I was nine, and I felt the sharp end of that sword."
Here, I thought. Two minutes into the interview, and already at the heart of the matter.
Half an hour later, I wasn't so sure. His list of complaints, printed carefully by hand, included such disparate concerns as noisy neighbors, difficulty finishing projects he started, and sorrow. Mr. Edwards said he was an artist with the desire to return home to England before he died. He claimed to have been depressed off and on for a year. And, by the way, he was arrested during his teenage years "for effeminacy." I spent most of the meeting chasing clues: what's wrong with your health? What happened a year ago that made you sad? What did the police charge you with?
Like the craftiest of con artists, Mr. Edwards steered me away from the emotional content of his stories.
Finally, I tried to hone in on his worry. "Mr. Edwards, why do you believe you won't live much longer?"
"I'm terribly weak. And I'm getting weaker."
I looked on his intake sheet for a diagnosis that would explain this symptom. "Is that from tertiary syphilis? Or is this something new?"
"I don't know, really."
I asked a string of questions to assess what he was able to do for himself, and what required help. He was afraid to take the bus anymore, he said, because he felt fragile in large groups of people. But he rarely allowed anyone to drive him around.
"I'm a very dependent person," Mr. Edwards said.
"Very dependent?"
"No, independent. I dislike waiting around for other people. I'd rather walk than sit around half the day waiting for someone to take me to the market when it conveniences them. It messes with my schedule."
"In what ways are you dependent?" I asked.
"Well, I live in public housing. And I receive SSI." Supplemental Security Income is a federal program providing monetary support to people with long-term disabilities or age greater than 65 years.
"Have you needed more time to get around recently or found that there are new things you can no longer do?"
"No."
A phone call to his primary physician was no more revealing. She chuckled and told me he was prone to somatization-had physical symptoms for emotional ills-but that his state of health had not changed in the last five years. She had prescribed antidepressants for him at one time, but they had not been of help.
The next time I met with Mr. Edwards, his story had grown more robust-and disturbing. His mother had lovers other than his father, and had left her family for one of them. Then my patient's father, until he remarried, shared a bed with him, sometimes fondling the boy at night. This began a string of very personal revelations: how he had performed fellatio on a sailor in front of onlookers at age 13; how he had swallowed needles at reform school, and poured acid on his hands at military school, to get his mother's attention; how he had tried to kill himself with carbon monoxide after contracting syphilis from a lover. About these elements of his past, he was only mildly reluctant to talk. About the present, however, Mr. Edwards remained stubbornly vague. There were no significant relationships in his life, he said at first. Later he said his "significant other" for the last thirty years was a man he saw rarely, though they both lived in San Francisco. About drugs his story changed as well: he smoked marijuana "occasionally"-which meant every night for the past thirty-five years. Repeatedly, the suspicion that I wasn't getting the whole story stopped me from trusting his answers. How could it make sense that he could walk no more than a few blocks but refused to let anyone help him get groceries? My task as a student was to create a "psychodynamic formulation," a postulation about my patient's formative life experiences and current psychological struggles. By the end of our fourth session, I was to assign him a provisional diagnosis and be able to discuss him with the psychiatrists coherently. Although I still felt that I hardly knew him, I tried to imagine being Mr. John Edwards. Donning my writer's cap, I started by describing him in detail. Then I tried to analyze him, amateurish as it felt. Under my pen, he became a character in a novel: events led to actions, and turmoil, and resolution in a logical, if slightly fabricated, way. But when it came time to assign him a diagnosis, I felt stuck. Mr. Edwards had a litany of complaints, but denied most symptoms. He couldn't express why he had come to the psychiatry clinic. Medication for depression had not helped him, and he didn't want group psychotherapy. If he had a burgeoning substance abuse problem, it had not yet interfered with his ability to tend his daily needs and make his appointments. The only clues to his current malady were in recent events: death of his estranged mother three years before, and that of an admired "friend" less than a year ago. My patient's most significant problem, it seemed to me, was loneliness. What could we prescribe for that? Loneliness isn't a diagnosis in the DSM. In medical terms, it would be more like a common cold than pneumonia: there are no medicines that help, no salves to make it go away. All one can do is tell a patient to take care of himself, and use whatever remedies seem to work. Though I provisionally called his problems dysthymia (longstanding depressed mood without other symptoms of depression), chronic pain disorder, and "rule-out" cannabis dependency (meaning I wasn't convinced), Mr. Edwards fell into the uncomfortable no-man's land of the medically undiagnosable. At the end of our last meeting, Mr. Edwards left abruptly. I had been accustomed to his lingering after each session, as though he would be content to stay and reminisce all day. From the window, I watched him hobble down the bustling street with surprising agility - he was not as hindered as he had intimated in our earlier session. Had he wanted only sympathy from me? Or the ear I lent him for an hour a week? Either way, he was on his own now. With the number of truly ill patients in psychotherapy at the clinic, there were no resources for the well patient who just wanted someone to listen to him. That was what our sessions had revealed: wellness, crippled by lack of support. He had to look elsewhere for empathy.
When I first arrived at the psychiatric emergency ward of San Francisco General Hospital for my assigned night "on call", the physicians and nurses appeared relaxed. It was dinnertime, and the evening shift staff sat at a long table, joking with one another and nibbling on food either brought from home or purchased on the way to work. But just as I started to feel comfortable, we were interrupted by the explosive entry of a young African American man accompanied by two police officers, who hoisted him into a padded cell. He was thrashing and hollering about things we could not see. A dark-skinned nurse materialized with a clear liquid-filled syringe, and a psychiatrist gave the man a shot of Haldol while the policemen were still there. Then they locked the crazed patient in the dark room, stripped of anything that could cause harm, and waited for the sedating effects of the anti-psychotic medication.
The vision shocked me: how, like an animal, this young man was injected and locked up-no time for an interview, no full assessment, shoot first and ask questions later. It was explained that he had been floridly psychotic, shouting at people who weren't there, irrationally terrified. But more than that, it seemed to me, he was strong, and agitated, and threatening. All it took was an injection to restore the calm of the psych emergency suite.
I spent the latter part of the evening interviewing a patient who had presented the same way. Mild-mannered and dulled by medication, he was nevertheless deemed potentially aggressive, and our interview occurred in a room with windows bordering the staff room. His chair was in the corner farthest from the door; mine was within reach of the exit.
The interview has faded in my mind. The possibility of danger turned out to be overblown. My patient spoke calmly of his hallucinations, denied knowing he was schizophrenic, and admitted to trying crack cocaine (the most likely trigger of his bout of psychosis). He showed no emotion while we talked, no expression that would fix him in my mind. I had the sense that he wasn't really there, and perhaps that's why, in the collection of patients I have had and faces I remember, he seems to have disappeared.
A significant percentage of homeless people are "mentally ill"-a vague term for schizophrenia. What I know is what I have seen: disheveled men and women talking to no one in particular, shouting at invisible traitors, howling their distress and being walked past, not acknowledged, left to flounder in the fickle tides of their mental chemistry. A bottle of medication might be tucked away under layers of clothing or in the bottom of a backpack, but people whose thoughts are disorganized often forget to take their pills. Someone who goes on a drinking binge, or gets high, isn't going to remember either.
I have a friend whose mother is schizophrenic. She was a married physician with two children when the symptoms first started. Over time she started to come undone, gradually slipping from living mostly in the present-day to succumbing to hallucinations, persecutory thoughts, lack of cohesion in her own mind. She lives in a psychiatric care home now, but sometimes she escapes and comes to his door, her lips working over words from the past, her own certainty of home and place askew. This isn't new to him. He understands the illness behind his mother's erratic behavior. He is no longer surprised if she doesn't recognize him. He still tries to visit her, manages her affairs. Sometimes she acts normal. Other times he might as well not be there. The hardest part is something he doesn't talk about: with a mother who has schizophrenia, he might turn out to have schizophrenia himself.
None of us are immune. In my family tree there are ancestors who killed themselves, others whose erratic behavior is still the stuff of hushed speculation. I'm sure there were a handful of alcoholics. Depression runs just under the skin. Anything can happen, and it is our very vulnerability that makes empathy so dangerous. Without the objective eye, who could recognize the tendrils of mental illness that weave into the fabric of a person's life? No category of sickness has a greater propensity to be ignored for a long time because it seems like something that can be treated at home, smoothed over by spouses or parents or children. After all, feelings are the most personal aspect of self that anyone has. If these can be tangled by a process beyond our control, what is left? For months, I tried to normalize Sean's outbursts and despondency. I dreamed with him about a peaceful life. I connected to the person he was most of the time; but sometimes he was different. Sometimes I couldn't reach him. Finally, desperation plunged me into the same, miserable melancholy that held him captive, and then I was no use to either one of us. What remains after all that has passed is the memory of helplessness. No amount of love could fix the turmoil in my ex-boyfriend's head. He didn't want to go to a psychiatrist. He didn't want medicines. All he wanted, so he said, was me. And in the end, the most caring thing I could do for him was to take that away. Only after we broke up would he finally seek professional help.
"Poof," the curious and imaginative teenager that I was, has grown more cautious now. She still exists-still finds satisfaction in listening to friends and offering advice. Still loves to stay up talking about intangibles like intuition. Still lets herself believe that the world works in a magically, mysteriously karmic way. She even appears in me when I listen to some of my patients, the ones whose emotional needs I can handle. The ones who don't ask too much.
She is-I am-not suited for psychiatry. The difference between medicine and psychiatry, to me, is in the depths of empathy: who can conceive having voices intrude on their thoughts? Who dares to admit she might understand the tides of insecurity and breathtaking sense of worthlessness? In psychiatry, you do not relate. You stay near the surface, eyeing the landmarks that allow you to make a diagnosis. Beneath that uppermost layer, the water is too deep, too cold, too unfamiliar. I keep wanting to dive in and put my arm around the person who is drowning, drag that struggling form up for air. I should know better, but I don't. I almost drowned; I should have learned. I can't bear the possibility of ending up there again-but I still jump in. The only way to save myself is not to go in the water.
The holy grail of psychiatry, of course, is to learn to dive just deep enough. There are tools-medicines-that can change lives, bringing the almost-lost back within reach. I am glad there are people who can do this. As a near-physician, I can recognize signs and symptoms, now. I take psychiatric illness seriously. I know what a world of difference treatment can make. But I still fight the current of my own irrational fears, and the memory of choking in an implacable sea.
For myself, I had better stay on shore.
Claire M. Unis is a pediatrician living in the San Francisco area. She says that "Poof: the Psychiatrist" is a personal essay and a reflection of her experiences with the field of psychiatry as a young teenager. "My psychiatry clerkship was one of the most trying experiences of medical school for me, and in this essay I explore the preconceptions I brought with me and realizations I took away."