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The Stigma of Psychiatry as a Medical Student

September 29, 2013

This is a piece I originally wrote for the Medical Student. Read it here if you want.

‘So what kind of doctor do you want to be?’

It’s an innocent enough question and, after six years at medical school, one I have grown very familiar with. It can be applied to conversation with a medical student in any kind of social situation. Friends and family over rarefied Christmas get-togethers; friends at university when the well of discussion pieces dries up; doctors of every speciality, peering at you with the ill-concealed desire that you want to follow their illustrious footsteps into their chosen speciality. I have always disliked the inquiry because I have never had a good answer.

For the first five years or so, I would mumble that I didn’t really know, that I enjoyed every field of medicine I had tried so far, that I hadn’t had enough experience to make a decision yet. But with the spectre of FPAS looming and the prospect of being a doctor becoming frighteningly real, this cop-out of an answer increasingly fails to impress. When I was younger, it showed openness and eagerness. Now it shows a lack of direction, and people follow my reply by listing the specialities, trying to find one that fits on the spot.

Thankfully, I was blessed with a very informative fifth year. Having had a series of attachments on a diverse range of specialities, for the first time, I can actually refine my tastes. I know that in specialities like obstetrics or orthopaedics, I would fit in as well as a mosquito at a malaria clinic. Conversely, I can see myself working in, and importantly, enjoying myself in other specialities.

So now when I am asked what I want to be when I grow up, I can confidently claim that I like the cut of paediatrics’ jib. It appeals to the generalist in me and I enjoy working with children. When I explain this to people, they all nod and smile approvingly. Everybody likes a paediatrician. By whatever metric they use to judge me, taking care of sick children is a ‘good’ job.

However, I still dislike being asked the question because, even though my answer is honest, I feel like a fraud. I do really like paediatrics but it comes second in my affection after psychiatry. While I find paediatrics interesting, I find psychiatry fascinating. Tenderness in the right iliac fossa can only prove novel so many times but every presentation of issues of mental health is as unique as the patients they affect. I like that, if I am able to help someone, my impact on them could be equivalent to treating meningitis. Psychiatry also offers a generalist approach in its holism.

But when I try and explain this to people, they nod curtly and the conversation wilts. Or they look at me askew and ask, ‘don’t you like medicine any more?’ or ‘I thought you wanted to be a real doctor?’ Trying to reach someone with suicidally deep depression or attempting to help a person with schizophrenia live a normal-ish life is, to most people, a waste of my talents. Psychiatry is a bad job.

Why is this speciality, under-appreciated and under-subscribed, so maligned? Is it because psychiatrists are agents of social control, policing the norms and enforcing rightspeak? Is it because they dole out powerful psychotropic medication (which is, at the same time, no better than placebo) like candy for what is just a case of feeling a bit sad or a rowdy child with bad parenting?

The Time to Change campaign aims to end the stigmatisation of issues of mental health, something I am so very keen on. Having witnessed the reality of mental health issues, both professionally and privately, the myths and assumptions I see stagger me. On the eve of my psychiatry attachment, my mum asked me if I was worried about catching schizophrenia from the patients. Yes, she thought it was contagious.

I think we need a parallel campaign to de-stigmatise psychiatry. We need to end the misinformation and hearsay that the likes of Giles Fraser and Ruby Wax replicate in the Guardian and on BBC Radio 4. We need to end the medical school cliché that psychiatry is a career for the crazy, eccentric and weird. We need to change things so that when asked what they want to do, a medical student can proudly reply, ‘Psychiatry.’

With the response, ‘Cool. Good for you.’

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