Sunday, September 27, 2009

Patience is Our Virtue

Magnetic Resonance Imaging scan of a head
Psychiatrists (and, by extension, psychologists) get a bum rap in movies and on television. Most of the time we're either more troubled than our patients, we're sleeping with them, or we're just plain goofy. It's our own fault to a certain extent, because (don't tell anyone, okay?) we're kind of boring. At least to the casual observer. There just isn't a lot of drama that goes on, most days, and we like it that way.

We prefer organization to chaos because we want to create an atmosphere in which people can get better, not worse. We want to anticipate crisis situations in order to avoid them. Calm is good, we like calm. And that just drives Hollywood crazy. Emergency medicine, surgery, and obstetrics are pregnant (no pun intended) with scenarios that can be rendered exciting. What do you do with an hour of psychotherapy on network TV? Change the channel.

Even ECT (electroconvulsive therapy) doesn't help because it's not at all like the version you see on film. Patients are under anesthesia, the charge is delivered, and if you didn't know otherwise, you'd think nothing happened. So, to make things interesting, some creative license has to be taken and we end up with a mobster in analysis (Analyze This), psychiatrists in love with their patients (Color of Night, Spellbound), or Hannibal Lecter terrifyingly doing what he does best.

Every now and then, however, you get a glimpse that suggests we might be right in the head after all. Robin Williams in Good Will Hunting is sane and empathetic. Gregory Peck in Captain Newman, MD, despite the comedy, is devoted and effective. Bruce Willis in The Sixth Sense actually helps his patient and Adam Arkin in The West Wing is down to earth and reasonable. See? We're not all nuts.

But it's a tough business, nevertheless. Gains are often slow and progress gradual. We can't call a code, apply the defibrilator paddles, and get a person's brain breathing psychological health in a matter of moments. Patience is our virtue. E.R. gave emergency medicine a real boost in popularity among medical students. We don't have the equivalent. Instead we have to rely on the old standby, third-year rotations, to show students how good it feels when someone goes home with hope in their pockets, knowing you made the difference.

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