I am currently on my 4-week General Psychiatry placement, after 4 weeks of Specialist Psychiatry at the beautiful Cardinal Clinic in Windsor and 4 weeks of Neurology at Queen Square. I must say, I am really interested in Psychiatry - more so the psychological aspect of it. Understanding and dealing with the mind has always been in my interest and I have even considered studying Psychology if not for Medicine. From my first 4 weeks of placement at the beginning of the year, I realized I may potentially be quite good at this field, being able to engage the patients very well and getting them to open up very readily. But when asked whether I would consider Psychiatry as a specialty in the future, I cast my doubts as I find it too emotionally involving and taxing for me, especially if I have to do it for life. It is not yet ruled out but I am definitely keeping my options and eyes open. That said, I know at the back of my mind there is still something that is deterring me from completely committing to Psychiatry and I have not been able to put words to it until today.

I was chatting with flatmate Holly who is equally interested in Psychiatry and we were discussing about disturbing stories in the news about rape and child abuse. We have concluded that, as judgmental as it sounds, some people should not be allowed to have children. Earlier in the day I had a session with the Community Mental Health Team and as much as sitting through 4 hours of meetings does not sound appealing at all, it did trigger some thoughts in my head when they were discussing about this apparently schizophrenic lady who spends most of her adult life in prison because of getting into trouble with the law on various occasions. And when she is out of the prison, she is either in hospital or doing other mad things that get her into trouble again. The team was highlighting the benefits (for her mentally and physically) of her being in prison. Given that so many prisoners have mental health problems, I was just sitting there wondering, why are we keeping all of them there? I am not addressing the humanitarian issue of whether they should be in mental health treatment centre instead but rather as a big picture in the society, what good are we doing expending taxpayers' money feeding and providing for them in prison?

So many of those rape criminals and those who have committed seriously violent crimes are defended by their mental illnesses. As much as I appreciate that things do go wrong in our brains, I am sorry but if I were raped, I am not going to forgive someone because he was mentally ill and he was plainly acting primitively or obeying voices in his head. It clearly crosses the line when one's mental health problems are manifested onto other people's lives and worse still, leave an irreversible damage or scar. I can't help but wonder, what good is Psychiatry and the wonders of today's medicine, defying natural selection and creating disease labels as defences, when centuries or even decades ago, such mishaps would have been eliminated by death or persecution. At the risk of sounding heartlessly fascist, many of these "deviant" behaviours (apologies for political incorrectness) would have been arguably rightly removed from the society and their opportunities to propagate would have perished together. Who am I to judge they are deviant and unworthy, but I do feel by classifying them into disease group, seemingly treating their symptoms and prolonging their existence in the world may not be as good an idea as it seems, pretty much like keeping someone who would not otherwise be breathing on his own on a ventilator for long.

Fellow medical student Azara pointed out today that Psychiatry is all about hypothesis and not diagnosis. Psychiatrists hypothesize and give treatment and if the treatment works that becomes the diagnosis. That may be exaggerating things a little bit. But it does make me realize how wishy-washy Psychiatry can be. It is very well because of the nature of this field - dealing with the mind which is so intangible almost makes it impossible to pin down things. But I am not entirely convinced by many diagnoses even. For a start, "Clinical Depression". Be it the level of serontonin or noradrenaline, the mechanism of how exactly SSRIs improve symptoms is not entirely clear and they work differently on different patients. As much as I appreciate that physiological changes play a part, I cannot disregard my belief that "it is all in the mind". I am a strong believer of that you can do so much with your mind - just changing mindsets, changing attitudes... The concept of "motivation" and level of neurotransmitters is merely a chicken-and-egg thing as opposed to the latter being the cause. Especially when doctors and psychiatrists already acknowledge somatisation and that the mind can "create" symptoms in the body, I am not buying the different disease labels just so someone can rest on them and push the blame on them. I do understand a lot of people have benefited hugely from the use of Prozac and being treated for clinical depression has changed their lives dramatically, and I am not against treating patients with depression etc, but I am just still not convinced that the labelling and the pharmacology are really what we need.

After all, I am still very intrigued by Psychiatry but until I have resolved my doubts and skepticism, I shall look forward to being inspired by Obs & Gynae and Paediatrics. But before that, let me do well in my psych and neuro exams!!!!!!!!!!