Unlike most other first-year medical students eager to make new friends, learn new things, and save lives, I was most excited for the distraction when I first entered medical school. Focusing on memorizing drugs, diseases, and various statistics made it easier to drown out the sadness of having just lost Jordan to suicide. The kind of pain that comes with sudden, unexpected loss of a loved one is unfathomable. To lose her to suicide, at least to me, made it even worse. Everyone has their own coping mechanism for loss and mine was to pick up, move across the country, and start taking a myriad of multiple choice tests. And it worked, for a time.
Psychiatry, as an academic subject, both fascinated me and deeply disturbed me. As a whole, psychiatric disorders are generally stigmatized, underdiagnosed, and undertreated. It’s a strange feeling sitting in a classroom hearing about these common mental diseases that immediately bring to mind a friend or family member. I wasn’t alone in this feeling… learning psychiatry as a medical student is an emotional experience. I remember a friend having to get up and leave lecture because a parent had suffered from bipolar disorder, and she couldn’t bear to hear about it without bringing back memories. Another friend broke down in tears after a lecture on Generalized Anxiety Disorder because she felt like she finally had an explanation for her own anxiety. Multiple students themselves suffer from depression. I was choking back tears and memories having to hear about psychiatry’s ultimate worst outcome: suicide.
But at least you can leave a classroom to deal with your own emotional processing. What I wasn’t quite prepared for was the real deal: finally seeing patients with true psychiatric conditions in the hospital.
For the first three weeks, I worked as a psychiatric consultant. In a typical day I would get called to see at least one suicidal patient who was being medically stabilized before they were transferred to the psych ward. I started to learn key terms like “passively suicidal” versus “actively suicidal”. The first patient I saw was “passively suicidal”. She was young, in her mid-30s, and suffered from schizoaffective disorder… basically someone who becomes psychotic at times with mood changes, like depression and mania. She had attempted suicide about 12 times in the past. She had cuts on her wrists, burns on her arms, bandages around her throat, but what was most striking was her face. Her face looked like a blank slate, like she had given up. She lay there and said she wasn’t going to kill herself, no, not now at least. But if there were two buttons in front of her, one that said “life”, and one that said “death” she would push the death button and have it over with. Her boyfriend had just died of an overdose, her parents barely spoke to her and certainly never visited her in the hospital, and she kept saying she was “just done with life”.
About a week later I was called to see a man who was “actively suicidal”. He was about 40 years old and had two young children and a wife. Though never admitting it or seeking treatment, he had been depressed for many years and his marriage was suffering. He had worked hard to plan a family vacation for his wife and two children at a cabin up north. He and his wife had been fighting and he simply couldn’t take it anymore. He got in his truck and drove back home in the middle of the night while his wife and children slept. He took a shotgun and shot himself in the belly. A neighbor had heard the shot fired and called 911- EMS was able to save his life. When I spoke to him, his wife and kids still had no idea where he was. He still could see no solution to his problems and his depression other than death.
I spent the next three weeks in a locked psychiatric unit- also known as a “psych ward”. I assumed it might be mostly psychotic patients, or maybe insane patients... I pictured white strait jackets that you see on TV. The first patient I met with in the psych unit was a 20 year old college girl who had recently tried to kill herself with pills. She was incredibly put together, a little shy, but very sweet. She insisted that it was just a low point in her life, she wasn’t depressed and certainly didn’t need medication. She was just overwhelmed with impending life after college, her recent breakup, and the pressure from her strict, traditional parents. After meeting with her the psychiatrist turned to me and said “That is called denial. This girl just attempted suicide and can’t admit she is even depressed. She needs help, and she’s not leaving here until she can at least admit to that”. This was a huge turning point for me. Maybe, just maybe, unlike my own college roommate, this girl’s life would be saved.
Every patient on psych that I met looked like just another person living their lives, dealing with stress, and trying to get by. Mental illness does not discriminate. Anyone can be effected, and we should try to explore and understand it when it’s our close friends, our family members or even ourselves.
Just a few months after my time on the psych ward, one of my classmates and close friends confessed that she had recently been in a locked psych unit. The pressure of medical school, her own relationships, and everything happening around her had made her think that the suicide was her best option. Thankfully she had confided in a friend who had immediately taken action. She spent two days in a locked unit having just rotated in one as a med student. She is now getting treatment, finding a happy and healthy balance in her life, and on her way to being a trained psychiatrist. She is one of the many examples of success stories of people who have spent time in a psychiatric unit.
I wasn’t sure I could deal with all of the suicide in psychiatry after my own loss, but I think my experiences made me all the more determined to not give up on people, even when they have given up on themselves.
- Stephanie Garbarino