Why I won't specialize in psychiatry?

As a medical student, you are often asked questions about what you will do after medical school. Many of us wonder what specialty to pursue after becoming medical doctors. In the first year of medical school, many of us had great ambitions of becoming top-notch neurosurgeons, cardiothoracic surgeons, or other highly paid medical specialists. As time went by, many of us figured that we did not want to dedicate our whole lives to our careers.

Some of my colleagues got pregnant, some got married, and some realized that they don’t want to pursue these high-end, stressful positions in medicine. As we go through medical school, we are exposed to almost all specialties to get the idea of what interests us and what we want to pursue.

I had three interests: neurology, neurosurgery, and psychiatry.

I wanted to know more about the human brain and all its complexities. I loved neurology rotation because I got to do what I loved most: neurological examination. It was incredibly fascinating to me how, merely by observing someone’s gait as they walk into the clinic, I could at least speculate what part of the patient’s brain was affected. For most neurological cases, my mentor had to do a CT or an MRI scan to be certain of the diagnosis, but there was something about the neurological examination that sparked real interest in the human brain.

"It was incredibly fascinating to me how, merely by observing someone’s gait as they walk into the clinic, I could at least speculate what part of the patient’s brain was affected."

Once we got to neurosurgery rotation, I was again really driven to learn more about it. I was never interested in a surgical specialty, but the idea of examining the human brain that closely sparked again real interest in me. For some time, I even wanted to pursue neurosurgery, but after thoughtful consideration, I knew that neurosurgery wasn’t for me. One of the surgeons who worked in our teaching hospital told me that neurosurgeons are primarily surgeons, and secondly, brain enthusiasts. He told me that most neurosurgeons would take any other type of surgical specialty over neurology. He asked me a simple question: “Are you interested in the human brain?” I said yes, of course, that’s why I considered neurosurgery. He told me that I need to go into neurology if I were truly as interested as I said.

This conversation changed my mind about neurosurgery, so I decided to focus more on neurology and the clinical aspects of neurological anomalies.

And finally, we were on psychiatry rotation. I figured since I want to study the human mind, why wouldn’t I go into psychiatry rather than neurology? I soon found out why.

The first patient we saw at the psychiatric ward was a 30-something-year-old man who suffered from schizophrenia.

He was extremely polite, and at first glance, he seemed completely normal. I noticed that he apologized a lot when we conversed, and he appeared a little bit frightened by our questions. The conversation went smoothly, and everything was fine until he started talking about his symptoms. He told us his story from the start- how his symptoms first started, how did he feel, what was the trigger that started it and so on.

From his story, I realized that he was extremely religious and that he grew up in a strict, conservative household. His hallucinations were almost all based on a story of a great battle between good and evil- Devil vs. God. He had a lot of hallucinations on a daily basis- he heard the Devil talk to him constantly, he saw a big cross made up of light in the corners of his room, and he even started praying while we were talking to him. Work-related stress and a sudden divorce were triggers for his condition, but what piqued my interest was the fact that almost everything he thought about was religion, and the only hallucinations he saw were of a religious type.

Even though the auditory and visual hallucinations he described were disturbing, what appalled me the most were the psychosomatic symptoms he described to us. He told us that the Devil punishes him every night by constantly burning his skin, and he told us that he was unable to sleep because he feels his eyes and skin are melting at bedtime.

Another set of symptoms that disturbed him were unorganized and forced thoughts that he had. Aside from his skin burning, another reason he couldn’t rest or sleep was the constant inflow of information inside his mind. He told us that he just cannot rest even for a minute without being heavily sedated because a storm of negative and chaotic thoughts spiraled inside his head almost all the time of day.

When we were done talking to him, we asked one of the senior residents if there is a possibility for him to go to a church since God is almost everything he thinks about. He told us that they tried that one time, but that his hallucinations got much worse, and he had to be taken away by police to avoid a scene.

His symptoms started three years ago, and he was admitted and diagnosed with schizophrenia and properly medicated. After about a month at the ward, he left almost a normal man. He had almost no symptoms with those medications and was ready to return to his job and his family. What was the worst regarding this patient was the fact that after about 2 months, he was admitted again because he stopped taking his antipsychotics, and his condition got drastically worse.

Psychiatrists at the ward found out that his mother was against him taking medication, and since he felt better, he stopped taking them.

This scenario repeated twice again, and he got worse and worse. The problem with schizophrenia is that every relapse the patients go through worsens their condition. This was the exact reason why he ended up in such a terrible condition, as he was the day we talked to him.

His story was so incredibly interesting to me that I still remember every detail about it, and I can recall the amount of suffering this man went through.

After this patient, we saw other schizophrenia patients, major depressive disorders, and even one mania. I quickly realized that psychiatry wasn’t for me. Even though it was one of the most interesting fields of medicine, I knew that I simply couldn’t listen to horrible stories like these for 8 hours a day for the rest of my life without going insane.

Even if I could stay completely mentally healthy, I knew that I needed to lose a lot of empathy for these patients if I wanted to help them.

I truly admire those who can deal with such difficult cases and still have the strength to go to their home and not bring any of that trauma they got on the job. From that day, I started respecting psychiatry more than any other specialty we saw after that.

Summary:

In my journey of exploring different medical specialties, I decided that I would never specialize in psychiatry. Initially drawn to neurology, neurosurgery, and psychiatry, I became fascinated with the brain and its complexities. I decided against neurosurgery because I found that neurosurgeons would rather pick a surgical specialty instead of neurology. They are primarily surgeons, and secondly, brain enthusiasts. During a psychiatry rotation, I encountered a patient with schizophrenia whose distressing experiences, including religious hallucinations and psychosomatic symptoms, deeply affected me. Despite the patient's eventual recovery with medication, I was troubled by the repeated relapses caused by the patient’s refusal to take antipsychotics. This, along with the emotionally taxing nature of psychiatry, led me to realize that I could not handle listening to such difficult stories for 8 hours a day without it affecting my own well-being. While I truly admire those who can manage such cases, I knew I would need to lose a lot of empathy to help these patients, and that wasn't something I was willing to do. From that day, I started respecting psychiatry more than any other specialty we saw after that.