— A day in the life, and a life in the day, of a doctor.
“Every patient I see is a person with a new life story, not a case of schizophrenia with Schneider’s first-rank symptoms. Each person is unique and not everyone can be categorized into neat syndromes to fulfil the DSM criteria. Psychiatry is about patients with different experiences and cultures - it is not just about the human mind but about the people; it’s challenging and complex. We have to respect the dignity of the individual human beings. Because time is premium, we often resort to checklist to diagnose and treat. We see psychiatry as mere molecular biology and reckon we can change behaviour by altering the amines in the synapses with medications. That’s being naïve. We forget that social and psychological therapies are equally important.”
— Dr Chang
Synopsis
This book is based on the last day of posting for a medical officer at IMH. It’s probably a real-life account by Prof Kua himself, though I suspect the names and details of the patients described have been changed to ensure confidentiality. The events that unfold are actually commonly encountered in the medical profession. Even as students, we would already have met some of them. Yet, when it is elaborated upon and reflected upon, as in this book, we would then realise the ‘gems’ in our daily life. Each day is so similar, so routine (rounds -> clinics -> clinics -> rounds -> home) yet the things that happen are ever-changing. We can really learn a lot just by reflecting on a day’s work.
Comments
The style of this book is really erm a bit odd. It sounds like a cross between an attempt to be poetic (with flowery descriptive language) and our textbook, ‘psychiatry for doctors’. The language is really not that simple, with bombastic vocabulary like ‘imbibe, parlance, curmudgeon, phlebeian…’ I’m sure it is very suitable and informative for medical students, doctors, or paramedics. However, it’s going to be a bit difficult for someone with a sec 4 education to read this. And I do believe that a large proportion of those who really need this book, like the caregivers, the family members of the mentally troubled might not find this book very readable.
I thought this was interesting:
Dr Kua: How do you, as a senior psychiatrist, assess dangerousness?
Dr Chang: Assessing dangerousness is a dangerous exercise. We don’t have a definitive checklist and sometimes our own prejudices blind our judgment. There are many factors but when I talk to a patient and what he says or his reaction makes me feel fearful and chilly, that patient is dangerous.
It’s really more of a gutteral reaction. And some other psychiatrist I met at IMH said the same thing… tough ain’t it.
I’m not entire sure what the author’s aims were when he wrote this book, but from what I surmise towards the end of this book, I think he’s trying to destigmatise mental illness, and to encourage the family, friends and society of the mentally ill to accept them, and have more compassion to them. I feel that to best achieve it, the book should be written in a language which the majority of the public understand. A bit like how MM LKY talks to the public. He’s able to moderate his language to best suit the ‘taste’ of the people he is speaking to.
In addition, I did not particularly like the few pages where we’re shown the ‘home life’ of a psychiatrist. It’s just so high-end, so westernised (though I wouldn’t say that ALL doctors are that ang moh). Somehow I feel that subconsciously, the public would be more ‘with us’ if we portrayed ourselves to be just like everyone else.
Despite all these, I would say, this book can be very persuasive for a medical student who’s already interested in psychiatry. Hehe… at the end of the book, I felt like I wanted to do something for these misunderstood and feared patients! Something in the region of rehab psychiatry and some kind of campaign to raise public awareness. Like the yellow ribbon campaign, we should have something similar to that for these people!
I’ll just leave you this very motivating and touching speech from the book:
Certain misconceptions have gained curency. There’s a tendency to associate mental illness with violence and traduce the suffering of those afflicted. The anguish of mental patients is not zany. In the portrayal of human suffering in the mass media, candour has to be tempered with sensitivity. Burlesque dramatization must be rejected, for they only serve to reinforce the myths in our collective unconscious about mental patients…
Beyond a doubt, the pernicious stigma often aggrieves the patient. If society continues to remain benighted by such prejudice, then patients who have recovered would have no chance to survive in a hostile community…
Mental patients should be accorded the same dignity and compassion as others with illness like asthma or diabetes mellitus. We speak of asthma with a respectful voice but mental illness stirs up intense emotion… The pain of the mind is worse than the pain of the body. [This I wholly suppor and totally agree with!]
Please don’t leave your loved one to face the darkness alone.
