Why I Went into Psychiatry

As a psychiatrist, I am frequently asked, especially by students, and some residents I have worked with, why I went into psychiatry. Perhaps writing down the answers I have generally given will still be of assistance to those who might read this as medical students still trying to make up their mind about what specialty to go into, if any. It could also stimulate others to understand better why they went into psychiatry.

As someone who had not even considered going into medicine until a couple of years after graduating from high school, while at college, the interest in the mind actually began with an interest in the person. Thus, right from the beginning, I was more interested in the whole person, not just the mind. The introductory influence in this direction was a wonderful book written by a Swiss psychiatrist, also a Christian, Dr. Paul Tournier: The Meaning of Persons. It was a recommended volume in the Christian Education course which was a mandatory component of the Bachelor of Christian Education Program, leading to the only biblical/theological-related degree offered at Canadian Mennonite Bible College (CMBC) when I attended in the 1960s. My first year there, 1964-1965, coincided with the first year when we were able to cross register introductory/first-year courses for credit with the University of Manitoba. Another book that was influential at the time in this course was Lewis Sherrill's The Struggle of the Soul. I remember particularly, even at that young, naïve and optimistic age, acquiring the understanding that many individuals reach a point in middle life or later when they realize that the person they are is not the person they wanted to become, and in too many cases, too much like the person they rebelled against in their younger years and did not want to become! So, I was warned about that potentially possible disappointment early in life.

As someone who became interested in the person, the teaching and biblically-based lived-out emphasis at CMBC at the time on the person as part of a community also had a significant influence I would have to say in the direction I took when I then did go into medicine. Although I had some interest in surgery because I liked the creativity that comes with the use of one's hands, and pediatrics because, perhaps having come from a family of five, with plenty of interaction with friends and cousins, I was interested in children, the melding of my interest in person and community made going into Family Medicine, as it was then beginning to be called, practically a given. Parenthetically, when asked what I miss about Family Practice, having left that for psychiatry, my reply is that it is the hands-on element of work available to the Family Physician. As a student, I had taken a special elective in Plastic Surgery and enjoyed making use of the limited skills I learned there in the lower level surgery and office practice that I engaged in upon ultimately completing a Family Medicine Program.

I consider myself to have come to this point at an important juncture in the development of the discipline of Family Medicine, as it was a rather new specialty at the time. Indeed, those who were proponents of it still struggled against those who thought that one year of a rotating internship was good enough to provide adequate training for a career as a General Practitioner (GP), as well as those who jealously guarded the world of the specialties. The program at the St. Boniface Hospital into which I entered, in Winnipeg, was, I believe, only four years old at the time I enrolled.

It was also an opportune time, as there was a growing sense of a need for qualified, Canadian-born physicians to go into the rural area. Indeed, the socially-inclined New Democratic Party provincial government of the time, even had in place what was called a Special Opportunity Bursary, which provided students and residents a good sum of money on which to live while making one's way through medical school and residency, provided one had committed oneself to going into practice in a rural area.

As I believe I have written in another installment in this blog, I was also part of an ad hoc committee that was concerned about our lack of education in matters of Family Medicine and had been successful in getting our University of Manitoba Faculty of Medicine to reinstitute a rotation in our clinical year of medical school that had been dropped years before with the rise of specialists. So, I had a taste of medicine outside of Winnipeg before even graduating (Personally, after fighting so hard to get medical students exposed to real rural practice, I had always felt a little guilty about where I ended up. Because of personal circumstances, namely my wife-to-be having to leave the country about the time I was was to start this rotation, I obtained a site at Selkirk, just 20 miles north of Winnipeg, so I could more easily get into see her more often before she left, as I had a car).

Indeed, small-town practice was for me in a way the only way to go. It was in part due to all of the above factors in my educational path to that point. It really was also the result of the belief I had come to at the time that to really know a person as part of a community and have a sense of working in the community in which one could have an impact, not just upon an individual, that the best way to do that was in a small town where one felt part of a whole community and could obtain a grasp of how the whole organism functioned. I had already come to understand that working in a large city often translated into being nothing more than a cog in a large and fragmented machine. The other element that made it easy for me to go into rural medicine, and also probably had some impact on my choice in that direction, was that, like a number of my colleagues who ended up in Family Medicine, and whom I had become good friends with; we were from the rural area to begin with.

I had also enjoyed my psychiatry rotation with Prof. Dr. John Varsamis at the Salvation Army-run Grace Hospital in Winnipeg in my 4th/clinical year of medical school. In fact, our whole class was impressed with this suave, personable and knowledgeable Greek physician and twice named him our Professor of the Year. Indeed, he obviously saw something in me as he thought I should go into psychiatry and encouraged me in that direction. So, it was gratifying to come full circle when I eventually got into psychiatry and spend my last six months of my residency in a self-developed and directed rotation with him. However, at this point, I first wanted to explore what was waiting for me in the areas described in the paragraph just above.

So it was, that I practiced Family Medicine for the next 12 years. However, with my interest in mental health and psychiatry, when I moved from my first sphere of practice in Gladstone, Manitoba, to the city of Brandon to start practice there in January 1986, it wasn't long before I began to get involved with psychiatry. Brandon, at the time, was still the site of one of the large regional/provincial psychiatric hospitals - asylums is they had been formally called -  that had been built in the earlier part of the century. Because of the nature of the practice with many chronic and severely ill patients in large institutional settings, it was not a work that attracted a lot of practitioners and so there was always a shortage of qualified physicians. Indeed, much of the work in the institution was being done by General Practitioners. It was in that capacity, that I first became involved in delivering care as the attending physician on the wards of the hospital. Over time, as I gained more experience and the need continued, I ended up actually being on call and taking admissions to the acute admission unit.

It was during this time that I began to realize that I really wanted to learn more about how to work with psychiatric patients and their families in terms of psychotherapy, not just medication. I was also reaching an age where I had to decide whether I was going to pursue the path of psychiatry or not. Part of the consideration was also the age of my children. They were old enough, both in school, but yet not teenagers, when I felt they would need me even more than in their latency age years.

Interestingly, just as when I was in medical school, the government of the day, having again sensed a shortage in the rural area, although this time of psychiatrists, was again offering a financial incentive. Talk about being in the right place at the right time. In essence, it was a doubling of the stipend paid to a resident provided that, as with the previous arrangement, a commitment was made to practice psychiatry in rural Manitoba. Of course, having a family to support, made this financial arrangement quite desirable too. Manitoba being basically the one-city town that it is, everything outside of Winnipeg was considered rural. For me, there was no question about returning to this ‘rural’ practice. My family was in Brandon, the mental health/psychiatric community there wanted me to come back, and I was not moving my family to Winnipeg to disrupt their lives the way mine had sometimes been changed by moves when I was growing up.

By this time, I had also seen the transition of the long-term patients on wards that I was working on at the Brandon Mental Health Center from that institution into a new psychogeriatric personal care home that was opened in Brandon in 1988. Indeed, I was the first Medical Director and sole attendant of the 100 residents of the Rideau Park Psychogeriatric Personal Care Home. After six months of this though, I had realized that was too much of a load, as I was still carrying a partial private practice in family medicine, and got another physician to take half of the patients. Some six months later, when I went into the psychiatry residency, of course, my share of the patients also had to be passed on to another physician. I had enjoyed my work with this facility, just as I had enjoyed my work in geriatrics at the Third Crossing Personal Care Home in Gladstone when I had been a Family Physician there.

However, none of that really influenced me in the direction of thinking about going into geriatric psychiatry. Indeed, when I was leaving to take up the residency, the mother of one of our son's classmates, a friend who was a social worker for the Brandon School Division, Laura Crookshanks, strongly encouraged me to consider going into child psychiatry. Her husband Doug, who worked at the Brandon Mental Health Center, and subsequently became my administrator, seconded that. So that in the end is what happened, and I completed my residency in that regard in 1994.

2016-4-9

Bullying and Resilience

We read a lot about bullying these days. We also see and hear a lot about it in the non-print media. There are workshops, recommendations and guidelines for workplaces, those who work in healthcare and education. We know that some people are very traumatized by their mistreatment from others and suffer for years, if not their whole lives. However, we also know that other individuals who have been abused in these ways appear to function quite well. What makes the difference? That is a question that is getting more attention these days as people realize that it is more productive to take that preventive and positive approach about issues like this than to keep dealing with the aftermath.

Have you been bullied? Do you know why? How is it affecting you now? If you are in healthcare or education, how is it influencing your work?

I was certainly bullied as a child. As the only blonde white boy in a community of mixed-blood (indigenous and European), mostly darker-skinned schoolmates, I was easy to pick on. Some of what I experienced might simply have been because I was different. Some of it may even have arisen from some latent antipathy towards whites.

However, I also know that one of the reasons I got bullied was to do with religion. My father, who was described in those days as a missionary in this community, preached a more fundamental gospel than what was spoken in the other churches in town, the Anglican and Roman Catholic. Sometimes that led to considerable bullying, which under these circumstances, some might even want to call persecution. I remember one particular time being quite verbally and physically attacked on Monday because on Sunday my father had preached that "all your righteousness is filthy rags," a quote from the prophet Isaiah. People did not take kindly to their self-righteous attempts at living a good life as being referred to as perhaps worthless when, in the view my father would have preached, the only way to righteousness was to believe in Jesus and what he had accomplished on the cross on which he was crucified. I also remember other occasions where iced snowballs were thrown at us, and sometimes even stones. It seemed that this treatment of us was either ignored or even condoned by the Catholics in particular.

Another way in which our family's religious beliefs played into my being bullied was that we were of Mennonite background. Mennonites are part of a larger group within the Christian Church that does not believe in the use of violence. As a result, we were taught at home not to fight and also not to retaliate when attacked. That probably just continued to make us more of a target for these children at school or in the community.

Again, perhaps because of who I was ethnically, my female classmates in particular loved to give me a hard time. They would frequently chase me around and trap me against places like the school wall so they could press up against and kiss me. In the first years of elementary school, this was not something a boy appreciated. They seemed to consider this teasing and much later in life, I learned that among people of indigenous origin, teasing is considered a sign of acceptance, a compliment. I am not sure if this applied to what was happening to me. It certainly did not feel like that to me.

The physical attacks then continued until well in my teens. Even younger boys loved to attack me. However, this never made me fearful or hindered my attendance at school are going out with schoolmates to play after school. In part it was because some of this physical behavior was simply rough-housing on the part of my peers with no ill feelings attached. They could just as well play very nicely with myself and my brothers when it came to hockey, soccer, volleyball or other pursuits that we engaged in. Those are good times certainly helped compensate for the negative experiences.

I also believe that our home life was a major factor in my development of resilience. As far as I was concerned, we had loving and caring parents who provided generously for us under our circumstances. They spent a lot of time with us, which is what child wants. I had siblings to play with at home. Those sorts of things can make a home a refuge for a child who is bullied otherwise. That can help a child overcome the negative influence from bullying in the community. Therefore, if we are talking about prevention of bullying, looking at child's parents and their home life is one aspect of this. In some ways, having a good home life is a good bully-proofing measure.

Interestingly, I think another factor that helped in my positive development in spite of what I was experiencing was what I had also identified as being a negative contributing factor, namely religion. What our parents and their helpers taught and exemplified for us in their everyday lives towards us made us feel worthwhile. We knew that we were loved. This came not only from them but we also came to understand that it came from our Creator, that he also loved us and had made us good and considered us worthy of his love and care.

The bullying did come to an end, at least physical component. By this time, the verbal was not as prominent as well either. A number of us boys were hanging around one time waiting for Boys Club to start. This was an activity my father conducted in which usually consisted of some craft or building project followed by some spiritual input and physical refreshment, a.k.a. food and drink. It was a warm spring evening and the sun was still shining. Some younger boys were again teasing and I had enough. By this time, I was 6 feet tall and probably had developed fairly good muscles from all the pails full of water I carried from our rainwater cistern in the basement upstairs for washing, not to mention from the lake for drinking and cooking. I also had the responsibility of keeping our home supplied with fire wood for cooking and heating, which meant a lot of sawing, chopping, piloting and carrying wood. So, I actually picked this boy up by the front of his jacket and another grip on his pant legs and dropped him on the table of the saw which we were standing around. That caught them all off guard and that was the end of bullying for me. They realized that there was a limit to how much they could mess with me. I am not sure if that crossed the Mennonite boundary of non-violence and whether that is a measure that I would recommend, but it worked.