It’s quite odd to think of myself that way, but that’s what I am. I’m sure Kathleen feels more of it, since she’s on her internal (eternal?) medicine rotation. The joke is quite apt in her situation, since she’s been QUITE busy, especially compared to me. I’m on inpatient psychiatry for the next 6 weeks, and it has been particularly low key lately – all the 3 days that I’ve been on this rotation.
I have really enjoyed this rotation, and I think I will continue to like it. Not just because of the schedule, but because the schedule and experience is just the right balance, I think, so that there is time to both see patients and be real to them, and because I get to think and write, as well.
There have been a number of interesting questions brought up in my mind.
1) Assuming a spiritual reality, which I do believe in, and assuming that that spiritual reality affects the physical reality, how much of psychiatric disorders is a result of actions in that spiritual reality? For example, could some of the voices that schizophrenics hear really be the voices of demons? Many, if not most, of those voices are often of a persecutory or depressive type – someone is out to get them, or that they’re not worth anything, or something to that effect. Modern American medicine does not take that into consideration at all, since it assumes that anything in the realm of the spiritual is untestable, and therefore not valid for consideration within the confines of the modern scientific method.
I’m not trying to say that all psychiatric illnesses are totally and completely spiritual in nature. That would be an extreme oversimplification. At the same time, we have little idea as to what some of these things are “caused” by. What leads someone to have grandiose delusions, to think that they are god? What leads people to simply stop listening to the world around them, and ascribe greater authority and validity to the voices in their head? On some level, beyond original sin, I would imagine that there’s something going on that may very well be the work of demons. As most of you readers ought to know, I’m definitely NOT of the charismatic or pentecostal tradition, but as a believer in a very active spiritual reality, I can’t ignore that. I also can’t ignore that our present treatment of these things is not going to begin to address that spiritual reality.
So if modern medicine doesn’t allow for the possibility of a spiritual reality when looking at patient treatment, where does that leave those who DO believe in a spiritual reality? There are a handful of books on Amazon.com, but none of them seem to have been read/reviewed adequately. There are some more focused books on Christianity and depression, or things like that, but little written on the fundamentals of being a psychiatrist applying the belief of a spiritual reality. If anyone knows a Christian psychiatrist, I’d like to pick their brain.
2) I am reminded of Thomas Szasz and his thoughts on the nature of psychiatry and the goals of the field. What is the purpose of having these classifications of various “illnesses?” He argues that they are little more than subjective ways to separate out those who are socially disruptive and only rarely, actually dangerous. After all, normal is just what most people define it to be, right? And so when someone hears voices in their head, they’re not “normal” because the rest of us don’t hear those voices.
If so, why do we involuntarily hospitalize these people and get court orders to force them to take their medication? Just about every other field in medicine allows patients to leave against medical advice, refuse treatment, and generally not listen to anything their treatment team says. After all, it’s a natural extension of autonomy.
I have read some rebuttals to Szasz, but am not convinced, given the great weight that autonomy is given in today’s culture and day-to-day medical practice.
Most people around here never comment, so if you have any ideas or thoughts, I REALLY want to know what you think. Comment like mad. Or even better, maybe post something over at Rasheed.
More to come later as I ponder and stew on stuff.