From The Doctor's Side

I just finished reading Weekends at Bellevue by Julie Holland, M.D., It is her memoir about working the weekend overnight shift in the psych ER at New York's Bellevue Hospital. I really enjoyed reading about the psychiatrist's point of view. She tells countless stories of patients she saw come through the ER. in many shades of insanity. Toward the end of the book she has a short chapter in which she discusses the relative nature of mental illness.

She writes, "If any of us shared with a psychiatrist every intimate thought we had, our darkest secrets, is it possible we would still be judged safe and sane? There are plenty of times we feel murderous rage, or we think it would be easier if we didn't exist anymore. It's a common fantasy to see ourselves driving the car over the edge of the embankment or into oncoming traffic. Using the criteria of danger to self or others for involuntary commitment, any of these impulses and fantasies is enough to buy you a short stay in the hospital's inpatient psych ward. On the other hand as lon as you keep them to yourself, you can walk around the city freely."

She says shortly after this, "The reality is this: All of us, to some degree, are mentally ill." She lists off various manifestations of this including anxiety, depression, insomnia, compulsions, addictions great and small. Then she continues, "Every one of us has psychiatric symptoms, many of them serious enough to warrant attention, even if they are not incapacitating. But few of us are willing to let on that we are suffering. This secrecy and shame compounds our avoidance of those who have been officially diagnosed as mentally ill."

And later, "We avoid dealing with psychiatric patients because we hate to see things in others that we don't want to see in ourselves: weakness, need, despair, aggression. Our experiences with the psychiatrically ill often fill us with dread; they confront us with our own terror of reaching a catastrophically altered state from which there is no return, We should be compassionate to those who stumble out of our lockstep. Yet in our culture, the mentally ill are demonized and shunned They are ostracized and marginalized as a by-product of our primal fear of going cray ourselves."

She talks more about how we treat the mentally ill in this country and contrasts it with other countries, citing Vietnam as one example. Then she writes, "Instead of integrating them among us, we shutter our psychiatric patients away so that we will not have to be reminded of all that can go wrong with our own minds and brains."

I really liked this chapter. The tone is different than most of the book because she is making more of a commentary than recounting her experiences in story form, but because she doesn't preach much in the rest of the book, this sermon isn't off-putting.

I recommend this to anyone dealing with mental illness, either their own or someone else's It is a great perspective that most of us don't get to see.