When my GP referred me to a psychiatrist for an ordinary medication review, the first thing I did, of course, was Google the guy. It took me about two minutes to find out that he was not only a consultant psychiatrist, but also a neuroscientist working in the Department of Psychiatry. That is, the same Department of Psychiatry that I work in. You may think “What are the odds?!” but truth is, the odds are quite substantial in a small and university-oriented town like Cambridge… I deliberated for a few days. After all, Google had told me he was based in another building, and also that he looked kind of cute. Nonetheless, I eventually rang and asked to be seen by another doctor. To my surprise, this request was declined; hence I canceled my appointment.
The next day, the cute psychiatrist was on the phone. He explained that my care would never be affected by our work connection and invited me to come in later that week. I replied that I wasn’t the least worried about my care, but rather about my job. His response: “why don’t you come in so we can talk about that?” As our conversation continued to go in circles, I realised two things: 1) he had by now read my file anyway, and 2) he was not the kind of guy who would let go easily. And so, eventually, I agreed to see him. Later that week, in his office, we talked about the department, about the University of Cambridge, and about scientific research in general. He told me that he no longer does scientific research these days, but focuses on his clinical work. This was as much a relief for him as it was for me, he said, as he, too, suffered from insomnia in his research days. He was very kind, and, indeed, kind of cute too.
A week or so later, my colleagues and I attended the Paykel lecture, an annual departmental event. We had the incredible honour of being addressed by one of the major contributors to the newly revised Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. Prof David Kupfer had come down from Pittsburgh to share his views on the future of psychiatry research. What we should not do, he said, is place psychiatric patients in diagnostic boxes, or categories. Instead of the traditional categorical approach where disorders are either present or absent, his revised DSM-5 introduces a ‘dimensional’ system. Symptoms and disorders are now described on a gradual scale from ‘normal’ to ‘abnormal’ and from ‘mild’ to ‘severe’. The dimensional approach fits very well with the reality of mental illness, in which two patients with the same diagnosis often are quite different from one another. Moreover, it recognises that there is a large group of people who are neither very ill nor absolutely fine.
As I was listening to Prof Kupfer, I felt a cramp creeping up my left leg. In what was intended as a preventive repositioning of my leg, but undoubtedly looked more like a spasm, I kicked the back of the seat in front of me. Fortunately, the guy in that seat decided to ignore my friendly gesture, but not without turning his head slightly to the left; which was enough for me to realise that I was sitting right behind my cute psychiatrist. Literally, I could pinch his shoulder or ruffle his hair if I wanted to. Now that’s great, I thought. So much for ‘no more research’.
Sitting behind my psychiatrist, I clearly had the upper hand. I could watch him, or at least the back of his head, without being seen. After the remainder of Prof Kupfer’s talk, on my way out of the lecture theatre, he walked right behind me; he stepped aside as I climbed the stairs, and I kept the door open for his friend or colleague. All the while I avoided eye contact. Luckily, he returned the favour. He didn’t smile or glimpse or even blink (as far as I could tell while keeping my eyes on the carpet). At some point during the drinks reception, he happened to be standing in the corner of my eye, but the colleague I was talking to unknowingly helped me be blocking my view. All in all, I think my doctor and I handled the situation pretty well. It was a little bit awkward, but it was also fine.
Cycling home, I thought about the dimensional nature of mental illnesses, and how the encounter with my psychiatrist provided a pretty perfect illustration. I bet I was not the only one in the audience who is sometimes researcher, sometimes patient. Not every aspect of me is patient all the time. There are healthy (on good days I may even call them ‘normal’) sides to me as well. In fact, all of us in the audience that night, including my cute doctor, are somewhere on the scale between normal and abnormal. The fact that I had once had an appointment with that psychiatrist certainly doesn’t mean I’m the furthest out on the abnormal side.
Illustration by Ellen Surrey, from the Society of Illustrators online gallery.
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