Narrations In Psychiatry Training



 

Hena Jawaid, MBBS, FCPS (Psychiatry)1,2

Perm J 2020;24:19.218 [Full Citation]

https://doi.org/10.7812/TPP/19.218
E-pub: 04/16/2020

“… and then he yelled over me and I was confused about what to say. I wanted to stop him, but I was overwhelmed by the memories and flashbacks of my childhood when my father used to shout at my mother in a same way …”

I was looking at her lips, fingers, and body language, which were following the tone of her speech and the context while she was telling me her thoughts and how she responded to one of her stressors. I was conceptualizing her story in my mind, trying to piece together the whole picture into an algorithm of International Classification of Diseases, 11th Edition or Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition—an algorithm of guidelines, concepts, criteria, definitions, and schemas. I was trying to squeeze the protruded ends of her story,, ranging from the date of her birth until this moment, into a box of fixed theories.

It was my first year in psychiatry training.

Tracing from her childhood to link it with parenting, relationships, attachment, strengths and weaknesses, failures and achievements, ego, personality makeup, temperament and preferences.  The whole panorama of her life was imprinting on my mental sketch board with the colors of her tone, gestures, and emotions.

It becomes hard to avoid an irresistible urge to follow the biomedical model of disease in the process to become a psychiatrist. It is partly because trainees have a background of studying 5 years of basic medicine.

Experience and time are the best teachers in how to link patients’ narrations holistically to create out a mental map of a person. Not to mention, the knowledge of basic theories is inevitable. However, overemphasis on defined concepts to the point to adjust living pictures in the logbooks is inapt.

Training requires the capacity to delay gratification. Delaying gratification is a significant milestone to achieving anything in life. For an amateur trainee, it becomes quite difficult not to jump to conclusions, to avoid a reductionist approach and to hold back from diminishing abstract thoughts into concrete facts.

All it requires is active listening, keeping aside checklists and criteria.

With time, a person gradually gets a grip on personality types, coping mechanisms, varying life circumstances, and diverse backgrounds. The opportunity to see a person beyond the arena of didactic explanations enriches a trainee.

The urgency of diagnosis incites a trainee into a spiral of quick prescription, treatment, alternatives, and thus, poor management. The havoc creates anxiety and worry in patients and their families (and physicians too) that is mind-wrecking and damaging for the physician-patient alliance as well.

The whole phenomenon of deciphering the issue takes time and patience. It requires one good psychiatrist to view things holistically from the window of the presenting complaints (using a biopsychosocial and spiritual model) to reach the innermost closet of a persona.

Narrations should be given significance in the process of psychiatric training in the form of story-telling, art, music, poems, essays, and novel writing. It enriches the trainee to be acquainted with different perspectives of life. It widens the horizons of mental acuity to think in broad lines and in diverse ways. It offers patience and deepens the information process to understand events and reactions at different levels.

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Author Affiliations

1 Aga Khan University, Karachi, Pakistan

2 Minaret College, Officer, Victoria, Australia

Corresponding Author

Hena Jawaid, MBBS, FCPS (Psychiatry) ()

How to Cite this Article

Jawaid H. Narrations in psychiatry training. Perm J 2020;24:19.218. DOI: https://doi.org/10.7812/TPP/19.218

Keywords: behavioral health, mind-body, narrative medicine, physician-patient communication

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