Creepy way to start the days...

I've almost forgotten that I actually like psychiatry. Well, part of it anyway. 

Two days into my psychiatry rotation at St. Paul's Hospital and I've never felt this sick to start each day. As we sat across the table over our 8:30 am rounds, I patiently listened to accounts after accounts of violent behaviors on the ward from the previous night. Large, angry, often unpredictable and emotionally labile men enclosed in a small contained space, feeding on each other's psychoses, being contained mainly by medication or what little trickle of reason left in them. Half of them have criminal pasts, forensic investigations, and various accounts of violent acts when they were out on the street. Today, as I interviewed this one patient who openly admitted to having killed some random stranger in one cold and lonely night, I felt sick to my stomach. I remember that I had never sat face-to-face with someone who had killed a man. The scariest part was that in-between episodes, these people are almost downright normal. Their random acts are often dictated by their illnesses, and I feel skeptical to believe that even if their diseases were properly managed by medication and close observation, that they will ever be considered "safe". The human mind is a powerful thing, and at extremes, it is the most dangerous weapon we have got. 

Of course, I see this mainly because St. Paul's happens to house a selected population with its inner city focus. A large part of psychiatry deals with the much milder but very unfortunate souls who are otherwise functional and productive vehicles of society. And even the extreme patients that I see on this ward are mainly the victims of their poor neuronal mishaps. Had they not been disabled by their own minds, they might have grew up to be lawyers or accountants. The diseases have failed them. Science have failed to save them. And very often, the social and medical system is failing to support them, allowing them to spiral into a black hole of dysfunction and often become sociopathic. How does one break the cycle? How does one cure them? Can the diseased mind ever be cured, or simply contained and controlled? 

It's really heavy, working among these people. I can appreciate how many staffs who work in psychiatry after a long time can appear often a little on-edge. Today, even though I didn't see too many patients, I felt already keyed up and mentally tired. I'm beginning to appreciate that I probably made the right decision in regards to not pursuing my one-time consideration of psychiatry as a career. It's really amazing what these people do day in and day out. As for me, perhaps I like to mix it up a little, and enjoy sometimes an emotionally lighter day. I still very much enjoy the process of the psychiatric interview and the mental and word games I engage in with my patients. But I don't want to get into the habit of constantly trying to identify pathological behaviors in the people I see each day. It makes me feel that everyone in the world are pathological, forgetting sometimes that the range of normal is very large and that we should celebrate our often odd but quirky different behaviors.