Psych Me Out

Anna Burkhead -- “I’m so worried, I don’t know if all my things can fit into these bags…” The patient was a woman somewhere between middle aged and elderly, but desperately trying for a more youthful look, judging from her dress and makeup. She was being discharged that day, after nearly ten days spent on the Psychiatry Crisis Unit. The patient had Axis I and II diagnoses of bipolar affective disorder and borderline personality disorder, and was originally admitted for depressive symptoms and suicidal ideation.

“Well, why don’t we try putting your belongings in the bags, and if they don’t fit, we’ll get some more bags.” My response seemed simple enough. My patience was running thin. I didn’t understand how a person could be so anxious about something as minor as fitting clothes in bags, especially when there was a simple and ready solution nearby (more bags), should any difficulties arise.

In this patient interaction I found myself reassuring the patient many times on many topics. To me, most of these topics were unworthy of the level of anxiety that this woman was exhibiting.

The funny thing is: on many days I find myself on the other side of an interaction very similar to this one. I am the anxious person, angst-ing about one thing or another, and someone, usually a friend or parent, is reassuring me and offering solutions. Of course, my angst-producing issues are worthy of the worry in me.

Or are they?

If anxiety is a spectrum, this patient would be at one extreme. I would place myself somewhere in the middle. To me, this patient’s worries are extreme and unreasonable. But what do my worries look like? Is my fear of flying irrational? Is my test anxiety excessive?

So far in my Psychiatry rotation, I have seen parts of myself and exaggerations of my traits in multiple patients. Every time I feel myself becoming frustrated with these patients, I stop and take note. Oftentimes, the behaviors that irk me are extreme versions of things that I (and many others) do.

The point I want to make is this: when you have a patient who gets your britches in a bunch, and you find yourself getting frustrated, make a mental note. It’s entirely possible that the quality that irks you is one of your own, only magnified a bit and shown in mirror image. Just a thought!