Adolescent Psychiatry

Today was my penultimate day on what has been potentially my last ever placement as a medical student. For the past 4 weeks, I've been based in the Young People's Department at the psychiatric hospital. This provides care for young people aged between 13 and 17 who suffer from a range of mental health problems.

I haven't made any particular secret of the fact that, whilst I have found this placement fascinating and at times really enjoyed myself, I've also found things bloody difficult. I know that no one really has a particularly great time during their adolescent years, but having suffered from mental health problems myself (detailed here if you're interested/haven't read my blog before) which began when I was a teenager, this last few weeks have dragged up several uncomfortable memories. This may make uncomfortable reading for anyone easily "triggered" by talk of self harm, depression, suicide etc.

Where I grew up, we didn't have a separate adolescent psychiatry department. Anyone under 18 was sent to the Child & Family Mental Health Service. I vividly remember my first appointment there. I was 15 and it was the Christmas holidays. The department was located in an old, probably Victorian, terraced house which hadn't been particularly well renovated. The room I was seen in was freezing. There were two people seeing me; a middle aged lady who was a social worker and a younger man who introduced himself as a "trainee doctor" - I suspect that he was a psychiatry registrar but at the time I was pretty convinced he was a medical student. They sat behind a desk for the whole consultation and the seats for us (my parents were with me) were a good few metres away from them. There was also a little window at the top of the wall where someone else was apparently watching what was going on. On the wall were several posters about how to deal with your child's difficult behaviour and advising against smacking. There were toys all over the floor.

My first impression was that they thought I was a child (which of course I was, at least legally, but what 15 year old doesn't think they're incredibly grown up?). I don't recall much of the discussion we had. I remember them repeatedly asking whether I'd ever been abused, and then later taking great delight in asking my parents to leave the room so that they could ask me again. Actually I only wanted my parents out of the room because I knew they'd be upset if they knew the extent of my depression etc, but the doctor and social worker seemed pretty desperate to uncover some horrific trauma which must have caused my problems. The only other thing I remember was that right at the end, they asked what I would like if I could have 3 wishes. I still get a bit emotional when I remember my responses, because actually I think they'd be exactly the same if I were asked the same thing now. Firstly, I wanted to be pretty. Secondly, I wanted to be cleverer. Finally, I wanted to be better at music. They seemed rather bemused that I didn't say I wanted to be happy, but even now there are still moments when I think that if I had those things, everything else in my life would/will miraculously fall into place and I would be happy. ,

I didn't go back after that first appointment. They put me on fluoxetine the first of many antidepressants I took. They also wanted me to have CBT but I declined. In retrospect, I probably should have gone for it, but at the time the only time I could cope with being "mental" was to tell myself and everyone else around me that it was due to "a chemical imbalance in my brain". Taking medication to correct this was fine. To have CBT would have been admitting that my thinking was fundamentally flawed and that it was therefore some weakness of character resulting in my problems and not a "proper" illness. Of course I know now that that isn't true, but the explanation I got was such that that was what I believed at the time.

Over the past 4 weeks I've met lots of young people who've suffered with, amongst other things, depression and self harm. Self harm is a strange phenomenon. No matter how much I read about it, I can't fully understand it. What I do know is that for me personally, there was an addictive element to it. Just as a recovering alcoholic may struggle to sit in a pub and watch other people drinking, I as a recovering self harmer find seeing obvious evidence of others' self harm incredibly hard. I know that it was a maladaptive pattern of "coping" with problems. I know it didn't make things any better in the long run. I know that not doing it is much, much better for me than doing it. Yet each time a teenage girl (they were mostly girls) came in with the tell-tale lacerations on her forearms, I felt a strange pang of envy. I do not envy their mental distress. I do not envy the having to wear long sleeves even at the height of summer. I do not envy the having to sprint from the bathroom to the bedroom after a shower so no one would see the cuts. But somewhere deep down inside, a part of me feels an odd craving to cut.

Although I have struggled with many things over the years, self harming hasn't been a major issue for me since before I came to university. I wonder, sometimes, whether I will ever be totally recovered from this issue. Will I be always fighting it? Each time I see a patient who has self harmed, will I have to fight the urge to go back to that pattern of behaviour? I don't know. Possibly. As I get better at coping with emotions - something I am learning more about all the time - I hope the desire will be less strong.

The most positive thing I can take from the past four weeks is that I have survived. Some days were ok, some were great, some were awful, but I got through. Perhaps, one day, I'll be ok...

Changeover Day

Just over a week or so ago was changeover day,- the day when junior doctors move to new jobs. Under the current UK system, all newly qualified doctors work for two years in "foundation posts" where they spend 6 blocks of 4 months working on a range of specialties and developing the skills they will need for their future careers.

As a student, I don't usually think too much about changeover days. Sometimes it's a shame when they happen halfway through a rotation as the staff you have got to know for a while all change, but that aside they don't really impact on us too much. This last changeover day has played on my mind for one reason, and one reason only. Next changeover day will be the day that I START WORK.

I've probably stated numerous times before that as a graduate medic I've been at uni for seven years. I'm in more debt than I care to think about, my younger sisters are both self-sufficient professionals (as are lots of my friends) and at 25 I feel that it's high time I stopped "tax dodging" and got myself out into the world of work. This does not make the prospect any less terrifying.

If you're planning on being ill at all, try to avoid the first week of August!