Thursday, December 9, 2010

All Shapes and Sizes

 Walking home from church earlier tonight, I passed by a busy street, which was right along the mall I was on my way to. Like any regular sidewalk in Manila on a busy rush hour time, there was the usual cacophony of honking horns and rumbling engines. People were walking about to and fro, all busy, walking fast to get somewhere. For a while, I had walked on, not minding the melded sensory experiences anymore, just eager to go about my business as well. 

What broke my reverie was a piercing, "HOW COULD YOU DO THIS TO ME??", which came from a girl on the side of the street, yelling at her boyfriend (her significant other, I presumed). Judging from the way her face was scrunched up, and the voluminous tears flowing down her cheeks, she looked very upset. A major infraction had occurred between the two of them, and with her fists balled at her sides, I assumed there was little holding her back from punching the guy in the face.

The guy was absolutely silent and motionless, he said and did nothing. She did all the talking and yelling… She didn't seem to care that passers-by and people in the jeepneys passing by were watching them. I was tempted to just stop walking and watch the human drama unfolding on that very street, but it wasn't proper…nor nice. (Sayang, really. ) And besides, I was a hurry.

I never got to see what happened next, and judging from the traffic jam they were causing, a policeman probably came over eventually to break them up and keep the peace.

I had this thought at the back of my mind that it was probably going to end up like this (from the many cases I've experienced since starting pre-residency); the girl, due to the present stressor was going to drink/ingest anything close at hand that might presumably kill them (i.e. aspirin, paracetamol, yes, even vitamins…or even some "esoteric" substances such as, well, silver jewelry cleaner, for instance. 

A desperate person intent on harming himself or herself really will try anything.) If that patient is lucky, he or she will be prevented from successfully completing the attempt…and be put on the road to putting himself or herself back together in order to cope. Only then can this person go through that experience whole.

Mental health is one of the most pressing health issues, I believe. I don't say this because I'm training to be a mental health specialist, but I say it because, well, it is the truth. Last weekend, I attended a psychopharmacology and I took a picture of one of the slides they used during one of the lectures. I found the striking statistics quite terrible. Mental illness is not really something talked with as much "ease" as other diseases such as diabetes or hypertension, and most often, people don't even like talking about it…especially when family members are involved. The prevailing stigma is appalling.

One of my teachers from medical school shared this with me this morning on when I posted this picture on my wall, and I quote her: 

 Philippine population = 90M
Philippine psychiatrists = about 500, just five HUNDRED.
Prevalence of Schizophrenia - 1 in 100 people
Prevalence of Schizophrenia in the Philippines - about 900,000
Only 1 psychiatrist for every 1800 Filipino patient with Schizophrenia

Note: Not included are patients with Mood disorders, substance dependence, anxiety disorders...
Mental illness is no joke, and I never could get why people find making fun of mentally ill people amusing. I mean, it's neither glamorous nor funny to be "unwell", and it even annoys me to an extent when people poke fun at mentally-ill people, imitating them and even patronizing Schizophrenia being a "split-personality" thing… 

When your mind turns on you (as it does in psychosis and even major depression), you are no longer in control of yourself, and no amount of exercising nor pill-popping of vitamins is going to work on you (unlike other diseases, although I'm not saying they are not equally serious). Sure, quirks and tics may be funny to watch for certain periods of time, but it really is no laughing matter… And even if we people on the inside smile and share anecdotes of patient's idiosyncrasies, it is done always with the intent to share knowledge and treatment options.


This week, me and my co-residents have been introduced to our new patients at the out-patient department, mostly of psychotic cases and bipolar patients (for the first year level). We've logged our patients in our planners, scheduling their follow-up check-ups accordingly.

To be perfectly honest, I find it daunting that I'll have to deal with these patients on a monthly basis, seeing to their care and well-being. So far, the ones I've met are going to be fairly challenging. No specifics, but suffice to say that I'll be dealing with patients of all shapes and sizes (well, figuratively, anyway)… there's an intellectual, an obsessive-compulsive patient with obvious tics, a floridly psychotic woman who doesn't take any of her medications, but on the other hand, there are those who are in remission; so much like everyone else that you can't even tell that they were even on anti-psychotic medications.

I face this trepidation on one hand, fascination on the other. I'm sincerely hoping I'll be up for the task.

(And yes, balls of steel are still on my wish list, Santa.).

Wish me luck! :-)


  1. funny, but back before i entered the medical field i too associated schizophrenia with split personality disorder. of course now i know that they are entirely different.

    i too find psychiatry fascinating. you really get to see a lot of interesting cases. and it is such a joy to see how you've affected your patients and see the changes in them as you treat them.

    honestly though, i don't think i can handle psychiatry as a specialty. you need to somewhat distance yourself from your patients in order to treat them objectively, and that's very hard for me to do. i can't help but relate to my patients on a more personal level, but not to the point of getting attached of course.

    anyway, i wish you luck on your chosen field. i'm sure you'll do well.

  2. Good luck, I know you'll be great!

    I get mad when I see people make fun of the handicapped or the mentally ill. It's so mean and pointless to make fun of people who are doing the best they can, but have problems.

    My brother once threatened to shoot himself--after his wife left him (he was cheating on her). My parents called and made it my job to stop him. For a moment I worried he would shoot me, but it worked out okay. I don't think he really wanted to hurt himself. I think he just wanted someone to feel sorry for him and help him.

  3. Fyi, you're my blog of the week.

  4. I'm not a doctor, but a student nurse, and once we tried to communicate with patients who are mentally ill, and the patient I had was having paranoid schizophrenia..

    And it's hard to communicate with him, because he is a kind of sensitive to anything, and I for once realize how important it is to learn how to communicate well with them.. and i love this specialty for that reason that communication is very therapeutic for that illness..

    wishing you goodluck for your specialty!!! :)

  5. How refreshing to read this blog post. I grew up where therapy/anti-depressants were considered a waste of time and money. People who couldn't control depression on their own were either lazy, or simply liked being unhappy.
    For years people have simply looked at me in exasperation and asked "Why can't you just not be sad!"
    So thank you for letting me know that there is at least one person out there who understands.



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