Trigger warning: suicide, death, cancer, substance abuse, opioids

Tharshika Thangarasa is a third-year medical student at the University of Ottawa. She is studying to be a physician.

Tharshika Thangarasa (Photo by San Ahn)

My love of medicine and mental health began in a cancer ward.

As a high school student, my ability to directly contribute to patient care was limited. I spent most of my time with the hospital’s Chaplain and the patients. During this time I had my first encounter with death, in the passing of one of the patients I had become close with.

Something about this experience has remained with me. Some of the patients were so content, despite their often-horrible prognoses. They had made peace with their fate and expressed gratitude for what they had. It was such a stark contrast to patients I had observed with mental illness, who sometimes considered suicide despite optimal physical health.

I came to realize that each individual has unique psychological and social circumstances that frame the way they experience life. An individual’s perceptions are a direct by-product of years of nurture, combined with a biological baseline, or nature.

The same stimulus often elicits very different emotional responses in people. The concept of death, for example, is perceived quite differently by a mentally stable cancer patient than one with a severe depressive disorder. As I continue on my journey to becoming a physician, I am increasingly aware of this phenomenon.

Working in healthcare involves interacting with a diverse range of people, many of whom have psychiatric diagnoses. So many conflicts and frustrations arise from a failure to appreciate, or even try to appreciate, the context behind people’s opinions and emotional responses.

The unanswered questions in healthcare

There are important questions to understanding another person that I rarely see asked, particularly when it comes to addiction.

What factors shape a patient’s views? To what extent is blaming someone for a condition or disorder justified? Is this patient with a substance use disorder entirely responsible for their addiction? How much control do they really have? Should they be viewed as a burden on the medical system? Why do healthcare providers often respond to patients with substance use disorders so negatively?

Asking myself these questions has led to heavier philosophical questions that I continue to grapple with. Generally, I have found people readily point fingers at each other in cases of mental illness and healthcare. Blame is instinctual – a defense mechanism, perhaps?

From my experiences, I have come to believe that mental illness is not well understood in the medical community. I feel psychiatry is an area of medicine that direly needs more research. There is still much to be done to eliminate stigma around psychological conditions, but Western society has made tremendous progress in acknowledging and stimulating dialogue around mental illness.

Yet much remains unknown. It is mere human beings, with their own biases and psychological vulnerabilities, that are tasked with delivering mental health care. This adds another layer of complexity to understanding mental illness and delivering treatment.

I came to realize that each individual has unique psychological and social circumstances that frame the way they experience life.

Medical culture and mental illness

I have found that because mental health is so poorly understood, it easily attracts blame. People point at mental illness as causes for various adverse events, without trying to understand a patient as an individual. This is inherently problematic.

Consider the opioid-seeking patient. It is so easy for a healthcare provider to label them as “mentally ill,” roll their eyes, and send them to the psychiatric wing, knowing this individual will likely be back. It is harder to critically evaluate one’s own response to this patient and try to appreciate the factors that have led to their circumstances.

I have noticed people who recreationally use drugs tend to have experienced emotional trauma. It is as if they resort to these drugs to fulfill a need for pleasure – one some others are able to obtain from strong interpersonal relationships.

I must acknowledge that I am still early in my career, and my opinions may evolve as I continue to experience life, on and off the ward. But I believe instead of blindly attributing personal and societal issues to “mental illness,” it is fundamentally important to take a moment to at least attempt to understand the various factors at play for a patient as an individual, not as a mental illness with a host.

Mental illness is a very personal matter. Everyone has the potential to make a difference in another person’s life. Often making this kind of real and lasting difference involves just one person taking the time to try to understand another. There is not an overnight solution to mental illness and its many social consequences. Simply acknowledging psychiatric conditions is not enough, especially in the healthcare community.

So I challenge you: the next time you feel a negative emotional response towards someone or something, take a moment and question your own perceptions. Are your views just? Is there something about this person that you are failing to appreciate? You may be surprised at how much you learn.

By Tharshika Thangarasa

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