We are currently moving through a horrid period of "interesting times". There is so much fear in the world, about things that might go wrong, about what we see in the news and read online, and what we see around us. It can be utterly overwhelming. We are afraid to lose the little that we have gained, afraid to lose our safety and the safety of the ones we love and care for. These times provoke anger, hatred and fear. This post specifically refers to psychiatric care. In some ways it can be applied to life more broadly.
Every single one of us is different and while we belong to certain groups within society, we are all complex individuals. We fit patterns but no two of us are the same. We change over time, some parts of us stay the same, other parts grow stronger, other parts are no longer needed and fall away. In an ideal world, we develop more skills, strengths and knowledge about ourselves and the intricacies, variations and ironies of the world around us as our lives move from season to season.
In addition to the joys and happy accidents of life, all of us are hurt, disappointed and need to find ways to flourish alongside small disappointments, pain, new scars and old losses without letting them consume us. We continue, we do not stop, and hopefully we get to move on to a new season in our lives, having learned and grown as complex and wise people. We need to feel safe in order to do so. In interesting times, this is difficult.
We should all be treated with kindness and considered as a whole person. We should all be safe from discrimination and violence. We need safety. We should all be able to walk away and be safe from people who do not respect us, who use and abuse us and exploit us, even subtly. We do not have the right to manipulate, exploit or practice cruelty or violence towards other people. Every one of us should be considered as a whole person and have stereotypes thrown away, while also maintaining awareness of our vulnerabilities due to what we have been through or who we are. The more we know about individual people, the more the stereotypes dissolve into meaningless and toxic rubbish You will change. Your needs will change. Your experiences should be heard. Care should be centred around the person across their entire lifespan and reflect this. This is ideal.
No person wants to remain in a state of sadness and distress and it is our role as psychiatrists to do our best to help people in those moments. Most of the time, people try to do this with the tools that they have and the tools they are familiar with. Helping people through such times may mean being with them and working out how to change their lives so that they are able to move past their difficulties and into a better place (including literally and psychologically), or helping them take the time to understand themselves and the world around them first, and develop the skills to move on in a way that is true to themselves.
While this post mentions gender diversity, this applies to every person and many other areas of psychiatric care. It can even apply to the current situation in NSW with the public sector psychiatrists being willing to lose their jobs to fight for necessary change in a woefully inadequate system while being stereotyped as money-hungry doctors. They are willing to move away from their homes, their communities, their schools, and have put themselves on the line. They care. They are also not a monolith.
The RANZCP Position Statement on the Role of Psychiatrists in working with Trans and Gender Diverse People captures quite a lot of the complexity and I practice according to their guidelines. There are a multitude of citations on this document, please read it if this is an area of interest for you. All care should be person-centred, nuanced and complex and held to high standards. I can post the same about all other areas of psychiatry, where the guidelines are constantly being re-evaluated looking at new evidence and international standards. A thoroughly-researched area will have complex evidence that builds up a nuanced database of information over time. Our statistics on ADHD and autism prevalence are continually changing with research, increased public awareness and increased willingness to consider a diagnosis of these neurotypes.
Medical knowledge should never remain the same and MUST be constantly refined, revised, re-examined, criticised, pulled apart and rebuilt to be better. Otherwise it fails all of us. You see a doctor for their expertise because they have training and qualifications, followed by clinical experience, ongoing studies and continuing professional development. Your doctor must consider your health through the framework of their clinical expertise and knowledge. It is their professional responsibility.
I listen to my patients. I want your long-term mental and physical health to be considered as part of your care. I respect your right to be fully informed.
My patients are, as always, welcome to ask questions. I may not be able to provide everything that is requested (e.g. asthma puffer or OCP refills, family court reports), but as your psychiatrist, if you ask, I will share my clinical expertise and opinion and respect your autonomy, intelligence, strength and life experience.
