Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Re-wounding the wounded healer

Constantine Ioannou, MD
Physician
June 13, 2022
7 Shares
Share
Tweet
Share

I walk onto the inpatient unit on a Monday morning. The feeling of discomfort begins to overwhelm me. Perhaps this was due to being forced back to inpatient, but I felt it had to do with changes in the process.

I started my training at a time when therapy was a central part of education. Understanding even the most psychotic patients was a key element of our field. I do not recall the vast number of court cases that we have today. I do not recall the regulatory demands being as onerous.

The ideal during my training was to provide multiple treatment modalities with psychotherapy, group therapy and family therapy. Today we remand to the hospital, medicate over objection and force outpatient care.

We complete multiple forms to ensure patient “safety” and maintain compliance with regulatory affairs, but few of my clinicians “know” their patients in the way that Sullivan thought we should.

Therefore, I go through the motions of covering my team. — rounding, trying to talk to staff and patients but feeling mentally exhausted. My lessons to students and residents feel completely out of date. I feel that my experience adds little value to the provision of care in 2022.

Rounds being over, I have the ability to reflect on my day and my internal state and think about the archetype of the wounded healer. I am the first to admit that my wounds have an important role in my development as a physician, psychiatrist and person. The work that I have done has been immensely helpful in my becoming a therapist. However, the literature does not speak to this wound having much to do with my feeling of exhaustion. It is all about burnout. Gyms and pet therapy are all that I need.

I believe this discomfort stems from my own personal wound. Although the wound allows me to be empathic and understanding, the system does not allow me to do what I want to do. I must neglect my needs entirely and go through motions that “re-wound” me.

My desire to go into psychiatry is a complex one, and a number of “wounds” were involved in my becoming one. One of my issues has always been the hating of confrontation, noise and threats. My background was a loud one, to say the least, and entering into a loud and confrontational situation continues to trigger me.

I have always tended to be quiet concerning my needs. I had two roles in my family system, one of which was the “hero” who would achieve all the things that my family wanted me to achieve, and the “joker” who would use humor to de-escalate confrontations. Using my time in therapy, I was able to see my own needs, and rather than blindly remaining the “hero,” I decided to embrace my own path.

Being a therapist fit perfectly into my picture of self. It has the elements that allow me to use the wound in a productive manner and help others. Inpatient psychiatry is different. It is loud, violent and confrontational.

None of my patients voluntarily seek care. A third of my patients refuse treatment, and their case ends in court. In truth, I do not want to force treatment on a person. I understand that I have the right (and responsibility) to do so, but it does not sit well with me in general. The patients want to leave, and they do what they can to convince us that it is safe. We spend little time on the process of healing, acting more like a stabilization service. We cannot wait for the therapeutic relationship since the insurance companies want them medicated and out.

I feel the need to protect myself, physically and mentally. I enter the unit alert for potential physical dangers. I then try to engage with people, but they, for the most part, just want to leave. I want to leave as well, but neither of us has that ability.

There is a “system” that includes government, regulatory affairs, third-party payers, CFOs, legal systems, and family. There is the constant need to satisfy this “system,” but that usually entails committing people and keeping them until they are “safe.”

Of course, the elements of the “system” cannot all agree as to what is meant by safe, what is meant by least restrictive, most cost-effective, so the patient and provider are responding to multiple layers of rules that are provided by the “system.”

We are always going to upset some part of this group. Civil libertarians want maximum freedom. Families often want the tightest control. Finance people want whatever costs less. In the end, there is a lack of consensus.

As I try to explain, the anger only increases. The idea of a therapeutic alliance is lost, and we now enter into the world of conflict. There is no other option, however. I must take this person to court. I must learn to embrace the conflict. After all, it is for their own good. Or is it?

After so many years of practice, I am not sure whether treatment will work or not. I have no ability to predict whether the treatment will work or whether the lack of treatment will be detrimental. I am making a well-educated guess. In the end, I am colluding with the removal of an individual’s rights based on an inexact science. The only thing that I do know is that no treatment is obviously not working for this person. I move forward with at least this fact in hand.

I swear to tell the truth. I try my best not to deviate from the truth. I do not put words in the patient’s mouth.

At the very end, I am asked if I feel that this is the best treatment available, and I can truthfully say yes. It is the best available. More often than not, the order is granted. We must tell the person that if they do not take the pill by mouth, we will inject them. Some continue to refuse and insist on the injection.

Others passively take the medication. Staff talks about winning the case, but there is no real winner. I did not go into this work to deny people their rights and inject them over their objections. I lost a part of the human connection that I had hoped for. The patient has lost. They have to take the medication, and in a court of law, they are now considered mentally ill. The label will follow them for the rest of their lives.

Thomas Szasz would speak about this inherent difference between psychiatry and other fields of medicine. If I have chest pain, I come to see the doctor and hope that they can help me. I am offered options, and I must consent to the treatment. In psychiatry, it is different. Consent is a term we use but, in the end, is not needed. The reason the individual is brought to the hospital is for behavior that is not acceptable in the community. I can be ill and at home as long as I do not bother anyone. One of my old teachers once told me, “Psychiatrists are called when people do not behave.”

I do not believe much will change in my lifetime. In the meantime, I guess I will go home, take a deep breath and pet some animals. It might not cure the wound, but it cannot hurt.

Constantine Ioannou is a psychiatrist.

Image credit: Shutterstock.com

Prev

Gender inequality is making burnout worse [PODCAST]

June 12, 2022 Kevin 0
…
Next

3 ways to revitalize your health care career

June 13, 2022 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
Gender inequality is making burnout worse [PODCAST]
Next Post >
3 ways to revitalize your health care career

More by Constantine Ioannou, MD

  • The legend of the “oatmeal law”

    Constantine Ioannou, MD
  • Don’t yell at me. I’m trying to help.

    Constantine Ioannou, MD
  • Alone and frightened is the way COVID patients die

    Constantine Ioannou, MD

Related Posts

  • From physician to holistic healer: my journey on Clubhouse

    Holly MacKenna, MD
  • My healer, please guide me on this journey

    Michele Luckenbaugh
  • Healer, are you so different from me?

    Michele Luckenbaugh
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Healer: Heal thyself; forgive thyself

    Michele Luckenbaugh
  • How a physician keynote can highlight your conference

    Kevin Pho, MD

More in Physician

  • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

    Elizabeth Cerceo, MD
  • Raw humanity on night float: inspiring patient encounters and overcoming challenges

    Johnathan Yao, MD, MPH
  • Revolutionizing emergency medicine: Overcoming long-term challenges with innovative solutions for physicians and patients

    Anonymous
  • The pediatric health care system tested to the limits: an inside look at the “at capacity” period during the tripledemic

    Jacqueline Bolt, MD
  • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

    Juliet Morgan and Meghan Jobson
  • How biased language and stigmatizing labels affect patient care and treatment

    Joan Naidorf, DO
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Uncovering the truth about racial health inequities in America: a book review

      John Paul Mikhaiel, MD | Policy
    • Why electronic health records are failing patients: the dark side of copy and paste [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

      Teresella Gondolo, MD | Conditions
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • 'Medically Relevant to Saving the Life of Your Patient': What We Heard This Week
  • Want to Solve the Nurse Shortage?
  • Why Are Female Doctors Sued Nearly Half as Often as Male Doctors?
  • What Drug Did FDA Just Approve for COVID?
  • PET Scan for Alzheimer's Dx; Predicting Colon Cancer Survival

Meeting Coverage

  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Trial Results Spark Talk of Curing More Metastatic Cervical Cancers
  • Cross-Border Collaboration Improves Survival in Pediatric Leukemia Patients
  • Monoclonal Antibody Reduced Need For Transfusions in Low-Risk MDS
  • Less-Invasive Surgery for Pancreatic Cancer Proves Safe, Effective
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Uncovering the truth about racial health inequities in America: a book review

      John Paul Mikhaiel, MD | Policy
    • Why electronic health records are failing patients: the dark side of copy and paste [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

      Teresella Gondolo, MD | Conditions
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...