My brain: In sickness and in health

Chapter 1: Physiology

“I am a brain, Watson. The rest of me is a mere appendix.”
– Sir Arthur Conan Doyle

Bound by flesh and bone, therein lies a mystery of undefined potential which the cosmos cannot even parallel in mystery and in complexity beautiful and terrifying. It is that which allows movement to leave the study hall beneath the starry sky, professors to lull us to sonorous sweet slumber, to remember minute details which escape us at the moment of interrogation, and invoke compassion and bonding with patients. It is the brain that permits each and every movement, sensation, memory, emotion, consciousness, and more importantly, survival in medical school.

Chapter 2: Pathophysiology

“At the root of the dilemma is the way we view mental health in this country. Whether an illness affects your heart, your leg, or your brain, it’s still an illness, and there should be no distinction.”
– Michelle Obama

In a systemic review and meta-analysis by Rotenstein et al., published in JAMA 2016, found the overall prevalence of depression among medical students was 27.2 percent and the overall prevalence of suicidal ideation was 11.1 percent.  Among medical student who screened positive for depression, 15.7 percent sought psychiatric treatment. In physicians, the rate of suicide is known to be higher than that of the general public. Several studies have shown the undeniable influence of major depression on suicide risk.  However, it has also been shown that mental illness in physicians is complicated by significant stigma, resulting in reluctance to seek treatment.

This leads to the question: Is the brain not an organic mass of cells with anatomical distinction and physiology susceptible to infection, vascular disease, metabolic dysfunction, genetic influence and the environment? How is a stroke different from schizophrenia that one would be more comfortable saying “I had a stroke” vs. “I have a mental illness”? Why do we as a medical community, who are the bearers of rationality and progress, perpetuate the stigma founded on ignorance?

Chapter 3: Signs and symptoms

“Out of suffering have emerged the strongest souls, the most massive characters are seared with scars.”
– Khalil Gibran

It all started with an adjustment disorder that transitioned into major depression disorder. It was only a matter of time, when I started riding my bike 200 to 300 miles per week all the while writing “masterpieces” for my English literature classes at UC Berkeley. Since the age of 18, my episodes of mania became more severe and frequent, resulting in behavior that has influenced the course of my life, health, and academic progress. The unfolding of my mental illness also began around the time when my sister came under my care exhibiting symptoms of schizophrenia. As a result of my sister’s illness, I refused to confront and accept the illness that I felt would haunt me personally, socially, and professionally. I perpetuated the stigma that would result in delayed treatment. I eventually accepted the diagnosis in 2014, after 15 years, as a result of two school psychiatrist who patiently guided me through the process of realization and the self-empowered choice to seek treatment.

Chapter 4: Treatment

“The best way out is always through”
– Robert Frost

What I have learned from my personal experiences with mental illness is that the stigma is real and exists in all corners of our society, from pop culture to the academic halls of renowned institutions and amongst my medical student peers. However, the greatest stigmas that I encountered in the past 15 years was within myself. Through the help of a highly experienced and supportive psychiatrist, an insightful and gifted psychologist, and an understanding and compassionate dean of student affairs, was I able to gradually stabilize and continue my medical training without any major bumps in the road (knock on wood). Thus, I am compelled to share my journey because I wish the same freedom for all who suffer from mental illness imprisoned by personal and societal stigma.

Is it not true that the change I want to see begins with me? Begins with you?

“Macbeth: How does your patient, doctor?

Doctor: Not so sick, my lord, as she is troubled with thick-coming fancies that keep her from rest. Macbeth: Cure her of that! Canst thou not minister to a mind diseased, pluck from the memory a rooted sorrow, raze out the written troubles of the brain, and with some sweet oblivious antidote cleanse the stuffed bosom of that perilous stuff which weighs upon her heart.

Doctor: Therein the patient must minister to himself.”
– William Shakespeare

The author is an anonymous medical student.

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