For many of us, winter represents a slowing down of things. The days are shorter, suddenly you’re less inclined to go to the gym after work. Vacations have settled for the most part, and energies are redirected towards class or work or whatever it is you do.
It can also kind of suck.
Why is it that our moods are affected by this change of season? What is it about humans that makes us so sensitive to these changes? Does this have an evolutionary benefit? What if we get too sad?
To think about why the human mood (in general) changes during the season, we must first think about what mood is. Where did mood come from? One of the earliest forms of “mood,” is hunger. When in a hungry mood, even the most primitive animals will change their behaviour, and begin food-seeking behaviours. Their cytoplasmic cilia might undulate towards a chemical stimulus. They may swim to a shallower depth towards the scent of a school of fish. If you are a hunter, and encounter a bear in the woods, hope that it’s not hungry. It may not eat you. If it’s looking for a meal? Good luck! The point is the moods, in animals, represent a set of behaviours suited to a particular circumstance.
Does this apply to humans? Of course. We gorge the cupboards when we’re hungry. On a macro level, countries and nations suffering from famine and starvation have orders-of-magnitude more unrest and civil war than their well-fed counterparts.
While hunger is a relatively easy “mood” to understand the benefits of, the behaviours and utility provided by more traditional moods like happiness, sadness, and anger, are more subtle, yet equally significant.
Anger can be considered synonymous with threat. People who are angry often feel threatened, and many of the behaviours associated with anger are involved with defense and mitigating a threat. Yelling, like the growling bear, is making yourself “big,” to intimidate an enemy. Elevated heart rate (tachycardia) occurs when you’re angry, in case the most extreme manifestation of anger, violence, is necessary. Sadness can be a little less clear. After all, what could be the evolutionary benefit of something often so painful?
Sadness is afforded power by virtue of the pain it causes. If we are sad about something, our brains want us to avoid that same circumstance from happening again. Losing a job, a messy break up, losing a loved one, these are all circumstances that our brain is telling us we should avoid again, and our behaviours begin to modify in hopes to avoid triggering the sadness again. If you’ve lost your job because you continually showed up late to work, the sadness afforded by the job loss may motivate you to be on time for the train more often in the future. While wallowing over a messy break up, you may find yourself reflecting on the relationship in search of “what went wrong,” and using this information to improve your relationships in the future.
The pain caused by the loss of a loved one is a little more nuanced. What change could sadness drive? There are a few answers. Historically, most deaths werepreventable, and the result of a sabretooth tiger attack, or tribal warfare. Sorrow caused by deaths in these circumstances were clearly cause people to be more weary of protecting against tigers, and may either question the benefit of their war or double down and fight even harder. Today, many deaths have a component of lifestyle contributions, and grief after a loved ones death from lung cancer, who smoked, may cause us to question our own habits. The point is, even grief, sadness, and sorrow drive change, and have clear utility on an evolutionary, population level.
So what happens when you get too much of this? Well, depression, for one. A disruption of the normal mood cycle, by any number of factors, can contribute to the development of depression. In the case of anger and happiness, they can contribute to the development of mania. And the fact is, all of us are vulnerable to alterations in our moods when the environment changes, even if it doesn’t represent a frank depressive or manic episode. One of these factors is the season, as we discussed above. For most of us, it’s just the way things are. For some of us, it’s the winter blues. In extreme cases, it’s seasonal affective disorder (SAD).
What is SAD? How is it caused? What about the seasons impacts our moods? Can we use this information to inform SAD treatment? Tune in to part 2 to see!
Dr. Travis Barron is a resident physician in Toronto, Ontario.
The ability to read minds is a superpower often portrayed in many forms of popular media. The idea of being able to understand our peers, down to the most minute detail, is both seductive and a credence to our innate desire to understand one another. It is our perception, of the understanding of others’ minds, that we use to shape our views of the world. Mount Rushmore, in the United States, for example, only holds meaning because of our collected understanding of the grandeur of the monument, and an appreciation of what/who we gaze upon.
All humans sort of read minds – it’s called intuition. Based on the feelings, actions and behaviours of another person, someone with well practiced intuition can often tell when something is wrong, or when someone is excited. Believe it or not, these functions are encoded directly into our brain, in an area called the posterior superior temporal sulcus, an area dedicated to recognizing facial expression. The ability “read ones feelings” is so integral to our survival as a social species in fact, that many animals exhibit this level of intuition, dogs being the most obvious example. Have you ever had your pet dog come and comfort you on a difficult day? Ever have your German Shepherd start barking at a stranger when you start to look alarmed and panicked? Ultimately, this phenomenon comes from a profound ability to react to subtle nonverbal communication, like facial expression and body position, on a seconds’ notice.
People have different degrees of intuition. For some people, they are able to “read a room” without ever having met anyone in it. For others, they have a difficult time guessing a loved ones’ thoughts, despite their best effort. There are likely genetic and environmental reasons for this, although they are not well-defined.
Someone practicing as a psychic shows a high level of human intuition and understanding of the human experience, for example. By reading your face, body language, reaction to their readings, and with a little context, they are often able to provide spookily relevant advice to you about, for example, the death of a loved one.
Anxiety and mind reading
A psychic is a great example of a person using an innate ability to their advantage for their profession. Not always, however, does strong intuition on the feelings of others provide us an advantage. Many people with an anxious disposition find themselves hyper-aware of situations, and consequently, it can become overwhelming. Seeing a young group of teenagers for example might set off the anxious persons “spidey sense” and prevent them from walking by the group, whereas someone else may find themselves less preoccupied by this group of people.
An anxious person may also find themselves taking too much responsibility for keeping the flow or a party, group, or conversation comfortable, because they are more sensitive to the various social cues sent out by the attendees. An anxious person would be the first to recognize when Tim was getting bored or when Siobhan is feeling uncomfortable. They might be the first to recognize when dad has had too much, or when the hostess is getting tired. Obviously, having some degree of this behaviour shows high social intelligence. If you find yourself being unable to enjoy your own birthday party for the same reason, it might fall under the umbrella of a disorder.
Cognitive mind reading and depression
“Everyone hates me.”
“My friends think I’m boring.”
“I know everyone is looking at the weight I put on when I go to work.”
“I give a bad first impression.”
“They all think my clothes is lame.”
One of the most common forms of pathological mind reading, is cognitive mind reading. See the examples above. We have all, probably, had a thought at least something like that at some point in the past. We might even be having those thoughts now.
The above examples represent cognitive mind reading, a phenomenon common to many forms of depression. Cognitive mind reading involves someone often making a negative assumption about someone’s thoughts, as it relates to themselves, out of keeping with reality. “Everyone hates me,” for example. Everyone does not hate you. Most people on the street don’t know you! These thoughts are actually a reflection of a depressive process.
When you become depressed, you put on some “gray-coloured glasses.” What this means is you often view things in a more negative light. The skies are grayer, video games are less fun. And seem esteem deflates. The social intuition discussed at the beginning of this post is no exception. When you’re depressed, this part pf your brain becomes hijacked, and all of a sudden, you may find yourself thinking that the world is thinking a lot more negative of you, even though it isn’t. In reality, those negative mind reading assumptions (where you believe that all of the negative things you worry people are saying about you are true) are a reflection of your brain being depressed. When you’re depressed, your brain colours everything gray. It sucks!
But it’s not all doom and gloom. Cognitive mind reading is one of the most common forms of cognitive distortions seen in depression, and physicians and therapists are well positioned to help you handle this. One of the first steps to this is understanding what cognitive mind reading is, why it’s happening, and importantly, that it’s very common in situations like your own. You’re not going crazy.
And not everybody hates your jacket.
While cognitive mind reading is extraordinarily common, with many depressed and non-depressed people experiencing some degree of this on any given day, thought reading is relatively rare.
Thought reading is a delusion, and is actually one of the more classic features of a
psychotic (not psychic) illness called schizophrenia. When someone is experiencing thought reading, they literally believe that they are privy to the thoughts of others. I can literally hear your thoughts. This can be differentiated from cognitive mind reading in a few different ways.
Someone with thought reading may (though not necessarily) literally hear the thoughts as a form of auditory hallucination.
When you ask someone with cognitive mind reading to explain how they know “Yousef hates me,” they will usually give a lot of evidence, as if building an overwhelming court case. “Look at the way he did this… look at this behaviour… and I just know he does because this… he hugged me last and it seemed uncomfortable…” Someone experiencing thought reading will often reply, “I can hear their thoughts.”
The clinical picture is wildly different in both (though there are of course borderline cases). Thought reading is accompanied by psychosis. Cognitive mind reading is accompanied by anxiety and depression.
An important note here is that cognitive mind reading usually upsets the person and causes them problems. Thought reading has a variety of much more extreme reactions attached to it.
A twenty two year old male presents to the unit acutely psychotic and paranoid. During the course of the admission, he is very aggressive, and damages much of the furniture on the wards in a psychotically driven rage. When he’s better treated, you speak to him, and he discussed that he read the thoughts of the female nurses, and they all thought he was disgusting, which angered him.
A thirty year old male tells you about the microchip he had implanted so he can now read minds. He plans to kick some ass on the stock market with this new information. You diagnose him with a grandiose delusion.
If you are worried you have some form of mind reading, it’s most likely some degree of cognitive mind reading. If you’re concerned, see your doctor. They might help!
Dr. Travis Barron is a resident physician in Toronto, Canada.
“Hey, would you like to come catch some lunch with us? There’s this new Mexican place around the corner.”
“No thank you, I have a lot of work to do, I’m going to stay here and catch up on some documentation, next time though!”
“Alright, have a good lunch.”
I quietly closed my office door and flushed pink with embarrassment. I hope that was convincing. I reached for my battered book-bag, and pulled out the two slices of toast and the bag of almonds I had laying around the apartment that morning. My chopped up frozen peas and corn were still frozen.
It tasted a little like cardboard, but it was OK. As I sat eating, I couldn’t help but think about other social events I had to come up with some elaborate excuse to avoid, because I was broke. Beyond broke. I recalled the Tim Horton’s server earlier that week, who stood by annoyed as she counted out my forty nickles – or I thought it was forty. I was five cents short; luckily the annoyed customer behind me overheard and threw a dime down on the table, a little in kindness, but also to help get the line moving, I thought.
That was three days ago. I haven’t been able to afford a coffee all week.
It gets more difficult some days, particularly when tempted with succulent chicken polo frito I know I can’t have. I looked down at my jeans, which I had worn every day this week. They looked shabby and I saw a small yellow dot of something – mustard? – on one pocket. I tried to brush the spot off but it only smeared the yellow-goo deeper into the fabric. I felt the seam of the jeans, gently rubbing the pale, white thread I could tell was going to give out, at some point. Hopefully they last until my birthday… I only owned two pairs of pants that fit me you see, and one was in the wash.
And the drier was broke.
This scene may seem vivid, I hope it is. These events don’t begin to touch on the poverty many residents of the world, country, and Toronto face on a daily basis. I have a relatively safe apartment in a decent neighbourhood, and most months I can afford to get a transit pass.
This story is also about me, and it’s not where I expected to end up as a doctor. So what gives?
For those of you who have read this blog for some time, you will know that I am something called a resident physician. Residents are kind of primordial doctors, having finished medical school, and now completing a program in the specialized area of medicine they will eventually work in for the rest of their life.
Becoming a resident, and a doctor, takes many things. It takes academic rigour, professionalism, dedication, and mental toughness. It also takes a tremendous amount of money.
To enter medical school, you need an undergraduate degree. For most people in Canada, those degrees, four years in duration, can cost anywhere from $10 000 to $50 000, depending on the school you attend. Most young people in Canada don’t have this kind of money just sitting around, and ultimately the vast majority of university students depend on one of two sources of funding – student loans, or help from their parents. Leaving conversations about how the education system is designed to discriminate against the poor aside, I’ll mention here that I was one of the more fortunate undergraduate students at Memorial University, and only graduated with about $15 000 in student loan debt.
In the fourth year of my BSc (Hons) in Cell and Molecular Biology, I began applying to medical schools – at about $700/$800 per application. Those of you who know anything about medical school admissions knows that you don’t want to “hang your hat” on one school, it’s not unlike the lottery. Keeping this in mind, I ultimately opted to apply to seven medical schools, which stung my pockets, but felt necessary at the time.
I was ultimately offered two interviews, one of them here in Ontario, and after some reflection and my acceptance, I found out I was going to medical school! In Windsor, Ontario.
Most Canadians mistakenly associate things like $25 000 a year education to places like the United States. Not so, for medical school. I was dismayed to realize my tuition would be that, and more per year, considering the various $1000 “enrollment fees” and the “one time $800 course fees,” for the odd mandatory skill seminar put off by the school. I did the math, and yes, this was going to cost me $100 000. And I was going to pay interest on that money, as well as my $15 000 student loan, every single day, until the time I graduate. (As an additional fuck-you from my medical school, they went on to increase the cost of tuition every single year I was in medical school; my fourth year, initially supposed to be $21 000, the cheapest year since it was essentially six-months in duration, costed $26 000 by the time for me to pay).
Now of course, as anyone with student loans will attest to, the cost of education is hell of a lot more than tuition. There are textbook costs, transit passes, rent, groceries. All of these things costed money, and since I was going to school 3000 km away from my nearest relative, I had nobody to lean on.
It’s here my trajectory deflected from my colleagues. You see, not everyone enters medical school as equals. The vast majority of my colleagues received significant financial help during medical school from their families. Most people in medicine you see, have doctors for parents, many have a trust fund. A quick Google search can shed light on the tremendous problems of socieoeconomic skewing in medical school classes – it seems like hiring and accepting people from penthouse suites doesn’t increase physician availability in the projects (no s*** guys I could have told you that)!
This is also the case in all education programs, where some students have it better than others, but when you’re surrounded by people without student loans, travelling across the world on the odd weekend, you feel it a bit more. Everything I paid for in medical school was on my back, and it still is.
And I’ll be the first to admit it. I had housing costs, groceries, living expenses. I also enjoyed myself during medical school, not excessively, but in an effort to feel like a part of my class. It was difficult, living in Ontario, and being the only person not travelling to Europe over the summer. It hurt wearing shabby mall-bought clothes among my peers when most of them shopped at expensive outlets.
I eventually finished medical school, and it was finally time for a pay day.
I also fell in love.
I ended up being accepted into a residency program at the University of Toronto, and I moved to the city to be with my partner. She had just finished a different academic program herself, and we had very little money. We accepted the cheapest apartment we could find that had access to the subway. You see, with both my partner and myself working in health care, we worked 12 hour days, if not longer, and a two-hour-each-direction transit ride was not an option. We found something that was a 45 minute transit ride away from our work, 700sqft, at $1800 a month. Yes, that’s obscene. It’s also the reality in Toronto.
The Canada Mortgage and Housing Corporation estimates that housing becomes “unaffordable” when it takes up more than 30% of your income. Many people in Toronto are in an unaffordable housing situation, myself included. This rent costs about 52% of my income per month.
Now I know what you’re saying. “That’s not a lot of money for a doctor.” It is for a resident. My resident salary in Ontario is $58 000, before taxes.
And before my $1200 of student loan INTEREST payments a month (barf).
And before groceries.
And before cell phone.
And before my transit pass.
At the end of the day, it’s really not a whole lot of money. There’s often a month where I have no transit pass for the first few weeks, and I count dimes I have left around the house in hopes of getting on. A few times, I’ve had to sneak onto the bus. Often the bills go unpaid. Don’t ask me about my VISA.
All of that to say, I’m hurting, and a lot of young professionals in this country and city are as well. It’s atrocious that medical schools, or any school, can gouge you for money they know is going to sit on your student loans – I’ve paid enough interest to my bank at this point I could have almost paid off a quarter of my debt. It’s disgusting that the government of Ontario does not account for the school of residency when determining salary – you make the same in Thunder Bay, with a significantly lower cost of living, than you do in Toronto, the most expensive city in the country.
So what’s it like living like a doctor near the poverty line? Just ask me.
It was happening again. These damn asthma attacks. My shortness of breath was getting worse, and I was bent over breathing to try and get a sufficient breath.
“I think I need to go to the hospital.”
An ambulance costed $75… I checked my Uber app – declined. “Please update payment method.” Fuck.
I got in the subway, wickedly coughing, and then transferred to a bus, which I took to the hospital. I was somewhat blue by the time I got there, and they admitted me right away. They prescribed some puffers, and told me to take my allergy pills.
The following day, I went to the pharmacy with my two puffer prescriptions. I left the allergy pills in the aisle – $15 for ten pills? Not happening.
“Alright, that will be $15.”
“I thought my insurance plan covered the drug costs?”
“It does, but for this medication, there’s a co-pay.”
“I’ll only take the one then.”
Dr. Travis Barron is a resident physician in Toronto, Canada.
I recently had a patient who was diagnosed with pneumonia. We had been treating with antibiotics, as well as some temporary puffers, for symptom relief. Unfortunately the puffers did not suffice, and the antibiotics had not acted quickly enough. One evening, after he finished dinner, this gentleman began experiencing shortness of breath. He was concerned, and called an ambulance, who took him to the hospital.
On arrival to the emergency room he was offloaded from the ambulance and given some oxygen, which helped him immensely. His breathing actually settled relatively quickly and he was able to breath without the oxygen mask. The emergency room physician (ERP) took this opportunity to get a more wholesome history from him.
“Do you smoke?”
“Not for the last few years.”
“Do you take any medications?”
“Just the puffers and antibiotic my doctor had prescribed.”
“Very good. Do you have any medical illnesses?”
The patient paused for a moment to think. He had been through this rodeo before, for other medical problems. He was wondering whether or not to mention to the doctor a previous diagnosis of bipolar disorder.
In the past, he had told physicians and paramedics about this diagnosis to underwhelming results. Instantly, the affect of the providers would change. Suddenly, his credibility was drawn into question. Where before he was allowed to speak and describe his story without interruptions, he was now met with requests to, “slow down.” The questions like, “are you feeling like yourself right now?” seemed to bother him the most.
This ERP on this particular day however seemed professional enough, and the patient wanted to be as transparent and honest as possible, so that his medical care could be the most informed it could be.
“I’ve been diagnosed with bipolar disorder, though I’m not on any medications, and I don’t know that I agree with the diagnosis.”
The silence was deafening, although it only lasted a second. The physician quickly regained her composure and started down another line of questioning.
“Have you used any drugs recently?”
“Do you smoke?”
“I already told you I didn’t.”
“Are you manic right now?”
He tried his best not to role his eyes.
“I feel perfectly fine, I’m sleeping eight hours a night.”
“Are you having thoughts of violence or suicide?”
He looked at her sternly and decided not to answer this question – he was here, after all, for pneumonia. No razor blades had been held at any wrist.
The conversation continued and eventually the physician left to order some investigations. Various nurses were in and out of his hospital room, all of whom seemed to suddenly have a lot less to say.
The patients condition improved, and he was eventually discharged on a low dose steroid for a few days to aid in his recovery.
“I don’t think I’ll take this tonight but I’ll take it in the morning.”
It was the ERP’s turn to role her eyes. The patient felt obligated to explain himself.
“If I do have bipolar disorder, the absolute last thing I want to do is take a steroid tonight, be awake the whole night, and have an episode.”
“Alright, see ya,” the doctor said as she left the room.
Now I had heard this story from the patient second hand of course, and I’m sure the dialogue wasn’t exactly as I have described above. But there are some things that are certainly true. This man was extremely aware of the prejudice he received, by virtue of the (unconfirmed) diagnosis he carries, and suffered because of it. He felt insulted, degraded, and less than human.
Great way to make people want to seek treatment for mental illness, eh?
There were a few things that bothered me about the story, the least of which was this physician’s skill in assessing mental illness. For the record, you could ask a naked man screaming about Jesus on top of a Walmart, who hasn’t slept in eight days, “are you manic right now?” and I would be shocked if they said yes. To those of us in the field, we recognize the mental status exam and the whole picture as key instruments leading to diagnosis. Personally, I don’t see the utility in asking seemingly well and euthymic (normal emotion) people what they think of their mental status, irrespective of their diagnoses, when they are seeking help for an unrelated medical problem.
Bipolar people get pneumonia too, y’know.
The physician’s apparent novice skill in this field isn’t why I chose to write this post – it’s the prejudice that came attached. Because this man had a diagnosis of mental illness in the past, and one of the “scarier” ones, his credibility was immediately drawn into question. Are you sure you didn’t accidentally take a bunch of cocaine before you arrived here? Are you positive you don’t want to blow your brains out after you leave here?
That’s not to say that this information doesn’t matter, because it does. On a professional level, whenever I assess someone with mental illness that may put them at risk, I’m always on the look out for any red flags or warning signs.
I’m also sure to treat the patients like humans.
Medicolegally, I understand the need. “Oh Doctor, you didn’t ask about suicide when you assessed Mr. so and so five months ago? And why is that? He did have bipolar disorder, after all.” And Im not saying theese questions shouldn’t be asked. How you go about it however, is another story.
Do any of you have real life examples or prejudice inflicted upon you, or a friend as a result of mental illness? Without going into too much personal detail, share below!
Dr. Travis Barron is a resident physician in Toronto, Canada.
Often times, late at night, I find myself reflecting. Reflecting on life, myself, all I have become, and all I have lost. Growing up, I didn’t have the most friends, but I could always count on my brain. Looking at where I am now in life, is a tremendous source of pride. I was the first in my family to attend post-secondary education, and the first physician as well. In many ways, to my family, I’m seen as a stepping stone for the Barron clan to exit from rural poverty.
That doesn’t mean there aren’t some regrets.
One thing I reflect on often, is faith. Growing up, the church was a huge part of my life. I ached to attend Sunday mass, and volunteered as an altar boy at the first chance I had. At my parish, Confirmation was typically reserved for 12 and 13 year old children. With special permission from the priest, I was allowed to be confirmed at age 8. And I came in top of my class. One of the highlights of this part of my life was when the priest at my church – Holy Trinity Parish, sharing a name with my elementary and high schools, Holy Trinity Elementary and High School – asked my mother and I to be the parish’s representatives at a special visit by the Archbishop of Canada, to the largest Catholic church in St. John’s, the Basilica (as a side note, on that day, I tripped on my way into the pew, and muttered, ‘Jesus, Mary, and Joseph!’ under my breath; my mother made sure I heard it later!).
As these things go, you get older, and you try your best, in many ways, to differentiate yourself from your family. Religion took a smaller role in my teenage life, although it remained important to me. Friends and school and manhood became my primary concerns.
Eventually, I attended post-secondary university at the Memorial University of Newfoundland, majoring in Biochemistry and then switching to Cell and Molecular Biology. That was followed by medical school, in Windsor, Ontario, and eventually residency in Toronto, where I am today.
When I moved to Windsor, a sense of community was lacking. What was this foreign place, so very different from my home? People avoided eye contact in the street, there were no friendly greetings or short conversations with the server at Tim Horton’s. And I missed that. So, I went to the nearest place I could think of, to help bring back that sense of community. I went to church.
A church service is a church service and in many ways the mass at Our Lady of Assumption in Windsor (the oldest church in Canada west of Montreal, now tragically shuttered and closed down), and I felt at home. Though the parishoners and the priest were different, the prayers remained the same, and in some ways I was at peace.
After my second service at Assumption Parish, I began to worry. Something wasn’t feeling right, and it took me a while to realize what it was. I stopped going to the church and looked elsewhere for community. If anyone out there has gone to medical school, you’ll know that my only option was the medical community, a sort of cult, comprised of medical students, residents, and doctors, and where the conversation invariably turns to the latest asthma medication or multiple sclerosis study.
Eventually, it came to me. I had lost faith.
Putting in to words what this meant to me is difficult. If any of you have faith, you know what I mean. God and Jesus were in many ways part of my own being, and the Catholic faith was for me the compass by which I navigated the world. Religion, to my perennially teased and tortured by my classmates in grade school soul, was for many years my anchor. And here I was, drifting off to sea.
I struggled with this for some time and eventually religion moved from my mind. I immersed myself deeper in medicine, and intentionally avoided any religious themed discussions, out of fear it would rip my being in two. To add some context, I’ve been in post-secondary education for eleven years at this point. Eleven years of fanatic education, of evolution, world religions, the big bang, science, and medicine. Eleven years of learning men (and women) are the masters of this world and that it is ours to discover. God, in fact, was only ever mentioned in discussions surrounding the unreasonableness of a Jehovah’s Witness refusing a blood donation. The problems caused by belief in Allah during Ramadan for kids with nutritional disorders. Never did that lens turn inwards, never was the question asked about our relationship with God.
That’s not to say I’m the only religious person that attended medical school, I know I wasn’t. I have friends and colleagues that were and continue to be active in the church. Me, I was Captain Scott, frozen in the Antarctic ice lost and without hope of rescue.
But like Captain Scott, there was hope. Although he died, Captain Scott is famous for the journals he comprised while he and his crew used pick axes to try and cut their boat free of his frozen water coffin. Of course this was a failed venture, and not until a subsequent Antarctic expedition during which his remains were discovered were his journal entries found and disseminated. And what was found was remarkable. These men, faced with their inevitable death, had been singing. They were in good spirits and they sat and played cards and ate breakfast. They joined together in prayer. They had faith, and the spirit lived on.
“God help us, we can’t keep up this pulling, that is certain. Amongst ourselves we are unendingly cheerful, but what each man feels in his heart I can only guess.”
― Robert Falcon Scott, Scott’s Last Expedition: The Journals
I am not an Antarctic expeditionist, but like Captain Scott, my spirit lived on. The Holy Spirit? Maybe. I’m not going to call myself divine. Like an ember on the floor of a seemingly dead fire, I would soon realize my faith could again burn bright.
I was at a low point of my life in the third year of medical school, and I was wondering whether the choices I had made were truly the right ones. I felt like most of my friendships in Ontario were superficial, and that most of my friendships in Newfoundland were decaying. In many ways, I felt caught between two worlds and two provinces, not dissimilar to how I felt being caught between religion and medicine.
So naturally, I went to church.
And I went again.
And eventually the happiness I once had from sermon returned, and I found myself at peace. What had changed, I asked myself. I was still a physician-to-be, I still felt trapped in mainland Canada. Simply put, I had faith.
To this day I continue to struggle. Struggle with thinking about the impacts of evolution on the development of our planet and climate, and reconciling that with the Catholic calendar. Struggle with thinking about life saving blood transfusion and a deeply held belief having ones blood other than your own is a sin. Struggle with my obligations as a doctor to discuss treatments that in many ways go against the very fabric of Catholicism. Sometimes, it isn’t easy.
But I have faith. I have faith that both my lives and both sets of beliefs can co-exist peacefully. Faith that it will all work out. Faith that as a doctor who has tried to do nothing more than elevate his family and extended family out of poverty, and to help the sick and diseased and unwell and disadvantaged, there is a place for me in Heaven.
Some days are easier than others; today is a good day. I’ll continue to toe the line and think and reflect and consider what it means to be a Catholic in 2019. And in the end, I’ll always know, both things can be true. They have to be.
Editor’s note: There are many faiths in the world and I don’t think asking which faith is, “correct,” is a helpful question. What matters to me is that people feel at peace with themselves and their choices. Maybe that means Catholicism, Islam, Hinduism, or Environmentalism. However you identify, there are bound to be conflicts between your faith and what the modern world asks of you. The purpose of this post is to describe my own struggles in reconciling these two ideas.
Dr. Travis Barron is a resident physician in Toronto, Canada.
Depending who you’re asking, you might not always get the same answer.
I had just begun working at a psychiatric hospital in Ontario when this quirky word suddenly became part of my vocabulary – client. I had met countless patients before but these clients, it would seem, represented a new hurdle. What is a client? What do they want? Do they like the Raptors? Do they drink water?
Well as I would come to learn, clients are not so different from patients. Clients breath air, live in cities, and walk among us. They suffer from depression, anxiety, mania, and psychosis. They have addictions.
So what makes a client? Themselves.
Medicine is rooted in a millennia of traditions. Some of the principles of medicine still used today date back as far as the Ancient Greeks. Hippocrates, and the Hippocratic oath, remain a quasi-initiation at the front end of most medical schools. Leonardo DaVinci, and his drawings of the human body, can be considered to still have an impact on the field of medicine today.
With all history, we tend to focus on the highlights, and leave the dark corners undiscussed and ignored.
Paternalism is part of medicine’s darkest legacy. What is paternalism? Here’s a long, winded answer.
In broad strokes, medicine is super #$%&ing complicated. No doctor understands all of medicine perfectly, and we certainly don’t expect a patient/client to understand all, most, or even some, of medicine. As a physician, my job is to explain the relevant information to you, so that you can make your own decisions. I have the responsibility to give you the required information, and to ensure that whatever I do, is in your best interests. This results in something called a fiduciary relationship, meaning that if you need a test ordered, it is on me to order that test, even if it’s seven o’clock in the evening on a Friday and the Blue Jays are about to take their first swing. Fiduciary relationships are a great and essential part of medicine. I reiterate my comments on just how complex medicine is! However, there are also some unwanted side effects.
As a doctor, if you are under my care, as we would say in the field, I am taking ownership of your care. This doesn’t mean I own you or your property, but basically that I am the captain steering the boat that is your health into harbour. Ownership in many ways is how things get done in medicine. If nobody feels responsible, than who would make sure your x-ray was ordered or that the proper consultations had been made, after all. Like all captains, we have a natural aversion to back seat drivers. “I know how to lay the anchor, so bug off!” kind of deal. We can even start feeling this way when the patient has different opinions from our own. Sometimes, we can even have a natural tendency to dismiss a patient’s thoughts when they conflict with our own. This would be paternalism, or in other words, a medical care model where the doctor’s wishes are given the highest priority, although presumably to save your life (whether or not you want your life saved – a whole other discussion there).
In another time, only decades ago, you might find that this is actually how medicine was practiced. What the doctor says goes. Forced sterilization and lobotomy being some more infamous examples. Today, we know better.
You are the captain, and I am the first mate. I help you navigate, but it’s up to you to steer. As a physician, it’s my job to listen to your concerns and give them thoughtful reflection, no matter how they may conflict with my own thoughts. This doesn’t mean ordering unsafe medications or needless tests, but giving an honest, thoughtful, patient-centred approach to care in all respects. This is the opposite of paternalistic medicine.
So what does this have to do with the whole patient/client conundrum?
Patient is a physician-born word. It’s language we have always used to describe those we care for and it’s comfortable. But some people take offense to that word, and that’s OK. This is particularly important in psychiatry. The reasons for this? They’re many and complex, the stigma associated with being a “mental health patient,” born out of 20th century mass media being the most surface-level example. In psychiatry, the word “client” carries particular meaning, and has more voluntary connotations than “patient” can sometimes imply, given the history of (at times necessary) coercive treatment in psychiatry. The point is not every “patient” likes the word, and they have a right to not be addressed that way. Mental illnesses are to many, after all, not considered illnesses, and people would prefer to describe their experiences as something akin to psychological distress.
At the hospital I worked at in Ontario, the alternative term adopted by the institution was ultimately “client.” (As a side note, we borrowed this word from out psychologist colleagues!) They chose to institute an institution-wide movement to address every single patient as a client. As you can see from reading this blog, I obviously don’t do that. But I also do not call everyone a patient. The reality is, I am more comfortable with the word patient and it’s been what I’ve always used. But the moment my client or patient or glerblegerker let’s me know that they disagree with the idea of being a patient, I’m quick to change my language with them. It’s about them, after all.
So you tell me – are you a patient or a client?
Editor’s note: Mental illnesses are true illnesses from my perspective, but not because of any of the particular symptoms you have – hear and chat with the voices in the empty room all you want. To me, your experience is an illness when it begins to interfere with your functioning and safety.
Dr. Travis Barron is a resident physician in Toronto, Canada.
Medicine is complicated. Twenty three years of schooling later, and I still find myself stumped with some of the patients I encounter in various medical disciplines.
Imagine how the patients feel.
One thing I’ve come to appreciate in my time as a physician, is how much we can take our knowledge for granted. Things that seem so obvious to me, like why do I get heart burn when I lay down, often mistify the patient, by no fault of their own, but simply by virtue of the fact that medical science isn’t part of traditional education.
Doctors forget this. Myself included. Which brings me to today.
I met a gentleman today with a number of chronic illnesses. As these things go, a number of illnesses means a number of medications. It can often be overwhelming to the doctor, let alone the patients. It can be difficult for patients to keep track of why certain medications were started, and how long they should be continued. Let alone what each individual pill looks like.
Don’t worry. As a physician my job is to help you keep track of these things, and to make sure you’re taking what you should, whent you should.
But that doesn’t mean leaving you in the dark.
“I had something stuck in my stomach,” the gentleman from the clinic said. “I was in the hospital for a few weeks… They cut me open, did something.” Tears began to fall and I moved closer. “I used to be so healthy, so active. Now, I can barely move. I’m terrified every night when I go to bed. ‘Will this be my last? I hope I go in my sleep… At least it’s painless.'”
He was terrified.
As you’ve heard me preach time and time again, knowledge is empowering. The opposite is also true. Ignorance is paralyzing.
This gentleman had no idea what had happened to him. They cut him open and entered his body and he was in the dark. Traumatizing? You tell me. Sure, many physicians had reminded him time and time again what had happened, but this information isn’t always easy to retain. To him, he felt abandoned. He had quit his medication, not only because he felt like he was taking pills blindly, but also as a form of protest. This man, who put his lives in our hands and felt so disempowered, had one last way to assert his control. By refusing.
“I can understand. That sounds absolutely terrifying. Of course you’re anxious. I want to help you through this. I am going to help you.”
I sat with the patient for a while and discussed with him his illnesses, and his medications. He was beaming by the end.
And maybe the same thing will happen tomorrow. He might forget. And that’s ok. It’s not his responsibility to understand the medicine perfectly, I did eight years of medical education to achieve that. And trust me, I’m still working. What’s important, is that we as physicians remember the value of taking a minute to check in and make sure our patients feel educated, and included.
Dr. Travis Barron is a resident physician in Toronto, Canada.