Wednesday, January 4, 2012

A Routine Day for an Addiction Psychiatrist

Today I had a fairly routine day in my practice. On a typical day, I encounter a wide range of people, problems, challenges and successes. I suppose it's not much different from any medical practice that way. But all of my patients are pretty complex and challenging. They all have multiple problems that are intertwined and that cannot be fully teased apart. The most common problems I encounter are addiction, pain, depression, anxiety, insomnia, brain injury, ADHD and PTSD. Relationship, marital and family problems are very common, as are various social and economic problems such as unemployment, disability, poverty, lack of health insurance and homelessness. These are all common problems, and they usually occur in some combination of two, three or more of them. Often there are significant other medical problems as well, including arthritis, heart disease, cancer, multiple sclerosis, lung disease and many others. I have to say it's enough to scare a person once you realize what fate can bestow on you. Most of my patients feel very alone and isolated. They often think they are the only ones who experience what they are experiencing and there is therefore something wrong with them. This isn't true of course. The experience of suffering from these problems is pretty similar across different people, which is not to diminish the importance or meaning of suffering for each person. But most of us don't meet others who are confronting the same or similar issues we are so we feel alone. Those around us who are well almost never understand, and all too often are judgmental. I think some of that is redirected anger at the inconveniences and losses that they experience when a loved one becomes disabled. Most of us think it isn't ok to feel angry with a loved one who becomes ill or disabled, but anger along with sadness and empathy are almost universal. But for someone who has never experienced depression or chronic pain or addiction, it can be very hard to understand why their loved one isn't responding better, isn't getter better or well, or requires ongoing medication to function. I spend quite a bit of time with friends, partners, spouses, children, parents of my patients explaining the illness(es) and treatment(s). It usually makes a difference, sometimes to the point of saving a marriage or preventing rejection from a family. Every day, however, I feel privileged that these people, my patients, let me share their lives in a pretty intimate way. A lot of whatever effectiveness I have comes from simply sharing the path and doing my best to understand what someone is going through without judging them. If nothing else, at least I can give them that.

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